PURPOSE:To establish consensus-driven guidelines that could support the clinical decision-making process for implant-supported rehabilitation of the posterior atrophic maxilla and ultimately improve long-term treatment outcomes and patient satisfaction.MATERIALS AND METHODS:A total of 33 participants were enrolled (18 active members of the Italian Academy of Osseointegration and 15 international experts). Based on the available evidence, the development group discussed and proposed an initial list of 20 statements, which were later evalu-ated by all participants. After the forms were completed, the responses were sent for blinded ana-lysis. In most cases, when a consensus was not reached, the statements were rephrased and sent to the participants for another round of evaluation. Three rounds were planned.RESULTS:After the first round of voting, participants came close to reaching a consensus on six statements, but no consensus was achieved for the other fourteen. Following this, nineteen statements were rephrased and sent to participants again for the second round of voting, after which a consensus was reached for six statements and almost reached for three statements, but no consensus was achieved for the other ten. All 13 statements upon which no consensus was reached were rephrased and included in the third round. After this round, a consensus was achieved for an additional nine statements and almost achieved for three statements, but no consensus was reached for the remaining statement.CONCLUSION:This Delphi consensus highlights the importance of accurate preoperative planning, taking into consideration the maxillomandibular relationship to meet the functional and aesthetic requirements of the final restoration. Emphasis is placed on the role played by the sinus bony walls and floor in providing essential elements for bone formation, and on evaluation of bucco-palatal sinus width for choosing between lateral and transcrestal sinus floor elevation. Tilted and trans-sinus implants are considered viable options, whereas caution is advised when placing pterygoid implants. Zygomatic implants are seen as a potential option in specific cases, such as for completely edentulous elderly or oncological patients, for whom conventional alternatives are unsuitable.

Dens evaginatus (DE) presents a clinical conundrum due to its fragility and propensity to cause pulpal and periapical complications. Clinicians should heed the presence of DE during clinical examinations and avoid unnecessary intervention.

ObjectiveAcute traumatic defects in the esthetic zone pose a significant challenge in dental implant rehabilitation, requiring innovative techniques to achieve optimal functional and esthetic outcomes. This article investigates the use of a novel combination of root submergence and guided bone regeneration (GBR) to address these defects. The goal is to evaluate the potential of this integrated approach for achieving predictable bone regeneration and long-term tissue stability.Clinical ConsiderationsStudies have shown significant improvements in soft-tissue contour, papilla preservation, and emergence profile when root submergence is employed. Despite these benefits, the integration of root submergence with GBR remains underexplored in the literature. This combination shows considerable potential for achieving predictable bone regeneration and sustaining tissue stability in the esthetic zone.ConclusionsThe integration of root submergence with GBR offers a promising solution for managing traumatic defects in the esthetic zone by enhancing soft-tissue contours and facilitating predictable bone regeneration. However, additional clinical studies are needed to support the long-term success of this innovative approach in dental implant rehabilitation.Clinical SignificanceThe combined use of root submergence and GBR for treating acute traumatic defects in the esthetic zone represents a notable advancement in dental implant rehabilitation. This article presents a detailed analysis of the rationale, technique, and clinical outcomes of this approach, underscoring its importance in achieving optimal esthetic and functional outcomes for patients with complex clinical needs.

Antibiotic prophylaxis in the context of dental implant procedures has been a matter of controversy. The use of antibiotics as a preventive measure aims to minimize the risk of postoperative infections associated with implant placement. 1 Esposito M. Grusovin M.G. Worthington H.V. Interventions for replacing missing teeth: antibiotics at dental implant placement to prevent complications. Cochrane Database Syst Rev. 2013 Jul 31; 2013 (PMID: 23904048; PMCID: PMC6786879)CD004152https://doi.org/10.1002/14651858.CD004152.pub4 Crossref Scopus (146) Google Scholar While there is a consensus on the importance of preventing infections, the specific protocols for antibiotic prophylaxis have been a matter of debate. Antibiotics may lead to a variety of side effects, from diarrhoea to life-threatening allergic reactions. Moreover, the extensive use of antibiotics is associated with the rise of antibiotic-resistant bacteria. 1 Esposito M. Grusovin M.G. Worthington H.V. Interventions for replacing missing teeth: antibiotics at dental implant placement to prevent complications. Cochrane Database Syst Rev. 2013 Jul 31; 2013 (PMID: 23904048; PMCID: PMC6786879)CD004152https://doi.org/10.1002/14651858.CD004152.pub4 Crossref Scopus (146) Google Scholar However, the choice of antibiotics can vary based on factors such as clinician's preference, patient's medical history, allergies, and the type of implant procedure being performed.

