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A systematic review was conducted to investigate the three-dimensional (3D) effect of Le Fort I osteotomy on the nasolabial soft tissues. The literature search was conducted using the MEDLINE (accessed via PubMed), Embase, and Cochrane electronic databases until January 2018. A total of 333 studies were identified (PubMed, n=292; Embase, n=41; Cochrane Library, n=0). Seventeen met the inclusion criteria. The studies were essentially retrospective. The risk of bias was considered high in 15 studies, medium in one study, and low in one study. 3D soft tissue analysis was performed at least 6months after surgery (mean 8.3months). The main image acquisition technique reported was cone beam computed tomography (CBCT), associated or not with 3D photography. Approximately 50% of the studies performed two-jaw surgery, 25% performed maxillary surgery only, and the other 25% included heterogeneous intervention groups. The most reported nasolabial changes were anterior and lateral movements of the nasomaxillary soft tissues and upper lip, together with anterior and superior movement of the nasal tip. The alar cinch suture and V-Y closure technique seemed to have little effect in counteracting the undesirable postoperative nasolabial changes. CBCT superimposition presented a reliable 3D assessment for simultaneous measurement of skeletal and soft tissue changes., (Copyright © 2019 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Background: Orthodontic treatment combined with a maxillomandibular advancement (MMA) can be an effective option for patients who need not only corrected occlusion but also facial rejuvenation. In this case series, two patients underwent orthodontic treatment and bimaxillary orthognathic surgery involving MMA, one of them with a counterclockwise rotation of the occlusal plane (OP)., Findings: In both cases, the face was rejuvenated, a functional occlusion was established, and the posterior airway space (PAS) was widened., Conclusions: The facial mask ages three dimensionally. MMA should be offered to patients who have insufficient skeletal projection and are considering improving their facial appearance beyond just correcting a malocclusion problem. The reverse facelift provides more soft-tissue support, resulting in mid- and lower-face rejuvenation.

The purpose of this animal study was to determine which ratio of hydroxyapatite (HA) and tricalcium phosphate (TCP) is the most appropriate in the composition of alloplastic biphasic block grafts, in terms of bone density and bone formation, for the regeneration of alveolar defects. Different concentrations of HA/TCP were used for the alloplastic block grafts: 100/0 (HA100 group), 79/21 (HA75 group), and 57/43 (HA50 group); the control treatment filled the defect with a collagen plug. All control and test sites were covered with a resorbable collagen membrane. Sacrifices were performed at 4, 12, and 24 weeks after grafting. Microcomputed tomography and histologic and histomorphometric analyses were performed to determine bone density and the characteristics of the regenerated bone as well as the percentages of newly formed bone (NB), residual material (RM), and connective tissue (CT). Bone density increased significantly over time (P < .001), with stabilization between 12 and 24 weeks (P = 1.000). No differences in density were observed between the different test blocks (P = .813). The percentage of NB increases over time, independent of the concentration (P < .001). At 12 weeks, the control group exhibited more NB than the HA100 group (P < .001). At 24 weeks, the HA50 group exhibited more NB than the HA100 (P < .001) and control (P = .066) groups. At 24 weeks, the HA100 and HA75 groups showed high RM percentages. The HA50 group exhibited an increased tendency of less RM percentage compared with the HA100 and HA75 groups. Although slight differences were found, the HA50 group's HA/TCP ratio seems the appropriate concentration when taking into account the bone density and percentage of NB and RM at 12 and 24 weeks of healing.

Objectives: Guided bone / tissue regeneration (GBR/GTR) procedures are necessary to improve conditions for implant placement. These techniques in turn can be enhanced by using growth factors (GFs) such as bone morphogenetic protein (BMP-2) and platelet-derived growth factor (PDGF) to accelerate regeneration. The aim of the present systematic review was to evaluate the GF loading and release kinetics of barrier membranes., Study Design: A total of 138 articles were screened in PubMed databases, and 31 meeting the inclusion criteria were included in the present systematic review., Results: All the articles evaluated bio-resorbable membranes, especially collagen or polymer-based membranes. In most studies, the retention and release kinetics of osteogenic GFs such as BMP-2 and PDGF were widely investigated. Growth factors were incorporated to the membranes by soaking and incubating the membranes in GF solution, followed by lyophilization, or mixing in the polymers before evaporation. Adsorption onto the membranes depended upon the membrane materials and additional reagents such as heparin, cross-linkers and GF concentration. Interestingly, most studies showed two phases of GF release from the membranes: a first phase comprising a burst release (about 1 day), followed by a second phase characterized by slower release. Furthermore, all the studies demonstrated the controlled release of sufficient concentrations of GFs from the membranes for bioactivities., Conclusions: The adsorption and release kinetics varied among the different materials, forms and GFs. The combination of membrane materials, GFs and manufacturing methods should be considered for optimizing GBR/GTR procedures., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: After tooth loss, the posterior maxilla is usually characterized by limited bone height secondary to pneumatization of the maxillary sinus and/or collapse of the alveolar ridge that preclude in many instances the installation of dental implants. In order to compensate for the lack of bone height, several treatment options have been proposed. These treatment alternatives aimed at the installation of dental implants with or without the utilization of bone grafting materials avoiding the perforation of the Schneiderian membrane. Nevertheless, membrane perforations represent the most common complication among these procedures. Consequently, the present review aimed at the elucidation of the relevance of this phenomenon on implant survival and complications., Material and Methods: Electronic and manual literature searches were performed by two independent reviewers in several databases, including MEDLINE, EMBASE, and Cochrane Oral Health Group Trials Register, for articles up to January 2018 reporting outcome of implant placement perforating the sinus floor without regenerative procedure (lateral sinus lift or transalveolar technique) and graft material. The intrusion of the implants can occur during drilling or implant placement, with and without punch out Schneiderian. Only studies with at least 6 months of follow-up were included in the qualitative assessment., Results: Eight studies provided information on the survival rate, with a global sample of 493 implants, being the weighted mean survival rate 95.6% (IC 95%), after 52.7 months of follow-up. The level of implant penetration (≤ 4 mm or > 4 mm) did not report statistically significant differences in survival rate (p = 0.403). Seven studies provided information on the rate of clinical complications, being the mean complication rate 3.4% (IC 95%). The most frequent clinical complication was epistaxis, without finding significant differences according to the level of penetration. Five studies provide information on the radiographic complication; the most common complication was thickening of the Schneiderian membrane. The weighted complication rate was 14.8% (IC 95%), and penetration level affects the rate of radiological complications, being these of 5.29% in implant penetrating ≤4 mm and 29.3% in implant penetrating > 4 mm, without reaching statistical significant difference (p = 0.301)., Conclusion: The overall survival rate of the implants into the sinus cavity was 95.6%, without statistical differences according to the level of penetration. The clinical and radiological complications were 3.4% and 14.8% respectively. The most frequent clinical complication was the epistaxis, and the radiological complication was thickening of the Schneiderian membrane, without reaching statistical significant difference according to the level of implant penetration inside the sinus.

Purpose: To determine the ideal position of a dental implant to assist a posterior extended partial removable dental prosthesis (PRDP), through stress values, displacement values, and deformation of periodontal ligament (PDL)., Materials and Methods: A finite element analysis of different implant positions was analyzed using a 3D mandible model from a human patient. Test models were created: model A (implant in second molar area), model B (implant in the first molar area), and model C (implant in premolar area). A control model without implant support was also created. Overall displacement values, von Mises stress distribution maps, and nonlinear deformations were evaluated., Results: Some differences could be observed between test models. The introduction of an implant in the edentulous area, unlike a conventional removable partial denture without implant support, decreases stress values in the biological structures such as: mandible, tooth, soft tissue, and PDL. Placing the implant in the first molar area resulted in improved displacement values, and reduced maximum stress values at the peri-implant bone area, metal structure, and implant were observed., Conclusions: Within the limitations of this study we can conclude that placing the implant in the position of the first molar improves biomechanical behavior of implant-assisted PRDPs., (© 2017 by the American College of Prosthodontists.)

