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Objectives: To evaluate the outcomes of bone regeneration using a customized titanium mesh scaffold to cover a bone graft for reconstruction of complex defects of the jaws. Materials and Methods: 19large defects were digitally reconstructed using CT scans according to the prosthetic requirements. A titanium mesh scaffold was designed to cover the bone (autologous/bovine bone particulate) graft. At least 6months after surgery, a new cone-beam CT was taken. The pre- and postoperative CT datasets were then converted into three-dimensional models and digitally aligned. The actual mesh position was compared to the virtual position to assess the reliability of the digital project. The reconstructed bone volumes (RBVs) were calculated according to the planned bone volumes (PBVs), outlining the areas under the mesh. These values were then correlated with the number of exposures, locations of atrophy, and virtually planned bone volume. Results: The mean matching value between the planned position of the mesh and the actual one was 82±13.4%. 52.3% (40% early and 60% late) exposures were observed, with 15.8% exhibiting infection. 26.3% resulted as failures. The amount of reconstructed bone volume (RBV) in respect to PBV was 65±40.5%, including failures, and 88.2±8.32% without considering the failures. The results of the exposure event were statistically significant (p=.006) in conditioning the bone volume regenerated. Conclusions: This study obtained up to 88% of bone regeneration in 74% of the cases. The failures encountered (26%) should underline the operator's expertise relevance in conditioning the final result.

In this study, we aimed to systematically review and critically appraise the available literature concerning the effectiveness of marsupialisation and decompression on the reduction of cystic jaw lesions. The 'Preferred Reporting Items for Systematic Reviews and Meta-Analysis' guidelines were followed and the study protocol was registered at the 'International Prospective Register of Systematic Reviews' (CRD42019116099). Six main databases were searched: Embase, LILACS, PubMed, Scopus, The Cochrane Library, and Web of Science. Searches were complemented with three grey literature sources: Google Scholar, ProQuest, and Open Grey. Any reduction measures, compared with preoperative status or other procedures, were considered. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Tool. Thirty-one studies were included, of which five were judged with low, 24 with moderate, and two with high risk of bias. Considering surgical approach, 20 studies assessed the decompression and 11 the marsupialisation technique. Most studies considered these techniques as preliminary treatments, followed by enucleation. From 1088 lesions found, most were odontogenic keratocysts (33.8%), followed by unicystic ameloblastomas (21.0%), dentigerous cysts (20.6%), and radicular cysts (8.4%). Large lesions and younger individuals frequently presented more favourable responses to treatment and anatomical location was not associated with lesion reduction overall. The intervention duration generally ranged between one to two years. In conclusion, marsupialisation and decompression were mostly considered as preliminary treatments, followed by enucleation. Lesion reduction was generally considered insufficient for these techniques to be used as definitive therapies, although benefits concerning the diminished invasiveness of the secondary surgery were often proposed.

Objectives: The aim was to evaluate the role of resorbable membranes applied over customized titanium meshes related to soft tissue healing and bone regeneration after vertical/horizontal bone augmentation. Materials and Methods: Thirty patients with partial edentulism of the maxilla/mandible, with vertical/horizontal reabsorption of the alveolar bone, and needing implant-supported restorations, were randomly divided into two groups: Group A was treated using only custom-made meshes (Mesh-) and Group B using custom-made meshes with cross-linked collagen membranes (Mesh+). Data collection included surgical/technical and healing complications, “pseudo-periosteum” thickness, bone density, planned bone volume (PBV), regenerated bone volume (RBV), regeneration rate (RR), vertical bone gain (VBG), and implant survival in regenerated areas. Statistical analysis was performed between the two study groups using a significance level of α=.05. Results: Regarding the healing complications, the noninferiority analysis proved to be inconclusive, despite the better results of group Mesh+ (13%) compared to group Mesh- (33%): estimated value −1.13 CI-95% from −0.44 to 0.17. Superiority approach confirmed the absence of significant differences (p=.39). RBV was 803.27mm3 and 843.13mm3, respectively, and higher RR was observed in group Mesh+ (82.3%) compared to Mesh- (74.3%), although this value did not reach a statistical significance (p=.44). All 30 patients completed the study, receiving 71 implants; 68 out of them were clinically stable and in function. Conclusion: The results showed that customized meshes alone do not appear to be inferior to customized meshes covered by cross-linked collagen membranes in terms of healing complication rates and regeneration rates, although superior results were observed in group Mesh+compared to group Mesh- for all variables.