AbstractObjectiveIn this article, we will discuss strategies for enhancing peri‐implant soft tissue contours and pontic sites with hard tissue augmentation.Clinical considerationOne of the keys to the esthetic illusion of an implant‐supported restoration is to create an ideal emergence profile. A critical part of any emergence profile is based on the height and thickness of the tissue surrounding the restoration and whether there are any defects in this tissue. Even when there is adequate bone in which to place implants, if any irregular ridge anatomy that supports this tissue is not corrected, then an unesthetic appearance of the restoration can result due to the lack of soft tissue with which to develop a proper emergence profile.ConclusionMost peri‐implant soft tissue deficiencies represent an underlying bony defect that can be corrected or enhanced through bone augmentation.Clinical significanceTraditional methods of enhancing soft tissue emergence profiles around implants and pontic sites mostly involve the use of soft tissue augmentation techniques. Although there are few reports of the use of bone augmentation for this purpose, soft tissue contours can be enhanced by augmenting the underlying bone contours and, in many instances, may obviate the need for subsequent soft tissue augmentation.

The loss of teeth can result in moderate alveolar ridge shrinkage. This bone loss is exacerbated if there are pre-existing endodontic pathologies and/or periodontal disease. Achieving an ideal esthetic outcome is challenging when moderate bone and soft-tissue defects exist. Bone augmentation is often required to create ideal gingival contours and esthetics. This article discusses augmentation strategies to enhance esthetic outcomes for common alveolar ridge defects.

The purpose of this study was to report the outcomes of interpositional osteotomy with mineralized allograft in the treatment of alveolar vertical defects in preparation for implant placement. Thirteen defects (11 maxillary and two mandibular) were treated with osteotomy segments ranging in length from two to five missing teeth. The segments were positioned 5-7 mm coronally, with the gap space filled with allograft and then fixated with titanium hardware. Vertical bone augmentation was analyzed by superimposing pre- and post-surgical cone beam computed tomography images and stratified based on the length and number of missing teeth in each edentulous segment. The mean vertical bone gain was 3.7 ± 1.6 mm in the area of greatest vertical defect and the mean length of the transport segment was 20.5 ± 8.1 mm. These segments represented two-, three-, four-, or five-tooth edentulous sites; the mean vertical bone gain for these segments was 1.7 ± 0.5 mm, 3.8 ± 1.0 mm, 4.6 ± 0.9 mm, and 6.7 ± 0.0 mm, respectively. Stability of vertical height gain was found to be directly proportional to the span length of the osteotomy segment, with the largest five-tooth segment achieving the greatest gain. Vertical bone gain in two-tooth segments was minimal, indicating a moderate amount of resorption.

Purpose: To evaluate the crestal bone loss and implant stability quotient trends of photofunctionalised versus untreated implants. Materials and methods: A total of 34 patients (age 46.94 +/- 12.03 years) with bilateral single missing teeth in the same arch were enrolled in this study. Each patient received an untreated implant on one side (control group, n = 34) and a photofunctionalised implant on the contralateral side (test group, n = 34). Crestal bone loss was assessed at the time of crown insertion and 1 year later. The osseointegration speed index was evaluated for both the control and test group. An independent t test was used for intergroup comparisons of crestal bone loss and osseointegration speed index. Bivariate analysis was performed for the confounding variables. Results: The test group showed a statistically significantly higher osseointegration speed index (3.07) as compared to the control group (1.29) (P < 0.01). Statistically significantly higher crestal bone loss was observed in the control group (-0.57 +/- 0.41 mm) as compared to the test group (-0.27 +/- 0.35 mm) (P < 0.01). The difference between mean Plaque Index and Bleeding Index in the control (0.74/0.38) and test group (0.73/0.35) was statistically insignificant (P > 0.05). A negative correlation (r = -0.272) was noted between implant diameter and crestal bone loss. A positive correlation (r = 0.402) was observed between implant length and osseointegration speed index. Conclusion: Implants with photofunctionalised surfaces reduce overall healing time and crestal bone loss. Photofunctionalisation is an effective aid for chairside conditioning of implant surfaces to achieve faster osseointegration with good crestal bone stability.