Purpose: This report describes a technique to suspend the submandibular space (SS) through an intraoral approach in the context of a bilateral sagittal split osteotomy (BSSO), thus improving the jawline contour and achieving a neck-rejuvenating effect., Patients and Methods: A sample of 6 consecutive patients referred for orthognathic surgery who also sought neck rejuvenation and contouring surgery was selected to implement the technique. The following measurements were used to evaluate the procedure: patient satisfaction with a visual analog scale, photographic assessment, additional operative time, and complications related to the procedure., Results: The average patient age was 47 years (range, 38 to 57 yr). Three patients were women and 3 were men. All patients were highly satisfied with the results achieved at the jawline. No surgical complications occurred in any case. There was an average increase of only 5 minutes in total operative time for each side., Conclusion: Suspension of the SS through an intraoral approach is an effective, well-tolerated, and technically straightforward method for neck contouring in patients in whom a BSSO procedure is foreseen., (Copyright © 2018 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: To illustrate the workflow for simultaneous LeFort I maxillary advancement and zygomatic implant (ZI) placement., Materials and Methods: Three consecutive patients referred for the rehabilitation of the severely atrophic maxilla were treated with simultaneous LeFort I maxillary advancement and ZI placement. An evaluation of the treatment protocol was carried out to validate the proposed workflow: indications, treatment planning, surgical splint manufacturing, surgical procedure and prosthetic loading., Results: Maxillary reposition was carried out according to the previous virtual planning. Consequently, in all cases extrasinusal or sinus slot paths were used, proper emergence of the implant platform fully surrounded by alveolar bone was ensured, and full-arch rehabilitation supported by ZI was performed. A straight facial profile was achieved postoperatively in all cases and no surgical complications were noted. No resorption of maxillary distal bone was evident at the end of the first year of follow-up. However, a mean relapse of -4.3 mm (-10.06%) was evidenced for maxillary downward movement, and conversely, an extra-forward maxillary movement was observed (mean +1.4 mm, +82.8%) in all cases., Conclusions: Besides restoring oral function and aesthetics, this technique avoids donor site morbidity, decreases surgical time, and shortens the overall rehabilitation period., Competing Interests: Conflict of interest statement: The authors have no financial interests to declare regarding the contents of this article.

Background: To compare the radiological parameters and success of posterior maxillary direct sinus lift with simultaneous or delayed implant placement, or implant placement in native bone, after a minimum follow-up period of 5 years., Material and Methods: A retrospective cohort study was carried out in a university clinic, selecting patients subjected to implant treatment in the posterior maxilla between the years 2005 and 2011. The patients were divided into three groups: 1) implants placed in native bone; 2) direct sinus lift with simultaneous implant placement; and 3) direct sinus lift with delayed implant placement. Bone crest level, bone loss, vertical bone gain, and implant success and survival after a minimum follow-up period of 5 years after prosthetic loading were analyzed., Results: A total of 163 patients and 329 implants were included in the study. The mean duration of follow-up was 7.0 ± 1.9 years. Bone loss and implant success and survival were very similar in all three groups, with no significant differences among them. Graft reabsorption was greatest during the first 12 months, though graft stabilization was confirmed after 5 years of follow-up., Conclusions: Bone loss and percentage success and survival proved very similar for the implants placed in native bone and for sinus lift with simultaneous or delayed implant placement. The height of the graft material decreased mainly in the first 12 months, and continued until stabilization after 5 years, with no significant variations thereafter.

Purpose: The aim of this clinical study was to determinate if patients allergic to penicillin present a higher incidence of dental implant failure compared with nonallergic patients., Materials and Methods: This cross-sectional clinical study analyzed patients rehabilitated with endosseous dental implants between September 2011 and July 2015, at the University Dental Clinic, School of Dentistry, International University of Catalonia (UIC). Prophylactic antibiotic therapy was prescribed for all patients: a single dose of 2 g of amoxicillin taken orally 1 hour before implant surgery for non-penicillin-allergic patients, and 600 mg of clindamycin taken orally 1 hour before the implant surgery for penicillin-allergic patients. Postsurgical antibiotics were prescribed to prevent early implant failures and postoperative infections: amoxicillin 750 mg three times a day for 7 days for nonallergic patients, and in patients with penicillin allergy, 300 mg clindamycin every 6 hours for 7 days. Implant failure was defined as the removal of the implant for any reason and was classified as early or late failure., Results: A total of 1,210 patients' files were analyzed; 8.03% of nonallergic patients and 24.68% of penicillin-allergic patients presented at least one implant failure. In penicillin-allergic patients, 21.05% were classified as late implant failure and 78.95% as early implant failure, with a lack of osseointegration (80%) being the mean reason for an early implant failure. Penicillin-allergic patients demonstrated a higher risk of implant failure with a risk ratio of 3.84 (95% CI) compared with nonallergic patients., Conclusion: Penicillin-allergic patients treated with clindamycin presented almost four times the risk of suffering dental implant failure, although other variables such as implant brand, location, and the surgeon's skill might have influenced these results.

Purpose: Owing to volumetric changes after tooth extraction, lateral ridge augmentation has become a common procedure prior or simultaneous to implant placement. Nonetheless, little is known with regard to the dimensional remodeling after healing of these lateral ridge augmentation procedures. Hence, the purpose of this systematic review was to assess the stability of bone grafting material between augmentation procedures and final healing, in terms of resorption rate., Materials and Methods: An electronic and hand literature search was conducted in several databases, such as the Cochrane Oral Health Group Trials Register, Embase, and Cochrane Central Register of Controlled Trials, up until February 2017. Only randomized controlled trials (RCTs) with a mean follow-up of at least 6 months after implant placement aiming to evaluate the stability of grafting material for lateral ridge augmentation were included and quantitatively analyzed., Results: A total of 35 articles were evaluated; however, only 17 RCTs met the inclusion criteria. A total of 15 studies reported information on bone resorption, leading to a total sample of 304 implants. The estimated overall mean horizontal bone gain at the time of regeneration was 3.71 ± 0.24 mm, with 4.18 ± 0.56 mm for the block graft technique and 3.61 ± 0.27 mm for guided bone regeneration (GBR). The estimated overall net bone gain at final re-evaluation (11.9 ± 7.8) was 2.86 ± 0.23 mm. The estimated mean (± SD) resorption after 6 months was 1.13 ± 0.25 mm, with 0.75 ± 0.59 mm for the block graft technique and 1.22 ± 0.28 mm for GBR. The implant survival rate was 97% to 100%., Conclusion: Regardless of the material used for regeneration, different degrees of graft resorption should be expected. Given the sample of investigations analyzed in this review, block grafts seemed to maintain the volume of the initial augmentation site more than GBR techniques. During the initial stages of healing, the GBR technique experienced more changes compared with block grafts. The resorption of the xenograft group was inferior compared with the combination of xenograft and autologous bone groups. Consequently, overcorrection of the horizontal defects should be performed to compensate for the resorption of the grafting materials.