CAD/CAM technology can enhance the dentistry application of ceramic materials that meet the more relevant biocompatibility and aesthetics demands. In implant-borne prosthesis rehabilitation, yttria-stabilized zirconia appeared to be a valid alternative to metal-alloys and titanium, with comparable mechanical properties and even better interaction with bone and soft tissues. The improvement of monolithic CAD/CAM manufacturing allows for a reliable, predictable, and rapid workflow that can correspond to a holistic treatment philosophy associated with zirconia fixtures. This reported clinical case highlights the advantages of this approach in resolving particularly functionally and aesthetically complex situations. A 40-year-old patient with permanent canine impaction and the persistence of a deciduous tooth compromised by caries was successfully rehabilitated with the surgical removal of the enclosed tooth, the seating of a mono-phase zirconia implant after the deciduous extraction and its loading with a zirconia single crown, without any clinical or radiographical alteration up to seven years follow-up.

The use of short (

Introduction: The results with shorter and shorter implants have been revolutionizing the implantology scenario and are worthy of being well-analyzed and understood. This review aims to add further knowledge about the last 10-years observation period on < 7mm-short implants in the posterior atrophic jaws, better defining the indication of their use. Methods: From a Medline database research, systematic reviews, controlled and no- controlled trials (CT, n-CT) with ≥ 3years-follow-ups on

Aim: Most of the intra- and postoperative patient discomfort related to complex mandibular third molar (M3M) extraction is proportional to the invasiveness of the surgery. This can be minimized through the support of dynamic navigation (DN) technology, which can be successfully applied in dental implantology. Material s and methods: Three patients, one female (aged 25 years) and two males (aged 18 and 51 years, respectively) underwent the DN-supported extraction of partially impacted M3Ms with a flapless approach that required minimal bone removal. The patients' discomfort and the speed of recovery were considered to be proof of the quality of the adopted procedure. Results: No postoperative discomfort such as pain or swelling was recorded in the immediate postoperative period, and no complications were reported within a month of the surgery. No medications were prescribed. The procedure lasted no longer than 20 min in all cases. Conclusion: Using DN technology, the real-time 3D monitoring of the clinical situation in each surgical phase enabled the surgeon to avoid soft tissue detachment as well as limit bone loss and intraoperative bleeding, thanks to a precise multi--section of the tooth and important nearby anatomical structures, respectively.

A full-arch rehabilitation of the edentulous upper jaw without grafting procedures exploits the residual alveolar or the basal bone, with the necessity of long implants placed with a particular orientation. The precision in planning and placing the fixtures is fundamental to avoid clinical problems and to allow an acceptable connection with the prosthesis. The computer-aided implantology resulted in more accuracy than the traditional one, with a high standard of correspondence between the virtual project and the real outcome. This paper reports about the two different digital protocols, static and dynamic, as support to implant-borne prosthetic rehabilitation of edentulous maxillae. Two pterygoid and two/four anterior standard implants were seated in both cases by two different operators, without flap raising, and immediately loaded. This approach avoided the posterior cantilever by-passing the maxillary sinus and was adequately planned and realized without any surgical or prosthetic error. The two digital flow-charts were described step by step, underlining each other’s advantages and drawbacks compared to a free-hand approach.