OBJECTIVE:To assess the correlation between the diameter of the mandibular lingual vascular canal (MLVC) as determined on CBCT examination to blood flow and arterial diameter as determined by ultrasound Doppler analysis (USG) in dentate and edentulous patients.METHODS:20 subjects were equally distributed into two groups based on the status of their dentition. Group 1 included dentate subjects (DE) and Group 2 included edentulous subjects (ED).The subjects from both the groups underwent CBCT scan for the assesement of the diameter of the MLVC.Similarly, USG was done to assess the diameter of the sublingual artery anastomosis and blood flow in the anterior mandible. Data was analysed using Karl Pearson's Correlation coefficient test and Student's unpaired 't' test.RESULTS:Irrespective of the status of the dentition and age, a positive correlation was noted between the diameter of foramen on CBCT examination and the diameter of anastomosing artery as studied by the USG (r ​= ​0.290).Similarly, a positive correlation was observed between the diameter of foramen on CBCT and the volume of blood entering the mandible (r ​= ​0.447).A positive correlation (r ​= ​0.138) was observed between the diameter of the anastomosing artery and the volume of blood entering the mandible.CONCLUSION:The anterior mandible has a rich vascular supply independent of age and status of the dentition.The dimensions and location of MVLC could be assessed on a CBCT prior to implant placement so that the operating surgeon has an idea about the vascularity of the region. Further studies with higher sample size should be undertaken to confirm these findings.

AIM:The aim of this study is to determine the incidence of obliterated osteomeatal complex (OMC) due to the presence of anatomic variants.SETTINGS AND DESIGN:Retrospective Study.MATERIALS AND METHODS:In this retrospective study, a total of 71 patients, 34 males and 37 females, aged 35-65 years were included in the study. Cone beam computed tomography (CBCT) scans of patients were assessed to identify the status of the OMC in the presence of anatomic variants and their incidence was recorded. The radiological assessment of the anatomical variants was made by viewing the coronal sections of the scans. The variants observed were deviated nasal septum, uncinate process), agger nasi, Haller cells, middle turbinate variants, enlarged bulla, accessory ostium, and maxillary sinus abnormalities). Ostium patency was evaluated in the coronal section of each sinus and classified as "patent" or "obstructed." The most common variants observed were then correlated with the patency of the ostium.STATISTICAL ANALYSIS USED:Chi square test was performed to assess the association between the anatomic variants and the patency of the OMC.RESULTS:In the present study, the incidence of an obliterated OMC due to the presence of anatomic variants was 73.2%. The four most common variants associated with the possibility of an obliterated OMC were the deviated nasal septum (76.2%), middle turbinate (86.4%), enlarged bulla (77.8%), and sinus cavity variants (80.0%). A statistically significant association was noted between middle turbinate variants and Haller cells and the patency of the OMC.CONCLUSION:Thorough pretreatment CBCT evaluation should be performed to assess the presence of anatomic variants and thereby, the patency of the ostium before sinus floor elevation procedures. The pre and postsurgical treatment plans and regimes can be modified according to anticipated postsurgical sequelae, thereby avoiding postsurgical complications and enhancing the success of the graft procedure.

Purpose: To evaluate the survival rates of dental implants that had been reimplanted in sites of previous failure, including first, second, and third reimplantations, and investigate the various factors that could affect the reimplantation outcomes. Materials and Methods: All dental implants placed in sites of previous implant failure were identified, including first, second, and third reimplantations. The survival rates were assessed, and epidemiologic and clinical data were collected and analyzed to evaluate the effects on reimplantation survival. Results: The survival rate for the total number of initial implants placed was 95.4% (5280 of 5532). For the 208 patients with failed implants, the survival rate was 62.0% (412 of 664). The survival rate of the implants placed in the sites of previous failure (first reimplantation) was 77.4% (137 of 177 implants). A statistically significant difference was found (P = .0001) between the survival rates of implants placed for the first time and implants placed into sites of previous failure. The survival rate of the second reimplantations was 72.7% (16 of 22). The survival rate of the third reimplantations was 50.0% (1 of 2). Each implant and reimplant group demonstrated a statistically significant greater percentage of postoperative pain reports in the failure group than in the survival group. A significantly greater percentage of early failures (failures occurring before abutment connection) occurred compared with late failures for each implant and reimplant group. Conclusions: Dental implants placed in sites of previous implant failure had lower survival rates than those of the initial implants, and our findings suggested that the survival rates will be consecutively lower with each successive reimplantation at the same site. Implant and reimplant failures were associated with higher rates of postoperative pain reports and were more often early failures. Such suggestions could improve clinicians' prediction for implant failure and allow for optimization of the conditions to improve implant survival. (C) 2019 American Association of Oral and Maxillofacial Surgeons

