Search

Purpose: To assess the accuracy of totally guided implant placement with static surgical splints in relation to the different types of supporting tissues (tooth, mucosa, or bone). Materials and Methods: This review was carried out following the PRISMA guidelines. An electronic search was done of the MEDLINE (PubMed), Embase, and Cochrane Library databases, without publication year or language restrictions. Results: The literature search yielded a total of 877 articles; 18 were included in the qualitative synthesis, and 16 of these articles were included in the quantitative analysis. The included studies presented a high risk of bias, except for one randomized clinical trial. The strength of the recommendations is therefore weak. In the angular deviation treatment, statistically significant differences were observed in the accuracy of the implants with tooth vs bone support: Bone support yielded 1.31 degrees greater deviation vs tooth support (SD = 0.43; 95% CI: 0.47, 2.15, P = .002). No significant differences were observed in the linear deviations. Conclusion: Tooth support proved to be significantly more precise than bone support splints. There were no differences referring to horizontal coronal deviation, horizontal apical deviation, or vertical deviation according to the type of splint support used. [ABSTRACT FROM AUTHOR]

Objective: To compare patient satisfaction during surgery, postoperative pain and inflammation and quality of life between high‐speed drilling with irrigation and low‐speed drilling without irrigation for implant bed preparation. Materials and Methods: Sixty‐six posterior single edentulous patients were included in a randomized controlled clinical trial. Implant beds were created using high‐speed drilling with irrigation (control group) or low‐speed drilling without irrigation (test group). Patient satisfaction during surgery (in relation to drilling‐time perception, vibration, pressure, noise, comfort, and drowning sensation) and postoperative pain and inflammation were evaluated using a 100‐mm visual analogue scale (VAS)‐based questionnaire. Quality of life was analyzed with a Likert scale (in relation to mouth opening, chewing, speaking, sleeping, daily routine, and job). The follow‐up period was 7 days. Results: Patient satisfaction in relation to drilling‐time perception, vibration, pressure, and noise did not show statistically significant differences (p >.05). The highest scores of drowning sensation (p <.05) were correlated (moderate correlation (r =.57)) with lowest scores of comfort (p <.005). Both postoperative pain and inflammation means were significantly higher in the control group than in the test group. No significant differences in quality of life were observed during the postoperative period (p >.05). Conclusion: Low‐speed drilling without irrigation for single implant site preparation was more comfortable for patients than high‐speed drilling with irrigation, due to the correlation between important drowning sensation and low perceived comfort. Postoperative pain and inflammation were lower for low‐speed drilling without irrigation. Further studies are needed to validate or refute these results. [ABSTRACT FROM AUTHOR]

Objective: To analyze the influence of 3‐mm high abutments with different shapes (cylindrical abutment vs. wide abutment) on marginal bone‐level changes (bone loss and bone remodeling). The influence of abutment shape on implant success, probing pocket depth (PPD), and bleeding on probing (BoP) was studied as secondary objectives. Materials and Methods: Patients with a partially edentulous area requiring fixed dental prostheses by two implants in the posterior mandible or maxilla were included. The implants were 1 mm subcrestally placed, and osseointegration healing was submerged. Three‐mm high abutments with two different shapes were randomly placed in second‐stage surgery: cylindrical abutments (cylindrical group) and wide abutments (wide group). Marginal bone‐level changes were measured using parallelized periapical radiographs at abutment placement, at definitive prosthesis placement, and at 1, 3, 6, and 12 months after loading. PPD and BoP were likewise measured at the control visits. Results: Sixty‐four dental implants in 25 patients were included. Statistically significant differences were found in bone‐level changes. The cylindrical group exhibited less mean marginal bone remodeling (MBR) and marginal bone loss (MBL) than the wide group (p <.05). Moreover, the cylindrical group showed significantly less BoP (p <.05). Conclusion: Abutment shape had a significant influence upon marginal bone‐level changes during the first 12 months. Cylindrical abutments caused less MBR and MBL than wide abutments. More clinical studies involving longer follow‐ups and analyzing other abutment modifications are needed to improve our understanding of how abutments can affect peri‐implant tissue stability. [ABSTRACT FROM AUTHOR]