AIM: To investigate the diagnostic reliability and accuracy of magnetic resonance imaging (MRI) to differentiate periapical lesions of endodontic origin and to compare the results with histopathological information. METHODOLOGY: The radiolucent periapical jaw lesions of 34 patients, which were surgically enucleated, were investigated by two radiologists using MRI, based on the same six criteria, to categorize the lesions as granulomas, radicular cysts or others. After apicoectomies, two oral pathologists (blinded to the radiologist's diagnoses) analysed all specimens by referring to seven specific parameters and diagnosed the specimens as granulomas, radicular cysts or other conditions. The inter-rater agreements between the radiologists and pathologists in terms of MRI and histological diagnoses, respectively, along with the discriminant power of the adopted criteria and the accuracy of the MRI assessments compared with the histopathological results, were calculated. Cohen's kappa test was adopted to examine inter-rater agreement between the two radiologists and two pathologists. Guttman's lambda coefficient (λ6 ) was used to evaluate the internal consistency of the items used for the differential diagnosis by radiologists. The accuracy resulted from a receiver operator characteristic (ROC) analysis. RESULTS: A strong inter-rater reliability was observed between the two radiologists (k-statistic = 0.86, P = 0.0001) and the two pathologists (k-statistic = 0.88, P = 0.0001). The internal consistency of the diagnostic items was 0.605 for cysts and 0.771 for granulomas. The accuracy (true positives plus true negatives) of the radiologists was greater than that of the pathologists based on analysis (area under the curve = 0.87 and 0.91, respectively). CONCLUSIONS: The reliability and accuracy of MRI were high and comparable to histopathological reliability, highlighting the usefulness of this noninvasive technique as a pre-treatment diagnostic method for periapical endodontic lesions.

Dynamic Navigation is a computer-aided technology that allows the surgeon to track the grip instruments while preparing the implant site in real time based on radiological anatomy and accurate pre-operative planning. The support of this technology to the zygoma implant placement aims to reduce the risks and the errors associated with this complex surgical and prosthetic treatment. Various navigation systems are available to clinicians currently, distinguished by handling, reliability, and the associated economic and biological benefits and disadvantages. The present paper reports on the different protocols of dynamic navigations following a standard workflow in correlation with zygomatic implant supported rehabilitations and describes a case of maxillary atrophy successfully resolved with this technology. An innovative and minimally invasive dynamic navigation system, with the use of an intraoral anchored trust marker plate and a patient reference tool, has been adopted to support the accurate insertion of four zygomatic implants, which rapidly resolved maxillary atrophy from a 75-year-old male system. This approach provided an optimal implant placement accuracy reducing surgical invasiveness.

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

Dynamic navigation (DN) is a computer-guided technique employed in different surgical fields and recently adopted in dental implantology to improve the accuracy of dental implant insertion. Medication-related osteonecrosis of the jaws (MRONJ) often requires the surgical removal of the impaired, hard tissue, trying at the same time to spare the healthy tissue and the noble anatomical structures. A case of extensive bilateral medication-related osteonecrosis, with the symptomatic involvement of the right mandibular canal, was successfully resolved with the use of ultrasonic surgery associated with a dynamic navigation, in order to limit the invasiveness of the surgical approach improving its reliability and accuracy. The usefulness of this technology in the management of MRONJ can be considered in future clinical trials to confirm the advantages and standardize the technique.

In this clinical case was investigated the basic principles of digital workflow and the surgical steps of a novel type of custom-made titanium mesh (Ti-mesh), validated this surgical approach for bone augmentation in an edentulous atrophic maxilla, and analyzed the stability of the augmented bone after 1 year of follow-up

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

BACKGROUND: Clinicians sometimes use decompression for secondary, low-risk cyst enucleation. The authors explored whether the decompression of dentigerous cysts associated with third molars is a reliable, long-term, definitive treatment option. METHODS: The authors monitored 25 mandibular cysts associated with impacted third molars in adults after surgical decompression without the extraction of the related tooth for a mean (standard deviation) time of 37 (15) months (range, 12-71 months). The authors carefully evaluated the postoperative clinical situation and the extent of radiographic shrinkage. RESULTS: A minimal epithelial slit remained patent in all patients. All lacked clinical problems, had no need for further intervention, and exhibited persistent impaction of the teeth. The cyst reduction rate calculated on panoramic radiographs ranged from 63.4% to 98.8% (mean [standard deviation] 87.5% [10.6%]) and was statistically significant (P < .05). In 13 patients, the reduction rate was greater than 90%. CONCLUSIONS: Decompression triggered marked radiographic reductions of cysts when epithelial communication persisted. The situation stabilized after the first 6 through 8 months, and no further intervention was required. PRACTICAL IMPLICATIONS: It is risky to enucleate cysts associated with impacted third molars and extract the molars. Clinicians can solve the problem in dental practice by using surgical decompression

