The reverse scan technique offers several advantages, such as improvements of accuracy and visibility of critical anatomical structures, minimizing chair time, and providing better patient comfort. This was a case report successfully employing the reverse scan technique. A 72-year-old male patient desired to restore his teeth in both jaws, as he experienced difficulty eating and had never worn dentures. Clinical examination revealed the presence of several remaining teeth with poor prognosis due to significant bone loss and mobility. The treatment plan involved extracting these teeth, placing four implants in both the maxilla and mandible, and fitting an interim immediate-loading prosthesis. Impressions were taken during the first appointment, and clear acrylic dentures, simulating the future prostheses, were fabricated. During surgery, full-thickness flaps were raised, and the remaining teeth were extracted. Implants and multi-unit abutments were placed, followed by impressions and the recording of the inter-jaw relationship using index dentures. After six months of osseointegration, the reverse scan technique was employed, involving the use of light silicone, reverse scan bodies, and extra-oral scanning to capture implant positions, soft tissue profiles, and prosthesis shapes. A resin jig was created to ensure a passive fit, and titanium frames were machined for the final prostheses-monolithic zirconia for the maxilla and zirconia crowns with composite gingiva for the mandible. These were delivered after confirming the fit, aesthetics, and occlusion. The technique enhanced patient comfort, minimized chair time, and ensured the quality of the prosthetic outcome.

The study aimed to investigate the influence of different gingival colors and abutment materials on the final color of peri-implant soft tissue. A total of 30-cylinder shaped specimens having 1.0- and 2.0-mm buccal thicknesses using five different gingivacolored composites [light pink (LP), dark pink (DP), orange (Or), brown (Br), and purple (Pr)] were prepared. Implants were placed straight into the center of cylinders and connected to abutments [Titanium (Ti) and Zirconia (Zr)]. Color parameters were assessed using a spectroradiometer. Color differences (ΔE*ab and ΔE00) were calculated and compared to 50:50% perceptibility (PT) and acceptability (AT) visual thresholds. Color variation data were statistically analyzed using 2-way analyses of variance followed by Tukey HSD tests (a=.05). Significantly higher ΔE*ab and ΔE00 values were recorded in LP and Or groups with 1.0 mm buccal thickness and Ti abutments (p<.05). Regardless of the thickness applied, all the gingival color groups with Zr abutment presented ΔE*ab and ΔE00 values below AT. The mean ΔE*ab value decreased as the gingiva thickness increased in the LP, DP, and Or groups with Ti abutments. Abutment material significantly affected the mean ΔE00 values in the groups of LP, DP, and Or with a buccal gingiva thickness of 1.0 mm (p<.05). Gingival color and abutment material was found to be effective on the final color of peri-implant soft tissue. However, further clinical research is required to confirm these findings.

This pilot study evaluated and compared histomorphometric and immunohistochemical characteristics of peri-implant bone tissue after implant site preparation using piezoelectric tips versus conventional drills.

This study evaluated the efficacy of poly(lactic-co-glycolic acid) (PLGA) mesh sheets for alveolar bone reconstruction in the anterior maxilla with significant bone defects. This prospective case series included four male patients (mean age, 34.5 years; range, 20-49 years) with anterior maxillary bone defects. Bone augmentation was performed using a staged guided bone regeneration technique with PLGA mesh sheets as barrier membranes and a 1:1 mixture of autogenous and xenogeneic bone as grafting material. The effectiveness of bone augmentation was evaluated using preoperative and postoperative computed tomography data at 1-month and 6-month. Secondary outcomes included complications such as wound infection and dehiscence. The treatment of the four patients required seven PLGA mesh sheets and particulate bone, followed by nine implant placements. Wound healing was uneventful except for one, wherein wound dehiscence and graft loss were observed. One patient had an exposed PLGA mesh sheet during healing, necessitating its removal. The mean vertical bone gain was 2.3±0.5 mm, and the mean horizontal gain was 3.7±1.3 mm at 1 month postoperatively. Sites without wound dehiscence exhibited a bone decrease rate of 6.5%-21.1%, while successful bone height and width increases were observed across treated sites. Bone augmentation using PLGA mesh sheets proved effective in reconstructing horizontal and vertical alveolar bone dimensions. This technique provides adequate support for implant placement, demonstrating its potential utility in cases of substantial alveolar bone deficiency.

This controlled in vivo experimental study examines the impact of two periosteum preparation techniques on microcirculation during bone augmentation with isogenic bone grafts in rats.