Purpose: A systematic review was performed of the dimensional changes in facial cortical bone following implant placement into healed ridges, with the aim of establishing a minimum bone thickness that limits such changes. The influence of such bone remodeling upon the soft tissues and implant survival was also evaluated. Materials and Methods: A search was done of two electronic databases (MEDLINE via PubMed and CENTRAL), complemented by a manual search and lists of references. The risk of bias and methodological quality were assessed using the Cochrane Collaboration tool, the Methodological Index for Non-randomized Studies (MINORS), and the Quality Appraisal Checklist for Case Series. Results: The search yielded 536 publications, of which 11 (four randomized clinical trials, two non-randomized clinical trials, and five case series) were entered in the review. All the included studies reported vertical and horizontal implant facial bone resorption. Decreased facial bone thickness was correlated with increased vertical bone resorption, which in turn was associated with slight soft tissue retraction. A meta-analysis could not be performed, due to the heterogeneity of the study designs and measurement sites. Conclusion: No minimum facial bone thickness was seen that would completely avoid peri-implant bone loss and maintain soft tissue stability. However, a thickness of approximately 2 mm was associated with diminished vertical bone resorption and less peri-implant mucosal recession. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the 5-year outcome of a previously reported case series of patients with severely atrophic maxillae treated with palatally positioned implants and fixed full-arch rehabilitations. Materials and Methods: A retrospective cross-sectional clinical study of patients treated between January 2000 and January 2004 with palatally positioned implants was carried out. The parameters evaluated at the 5-year follow-up visit were: implant success rate, peri-implant soft-tissue conditions, biological and prosthetic post-loading complications, radiographic peri-implant marginal bone loss, and patient satisfaction. Results: A total of 33 patients with 151 palatally positioned implants were included in the study; 15 patients had received cemented prostheses and 18 had received screwed full-arch prostheses. The success rate for palatally positioned implants after 5 years was 98.7%. Average peri-implant mucosa retraction was 0.39 ± 0.94 mm and the average probing depth was 2.89 ± 0.77 mm. Plaque Index was 0 in 63.1% of the implants, 1 in 18.8%, 2 in 8.7%, and 3 in 9.4%. The modified Bleeding Index was 0 in 71.1%, 1 in 14.1%, and 2 in 14.8%. Mucositis was found in 5.2% of the implants and none had peri-implantitis. Prosthetic complications occurred in 12.1% of the cases. Average peri-implant marginal bone loss was 1.03 ± 1.28 mm. General patient satisfaction averaged 8.2 ± 1.8 according to a 10-point visual analog scale, and good quality of life was reported by most patients. Conclusions: Palatally positioned implants were found to be an adequate treatment for patients with severely atrophic maxillae. A high implant success rate, good peri-implant soft tissue stability, low marginal bone loss, high patient satisfaction and few complications were registered. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the clinical, microbiologic, and host response characteristics (interleukins 1β and 6) in the peri-implant sulcus fluid (PISF) of patients with healthy dental implants and with peri-implant mucositis.Materials and Methods: Clinical parameters (modified Gingival Index [mGI], modified Plaque Index [mPI],probing pocket depth [PPD], and absence or presence of radiologic bone loss) were recorded, and PISF samples were obtained from peri-implant sites showing mucositis as well as healthy sites. The periodontopathogenic bacteria Tannerella forsythia (Tf), Treponema denticola (Td), and Porphyromonas gingivalis (Pg) were evaluated, together with the total bacterial load (TBL) and the interleukin (IL) 1βand IL-6 values. Results: The study population consisted of 34 individuals, and 77 dental implants were evaluated during the study (23 mucositis and 54 healthy peri-implant sites). The mGI, mPI, and PPD scores of the peri-implant mucositis group were significantly greater than in the healthy group. No differences in detection frequency were found for putative periodontal pathogens and TBL between the healthy peri-implant sites and mucositis sites. The mucositis group showed a significantly greater expression of IL-6 than the healthy group (P < .05). Although IL-1β was increased in the mucositis group, there was no statistically significant difference versus the healthy implant group. Conclusions: An analysis was made of the clinical, microbiologic, and host response characteristics in implants with peri-implant mucositis, establishing comparisons with healthy implants. In the patients studied, bacterial plaque induced an inflammatory response that can lead to the development of peri-implant mucositis. Adequate plaque control is therefore able to increase peri-implant health, avoiding the risk of future complications. No specific association to the studied bacterial species was established. [ABSTRACT FROM AUTHOR]