PURPOSE: To evaluate the three-dimensional (3D) reconstruction of atrophic alveolar ridges using titanium mesh (Ti-mesh) and its correlation with the extent and timing of mesh exposure and amount of reconstruction planned. MATERIALS AND METHODS: This study retrospectively evaluated 12 patients (mean age, 49.1 years) with 15 alveolar defects treated with Ti-mesh and particulate grafts (70/30 autogenous bone/anorganic bovine bone) followed by implant placement 8 to 9 months later. For each site, computed tomography images were analyzed using software designed to measure 3D volumes. The lacking bone volume (LBV) was calculated by subtracting the reconstructed bone volume at reentry from the planned bone volume (PBV). In all cases, the meshes were modeled preoperatively on a stereolithographic model. LBV was correlated with the extent and time of mesh exposure and PBV. RESULTS: The mean LBV (0.45 cm3) was 30.2% (range, 6% to 74%) of the mean PBV (1.49 cm3). The mean extent and timing of mesh exposure, which occurred at 80% of augmented sites (12/15), were 0.73 cm2 (range, 0.09 to 3.45 cm2) and 2.17 months (range, 1 to 8 months), respectively. LBV was significantly positively correlated with the area of mesh exposed, with 16.3% LBV for every cm2 of mesh exposed; there were positive correlations between LBV and early exposure and PBV. CONCLUSION: On average, there was 30.2% less bone than planned preoperatively; there was a significant negative correlation between the amount of reconstructed bone and area of mesh exposed.

We prospectively investigated in adults the decompression of dentigerous cysts associated with impacted third molars at high risk of iatrogenic damage during extraction. The computerised calculated volumetric postoperative reductions measured by cone-beam computed tomography at four and eight months were correlated with the duration of treatment, initial volume, and patient's age. We prospectively monitored 14 adult patients with 14 dentigerous cysts that were associated with impacted third molars, for eight months after decompression. The mean (SD) reduction in volume during the first eight months was 71 (14) % (51% after the first four months and 20% after the second four months), with a monthly reduction rate of 9%. Both the total decrease in volume (a) and the monthly rate of reduction (b) were significantly associated (p

Objective. The 'retromolar' nerve is a collateral branch of the inferior alveolar nerve. Cone-beam computed tomography (CBCT) provides higher resolution images. This CBCT study reports the frequency of the retromolar nerve. Materials and methods. From 2007-2010 the CBCT study of 233 hemi-mandibles have been examined. The CBCT study was obtained from an investigation of the posterior mandibular region in 187 patients suffering from different pathologies and it was aimed at detecting in patients the presence of a retromolar canal and foramen. Results. Thirty-four retromolar canals with a foramen were detected on 233 CBCT (14.6%) in 30 out of 187 patients (16%). In the 46 patients who underwent CBCT bilaterally, the retromolar canal was found in nine subjects (19.6%) and was present bilaterally in four subjects, for an incidence of 8.7%. Conclusions. The results suggest that the radiological frequency of the retromolar nerve is notable, with a possible relevance in the surgical approach of the mandibular retromolar area. The presence of a retromolar canal, well detected with CBCT, may warn clinicians about the possibility of inadequate pre-surgical anaesthesia, local intra-operative bleeding and post-operative alterations of the sensation in the third molar area.

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

Purpose To describe a successful clinical case of implant prosthetic rehabilitation in an atrophic posterior mandible reconstructed by inlay bone grafting after bone block harvesting from the mandibular ramus. Patients and Methods A 55-year-old woman with an atrophied right posterior mandible underwent surgical inlay ridge augmentation under local anaesthesia using a block graft harvested from the ipsilateral mandibular ramus. Three months later 3 dental implants were inserted, and after an additional 4 months abutments were connected and a definitive fixed bridge inserted. Results After a 24-month follow-up, no implant failure was recorded; the patient was functionally and esthetically satisfied. Conclusion The inlay procedure in atrophic posterior mandible, associated with mandibular ramus graft harvesting, may be considered an effective, minimally invasive and well-tolerated procedure for implant prosthetic rehabilitation.