Background: GBRs are essential procedures in implant dentistry and periodontology where barrier membranes play an important role by isolating soft tissue and allowing bone to grow. Not all membranes function the same way, as they differ from their origin and structure, it is important to understand how membranes behave and differ one from others in order to achieve a predictable treatment., Material and Methods: A systematic search on Medline by two independent reviewers was performed for articles published until July 2017 reporting the characteristics or properties of barrier membranes. The question that preceded the search was designed according to PICO rules., Results: A total of 124 articles were initially identified from electronic searching. After abstract/full-text review, 21 were included for a systematic review. According to the extracted data and article analysis, barrier membranes should fulfill the following criteria in order to success: biocompatibility, space maintaining, occlusive function, easy - handling and a bioactivation friendly property. With the development of new biomaterials and surfaces, a great advance in this area is expected., Conclusions: It has been clearly described that biocompatibility is the most important requirement to take into account when choosing a membrane, but other factors such as space maintaining capacity, cell oclusiveness, easy handling and bioactivation friendly materials are the ones that will fulfill our necessities. Key words: Barrier membrane, guided bone regeneration, dental implantology, oral surgery, collagen membrane, biomaterial., Competing Interests: Conflict of interest statement: The authors have declared that no conflict of interest exist.

Purpose: The aim of this study was to systematically review and compare the survival rates (SRs) of oral rehabilitations performed with 2 zygomatic implants (ZIs) combined with regular implants (RIs) versus 4 ZI., Material and Methods: An electronic search was performed in several databases for articles published in English between 2007 and 2015. Articles reporting human studies were included in this systematic review., Results: The search yielded to a total of 417 studies, of which 6 were included in this study. ZIs SR weighted mean was 98.0% with a 95% confidence interval (CI) of 96.7% to 99.8%. For the control group (2 ZIs + 2 RIs) and the test group (4 ZIs), the implant SR was 98.6% and 97.4%, respectively, with a 95% CI. No statistically significant differences in terms of SRs were obtained between both groups P = 0.286., Conclusions: The data analysis showed favorable results for treatment with 4 ZIs. The results showed no statistical differences in using 1 or another treatment, in terms of survival and failure rates. The reduction on treatment time and morbidity related to regenerative approaches may be its main advantage. In conclusion, the zygoma quad seems to be the treatment of choice for the rehabilitation of the severely atrophic maxilla.

Introduction: It has been suggested that alveolar corticotomies may accelerate tooth movement, broaden the scope of malocclusion types that can be treated orthodontically, decrease the need for extractions, and support long-term stability. Several techniques have been proposed, although the indications, ideal design and technical characteristics, potential complications, and objective clinician and patient satisfaction remain unclear. This systematic review aimed to provide scientific support to validate alveolar corticotomies as a reliable approach to accelerated orthodontics., Material & Methods: A literature search was conducted using MEDLINE (via PubMed), Cochrane, and EMBASE electronic databases until December, 2016. Articles written in any language other than English, Spanish, French, German, and Portuguese were excluded. Randomized controlled trials, controlled clinical trials, and case series involving healthy adult patients, with a sample size of at least 5 patients, and using alveolar corticotomy techniques were included. Two reviewers extracted the data independently., Results: Three randomized clinical trials, 2 prospective randomized clinical trials, 6 case series and 1 randomized controlled split-mouth study were included. No clinical trials were retrieved. Mean total treatment time in corticotomy-facilitated orthodontic cases was 8.85 months (range, 4-20 months); control groups treatment duration was 16.4 months (range, 7.8-28.3 months). Complications such as pain, swelling, and dentin hypersensitivity were reported. Few studies mentioned patient/clinician satisfaction. The faster and less invasive procedures appeared to be well tolerated. However, the methodological quality of the selected studies was low, with only low to moderate scientific evidence., Conclusions: Corticotomy-facilitated orthodontics resulted in decreased treatment time. Few complications and low morbidity were found. More solid evidence-based research is required to support these results., (Copyright © 2018 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

The objective of this study was to investigate the malar bone volume and length that a zygomatic implant can engage, and the relationship to the sinus according to the degree of alveolar bone atrophy. A three-dimensional evaluation was performed using cone beam computed tomography scans from 23 patients with a totally edentulous maxilla; quad zygoma implants were virtually placed. The predictor variable was the amount of malar bone volume and length that a zygomatic implant can engage. The primary outcome variable was the relationship to the sinus according to the degree of alveolar bone atrophy. Other variables were the residual alveolar bone height to the floor of the sinus and the nasal cavity. The mean volume of malar bone engaged in this sample of 92 zygomatic implants was 0.19±0.06cm 3 . The implant had an extrasinus path in 60.9% of cases, a parasinus path in 25%, and an intrasinus path in 14.1%. The results suggest that the average volume of malar bone engaged by a zygomatic implant is constant regardless of implant position and the degree of alveolar bone atrophy. As alveolar atrophy increases, the trajectory of the implant becomes more parasinus and intrasinus. The examiners were able to find enough bone to adequately distribute the implants in all cases., (Copyright © 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Purpose: To evaluate the peri-implant soft and hard tissues of dental implants placed in vertically regenerated posterior mandibles with intraoral onlay block bone grafts and patient satisfaction at 3-year follow-up., Materials and Methods: A retrospective study of patients with dental implants placed in posterior mandibular sites vertically augmented with intraoral onlay block bone grafts was carried out between 2005 and 2009 at the University of Valencia. The outcomes assessed at the 3-year follow-up visit were the peri-implant soft tissues (Plaque Index and Bleeding Index, probing depth, keratinized mucosa width, and recession), implant survival and success rates, marginal bone loss, and patient satisfaction., Results: Sixteen patients with 36 implants were included. The mean Plaque Index and Bleeding Index scores were ≤ 0.4. The mean band of facial keratinized mucosa was ≥ 3 mm in 52.7% of implants; 38.8% of the implants showed facial recession. The mean midfacial recession was -0.31 ± 0.75 mm. Implant survival reached 100%, while the success rate was 85%, and the mean marginal bone loss was 1 ± 1.03 mm (range: 0.1 to 5.3). Good quality of life (9.19 ± 0.40) was reported for all patients, and the overall general satisfaction score was 8.07 ± 1.04 (mucosa esthetics: 7.71 ± 1.45; prosthesis esthetics: 8.42 ± 0.6; chewing: 8.68 ± 0.94; ease of cleaning: 8.01 ± 1.03)., Conclusion: Considering the limitations of the study, implants in vertically augmented posterior mandibular areas with intraoral onlay block bone grafts showed good soft tissue levels and high patient satisfaction. No implants were lost at 3 years postloading, though one-fifth of the patients showed a statistically significant marginal bone loss.

Introduction: Adverse effects in the nasolabial region should be anticipated after Le Fort I osteotomy. Intraoperative factors such as the extent of surgical dissection, type of closure and perinasal soft tissue reconstruction seem to influence soft tissue response. Attempts to control these changes have been made over the years and several techniques have been proposed., Materials and Methods: The authors present a minimally invasive alternative surgical technique to control alar base widening as well as lip shortening., (© EDP Sciences, SFODF, 2017.)

Objective: The aim of the present study was to evaluate the principal anatomical characteristics of the maxillary sinus using Cone Beam Computed Tomography (CBCT) in order to facilitate prevention of intra- and post-operative complications., Materials and Methods: Three hundred CBCT scans from patients undergoing implant surgery were analysed. The following anatomical structures were evaluated: (1) Residual ridge height (RRH) and width (RRW); (2) Ridge bone density (BD); (3) Maxillary sinus angle (MSA); (4) Maxillary sinus lateral wall thickness (LWT); (5) Schneiderian membrane thickness (MT); (6) Maxillary sinus septa (SS); (7) Posterior superior alveolar artery (PSAA).', Results: Mean patient age was 59.5±13.6. Mean RRH at upper second premolar (2PM) was 8.66±3.95mm, 4.90±2.28mm at first molar (1M), and 5.26±2.13mm at second molar (2M). Mean RRW was 6.72±2.69mm at 2PM, 6.87±2.65mm at 1M and 7.09±2.80mm at 2M. Bone density was 330.93±211.02 Hounsfield Units (HU) at first molar position and MSA was 73.39±15.23°. LWT was 1.95±0.98mm. Mean Schneider Membrane thickness (MT) was 1.82±1.59mm; MT was ≤3mm in 72.9% of patients and >3mm in 27.10%. 20.56% of patients presented bucco-palatal oriented septa with a mean height of 13.11±3.82mm. PSAA was observed in 48.60% and mean distance to the top of the ridge was 13.15±3.71mm, and was mostly observed inside the sinus (53.85%)., Conclusions: CBCT scanning has been shown to be a useful tool for evaluating maxillary sinus anatomical variations. CBCT should be considered the gold standard when evaluating the maxillary sinus area., (Copyright © 2017 Elsevier GmbH. All rights reserved.)