A multifaceted study compared transgingival (flapless) implant placement with conventional flapped placement, which employed clinical, radiographic, biochemical, and patient-centered parameters. The study was approved by the institutional ethics committee and was conducted according to the ethical standards in the 1964 Declaration of Helsinki and its amendments. Seventy-five implants were placed, 37 by flapless method (group 1) and 38 by flapped method (group 2). The Group 1 subjects underwent flapless implant placement, while Group 2 underwent flapped implant placement. The modified plaque index was significantly higher in group 2 at 6 weeks (Mann Whitney test, z = -3.08, p = .002). Modified sulcus bleeding index was also significantly higher in group 2, up to the 12-week follow-up (Mann Whitney test, z = -4.63, p < .001). Crestal bone loss revealed no significant intergroup difference. Under biochemical evaluation, matrix metalloproteinase-8 (MMP-8) was significantly higher in flapped implants up to the 6-week follow-up. The patient-reported questionnaire-based acceptability assessment showed that the flapless technique is better regarding the perceived duration of the surgery and post-operative comfort.

The present pilot clinical trial was planned to evaluate the effect of particulate deproteinized bovine bone graft mixed with blood could be used as a vertical ridge augmentation material without covering with any form of collagen membrane in a tunnel pouch technique, resulting in sufficient bone formation to allow placement of dental implants, with maintenance of the newly formed bone after final restoration.

Periodontal procedures often require flap advancement for adequate coverage of the surgical site, with tension-free primary closure essential for successful outcomes. Although the periosteal releasing incision is frequently performed, it may necessitate deeper or more incisions, which could result in consequences such as edema, bleeding, paresthesia, and discomfort for the patient. To address these issues, the modified periosteal releasing incision was proposed to minimize trauma into the submucosa. In this paper, we update the technique, emphasizing its application in visualizing the mental nerve to avoid nerve damage during significant flap advancement in the posterior mandible. The technique provides an alternative approach to traditional techniques, ensuring patient safety and improving surgical outcomes. Future research is needed to explore its benefits and applications in various clinical scenarios.

Peri-implantitis (PI) is an inflammatory disease that affects supportive tissues around dental implants, and its progression eventually leads to bone loss and implant failure. However, PI effects may be different based on the presence or absence of adjacent teeth.

Full-arch implant rehabilitation in extremely atrophic edentulous mandibles is still challenging due to the high risk of fracture and the limited bone availability. The approach proposes using short implants with immediate loading for final prostheses as a treatment option, which offers shorter treatment times and fewer invasive procedures. A 66-year-old female patient with an edentulous mandible and severe alveolar bone resorption was treated with four short implants in the interforaminal area. The final hybrid metal-plastic full-arch lower prosthesis was delivered three days after the surgery, and the patient was instructed on cleaning methods and requested to maintain a soft diet for the first two postoperative months. After six months of follow-up, the patient experienced no problems; the prosthesis underwent a mechanical examination, each multiunit abutment's peri-implant tissue was assessed, and implants presented no mobility, fibrointegration, or signs of failure. X-ray images demonstrated stable bone levels around implants. Also, it was observed that the integrity of the entire jaw was preserved, and no signs of fracture were observed.

The tactile function and thermal perception are two primary functions of oral structures. Implants without periodontal ligament and pulp might fail to sense the tactile and temperature change. This study aimed to investigate implants' tactile, thermal, and electrical perception by detailed psychophysical assessments. A total of forty-eight patients with single implant restoration were recruited. Mechanical (5 intensities), cold (4 temperatures), and electrical stimulation were respectively applied to implants and natural teeth, and the psychophysical results were recorded with a visual analog scale (VAS) and compared between implants and natural teeth. For tactile perception, at low and medium forces, implants were significantly poorer than natural teeth (P<0.01), but at the largest force, there were no significant differences (P >0.05). Regarding thermal perception, thermal changes on implants could be detected, although the signals were weaker when compared to natural teeth (P<0.01). Implants were less sensitive to electrical stimulation than natural teeth (P<0.01). Even though there is no periodontium and pulp, dental implants could perceive the mechanical, thermal, and electrical stimulation weakly.

This study aimed to compare the angular, platform, and apical deviation of zygoma implants placed with the aid of a dynamic navigation (DN) device compared with the implants placed freehand. Eight cadaver heads were used for the study. Preoperative cone beam computerized tomography (CBCT) scans were made for the heads, and an implant-planning software was used to plan zygoma implants bilaterally in each scanned head. A total of 16 zygoma implants were placed using each surgical technique. Postimplant CBCT scans were merged with the preoperative plan to evaluate and compare the accuracy of the implants using each technique. Angular and linear deviations of the implants were measured and compared. The effect of implant length and position on the deviation was also investigated. The results showed a mean angular deviation of 2.44° ± 1.10° for implants placed using DN compared with 6.63° ± 4.81° for implants placed freehand. The mean apical deviation for implants placed using DN and for implants placed freehand was 2.14 ± 1.02 mm and 3.80 ± 2.49 mm, respectively. Finally, the mean platform deviation for implants placed using DN and for implants placed freehand was 1.66 ± 0.9 mm and 2.81 ± 2.1 mm, respectively. The analysis showed a significant difference between the two techniques in angular and apical deviation (p = .001 and .029, respectively). Zygoma implants placed with a DN device resulted in less apical and angular deviation than implants placed freehand.