Background: Clinical evidence of the autologous platelet concentrates effects on the patient-reported outcome measures (PROMs) after endodontic surgery is still limited. Objectives: To investigate the effect of the advanced platelet-rich fibrin (A-PRF+) membrane application upon patient postoperative pain, and quality of life in endodontic surgery. Materials and methods: A two-parallel-arm randomized clinical trial was made comparing endodontic surgery with or without A-PRF+ as adjunctive treatment. Fifty individuals comprehending 50 apical lesions (second premolar to the second premolar) of upper maxilla were included. Pain perception and quality of life (functional limitations and other symptoms) were assessed 1 week after surgery using a visual analog scale and a Likert scale-based questionnaire. Descriptive analysis was done using χ2 and t test. Binary logistic regression, ANOVA-type statistic, and GEE analysis were used for inferential analysis. Results: Pain perception was mild in both groups [A-PRF+ 12.7 ± 8.5] versus [no A-PRF+ 20.7 ± 16.3]; it proved less variable during the first 4 days in test group, showing lower extreme pain values (p = 0.096). Analgesic use was similar in both groups. Controls reported significantly worse sleep and speech functions (p < 0.05). Bleeding and bad taste/breath were the most discriminative symptoms. Conclusions: Postoperative pain perception was mild in endodontic surgery of the upper anterior maxilla. Differences in pain perception were not statistically significant. The use of A-PRF+ afforded less variable pain perception than in the controls. Altered quality of life parameters were more prevalent in the control group and prove significant for speech and sleep functions. Clinical relevance: Patient-related outcomes are of utmost importance in clinical practice. The use of A-PRF+ provides an affordable and safe alternative to improve postoperative quality of life in endodontic surgery. [ABSTRACT FROM AUTHOR]

Purpose: To describe implant survival at least 1 year after the surgical treatment of early apical peri-implantitis (EAP) and explore potential risk factors of failure of such treatment. Materials and methods: An ambispective cohort study was conducted, involving all patients in whom EAP was detected and surgically treated between 1996 and 2016. Reporting followed the STROBE guidelines. The time from implant placement (IP) to EAP surgery (EAPS), the diagnostic stage and intraoperative variables (location, apical lesion in the tooth being replaced, mesial and distal tooth-implant distance measured at the apex, periapical surgery of the adjacent tooth, guided bone regeneration, implant resection, explantation) were recorded to determine their impact upon treatment outcome. Results: The initial sample consisted of 58 implants in 46 patients. The mean time from IP to EAPS was 21.7 ± 10.1 days. At the time of surgery, eight implants presented mobility and were explanted. The final sample consisted of 50 implants in 39 patients evaluated for implant survival after surgical treatment. A cumulative survival rate of 78.3% was recorded. The mean survival time of the EAP treated implants was 85.4 months (standard deviation [SD] 5.94). The diagnostic stage (P < 0.001) and the existence of a previous periapical lesion in the tooth being replaced (P = 0.022) had a significant influence upon implant survival. Conclusions: The cumulative survival rate was 78.3%, with a mean survival time of 85.4 months. The diagnostic stage of EAP and the presence of a lesion in the tooth being replaced significantly influenced the survival of implants with EAP subjected to surgical treatment. [ABSTRACT FROM AUTHOR]