This systematic review was conducted to evaluate the stability and surgical complications of segmental Le Fort I osteotomy. The search was divided into a main search (PubMed, Embase, and Cochrane Library), grey literature search (Google Scholar), and manual search. Twenty-three studies were included: 14 evaluating stability as the outcome and nine evaluating surgical complications. The level of agreement between the authors was considered excellent (κ=0.893 for study selection and κ=0.853 for study eligibility). The segmental Le Fort I osteotomy provides stable outcomes in the sagittal plane, is less stable dentally than skeletally in the transverse plane, and provides little stability in the posterior segment after downward movement. The most frequent complications are oral fistula (six studies) and damage to the adjacent teeth (five studies), but the most prevalent complication is postoperative infection (32.62%). Four studies evaluating stability as the outcome showed a medium potential risk of bias, whereas all studies addressing surgical complications showed a high potential risk of bias. The segmental Le Fort I osteotomy should not be excluded from the technical armamentarium in orthognathic surgery. On the contrary, the literature consulted suggests it to be a useful tool for the three-dimensional surgical correction of maxillary malposition., (Copyright © 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

This study aimed to evaluate the reliability of cone-beam computed tomography (CBCT) imaging of the maxillary structures and the postoperative dentoskeletal, nasal airway, periodontal, and facial soft tissue changes after surgically assisted rapid palatal expansion (SARPE). A systematic review of the literature on CBCT analysis of SARPE was performed. The PubMed, Embase, and Cochrane Library databases were searched. Nine articles were included, involving a total of 228 patients. The general trend was tooth-borne distraction with pterygomaxillary dysjunction. A systematic increase in all transverse dimensions at the dentoalveolar and dental levels, as well as a certain degree of tipping and extrusion of the anchorage teeth and tipping of the skeletal segments, was detected. Soft tissue findings reflected the underlying dentoalveolar changes. A decrease in the buccal alveolar bone thickness and alveolar crest level occurred. Results confirm that CBCT is an accurate and reliable method to assess anatomical changes after SARPE. Although this systematic review provides valuable preliminary information about the effects of SARPE, results should be interpreted with caution due to the low level of evidence of the publications, great heterogeneity among study groups regarding outcome variables and surgical-orthodontic protocols, and lack of long-term data., (Copyright © 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Background: The aim of this systematic literature review was to evaluate the feasibility of topical bisphosphonate application for preserving/enhancing alveolar bone in oral implantology., Material and Methods: An electronic search was conducted in the PubMed/Medline, EMBASE, Scopus, Web of knowledge, and Google-Scholar databases for articles dated from January 2000 to December 2016. Two reviewers assessed the quality of the studies independently., Results: A total of 154 abstracts were identified, of which 18 potentially relevant articles were selected; a final total of nine papers were included for analysis. Comparison of the findings of the selected studies was made difficult by the heterogeneity of the articles, all of them animal research papers that showed heterogeneity in the methodologies used and a high or moderate risk of bias., Conclusions: The topical application of bisphosphonate solution would appear to favor new bone formation in alveolar defects, and boosts the regenerative capacities of biomaterials resulting in increased bone density.

Purpose: This study evaluated the long-term stability of bilateral sagittal split ramus osteotomy fixed with a single miniplate with 4 monocortical screws and 1 bicortical screw (hybrid technique [HT]) using 3-dimensional (3D) analysis and an objective measuring tool, cone-beam computed tomography (CBCT)., Materials and Methods: Sixty-four patients who underwent bimaxillary surgery with mandibular advancement fixed with the HT were selected from 2 different institutions and enrolled in this retrospective study. All patients underwent CBCT preoperatively, 1 month after surgery, and 12 months after surgery. To estimate the long-term stability of the HT, volumetric comparisons were performed using the following measurements: distance between the gonion and the B point in the sagittal plane; distance between the right and left gonion transversally; and the angle of the line connecting the mandibular notch and the gonion and the line connecting the gonion and the B point vertically., Results: Statistical analysis showed no relevant relapse (<1 mm or <1°) when using the HT. However, a positive correlation between the amount of advancement and the amount of postoperative relapse was observed., Conclusion: The HT produces stable postoperative 3D results after 12 months., (Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: The aim of the present study was to systematically evaluate the marginal bone loss (MBL), success, and survival of zirconia (Zi) implants and compare them with the widely studied titanium (Ti) implants., Materials and Methods: An electronic and manual literature search of several databases was performed by two independent reviewers for articles up to July 2015 that reported the use of Zi implants and survival, success, and MBL with at least 12 months' follow-up. In addition, random effects meta-analyses of selected studies were applied to analyze the weighted mean difference of survival, success, and MBL between groups. Meta-regression analysis was conducted to investigate any potential influence of confounding factors., Results: Twenty-one articles were included, analyzing a total of 1,948 Zi implants with a survival rate of 91.5% and a success rate of 91.6% for 1,250 Zi implants. In addition, three studies were included in the quantitative synthesis and were meta-analyzed for the comparison of survival between Zi and Ti implants, with Zi implants having an 89% greater risk of failure compared with Ti implants (OR = 1.89). There were no statistically significant differences (P = .968) in the success of Zi and Ti implants (odds ratio [OR] = 1.02; 95% confidence interval [CI], 0.47-2.20). MBL (± SD) for Zi implants was 0.89 ± 0.18 mm, which was greater than the MBL for Ti implants (mean difference = 0.14 mm). Also, survival of Zi implants (91.5%) was significantly lower than that of Ti implants (OR = 1.89). Metaregression analysis revealed a similar survival rate for one-piece versus two-piece implants. Similarly, no significant differences were found between immediate and delayed loading., Conclusions: The survival rate of Zi implants was significantly lower than that for the commonly used Ti implants. However, for certain clinical conditions, such as a thin tissue biotype or in the highly esthetic anterior area, Zi implants may offer some benefit when compared with Ti implants.

Purpose: To systematically appraise the effectiveness/reliability of vertical ridge augmentation (VRA) in the atrophic mandible. Articles that addressed any one of the following four areas were included in this study: amount of VRA, implant survival (ISR) and success rates (SSR) in the area of newly regenerated bone, complication rate during the bone augmentation procedure, and bone resorption., Materials and Methods: An electronic literature search was conducted by two independent reviewers in several databases, including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Oral Health Group Trials Register databases for articles reporting VRA in the atrophic mandible via distraction osteogenesis (DO), inlay block grafting (IBG), onlay block grafting (OBG), and guided bone regeneration (GBR). For meta-analysis, two primary (VRA and ISR [%]) and two secondary outcomes were studied (SSR [%] and vertical bone resorption [VBR] [%}). Additionally, for qualitative assessment, complications (ie, causes of failure) were further extracted and comprehensively described., Results: Overall, 73 full-text papers were evaluated. Of these, 52 articles fulfilled the inclusion criteria. The weight mean (WM) of VRA (± SD) was 4.49 ± 0.33 mm (95% CI: 3.85 to 5.14 mm). It was most notable that DO involved greater VRA than IBG, and thus, significantly higher than GBR and OBG. The technique significantly influenced the mean VRA obtained (P < .001). Nonetheless, no technique showed superiority in terms of ISR or SSR. VBR and complications were shown to be minimized for GBR., Conclusion: If ~ 4 mm of VRA is needed, any technique in optimum local and systemic conditions should be equally reliable in the atrophic mandible. However, when greater VRA is needed, DO and IBG have demonstrated accuracy. By means of complication and VBR rates, GBR was shown to have the lowest. For ISR and SSR, no statistical differences existed among all techniques. Controlled studies are needed to examine the long-term peri-implant bone fate and the frequency of biologic complications in each technique applied for the vertical augmentation of the atrophied mandible.