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

This article presents a technique used for the implant-bone prosthetic rehabilitation of a partially edentolous posterior mandible with a mean high

PURPOSE: To report the histological outcomes of a case of bilateral severely resorbed posterior maxilla augmented with the use of blocks of enzymatically deantigenated equine bone. MATERIALS AND METHODS: In conjunction with bilateral sinus lifts, blocks of enzymatically deantigenated equine bone were used bilaterally to augment the severely atrophic maxilla of a patient seeking a fixed implant-supported prosthesis. After 8 months, bone core samples were obtained from the augmentation sites and implants were placed. RESULTS: Six months after implant placement, the peri-implant bone levels were maintained. A prosthesis delivered 3 months after implant placement provided excellent rehabilitation. Histological analysis of the bone cores revealed that the graft material was still undergoing remodeling, with newly formed vital bone in all fields and osteoclasts included in the mineralized component. CONCLUSIONS: The deantigenated equine bone was biocompatible and resorbed only minimally. This material seems to offer excellent potential for being incorporated in a procedure that increases the width of edentulous alveolar crests.

This study was performed to evaluate the three-dimensional radiographic variation in mandibular odontogenic cystic lesions after decompression. Pre- and post-decompression computed tomography (CT) evaluations in 20 patients affected by keratocysts (n = 10), dentigerous cysts (n = 9) and ameloblastoma (n = 1) were analysed using software designed for three-dimensional measurement of volumes; the results were correlated with treatment duration, age, sex and histological type. The mean (range) decompression time was 5.70 (3–12) months. The mean (SD) pre- and post-decompression volumes were 9.50 (7.74) and 4.65 (4.34) cm3, respectively (P

The reconstruction of a severely atrophic left posterior mandible using inlay magnesium-substituted hydroxyapatite grafting is described. Three months after reconstruction, a bone specimen was retrieved, and two dental implants were placed. A mean vertical bone gain of 4.9 mm was measured at the time of implant placement, and no problems were recorded at delivery of the provisional and definitive prostheses 4 and 8 months after implant placement, respectively. Histologic analysis revealed residual grafted material infiltrated by newly formed bone. In this clinical case, Mg-hydroxyapatite was demonstrated to be an effective grafting material for reconstruction of the posterior mandible using the inlay technique.

Background: Reconstruction and rehabilitation of atrophic maxillae with bone grafts is a lengthy and demanding procedure. This study reports the immediate loading of 50 implants placed on six extremely atrophied edentulous maxillae reconstructed with Le Fort I osteotomy and iliac bone grafting. Methods: Six patients, aged 49 to 68 years, with severely atrophied maxillae were treated with Le Fort I osteotomy and iliac bone grafting to allow for implant-borne prosthetic rehabilitation. Four to 5 months thereafter, 50 implants (seven to 10 per patient) were placed in reconstructed maxillae and immediately functionally loaded with a screw-retained definitive prosthesis. The patients were followed by clinical and radiographic examinations for 24 months after prosthetic loading. Results: The grafting procedure and healing period before implant placement were uneventful in all patients. Two implants were lost within 2 months after prosthesis insertion in two patients, with an overall survival rate of 96%. The prostheses success rate was 100%. At the end of the follow-up period, all remaining implants appeared clinically healthy; crestal bone loss was >1.7 mm for six implants, resulting in a cumulative success rate of 84%. Conclusion: Immediate loading of implants placed after Le Fort I osteotomy and interpositional iliac bone grafting could be considered a viable protocol to rehabilitate extremely atrophied edentulous maxillae, considerably reducing the treatment time.