PURPOSEThe aim of this study was to compare the results of indirect sinus augmentation with and without the addition of a biomaterial.MATERIALS AND METHODSThirty patients aged 40 to 60 years participated in this randomized controlled clinical trial. After closed sinus lift operation, patients were randomly and equally divided into blood clot control and acemannan sponge graft groups. Simultaneous implant placement was then performed. Cone beam computed tomography was performed immediately and at 3 and 6 months postoperation. Bone formation was evaluated by the radiographic endo-sinus bone gain percentage around the implant.RESULTSCompared with the control group, the acemannan-treated group had a significantly greater radiographic endo-sinus bone gain percentage of approximately 2.4- and 2-fold at 3 and 6 months postsurgery, respectively (P < 0.05).CONCLUSIONThe addition of a biomaterial (Acemannan) with indirect sinus augmentation and simultaneous implant placement significantly enhances bone formation at 3 and 6 months postsurgery.

OBJECTIVES:To retrospectively assess malocclusions, skeletal relationships and the functional needs of orthognathic patients treated in a University teaching hospital.SUBJECTS AND METHODS:This study used clinical records of 100 consecutive patients [51 female, 49 males, mean (SD) age =21.5 (2.71) years] who had orthognathic surgery in a Shahid Beheshti University of Medical Sciences affiliated hospital (9/2014-7/2017). Malocclusion type (incisor classification), sagittal skeletal pattern (ANB angle), index of orthognathic functional treatment need (IOFTN) score, and osteotomy type were recorded.RESULTS:Overall, 66%, 31%, and 3% had Class III, II, and Class I malocclusions, respectively. Similarly, 68% and 32% had Class III and II sagittal skeletal relationships, respectively. Overall, 95% of patients scored IOFTN 4 or 5. The most prevalent IOFTN score were 4.3 (37%), 5.3 (16%), 5.4 (16%), and 4.2 (10%). There were no gender differences (P >0.05) for the distribution of malocclusions, sagittal skeletal relationships, different IOFTN scores, or when IOFTN scores were re-grouped (5, 4, and ≤3). When IOFTN scores were re-grouped (5, 4, and ≤3), they were equally distributed among patients with Class II or III skeletal relationships (P >0.05), but when the authors looked at different malocclusions, there were significant differences in IOFTN score distribution (P = 0.006). The use of genioplasty (4%) or distraction osteogenesis (2%) was limited. Single jaw surgery of either maxilla or mandible was used in 15% and 22% of patients, respectively. About 63% had undergone double-jaw surgery.CONCLUSION:Retrospective assessment using IOFTN identified 95% of patients as having great and very great functional needs, but prospective studies using IOFTN is needed to assess the need for orthognathic surgery. Class III malocclusions and Class III sagittal skeletal relationships were more common in this sample.

Purpose: The absence of an adequate volume of bone at implant sites requires augmentation procedures before the placement of implants. The aim of the present study was to assess the ridge width gain with the use of allografts and biphasic beta-tricalcium phosphate with hydroxyapatite (alloplast) in ridge split procedures, when each were used in small (0.25 to 1 mm) and large (1 to 2 mm) particle sizes. Patients and Methods: A randomized controlled trial of 23 subjects with severe atrophy of the mandible in the horizontal dimension was conducted in a private institute. The patients underwent placement of 49 dental implants after a staged ridge split procedure. The patients were randomly allocated to alloplast and allograft groups (predictor variable). In each group, the patients were randomly assigned to either small graft particle or large graft particle size (predictor variable). The gain in ridge width (outcome variable) was assessed before implant placement. A 2-way analysis of variance test and the Student unpaired t test were used for evaluation of the ridge width gain between the allograft and alloplast groups (predictor variable). Differences were considered significant if P values were < .05. Results: The sample included 23 patients (14 men and 9 women). The patients were randomly allocated to the alloplast (n = 11) or allograft (n = 12) group before the ridge split procedure. In each group, they were assigned to a small graft particle or large graft particle size (alloplast group, small particle in 5 and large particle size in 6 patients; allograft group, small particle in 6 and large particle size in 6). A statistically significant difference was observed between the 2 graft types. The average ridge width gain was significantly greater in the alloplast group (large, 4.40 +/- 0.24 mm; small, 3.52 +/- 0.59 mm) than in the allograft group (large, 3.82 +/- 0.19 mm; small, 2.57 +/- 0.16 mm). For both graft types (alloplast and allograft), the large particle size graft resulted in a greater ridge width gain compared with the small particle size graft (P < .05). Conclusions: Within the limitations of the present study, we suggest the use of large particle alloplast as the graft material of choice for staged ridge split procedures in the posterior mandible. (C) 2017 American Association of Oral and Maxillofacial Surgeons.