Introduction: Since the beginning of cephalometric analysis, a significant number of approaches to vertical facial proportions have been proposed. In our view, diagnosing a vertical problem has nothing to do with numbers or measurements. It's all about perceptions and - rather subjective - impressions. An "impression" of long face may be provoked by the following causes isolated or combined: vertical maxillary hyperplasia, open bite, anterior vertical mandibular hyperplasia, narrow face, lack of chin-neck definition., Method: Clinical planning in these cases is followed by 3D simulation and CAD/CAM generation of surgical splints., Conclusion: Surgical management of the Long Face Syndrome may include the following strategies isolated or combined : maxillary impaction, vertical chin reduction, counterclockwise rotation of the occlusal plane., (© EDP Sciences, SFODF, 2016.)

A significant proportion of facial asymmetry cases are caused by abnormal growth of the mandibular condyles. Surgical management is generally based on a condylectomy performed through a pre-auricular transcutaneous access. However, this approach entails potential neurovascular, salivary, and aesthetic complications. In this study, a proof-of-concept evaluation was performed of a novel minimally invasive technique for condylectomy performed through an intraoral approach. Based on precise three-dimensional virtual planning to define intraoperative references, this technique provides an excellent access for total or partial condylectomy through a limited intraoral incision. Piezoelectric surgery with customized attachments enables the safe, accurate execution of the condylectomy. In addition, experience gained in seven consecutive cases suggests that the need for coronoidectomy can be obviated, surgical time is reduced to an average of 16.9min, and postoperative morbidity is minimal. This alternative intraoral approach could become the treatment of choice for most condylar hyperplastic conditions., (Copyright © 2016 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

The aim of this research was to use cone beam computed tomography (CBCT) to analyze the volume, density, and morphology of the bone available in the anterior region of the maxilla, in order to investigate its potential as a source of bone grafts. Three independent zones were evaluated: the palatine process of the maxilla (PPM), anterior nasal spine (ANS), and subnasal bone (SN). The latter was analyzed bilaterally (SNR, SNL). One hundred CBCT scans were evaluated. The morphometric analysis comprised volumetric and subsequent automatic density calculations, as well as linear measurements. Potential correlations among these parameters, including demographic characteristics, were investigated. The study comprised 52 women and 48 men (mean age 49.6±14.5 years). The calculated bone volume averaged 2.41±0.72cm(3) for PPM, 0.46±0.16cm(3) for ANS, 0.58±0.2cm(3) for SNR, and 0.57±0.21cm(3) for SNL. The anterior region of the maxilla can provide a considerable amount of bone volume from different anatomical zones and should be regarded as a potential donor site for the regeneration of maxillary atrophic bones. Further investigation is required before these findings can be applied in the routine clinical setting., (Copyright © 2016 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Objective: The aim of this study was to evaluate the effect of topical application of vitamin D over implant surface, placed immediately to the extraction, throughout histological and histomorphometric analysis of peri-implant tissue., Material and Methods: Six American foxhound dogs were used in the study. Mandibular premolar distal roots were extracted. Twenty-four immediate conical C1 implants (MIS, Barlev, Israel) were randomly assigned to the distal site on each site of the mandible in three groups: (Group CI) 12 titanium implants alone; (Test Group DI) 12 titanium implants supplemented with vitamin D. Prior to implanting, test implants (DI) were submerged in vitamin D 10% solution. No treatment was applied at control implants (CI). After 12 weeks, animals were sacrificed. Block sections were obtained and processed for mineralized ground sectioning. Bone-to-implant contact (Total BIC and BIC%), new bone formation (NBF), interthread bone (ITB), and histological linear measurements (HLM) were analyzed., Results: At 12 weeks, all implants were clinically stable and histologically osseointegrated. BIC evaluation showed Total BIC mean and SD values for DI (48.96 ± 2.14), CI (44.56 ± 1.75) (P < 0.05), BIC% DI (43.59 ± 0.98), and CI (42.67 ± 9.26) (P > 0.05). For interthread bone formation, values were as follows: DI (15.21 ± 3.87), CI (14.79 ± 1.45) (P > 0.05), no statistically differences. Regarding peri-implant new bone formation, no statistically differences could be found between the two groups DI (31.87 ± 1.23), CI (27.18 ± 2.38) (P > 0.05). For linear measurements, test group (DI) showed statistically significant less buccal crestal bone loss (CBL) DI (0.37 ± 0.12)*, CI (1.26 ± 0.8) (P < 0.05), and vitamin D implants showed less lingual junctional epithelium DI (1.58 ± 0.43)*, CI (2.18 ± 0.48) (P < 0.05). No differences were observed in the buccal mucosa., Conclusion: With the limitation of animal studies, topical application of vitamin D on dental implants could reduce crestal bone loss and increase 10% more bone-to-implant contact at 12-week follow-up period., (© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

The use of titanium implants is well documented and they have high survival and success rates. However, when used as reduced-diameter implants, the risk of fracture is increased. Narrow diameter implants (NDIs) of titanium-zirconium (Ti-Zr) alloy have recently been developed (Roxolid; Institut Straumann AG). Ti-Zr alloys (two highly biocompatible materials) demonstrate higher tensile strength than commercially pure titanium. The aim of this systematic review was to summarize the existing clinical evidence on dental NDIs made from Ti-Zr. A systematic literature search was performed using the Medline database to find relevant articles on clinical studies published in the English language up to December 2014. Nine clinical studies using Ti-Zr implants were identified. Overall, 607 patients received 922 implants. The mean marginal bone loss was 0.36±0.06mm after 1 year and 0.41±0.09mm after 2 years. The follow-up period ranged from 3 to 36 months. Mean survival and success rates were 98.4% and 97.8% at 1 year after implant placement and 97.7% and 97.3% at 2 years. Narrow diameter Ti-Zr dental implants show survival and success rates comparable to regular diameter titanium implants (>95%) in the short term. Long-term follow-up clinical data are needed to confirm the excellent clinical performance of these implants., (Copyright © 2016 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