Background: Mandibular second molar (M2) periodontal defects after third molar (M3) removal in high-risk patients are a clinical dilemma for clinicians. This study compares the healing of periodontal intrabony defects at distal surfaces of mandibular M2s using bioabsorbable and non-resorbable membranes. Methods: Eleven patients with bilateral probing depths (PDs) ≥6 mm distal to mandibular M2s and intrabony defects ≥3 mm, related to the total impaction of M3s, were treated with M3 extraction and covering of the surgical bone defect with a bioabsorbable collagen barrier on one side and a non-resorbable expanded polytetrafluoroethylene (ePTFE) barrier contralaterally. The PD, clinical attachment level (CAL), M2 mobility, and furcation class probing were evaluated preoperatively and 3, 6, and 9 months postoperatively. Intraoral periapical radiographs were taken immediately preoperatively and 3 and 9 months postoperatively. Results: Both treatment modalities were successful. At 9 months, the mean PD reduction was 5.2 ± 3.9 mm for bioabsorbable sites and 5.5 ± 3.0 mm for non-resorbable sites; the CAL gain was 5.9 ± 3.3 mm and 5.5 ± 3.4 mm, respectively. The outcome difference between the two sites for PD and CAL did not differ statistically (P >0.05) at any assessment time. Conclusion: Bioabsorbable collagen membranes in guided tissue regeneration treatment of intrabony defects distal to the mandibular M2 obtained the same marked PD reductions and CAL gains as non-resorbable ePTFE membranes after M3 extraction.

We report the clinical outcome of dental implants placed on vertically distracted fibular free flaps that were used to reconstruct maxillary and mandibular defects after resection. Distraction osteogenesis (DO) of fibular free flaps was used for six patients (5 men, 1 woman) a mean of 19 months (range 11-38) after 5 mandibular and 1 maxillary reconstructions. A mean of 5 months (range 2-11) after removal of the distractor, 35 implants were inserted and loaded with implant-supported fixed prostheses. The mean (range) follow-up period was 39 (17-81) months. The course of the DO and the clinical and radiographic outcomes of the implants were assessed. Of six vertically distracted fibular free flaps, there was one case of vector lingual tipping during the consolidation phase and a fracture of the basal fibular cortex that necessitated additional grafting with iliac bone to stabilise the distracted area. The mean (range) vertical bone gain was 14 (12-15) mm. Four of 35 implants (11%) failed during the follow-up period. The mean peri-implant bone resorption was 2.5mm. Cumulative implant survival was 31/35 (89%) and survival after loading 31/33 (94%). Distraction osteogenesis of fibular free flaps caused a remarkable number of complications and pronounced resorption of bone around the implants, probably as a result of the formation of granulomatous tissue; a careful peri-implant follow-up and the maintenance of oral hygiene are essential.

Purpose To describe a successful clinical case of immediate prosthetic loading of modified sandblasting and acid-etching surface ITI dental implants inserted in a grafted maxilla after Le Fort I osteotomy. Materials and Methods A 59-year-old man with a severely atrophied maxilla was treated with Le Fort I osteotomy and interpositional iliac bone graft. Thirteen weeks later, 7 modified sandblasted and acid-etched surface ITI dental implants were inserted with immediate application of a screw-fixed prosthetic acrylic device kept in functional loading for 3 months until a definitive fixed prosthesis was inserted. Results After 20-month follow-up there has been no implant failure, with minimal bone loss and healthy peri-implant soft tissues; the patient is functionally and esthetically satisfied. Conclusions Immediate loading of implants placed after Le Fort I osteotomy and interpositional iliac bone grafting could be an applicable protocol to rehabilitate extremely atrophied edentulous maxillas.

Purpose To report a successful clinical case of dental implant provisionalization of a posterior mandible resected for tumor ablation and subsequently reconstructed with interpositional bone grafting after mobilization of the inferior alveolar nerve. Materials and Methods A 47-year-old woman with a severe posterior mandibular defect due to ablation of a squamous cell carcinoma was treated with transposition of the inferior alveolar nerve and inlay iliac bone graft. Four months later, 4 dental implants were inserted and immediately provisionalized. Bone core biopsies were taken during implant insertion. After an additional 3 months, a definitive fixed bridge was inserted. Results At the 24-month follow-up visit, all implants appeared to have osseointegrated. The histologic examination showed that the grafted bone was lined by newly formed bone without gaps at the interface. Conclusions Inlay bone grafting can allow implant provisonalization of the posterior mandible even with a remarkable bone alveolar deficit after tumor ablation.