This case report aims to describe a volumetric bone follow-up after 72 months of a bilateral maxillary sinus lift (MSL), using in each maxillary sinus a type of biomaterial associated with the Leukocyte-Platelet Rich Fibrin (L-PRF) technique– specifically, freeze-dried bone allograft (FDBA) from a Skeletal Muscle Tissue Bank and a xenogeneic bone substitute. The patient underwent MSL. The FDBA graft was used on the right side and the xenogeneic biomaterial Bio-Oss® associated with the L-PRF membrane on the left side. After 9 months, eight implants were placed. Tomographic monitoring of the volumetric bone maintenance of the grafts was performed after 45 days, 9, 36, 48, and 72 months. Bilateral MSL using the biomaterials associated with L-PRF achieved volumetric gain and bone neoformation. The treatment protocol allowed the placement of seven implants in the grafted regions. The 72-month follow-up revealed volumetric bone maintenance and osseointegration of the implants in both grafts.
ABSTRACT All-on-4/all-on-6 implant rehabilitation in severe periodontitis subjects is an unpredictable approach. Bone and attachment loss had been progressive in these kinds of individuals even after thorough treatment planning. In our report, we highlight the treatment modality in a controlled subject of this disease till complete restoration with a follow-up of 3 years.
ABSTRACT Introduction: Bone resorption following tooth loss often compromises alveolar ridge width, complicating implant placement and requiring augmentation. Chronic edentulousness leads to further ridge resorption, especially in the buccolingual dimension. Techniques such as onlay grafts, guided bone regeneration, and distraction osteogenesis are commonly used but have limitations. Ridge splitting has become an effective alternative for horizontal augmentation, allowing simultaneous implant placement and reducing morbidity by avoiding secondary surgical sites. Various modifications aim to lower risks such as fractures and enhance outcomes. Aim: To compare the effectiveness of motorized ridge expansion and osteotome-based ridge splitting techniques for horizontal ridge augmentation in implant placement. Materials and Methods: In this prospective study, 34 patients were recruited, with 4 lost to follow-up. The remaining 30 were divided into two groups: Group I (motorized expansion using the ESSET kit) and Group II (ridge splitting with osteotomes). Evaluations included pain, trismus, swelling, bone width gain, crestal bone loss, keratinized mucosa, implant stability, and probing depth. Results: Motorized expansion proved less painful and more reliable for ridge width gain compared to osteotomes. The swelling was not significantly different between groups on the 3 rd postoperative day. Presence of keratinized mucosa improved implant stability and probing depth. Group I had no mobility at 6 months, while three patients in Group II showed mild mobility. Crestal bone loss was greater in the osteotome group. Conclusion: Ridge splitting is minimally invasive, cost-effective, and effective for horizontal augmentation in both jaws, with no complications like cortical plate fractures observed.
ABSTRACT Objective: The aim of this study was to evaluate the changes in masticatory timing, movements, and muscle function resulting from replacing multiple missing teeth with an implant-supported bridge. Materials and Methods: Twenty-five patients were fully informed and provided consent to participate. Bite force, electromyography (EMG) functional activity, and masticatory incisor-point movements were recorded during gum-chewing and mastication of a hard bolus before and after replacing the missing teeth with an implant-supported bridge. Disclusion time reduction (DTR) occlusal therapy was applied to each bridge after placement. The obtained results were statistically evaluated for significance using the Wilcoxon signed-rank test and Student’s t -test (α =0.05). Results: For left-sided gum-chewing, the group mean values of 4 quantified parameters calculated from the average chewing pattern were found to have significantly improved towards more normal values ( P < 0.05). For right-sided gum-chewing, the group mean values of 5 quantified parameters from the ACP were found to have significantly improved towards more normal values ( P < 0.05). For left-sided hard bolus-chewing, the group mean values of 8 quantified parameters from the ACP were found to have significantly improved towards more normal values ( P < 0.05). For right-sided hard bolus-chewing, the group mean values of 6 quantified parameters from the ACP were found to have significantly improved toward more normal values ( P < 0.05). The mean disclusion time of the group was significantly reduced ( P < 0.00000) as was the mean muscle activity during lateral excursions ( P < 0.000002). Conclusions: Significantly measurable improvements in mean masticatory functional movements and associated muscle activity were recorded after the placement of the implant-supported bridges followed with DTR therapy to optimize the occlusions. More significant changes were seen when the subjects masticated a challenging hard bolus compared to chewing gum. Mean muscle effort during left and right lateral excursions was also significantly reduced.