The aim of this study was to perform a three-dimensional (3D) assessment of positional changes of the mandibular condyle after bilateral sagittal split osteotomy (BSSO). A prospective evaluation of 22 skeletal class II patients who underwent a BSSO for mandibular advancement was performed. Pre- and postoperative cone beam computed tomography scans were taken. Using the cranial base as a stable reference, the pre- and postoperative 3D skull models were superimposed virtually. Positional changes of the condyles were assessed with a 3D colour mapping system (SimPlant O&O). A Brunner-Langer statistical test was applied to test the null hypothesis that the condylar position remains stable after BSSO. The level of significance was set at 0.05. The mean mandibular advancement in the studied sample was 6.7±1.6mm. Overall, the condylar positional changes after BSSO for mandibular advancement were statistically significant (P<0.05). A positive correlation was found between the displacement of the left condyle and the amount of mandibular advancement (P<0.01). The results of this study suggest that statistically significant changes of condylar position occur after mandibular advancement. Long-term evaluation is needed to assess the capacity of the temporomandibular joint to adapt to these changes., (Copyright © 2016 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Introduction: Compared to the conventional approach to orthognathic surgery, "surgery first" protocols could be advantageous in terms of shortened treatment times and immediate esthetic improvement. However, consensus regarding patient selection, technical protocol, and stability is still lacking., Methods: A systematic review of the scientific literature on surgery-first treatment (January 2000 to January 2015) was performed. The PubMED and Cochrane Library databases were accessed. Patient selection criteria, specific surgical-orthodontic protocol, treatment duration, patient and orthodontist satisfaction, and stability of results were compared with a similar population treated conventionally., Results: The search yielded 179 publications. The application of strict selection criteria gave the final group of 11 articles. In total, 295 patients were managed with a surgery-first approach. A Class III malocclusion was the most prevalent underlying malocclusion (84.7%). Total treatment duration was shorter in surgery-first patients than in those treated conventionally. There was substantial heterogeneity among articles and high reporting bias regarding the inclusion and exclusion criteria, the orthodontic and surgical protocols, and the stability of results. A meta-analysis of combined data was not possible., Conclusions: The surgery-first approach is a new treatment paradigm for the management of dentomaxillofacial deformity. Studies have reported satisfactory outcomes and high acceptance. However, the results should be interpreted with caution because of the wide varieties of study designs and outcome variables, reporting biases, and lack of prospective long-term follow-ups., (Copyright © 2016 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Background: Implant restorations have become a high predictable treatment option. Several caracteristics such as surgical technique and implant design can influence the treatment outcomes. The aim of the present study was to evaluate the influence of implant macro-design on primary stability measured with resonance frequency analysis (RFA) and insertion torque (IT). Material and Mehods: A total of 47 implants divided in two groups: Test group (TI): 22 Tapered MIS® Seven implants; Control group (CI): 25 cylindrical Astra® Osseospeed implants. All implants were inserted following the manufacturers' standard protocols. Implant primary stability was measured at the moment of implant placement by registering insertion torque values (ITv) and ISQ values by means of Osstell™ Mentor (ISQv) (Integration Diagnostic Ltd., Goteborg, Sweden)., Results: In the mandible, mean ISQv for tapered implants (TI) was 71.67±5.16 and for cylindrical implants (CI) 57.15±4.83 (p=0.01). Mean insertion torque was 46.67±6.85 Ncm for TI and 35.77±6.72 Ncm for CI (p=0.01). In the maxilla, mean ISQ was 67.2±4.42 for tapered implants and 49.17±15.30 for cylindrical implants (p=0.01). Mean insertion torque for TI was 41.5±6.26 Ncm and for CI 39.17±6.34 Ncm (p>0.05). For tapered implants, no correlation could be found between implant diameter and primary stability. But for cylindrical implants there was a statistically significant correlation between implant diameter and primary stability: ITv (p=0.03); ISQv (p=0.04)., Conclusions: Within the limits of the present study, tapered shaped implants achieve higher primary stability measured through ISQ and insertion torque values. Moreover, for cylindrical implants positive correlation has been established between implant diameter and primary stability.

Background: Contemporary orthognathic surgery contemplates three-dimensional facial soft-tissue harmonization as one of the basic pillars in treatment planning. In particular, prominent malar regions are regarded as a sign of beauty and youth by Western societies. The aim of this article was to perform a subjective and objective three-dimensional evaluation of the pedicled buccal fat pad technique for malar augmentation in the context of orthognathic surgery., Methods: Six consecutive patients with underlying dentofacial anomalies and bilateral malar hypoplasia were managed with simultaneous orthognathic surgery and pedicled buccal fat pad malar augmentation. Patient morbidity and satisfaction with the procedure were evaluated with a visual analogue scale. Cone-beam computed tomographic data were used to perform a volumetric analysis at 1- and 12-month follow-up by means of image superimposition., Results: Subjective analysis revealed excellent patient satisfaction and minimal pain. Mean malar volume was 115,480.91 mm preoperatively, 124,586.32 mm 1 month after surgery, and 119,008.77 mm 12 months after surgery. Thus, the final mean increase 1 year after surgery was 3527.86 mm and the average amount of resorption was 5577.55 mm. The median variations in volume were 7.77 percent at 1-month follow-up and 3.52 percent at 12-month follow-up., Conclusions: In conclusion, the pedicled buccal fat pad technique is a reasonable alternative for malar augmentation in the context of orthognathic surgery. The results of this preliminary report suggest that it provides satisfactory soft-tissue augmentation; avoids the use of foreign materials; and has minimal morbidity, high patient satisfaction, and adequate stability at 12-month follow-up., Clinical Question/level of Evidence: Therapeutic, IV.

The aim of the present study was to use cone-beam computerized tomography (CBCT) to assess horizontal bone augmentation using block grafts, harvested from either the iliac crest (IC) or mandibular ramus (MR) combined with particulate xenograft and a collagen membrane for in the severe maxillary anterior ridge defects (cases Class III-IV according to Cadwood and Howell's classification). Fourteen healthy partially edentulous patients requiring extensive horizontal bone reconstruction in the anterior maxilla were selected for the study. Nineteen onlay block grafts (from IC or MR) were placed. The amount of horizontal bone gain was recorded by CBCT at 3 levels (5, 7, and 11 mm from the residual ridge) and at the time of bone grafting as well as the time of implant placement (≈5 months). Both block donor sites provided enough ridge width for proper implant placement. Nonetheless, IC had significantly greater ridge width gain than MR (Student t test) (4.93 mm vs 3.23 mm). This was further confirmed by nonparametric Mann-Whitney test (P = .007). Moreover, mean pristine ridge and grafted ridge values showed a direct association (Spearman coefficient of correlation = .336). A combination of block graft, obtained from the IC or MR, combined with particulate xenograft then covered with an absorbable collagen membrane is a predictable technique for augmenting anterior maxillary horizontal ridge deficiency.

Background: The ideal lip augmentation technique provides the longest period of efficacy, lowest complication rate, and best aesthetic results. A myriad of techniques have been described for lip augmentation, but the optimal approach has not yet been established. This systematic review with meta-regression will focus on the various filling procedures for lip augmentation (FPLA), with the goal of determining the optimal approach., Methods: A systematic search for all English, French, Spanish, German, Italian, Portuguese and Dutch language studies involving FPLA was performed using these databases: Elsevier Science Direct, PubMed, Highwire Press, Springer Standard Collection, SAGE, DOAJ, Sweetswise, Free E-Journals, Ovid Lippincott Williams & Wilkins, Willey Online Library Journals, and Cochrane Plus. The reference section of every study selected through this database search was subsequently examined to identify additional relevant studies., Results: The database search yielded 29 studies. Nine more studies were retrieved from the reference sections of these 29 studies. The level of evidence ratings of these 38 studies were as follows: level Ib, four studies; level IIb, four studies; level IIIb, one study; and level IV, 29 studies. Ten studies were prospective., Conclusions: This systematic review sought to highlight all the quality data currently available regarding FPLA. Because of the considerable diversity of procedures, no definitive comparisons or conclusions were possible. Additional prospective studies and clinical trials are required to more conclusively determine the most appropriate approach for this procedure., Level of Evidence: IV., (Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Purpose: Many techniques have been proposed to overcome the limitations displayed by maxillary atrophy. The aim of this systematic review was to assess the predictability, dimensional changes, and associated factors to successfully perform the alveolar ridge split (ARS) technique of augmentation., Materials and Methods: An electronic and manual literature searches was conducted by two independent reviewers in several databases, including Medline, Embase, Cochrane Central Register of Controlled Trials, and Cochrane Oral Health Group Trials Register, for articles written in English up to February 2014. A manual search was also performed to ensure a thorough screening process. Based on the PICO (problem, intervention, comparison, outcome) model, the chief question of this study was: Can patients with horizontal ridge deficiency be successfully treated with the ARS technique and implant therapy?, Results: Overall, 17 articles met the inclusion criteria, and a subsequent meta-analysis was performed. A Cohen kappa interagreement rate of 0.82 was reached. The implant survival rate of the included studies was 97.0% (range, 94.4% to 100%) with the full-thickness flap (FTF) approach and 95.7% (range, 86.6% to 100%) with the partial-thickness flap (PTF) approach. The weighted mean (WM) of horizontal bone width gain was calculated for included studies using FTF for the ARS technique. Four studies that had data were included in the meta-analysis. The WM ± standard deviation of bone width gain was 3.19 ± 1.19 mm (range, 2.00 to 4.03 mm). For studies using PTF for ARS, only one study provided mean and standard deviation of horizontal bone width gain (4.13 ± 3.13 mm); hence, meta-analysis could not be performed. Buccal wall fracture represented the most frequent postoperative complication, followed by postoperative ridge resorption., Conclusion: In selected scenarios, the ARS technique might represent a predictable approach as demonstrated by a high implant survival rate, adequate horizontal bone gain, and minimal intra- and postoperative complications. Further research is needed to determine the influence of the grafting materials inserted and flap tissue biotype, as well as the anatomical characteristics on final bone augmentation outcomes.