Placement of postextraction dental implants has become a common practice. Here, we reviewed current literature, along with clinical procedures, outcomes, and incidence of complications, associated with immediate implants in infected postextraction sites. The YSGG (yttrium, scandium, gallium, and garnet) laser can significantly reduce the bacterial concentration after extracting a compromised tooth. We treated a 40-year-old woman with a compromised tooth in the esthetic zone, presenting clinical and radiological signs of infection, particularly a periapical periodontitis. The tooth was extracted after administering local anesthesia using Optocain® (mepivacaine and adrenalin 1 : 100,000), following which the site was treated with an ErCr : YSGG (erbium, chromium-doped yttrium, scandium, gallium, and garnet) 2780 nm laser device (Biolase iPlus®). The implant (Straumann® fixture) was inserted with minimum 35 N torque, 1 mm below the most apical bone peak. Bio-Oss® and resorbable membrane were applied to improve bone healing. The use of ErCr : YSGG laser has ensured success of implant therapy performed on an infected site. There were no complications such as peri-implantitis or loss of peri-implant bone. The implant achieved good primary stability, immediate placement into an infected site did not increase complications, and the 5-year follow-up confirmed the treatment success. [ABSTRACT FROM AUTHOR]

Purpose: To explore risk indicators potentially associated with early apical peri-implantitis (EAP). Materials and methods: A retrospective survey was performed in 2017 with recorded information from patients receiving dental implants between 1996 and 2016. Reporting follows the STROBE (strengthening the reporting of observational studies in epidemiology) guidelines. Data were collected from the medical histories and radiographs: diagnosis of EAP (health/disease), gender, age, type of surgery (immediate/delayed placement), implants placed (position, width, length, location, mesial and distal tooth-implant distance measured at the apex, state of the adjacent tooth and tooth being replaced, and surgical complications. Once the EAP had developed, data were collected regarding days of evolution, symptoms, signs and radiological findings. Results: A total of 2548 patients (57.1% females and 42.9% males) with 8110 implants were enrolled in the study. 46 patients with 58 implants were diagnosed with EAP -- 23 in the maxilla (39.6%) and 35 in the mandible (60.4%) -- between 6 and 50 days after implant placement, with a mean period of 21.7 days (SD 10.1). The frequency of EAP was 1.81% in patients and 0.71% in implants. Immediate placement multiplied the odds of developing EAP 21-fold (95% CI 6.74 to 65.7; P < 0.001) versus delayed placement. The existence of an apical lesion in the tooth being replaced multiplied the odds of developing EAP 26.3-fold (95% CI 4.24 to 162.8; P < 0.001). Replacing a tooth endodontically treated increased the odds 3.48 times (95% CI 0.99 to 12.3; P = 0.052). The presence of an adjacent endodontically treated tooth increased the odds 0.97-fold (95% CI 0.26 to 3.60; P = 0.963). An apical mesial distance of ≤ 1.5 mm increased the odds up to 5.12-fold (95%CI 2.12 to 12.4; P < 0.001). Conclusions: The presence of endodontic periapical lesions or endodontic treatment in the tooth being replaced, immediate implant placement or mesial tooth-implant distance measured at the apex were significantly associated with increased odds of EAP. [ABSTRACT FROM AUTHOR]