ABSTRACT Background: The knowledge of anatomy is extremely essential for presurgical assessment for any surgical procedures. Anterior lingual foramen is one such crucial structures which needs to be carefully evaluated to avoid neurovascular trauma. The objective of the present study is to systematically evaluate the appearance, anatomical location, and variability of lingual foramina (LF) using cone-beam computed tomography (CBCT) in a regional population. Materials and Methods: Three hundred CBCTs were evaluated, selecting the most representative sagittal section. Observations recorded the appearance, frequency, location (superior and inferior to the genial tubercle), and morphological variations (midline and lateral). Results: A significant negative correlation was noted between age and width, indicating that width decreases with age. Conversely, there was a significant positive correlation between age and L_M, suggesting that L_M increases with age. Conclusion: CBCT imaging aids in effective visualization of the location and variations of LF in the anterior mandible. Foramina are predominantly medial, with most inferior ones inclined, followed by horizontal and vertical. Gender differences influence morphology. Age negatively correlates with foramina width, but other measurements were not significantly affected by age.
Atrophied alveolar ridges present special challenges to implant dentistry. The loss in height of the alveolar bone crest after tooth extraction makes the rehabilitation of the posterior maxilla challenging due to low bone density and atrophy, in addition to pneumatization of the maxillary sinus. The procedure of choice to restore this anatomic deficiency is sinus lift which aims to increase bone volume in the maxillary sinus to enable the installation of dental implants in the region. This clinical case report of a 25-year-old patient presents rehabilitation planning, including the surgical treatment of maxillary sinus lifting using the side window technique in combination with two-stage implant placement. The planning of rehabilitation of the posterior maxilla and careful sinus lift surgery using the side window technique is a predictable therapeutic option for clinical cases with bone gain in the height of the posterior region of the maxilla before the installation of dental implants.
ABSTRACT Dental implant treatment is a common therapy for missing teeth in partial and complete edentulous ridges. Its success depends on the osseointegration of the implant with bone and the presence of abundant soft tissues around it. A peri-implant soft tissue is a major factor for long-term stability with regard to implant restorations. Soft-tissue augmentation procedures often are recommended for gain in keratinized tissue with relation to implant retained prosthesis. In our report, we describe in detail the treatment of mucosal recession associated with crowns placed on implants in the aesthetic region. The long partial edentulous maxillary ridge reconstruction and rehabilitation required several surgical steps for a stable result.
ABSTRACT This case report describes the “Fast and Fixed” dental implant procedure, used to replace failing dentition with a fixed prosthesis that is supported by only four dental implants in each arch. This immediate loading protocol is designed to provide a more stable and permanent solution for individuals who have lost a significant number of teeth or are facing complete tooth loss. Dynamic navigation involves using computer-guided technology to plan and execute dental implant surgery in real time. In the context of a full-mouth implant restoration, dynamic navigation helps the surgeon to precisely determine the optimal prosthetic driven locations of the dental implants. This technology not only improves accuracy, reduces the risk of errors, but can contribute to better treatment outcomes in challenging cases of full-mouth implant-based rehabilitation.
ABSTRACT While rare, the ingestion of foreign bodies is a potential occurrence in dentistry, particularly during routine implant procedures if adequate precautions are not taken. Such incidents can lead to severe complications, including intestinal perforation. Confirmation of the presence or absence of a foreign body is crucial and is typically achieved through radiographs, enabling accurate diagnosis and subsequent treatment. The key to preventing such instances lies in obtaining a proper case history and ensuring the correct positioning of the patient. In general, instruments entering the gastrointestinal tract often pass without symptoms, and surgical intervention is rarely necessary. However, when indicated, a surgical approach may be required for instrument removal. Therefore, a precise diagnosis is essential to avoid unnecessary surgical interventions. This article aims to highlight a case involving the accidental ingestion of a hexdrive by a senile patient.