Objectives: The aim of this study was to evaluate the effect of two different designs, tapered vs cylindrical, on the primary stability of implants placed with an immediate loading protocol in edentulous mandibles to support fixed prostheses within occlusal contacts during the first 48 h., Material and Methods: Tapered and cylindrical implants were placed in a split-mouth study using the same implant protocol in ten patients with edentulous jaws. A total of 20 tapered implants (test group) and 20 cylindrical implants (control group) were placed. All implants were loaded immediately with provisional fixed prostheses during the healing period before the final restoration. The implants were evaluated at the implant placement by analyzing the insertion torque values (ITVs) and the resonance frequency analysis (RFA) and after the healing period of three months, the success of those implants and the marginal bone loss were evaluated., Results: Two cylindrical implants were mobile within the same patient and no tapered implants failed, resulting in implant survival rates of 90% and 100%, respectively after three months. The ITVs were statistically significantly different (P = 0.0210) for the tapered implants than for the cylindrical implants. However, no statistically significant differences in RFA values were found (P = 0.6063) when comparing the implant designs and the primary stability measured with implant stability quotient (ISQ) values. The control group resulted in a mean bone loss after three months of 0.91 mm while the test group resulted 0.42 mm., Conclusion: The tapered implant achieved greater primary stability values measured with ITVs and less marginal bone loss than the cylindrical implants., (© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

The purpose of this retrospective case series was to report on the clinical performance of implant-assisted removable partial dentures (IARPDs) with Locator abutments in different partial edentulism situations, with a mean follow-up period of 28.6 months. Twelve consecutive patients were treated with IARPDs. A total of 24 implants were placed in the edentulous area. Minimum follow-up period was 12 months. Overall patient satisfaction, health of peri-implant tissues, survival of implants and abutments, and prosthetic complications were reported. Overall implant survival was 91.6%; two implants failed. No major complications were reported-only one IARPD metal framework broke. No Locator abutment loosening was reported. Within the limitations of this retrospective study, treatment with IARPDs can improve the patient's function, phonetics, and esthetics without the need for extensive bone regeneration surgeries and prosthodontic rehabilitations. However, well-designed prospective clinical studies on IARPDs are needed to support their long-term use.

Together with the introduction of new orthodontic techniques and minimally invasive surgery protocols, the emergence of modern patient prototypes has given way to novel timing schemes for the handling of dento-maxillofacial deformities. The aim of this study was to define, justify, and systematize the appropriate timing for orthognathic surgery. A retrospective analysis of orthognathic surgery procedures carried out over a 3-year period was performed. Six timing schemes were defined: 'surgery first', 'surgery early', 'surgery late', 'surgery last', 'surgery only', and 'surgery never'. Gender, age at surgery, main motivation for treatment, orthodontic treatment length, and number of orthodontic appointments were evaluated. A total of 362 orthognathic procedures were evaluated. The most common approach was 'surgery late'. While aesthetic improvement was the leading treatment motivation in 'surgery first', 'surgery early', and 'surgery last' cases, occlusal optimization was the chief aim of 'surgery late'. Sleep-disordered breathing was the main indication for treatment in 'surgery only'. Compared to 'surgery late', orthodontic treatment was substantially shorter in 'surgery early' and 'surgery first' cases, but the number of orthodontic appointments was similar. In conclusion, the skilful management of dento-maxillofacial deformities requires a comprehensive analysis of patient-, orthodontist-, and surgeon-specific variables. Each timing approach has well-defined indications, treatment planning considerations, and orthodontic and surgical peculiarities., (Copyright © 2014 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Purpose: In some patients, "surgery first" (SF) may represent a reasonable approach for the expedited correction of a maxillofacial deformity. Based on the prospective evaluation of a large sample, this article provides a specific orthodontic and surgical protocol, discusses the benefits and limitations of this approach, and updates its indications., Materials and Methods: Forty-five patients were managed with an SF approach. Selected cases presented symmetrical skeletal malocclusions with no need for extractions or surgically assisted rapid palatal expansion. Periodontal or temporomandibular joint problems and management by an orthodontist without experience in orthognathic surgery were considered exclusion criteria. Virtual treatment planning included a 3-dimensional orthodontic setup. Standard orthognathic osteotomies were followed by buccal interdental corticotomies to amplify the regional acceleratory phenomenon. Miniscrews were placed for postoperative skeletal stabilization. Orthodontic treatment began 2 weeks after surgery. Archwires were changed every 2 to 3 weeks. At 12-month follow-up, patient satisfaction and orthodontist satisfaction were evaluated on a visual analog scale of 1 to 10. Descriptive statistics were computed for all study variables., Results: The studied sample consisted of 27 women and 18 men (mean age, 23.5 yr). The main motivation for treatment was the wish to improve facial esthetics. Bimaxillary surgery was the most common procedure. Mean duration of orthodontic treatment was 37.8 weeks, with an average of 22 orthodontic appointments. Mean patient and orthodontist satisfaction scores were 9.4 (range, 8 to 10) and 9.7 (range, 8 to 10), respectively., Conclusions: The SF approach significantly shortens total treatment time and is very favorably valued by patients and orthodontists. Nevertheless, careful patient selection, precise treatment planning, and fluent bidirectional feedback between the surgeon and the orthodontist are mandatory., (Copyright © 2014 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: This systematic review was aimed at assessing the feasibility by means of survival rate, histologic analysis, and causes of failure of allogeneic block grafts for augmenting the atrophic maxilla., Material and Methods: A literature search was conducted by one reviewer in several databases. Articles were included in this systematic review if they were human clinical trials in which outcomes of allogeneic bone block grafts were studied by means of survival rate. In addition other factors were extracted in order to assess their influence upon graft failure., Results: Fifteen articles fulfilled the inclusion criteria and subsequently were analyzed in this systematic review. A total of 361 block grafts could be followed 4 to 9 months after the surgery, of which 9 (2.4%) failed within 1 month to 2 months after the surgery. Additionally, a weighed mean 4.79 mm (95% CI: 4.51-5.08) horizontal bone gain was computed from 119 grafted sites in 5 studies. Regarding implant cumulative survival rate, the weighed mean was 96.9% (95% CI: 92.8-98.7%), computed from 228 implants over a mean follow-up period of 23.9 months. Histologic analysis showed that allogeneic block grafts behave differently in the early stages of healing when compared to autogenous block grafts., Conclusion: Atrophied maxillary reconstruction with allogeneic bone block grafts represents a reliable option as shown by low block graft failure rate, minimal resorption, and high implant survival rate.