The present systematic review and meta‐analysis was carried out to determine the extent to which supracrestal tissue attachment (STA) thickness affects marginal bone loss (MBL) around dental implants. An electronic search was conducted in PubMed (MEDLINE), EMBASE, and complementary sources covering the period up to June 2018. The studies were meta‐analyzed based on implant position with respect to the alveolar bone crest (crestal/supracrestal). The MBL values were categorized according to STA width (thick/thin). Of the 1062 eligible titles, nine articles were included in the review. The implants were positioned crestal or supracrestal with respect to the alveolar ridge. The difference between (thin/thick) STA was statistically significant among analytical subsets in terms of lesser MBL (crestal‐positioned: weighted mean difference [WMD] = 0.52, 95% CI [0.03‐1.01]; P = 0.036; supracrestal‐positioned: WMD = 1.26; 95% CI [1.12‐1.39]; P = 0.00; pooled analysis: WMD = 0.73; 95% CI [0.033‐1.13]; P < 0.01). Implant positioning and patient age showed statistical significance in the meta‐regression analysis. The heterogeneity explained by age was R2 = 39.8%. Despite its limitations, the present study demonstrates that implants with thin STA result in greater MBL. There is moderate certainty of the evidence for a large effect of MBL prevention "in favor" of a thick STA environment in crestal‐positioned implants and the pooled analysis, but lesser certainty when only supracrestal‐positioned implants are considered. No trials studying this topic in subcrestal‐positioned implants were found. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to compare marginal bone loss and success rates 1 year after implants had been placed in maxillary molar sites, either immediately postextraction or after the extraction sites had healed (delayed). Materials and Methods: A retrospective case study was made of subjects treated with immediate or delayed dental implants in the maxillary molar region between January 2006 and December 2008. A protocol was prepared in which patient age, sex, implant length and diameter, type of prosthesis, buccal plate width, and use of bone grafting were recorded. After 12 months, data relating to the clinical and radiologic conditions of the implants and the success rate according to the criteria of Buser et al were recorded. The variables were analyzed statistically (Student t test, Pearson correlation, Games- Howell test). Results: The study included 123 implants placed in 70 patients; 35 implants were immediate and 88 were delayed. Two immediate and six delayed implants failed, resulting in success rates of 94.3% and 93.2%, respectively. Average marginal bone loss was 0.56 mm for immediate implants and 0.67 mm for delayed implants. Conclusions: The placement of immediate implants in maxillary molar sites achieved similar results to implants placed in healed sites in the same region after 12 months. No statistically significant differences were found between implant survival rates or average marginal bone loss. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the present study was to determine bone density in designated implant sites using cone beam computed tomography (CBCT) and to evaluate possible correlations between age, gender, insertion torque measurements, and resonance frequency analysis (RFA) values. Materials and Methods: Completely and partially edentulous patients were treated with implants between 2007 and 2008 and evaluated retrospectively. The preoperative examination included a panoramic radiograph, CBCT, diagnostic casts, and a clinical examination of the jaws. With the CBCT scans, bone densities were recorded in Hounsfield units (HU). Insertion torque values and implant stability measurements (via RFA) were also noted. Results: Mean bone density and insertion torque values were 623 ± 209 HU and 42.4 ± 4 Ncm, respectively, for the 82 implants placed. Mean primary stability (implant stability quotient) was 62.4 ± 8. The differences in mean bone density at implant sites in the mandible (717 ± 204 HU) and the maxilla (490 ± 128 HU) were statistically significant for all patients (P < .05). There was a statistically significant relationship between bone density values and insertion torque measurements for implant sites in the anterior mandible (r = 0.562, P < .05), as well as between bone density and RFA values for men (r = 0.412, P < .05). Conclusions: Bone density measurements using preoperative CBCT may be helpful as an objective diagnostic tool. These values, in conjunction with RFA values and insertion torque measurements, can provide the implant surgeon with an objective assessment of bone quality and may be especially useful where poor-quality bone is suspected. [ABSTRACT FROM AUTHOR]