ABSTRACT Objectives: Surgical anxiety has emerged as a major limitation of implant surgery impeding its emergence as a leading choice of rehabilitation. It also triggers a series of physiological, emotional, and cognitive responses which adversely affects treatment outcomes and postoperative management. Hence, this study was designed specifically to address anxiety in patients undergoing dental implant surgeries. Materials and Methods: This study included 54 partially edentulous patients requiring single-implant rehabilitation. The patients were randomly assigned to the test group (Alprazolam group) and control group (Placebo group). Twenty-seven patients (test group) received Alprazolam 0.5 mg as a preemptive anxiolytic and 27 patients (control group) received a multivitamin tablet as placebo 1 h before implant surgery. Heart rate, blood pressure and respiratory rate of patients were measured to access the activation of sympathetic nervous system. Results: Oral administration of Alprazolam 1 h before the procedure showed significant reduction in preoperative anxiety in patients undergoing surgical placement of dental implants. Conclusion: Anxiolytic effect of Alprazolam mediated by binding to the alpha 1 subunit of GABA A receptor enhances the inhibitory effect on the nervous system. Preoperative administration of alprazolam 0.5 mg h prior, conceivably be standardized for management of surgical anxiety.
ABSTRACT The “black fungus” or Mucor mycosis affected a significant number of COVID patients during the pandemic. Aggressive surgical intervention of these cases resulted in large palatal & orbital defects that required prosthetic rehabilitation. This is a painstaking process due to compromised retention and minimum residual bone. In this dental centre, two case was rehabilitated with 3D printed titanium patient specific implants (PSI) followed by prosthetic rehabilitation.A 36-year-old male diabetic COVID patient was diagnosed with mucormycosis and underwent right orbital exenteration & maxillectomy. Upon recovery, a PSI was designed and 3D printed to provide support for orbital and maxillary prosthesis. PSI was fixed to the orbital rims and remaining zygomatic bone for supporting the prostheses and Bar-clip retained prostheses were fabricated using the conventional method.During COVID-19 pandemic, patients who contracted Mucormycosis had a poor prognosis with conventional prostheses since all the supporting structures had been affected by the infection. Conventional prostheses for maxillofacial defects do not have adequate supporting hard & soft tissues to provide retention and support. The PSI with Bar retained protheses have been selected as a treatment option for such types of defects.PSIs can be valuable aids in rehabilitating patients with large maxillofacial defects.
ABSTRACT The awareness and demand for implants as a treatment option have put the onus on the dentist to adapt to the patient’s requirements. Standard diameter implants cannot be placed in all situations due to limited bone volume, altered systemic status of patients, or financial constraints. Mini and narrow-diameter implants may be a reliable alternative in such circumstances. They have demonstrated good success and survival rates for the replacement of maxillary lateral incisor, mandibular anterior teeth, maxillary or mandibular posterior teeth when the occlusal load is favorable, and maxillary or mandibular overdentures. Splinting these mini implants has been shown to decrease the stresses on the bone and improve the load-bearing capacity. The three cases described here validate the usefulness of mini implants where standard diameter implants were not feasible.
ABSTRACT Elderly patients with multiple missing teeth, failed restoration, retained roots, and vertical and horizontal bone defects are very challenging to treat. This type of case needs strategic planning. A new index is proposed to assess the prognosis of individual teeth. Treatment planning is done for each quadrant and later conceptualized as a single entity. Diagnostic wax-up is an important step to educate and visualize the future restorative plan. The health of an individual tooth determines its usefulness in restorative rehabilitation. The osseous defect can be resolved by proper occlusal load distribution without the use of a bone graft. A 3-year radiological follow-up is done to assess the health of the tooth and endosseous implant. The patient’s health and quality of life were significantly improved.
ABSTRACT Aim: To evaluate and compare the crestal bone loss and implant stability with and without hyaluronic acid gel delivery at osteotomy site. Materials and Methods: This is a Prospective randomized controlled clinical trial. Eleven patients with 30 edentulous sites were randomly divided into two groups. Test (15 sites with hyaluronic acid gel injection) and Control (15 sites without hyaluronic acid gel injection). Peri-implant crestal bone loss around the implant and stability were measured at baseline and three months. Statistical analysis was done using Mann-Whitney U test and Wilcoxson Signed-Rank test. Results: Primary stability scores for the test and control groups were 70.45 ± 1.49 and 69.53 ± 1.69, respectively and was not statistically significant. Secondary stability scores for the test and control group were 72.37 ± 1.42and 70.63 ± 1.61 respectively and was statistically significant, mean crestal bone loss for the test and control groups was 0.83 ± 0.31 and 1.27 ± 0.32, respectively. which was statistically significant ( p -value < 0.05). Conclusion: Within the study’s limitations, the results showed that the local injection of osteotomy sites with hyaluronic acid showed a significant increase in stability and reduction in crestal bone loss.