This clinical report details the functional and esthetic rehabilitation of a patient with a severe maxillary defect secondary to subtotal maxillectomy for oral squamous cell carcinoma using a maxillary prosthesis anchored by 4 zygomatic implants. The procedure involved meticulous subtotal maxillectomy and defect repair with zygomatic implant support, incorporating advanced digital surgical methods, including 3D reconstruction, computer-guided surgery, and photogrammetry (Icam4D). A 3D finite element analysis was conducted to assess the method's efficacy in analyzing stress distribution around the zygomatic implants. The patient expressed high satisfaction with the prosthesis's functionality, esthetics, speech, and swallowing capabilities, underscoring the value of zygomatic implant-supported maxillofacial prosthetics. This synergy of advanced planning, surgical precision, and biomechanical analysis marks a significant advancement in maxillofacial prosthetics.

Treatment of gunshot injuries to the maxillofacial region requires a multidisciplinary approach with specialist collaboration. The primary goals of treatment are to stabilize fractures, control bleeding, reconstruct the affected tissues, and restore function. This case report discusses a patient's treatment sequence resulting from a gunshot injury to the right posterior mandible. The initial stabilization and debridement, followed by mandibular augmentation, and finally prosthodontic restoration of lost teeth and the alveolar process are illustrated. Understanding the consequences of gunshot injuries to the maxillofacial region underscores the importance of coordinated quality care for a successful result.

Peri-implant bone necrosis (PIBN) is a rare yet potentially serious phenomenon contributing to implant failure. It can be challenging to determine the exact etiology, especially when multiple intricate factors are involved. This case series reports on the successful management of PIBN during early and late implant placement and peri-implantitis-associated bone necrosis, with likely causes being bone over-compression during implant placement or a consequence of periimplantitis. This case series presents five cases of peri-implant bone necrosis, with three cases occurring immediately after implant placement and the other two presenting a delayed inflammatory process of peri-implantitis between one and five years after implant placement. Clinical presentation and histopathological evaluation data present ten failed implants managed with the removal of implants and the associated necrotic bone. All the cases were successfully managed without any signs of recurrence. Two cases confirmed bone necrosis via biopsy, illustrating the typical pattern of bone necrosis: multiple non-vital bone fragments surrounded by acute and chronic inflammatory cells and empty lacunae. All cases were successfully managed by removing necrotic bone and associated implants, with no indication of bone necrosis recurrence. Conclusions: This case series report highlights the unusual early and delayed implant failure associated with peri-implant bone necrosis. This condition most likely results from bone over-compression during implant placement or is a sequela of the inflammatory process of peri-implantitis.

Secondary reconstruction of the maxillary defect with discontinuity after partial maxillectomy is extremely challenging due to extensive, severe adhesions between the maxillary sinus membrane and oral mucosa, resulting in no space for the grafted bone and a lack of soft tissue to cover the graft. This case reports a 23-year-old female patient who underwent secondary reconstruction for a bone defect caused by a partial maxillectomy to remove an ameloblastoma that had invaded the maxillary sinus. We incised the existing soft tissue ridge at the bone defect and extensive adhesions below the maxillary sinus to create space for the grafted bone and to form an adequate buccal flap. To ensure the grafted bone's stability and to support the surrounding soft tissues, a cortical bone from the iliac crest was placed beneath the sinus membrane, with cancellous bone grafted underneath, and a titanium mesh was applied at the alveolar region. This approach allowed robust bone regeneration at the graft site, demonstrating dense, well-integrated new bone formation that facilitated successful implant treatment with good primary stability for two implants. This surgical approach, when indicated, can be less invasive than vascularized bone grafts.

Cemento-osseous dysplasia (COD) is a benign fibro-osseous pathology in which fibrous connective tissues, osteoid and cementum-like materials, replace bone. Concerning the hypovascularization and increased mineralization of bone that occurs in these patients, the clinician may face two types of problems: infectious complications such as osteomyelitis and increased implant failure. The present study aims to report the successful and innovative management of a COD patient complicated by mandibular osteomyelitis and the implant rehabilitation of this area. We report the management of a 54-year-old patient presenting with florid cemento-osseous dysplasia (FCOD) complicated by mandibular osteomyelitis, which required antibiotic administration and two surgeries to resolve. This area was then reconstructed with guided bone regeneration before three implants were placed using guided surgery, including one implant in a dysplastic area and one in the graft site. Osseointegration of the implants allowed rehabilitation with a supra-implant bridge. An optimal functional rehabilitation and complete integration of implants were observed 13 months after the surgery. Eight cases of implant placement in COD patients have been reported before in the literature (n=35 implants). The success rate of dental implants in non-dysplastic areas is comparable to the general population, but it decreases when implants are placed in dysplastic areas. Guided implant surgery is an interesting tool for placing implants outside dysplastic regions.

This study aimed to compare the angular, platform, and apical deviation of zygoma implants placed with the aid of a dynamic navigation device compared to the implants placed freehand.