Purpose: To assess the prevalence of radiographic signs of maxillary sinus pathology in patients undergoing dental implant treatment and to compare the efficacy of panoramic radiography, computed tomography (CT), and three-dimensional (3D) CT with Implametric software in the diagnosis of sinus pathology. Materials and Methods: Thirty patients were selected at random from those being treatment-planned to receive implant-supported restorations in the maxilla and who had a panoramic radiograph, a conventional CT scan in acetate, and a 3D CT scan in digital format. The radiographic maxillary sinus findings were categorized as: (1) no sign of pathology, (2) mucosal thickening, (3) mucous cyst, or (4) occupation of the entire sinus. Results: Seventeen women and 13 men were included, with a mean age of 50.9 years. There was a 38.3% prevalence of radiographic abnormalities (23.3% mucosal thickenings, 10% mucous cysts, and 5% occupation of the entire sinus). Of the 23 sinuses that displayed radiographic signs of pathology, only 1 (4.3%) was correctly diagnosed by the panoramic radiograph. Conclusions: The most common radiographic maxillary sinus finding was mucosal thickening, followed by mucous cysts and occupation of the whole sinus. Conventional CT can be considered a reliable method for the diagnosis of maxillary sinus pathology. [ABSTRACT FROM AUTHOR]

Complications in dental implant surgery are possible. Bleeding complications have been described that may be serious, particularly in the floor of the mouth. We present two cases of sublingual hematomas during dental implant osteotomies that impeded but did not close the airway. The clinical courses of these patient's complications are reviewed. One patient had immediate hematoma formation while the other developed a hematoma overnight, presenting the next day. The treatment rendered was a precautionary in-hospital tracheotomy for the first patient and only compression control for the second. Bleeding complications during dental implant placement in the anterior mandible can be serious issues. There is a potential for sublingual hematoma that could compromise the airway by pressing the tongue against the soft palate into the pharynx. In-hospital treatment may be necessary to prevent an adverse outcome. It must be noted that a hematoma in the submandibular space is life threatening by direct airway compression. [ABSTRACT FROM AUTHOR]

The article presents two clinical case studies of edentulous patients whose severe upper maxillary atrophy conditions were treated using prosthetic approach with horizontal overdentures. Topics discussed include the results of radiographic evaluations of the patients, surgical procedures, and preparations for the horizontal dentures. Postoperative treatment of patients is also mentioned.

The study aims were to evaluate survival rates of dental implants in patients wearing maxillary and mandibular overdentures in relation to age, sex, smoking, implant splinting or non-splinting, the maxilla rehabilitated, and number of implants per dental arch. This was a prospective study of patients who were completely edentulous in either mandible or maxilla or both, rehabilitated with implant-retained overdentures, with a follow-up of at least 3 years. 95 patients with 107 overdentures were supported by 360 implants were included in the study. Rehabilitations were monitored over an average of 95 ± 20.3 months (range 36-159). Implant survival in the maxilla was 91.9% and in the mandible 98.6%, representing a statistically significant difference (P < .05). Age, sex and implant splinting did not influence survival rates significantly. Smokers presented a lower survival rate. Implant numbers in the maxilla had a significant influence on survival, 100% for 6 but 85.7% for 4. Three mandibular implants achieved higher survival rates (100%) but with 2 (96.6%) or 4 (99%) survival was lower, although without significant difference. Long-term results suggest that 3-implant mandibular overdentures have an equivalent survival rate to 4-implant overdentures. In the maxilla, results showed that 6 implants may be the best treatment strategy. For smokers with fewer implants retaining the overdentures, there were higher numbers of implant failures. [ABSTRACT FROM AUTHOR]

We review the evidence-based literature on the use of tilted implants in the rehabilitation of patients with maxillary atrophy. Studies from 1999 to 2010 on patients with atrophic maxilla rehabilitated with tilted implants were reviewed. Clinical series with at least 10 patients rehabilitated using tilted implants and a follow-up of at least 12 months after prosthetic load were included. Case reports and studies with missing data were excluded. In each study the following was assessed: surgical technique, prosthesis type, timing of implant loading, success rate and marginal bone loss of tilted and axial implants, complications and patient satisfaction level. Thirteen studies were included, reporting a total of 782 tilted and 666 axial implants in 319 patients. Success rates went from 91.3% to 100% for axial implants and from 92.1% to 100% for tilted implants; radiographic marginal bone loss went from 0.4 mm to 0.92 mm in tilted implants and from 0.35 mm to 1.21 mm in axial implants. No statistically significant differences were found in any of the studies. No surgical complications and only minor prosthetic complications were reported. High patient satisfaction was found with all types of prosthesis (full-arch fixed, partial fixed and overdentures) placed over tilted implants. The literature on tilted implants shows that implants placed with this technique, both used alone and combined with axially placed implants, and rehabilitated with different prosthetic options have high success rates, minimal complications and high patient satisfaction. However, lack of homogeneity among studies and relatively short follow-up periods for most studies make necessary more studies. [ABSTRACT FROM AUTHOR]