ABSTRACT Although a number of approaches to implant-supported restoration of severely atrophic maxillae and mandibles have been developed, most of these treatments are expensive and protracted. An exception is the concept, which uses only guided implant surgeries and immediate loading with a hybrid, screw-retained provisional prosthesis delivered on implant placement, followed by a definitive hybrid prosthesis later. The present article describes full-arch rehabilitations using implant-supported prostheses and analyzes the functional efficacy of the treatment done by mastication analysis. This innovative technique allows for full-arch implant-supported prosthesis without the need for any bone grafting procedures even in atrophic situations and immediate function. In this technique, four or six or more implants are placed in the jaws, immediately loaded with temporalization, and put into function.
ABSTRACT Maxillofacial trauma is an excruciatingly painful condition for the patient both physically and psychologically. In clinical scenarios, wherein reconstructive surgeries fail to rehabilitate the patient, maxillofacial prosthesis comes to the rescue. Presented here is a clinical report of prosthetic rehabilitation of an orbital deformity for a patient who had an accident. A solitary intraoral dental implant was placed in the inferior lateral orbital rim. The patient was rehabilitated using a silicone orbital prosthesis retained by a unique metal framework housed with Dyna magnetic keepers and magnets embedded in a prosthesis. The framework was cemented on the implant abutment.
ABSTRACT Aim: The aim of the study was to evaluate the peri-implant microbiome in relation to the dental implant status such as plaque status, peri-implant sulcus depth, and bleeding on probing. Materials and Methods: Peri-implant subgingival biofilm samples were collected from three patients who received laser micro-grooved implants 18 months back, with paper points, and analyzed using 16s metagenomic sequencing and analyzed using nanopore sequencing platform. The microbial profile analysis based on the DNA classification of the microbial samples was done using the Burrows–Wheeler transform and Ferragina-Manzini index and optimized for metagenomic classification. Pavian was used to estimate and explore the taxonomic content. Results: The study results suggest that the microbiome diversity and species abundance showed high proportions of Veillonella , Streptococcus , Selenomonas , Fusobacterium , which could be considered as preliminary data for three different patients, one being diabetic, the other a smoker, and healthy control. Conclusions: The diabetic patients had predominantly Streptococcus (10%), whereas the smokers had predominantly Veillonella (18%) and Streptococcus (14%). The peri-implant sulcus region of diabetics and smokers shows a predominance of Gram-negative bacteria.
ABSTRACT The purpose of this article is to illustrate with case representation of complications that have been reported in conjunction with endosseous root form implants. On review of back volume on implant complication, the most common implant complications are peri-implantitis, hemorrhage, damage to vital structure, loss of implant, inability to rehabilitation, implant body, and component fracture. Successful implant rehabilitation is followed by meticulous case preparation and surgical protocol. Case examination can summarize certain challenges that may compromise implant success. We had focused on clinical data over a period of 15 years, regarding the management of challenges in implants and failure/complications in implant rehabilitation. The complications can be categorized into the following 2 categories: (1) surgical complications and (2) prosthetic complications.
ABSTRACT Subperiosteal implants were first introduced in 1942 in Sweden and were subsequently used worldwide for the treatment of mandibular and maxillary arches with advanced bone atrophy. However, due to the high complication rates and unsuccessful outcomes, this therapy fell in disuse. Advances in digital technology have led to a new interest in subperiosteal implants therapy and investigators are looking for innovative and effective techniques for dental rehabilitation. In this review, a critical analysis on the performance and characteristics of subperiosteal implants was carried out. Parameters such as materials and surface coatings, the design and manufacturing techniques, methods of implantation, complementary strategies and the main clinical outcomes were carefully assessed. Furthermore, a comparison with current dental implants and a proposal for an optimized solution are presented.