Inaccurate visualization of the inter-occlusal relationship has raised an important challenge to virtual planning for orthognathic surgery based on cone beam computerized tomography (CBCT). The aim of this study was to evaluate an innovative workflow for orthognathic surgery planning and surgical splint fabrication. The clinical protocol consists of a single cone beam computerized tomography (CBCT) scan of the patient, surface scanning of the dental arches with an intraoral digital scanner, and subsequent fusion of the two datasets. The "virtual patient" thus created undergoes virtual surgery, and the resulting file with the intermediate intermaxillary relationship is used to obtain the intermediate splint by CAD/CAM technology (computer-aided design and computer-aided manufacturing). A proof-of-concept study was performed in order to assess the accuracy and reliability of this protocol. The study comprised two parts: an in vitro evaluation on three dentate skull models and a prospective in vivo assessment on six consecutive patients. Vector error calculation between the virtually simulated intermaxillary position and the intraoperative intermediate intermaxillary relationship revealed high accuracy. The greatest average variation corresponded to the y axis. Compared to previously described methods for obtaining an augmented three-dimensional virtual model, this procedure eliminates the need for dental impressions, simplifies the necessary technical steps and computational work, and reduces the patient's exposure to ionizing radiation., (Copyright © 2013 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

The aim of this research was to use cone-beam computerized tomography (CBCT) to analyze the available bone volume in the palatine process of the maxilla (PPM), which is a potential source of bone grafts. 20 CBCT scans were evaluated. From the most caudal axial slice of the PPM, the bony surface was calculated cranially up to the nasal floor. The predetermined thickness of each slice was 0.9 mm. A 2 mm safety margin was established considering the incisive canal and teeth 14-24. A ± 0.1 mm error deviation was established for all calculations. By connecting these points and those defined at the posterior bone boundary, a surface was obtained. A three-dimensional (3D) image of the delimited zone was constructed and analyzed using 3D imaging software. The study comprised 6 women and 14 men (mean age 39.4 ± 11.5 years). Calculated bone volume averaged 2.41 ± 0.785 cm(3). The palatine process of the maxilla contains a considerable bone volume (2.41 ± 0.785 cm(3)). This area should be regarded as a potential donor site for the regeneration of maxillary atrophic bones. Further investigation is required before these findings lead to routine clinical application., (Copyright © 2012 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Purpose: To perform a preliminary validation with cone beam computed tomography (CBCT) of the combined use of intraoral bone blocks and biomaterials for total reconstruction of the atrophic maxilla., Materials and Methods: Consecutive cases of total edentulism of the maxilla (Cawood and Howell classes IV or V) treated with bilateral sinus floor elevation, mandibular bone block grafts, and biomaterials were evaluated prospectively. Implants were placed 14 to 16 weeks after grafting. Each patient received a CBCT scan preoperatively, immediately after bone augmentation, and at reentry. A three-dimensional reconstruction of the maxilla with volumetric calculations was obtained at each stage., Results: Fourteen patients participated. Successful graft integration occurred in all cases, with no major complications. Mean preoperative volume was 11,312 mm3. Mean postoperative volume was 19,997 mm3 immediately after surgery and 19,042 mm3 before implant insertion. The average percentage volumetric increase between the preoperative condition and the situation at reentry was 71.99%. One hundred eight implants were inserted. Immediate loading was possible with 81 implants in 10 patients., Conclusions: The rehabilitation of the severely resorbed maxilla remains a formidable challenge. The results of this study suggest that the use of mandibular bone blocks in combination with biomaterials is an effective, reliable procedure for the rehabilitation of the severely resorbed maxilla. Significant volume increases and adequate stability of the augmented areas at reentry were found with CBCT analysis. The grafted bone provided sufficient mechanical support to permit provisionalization and immediate loading. This technique enabled the restoration of function and esthetics with a fixed rehabilitation at 4 months.

Objectives: The purpose was to assess thermal changes and drill wear in bovine bone tissue with the use of twisted stainless steel and zirconia-based drills, during implant site preparation., Methods: A total of 100 implant site preparations were performed on bovine ribs using a surgical unit linked to a testing device, in order to standardize/simulate implant drilling procedures. Bone temperature variations and drilling force were recorded when drilling at a depth of 8 and 10 mm. A constant irrigation of 50 ml/min. (21±1°C) and drilling speed of 800 r.p.m. were used. Scanning electron microscopy analysis was preformed prior and after drilling., Results: Mean temperature increase with both drills at 8 mm was 0.9°C and at 10 mm was 2°C (P<0.0001). Statistical significant higher bone temperatures were obtained with stainless steel drill (1.6°C), when comparing with the ceramic drill (1.3°C) (P<0.05). Temperature increase was correlated with higher number of perforations (P<0.05) and drilling load applied. There was no significant association between drilling force applied and temperature increase by either drill or at either depth. No severe signs of wear of either drill were detected after 50 uses., Conclusions: Drill material and design, number of uses, depth and drilling load applied appear to influence bone temperature variations during implant site preparation. Drilling depth was a predominant factor in bone temperature increase. Both drills can be used up to 50 times without producing harmful temperatures to bone tissue or severe signs of wear and deformation., (© 2011 The Authors. Journal compilation © 2011 John Wiley & Sons A/S.)

The aim of this paper is to present a new approach to bone regeneration in a patient with multiple recurrent ameloblastoma of the left mandibular angle. Through an extraoral approach, complete resection of the tumor was achieved. Bone marrow aspirate from the iliac crest was centrifuged to concentrate the mesenchymal cellular fraction. Based on a stereolithographic cast, titanium mesh was bent preoperatively to accurately reconstruct the mandibular angle. The mesh was filled with two blocks of xenogenic material mixed with recombinant bone morphogenetic protein 7 (BMP-7) and stem cells. Nine months later, three endosseous implants were placed in the regenerated bone to restore the patient's masticatory function. At this time, bone samples were obtained for histomorphometric analysis. New bone formation was confirmed around the particles of xenograft material. The results indicate that adequate esthetics and function may be achieved with bone marrow aspirate seeded on a scaffold obtained from bovine xenograft blocks and BMP-7. This technique attains new bone formation with sufficient quantity and quality to allow for implant placement, with decreased patient morbidity and surgical time compared to conventional reconstructive methods.

Background: The dental community has expressed low acceptance of traditional corticotomy techniques for corticotomy-facilitated orthodontics. These procedures are time consuming, entail substantial postoperative morbidity and periodontal risks, and are often perceived as highly invasive., Methods: A total of 114 interdental sites were treated in nine consecutive patients. Under local anesthesia, a tunnel approach requiring one to three vertical incisions per arch (depending on the targeted teeth) was used. Piezosurgical corticotomies and elective bone augmentation procedures were performed under endoscopic assistance. Postoperative cone-beam computerized tomography evaluation was used to confirm adequate corticotomy depth., Results: Procedures were completed in a mean time of 26 minutes. Follow-up evaluations revealed no loss of tooth vitality, no changes in periodontal probing depth, good preservation of the papillae, and no gingival recession. No evidence of crestal bone height reduction or apical root resorption was detected., Conclusions: The tunnel approach minimizes soft-tissue debridement and permits effective cortical cuts. The combination of piezosurgery technique with endoscopic assistance provides a quick, reliable means to design and perform these corticotomies while maximizing root integrity preservation. Moreover, the sites needing bone augmentation are selected under direct vision. Compared to traditional corticotomies, this procedure has manifest advantages in surgical time, technical complexity, patient morbidity, and periodontium preservation.