Purpose: Horizontal atrophy in the posterior mandible presents serious limitations on conventional implant placement. The purpose of this study was to evaluate the use of tilted implants angled in a buccolingual direction for restoring atrophic posterior mandibular sectors. Materials and Methods: A cohort study was performed of 25 patients who had partial prostheses supported by more than 1 implant (≥1 tilted and 1 axial implant) to restore molar areas in the mandible. When the bone thickness was at least 5 mm, axial implants were placed; when the alveolar ridge was narrower, the implant was placed with tilted angulation. The beds for these tilted implants were prepared using a lingual approach, tipping the implant apex toward the vestibule. Twelve months after loading, bone loss was evaluated and the success rates of the tilted and axial implants were calculated. Results: The study included 20 women and 5 men (mean age, 54.8 yr) who received 67 implants in the posterior mandibular sectors. Thirty-nine implants were placed with a buccal angulation and 28 implants were placed vertically. Mean bone losses of 0.59 ± 0.26 mm among the tilted implants and 0.48 ± 0.34 mm among the axial implants were observed 1 year after loading. The success rate of the tilted implants was 94.9%, and that of the axial implants was 100%. No significant differences in success rates or in bone loss between the tilted and axial implants were found at 12 months after loading. Conclusions: Twelve months after loading, tilted implants provided good results for the restoration of posterior mandibles with horizontal atrophy and no significant differences in success rates or marginal bone loss between tilted and axial implants were observed. [Copyright &y& Elsevier]

Purpose: To present a case series of 5 patients with oral teratomas, discussing the treatment and follow-up. Report of Cases: Five patients (4 girls and 1 boy) with oral teratomas presented at the Maxillofacial Surgery Department of a University Hospital with a reference population of 1,000,000 between 1980 and 2002. The associated lesions, clinical examination, histopathology, treatment and follow-up were registered and described. The newborns presented associated congenital malformations such as cleft palate, bifid tongue, dorso-nasal fistula and nasal dermoid cyst. In all 5 cases the tumor mass was excised at its base with surrounding normal tissue under general anesthesia combining conventional and electric scalpels. Histological analysis resulted in different compositions of multiple tissues typical of teratomas. After a mean follow-up of 8 years no sign of tumor recurrence had been detected. Conclusion: Teratomas were a rare finding within a large population of newborn patients. Five tumors were excised and histologically diagnosed as teratomas. No recurrence occurred after 8 years of follow-up. [Copyright &y& Elsevier]

Epidermolysis bullosa (EB) represents a group of mainly hereditary skin disorders, manifested by an exceptional tendency of the skin and mucosa to form bullae and vesicles after minor friction and trauma. Oral features include repeated blistering, scar formation, elimination of buccal and vestibular sulci, and alveolar bone resorption. The use of endosseous implants in the fixed prosthetic rehabilitation of patients with recessive dystrophic EB might provide a considerably better outcome than conventional removable prosthetic methods. This clinical report describes the fixed rehabilitation with 2 implants placed simultaneously with bone graft in a partially edentulous patient diagnosed with recessive dystrophic EB. The implants, with simultaneous bone graft, were placed to decrease the number of surgical operations required, avoiding soft tissue ulcerations and discomfort in the patient. This treatment option appears to be favorable for recessive dystrophic EB patients compared with other options involving removable prostheses, which irritate the oral mucosa. [Copyright &y& Elsevier]