BACKGROUND:Medication-related osteonecrosis of the jaw (MRONJ) is a recognized complication of intravenous (IV) bisphosphonate therapy, particularly following invasive dental procedures such as extractions or implant placement. Although the risk of MRONJ decreases after discontinuation of therapy, prolonged skeletal retention of bisphosphonates necessitates careful long-term evaluation and surgical planning. METHODS:An American Society of Anesthesiologists (ASA) (II 72-year-old male with history of high-dose IV pamidronate therapy for multiple myeloma (last dose 11 years prior) presented for implant placement at tooth #18. Clinical and radiographic examination revealed a vertical root fracture with associated periapical pathology. The tooth was extracted, and ridge preservation was performed. Three and half months later, implant placement followed with the use of preoperative antibiotic prophylaxis. RESULTS:Five months post-implant placement, the patient developed a lesion on the lingual vestibular aspect of site #18, characterized by purulence, bleeding, and exposed necrotic bone measuring approximately 10 × 2 mm, without radiographic appearance. Histopathologic evaluation confirmed MRONJ. The lesion was treated with conservative surgical debridement, followed by 0.12% chlorhexidine gluconate rinses twice daily for 2 weeks. Healing was allowed by secondary intention without sutures, and postoperative systemic antibiotic therapy was prescribed. Follow-up examinations at 2 and 4 weeks demonstrated complete clinical healing, with no recurrence observed at 6 months. CONCLUSIONS:The risk of MRONJ may persist for more than 11 years after cessation of high-dose IV bisphosphonate therapy. The development of MRONJ, despite a C-terminal telopeptide (CTX) value traditionally considered favorable, underscores the limited predictive utility of CTX testing. Accordingly, management decisions should be guided by comprehensive clinical assessment and interdisciplinary communication rather than reliance on biochemical markers alone. KEY POINTS/HIGHLIGHTS:Why is this case new information This case reports stage 2 medication-related osteonecrosis of the jaw (MRONJ) occurring 11 years after high-dose intravenous (IV) pamidronate cessation following extraction, ridge preservation, and implant placement, illustrating very late-onset disease that can arise adjacent to the surgical site, highlighting the limitations of serum C-terminal telopeptide testing, and emphasizing the need for long-term clinical vigilance and cautious surgical planning in patients with a remote history of bisphosphonate therapy. What are the keys to successful management of this case? Successful management relied on thorough risk assessment, informed consent, atraumatic surgery with antibiotic prophylaxis, early detection and conservative stage 2 MRONJ treatment, histopathologic confirmation, healing by secondary intention with antiseptics and short-term antibiotics, and coordinated interdisciplinary care. What are the primary limitations to the success of this case? Limitations stem from the patient's history of high-dose IV bisphosphonate therapy, the unpredictable long-term risk of MRONJ, the lack of reliable biomarkers or imaging for risk prediction, multifactorial pathogenesis including local and systemic factors, and the potential for late recurrence despite initial successful management. PLAIN LANGUAGE SUMMARY:This report describes a patient who developed a rare complication of long-term bisphosphonate therapy, a medication commonly used to treat bone diseases such as multiple myeloma. Eleven years after receiving high-dose intravenous bisphosphonates, the patient underwent tooth extraction and dental implant placement, initially healing without problems. Several months later, a small area of exposed, infected bone appeared near the implant, which was diagnosed as medication-related osteonecrosis of the jaw (MRONJ). The condition was successfully treated with careful surgical cleaning, local antiseptic rinses, short-term antibiotics, and close monitoring, without the need to remove the implant. This case is important because it shows that MRONJ can occur more than a decade after stopping bisphosphonate therapy, even when routine blood tests suggest low risk. It also demonstrates that the disease can appear near, rather than exactly at, the surgical site. The report emphasizes the need for thorough risk assessment, careful surgical planning, prompt recognition of complications, and collaboration among dental and medical specialists. Overall, it highlights that patients with a remote history of high-dose bisphosphonates require long-term vigilance and individualized care when undergoing dental procedures.

(1) Background: OD burs are used in two different modes: (i) CW and (ii) CCW. The purpose of the study was to evaluate the ΔT during the preparation of implant osteotomies in a four-way interaction. (2) Methods: Three hundred and sixty osteotomies were prepared at 12 mm depth in human cadaver tibiae. The ΔT values were calculated similarly to the method used in two previous studies carried out by our group. Four different variables were evaluated for their effect on ΔT. (3) Results: A four-way interaction was observed in the CCW mode, allowing for 1000 RPM to have the least effect in both modes. However, in the CCW mode the use of 3.0 and 4.0 burs after 23 osteotomies showed a statistically significant increase in ΔT, and significant chatter, compared to the CW mode. In the CCW mode, the ΔT was increased significantly as the diameter of the burs increased in 800 and 1200 RPM. (4) Conclusions: The synergistic effect of drills’ diameter, CCW mode, 800 and 1200 RPM, and bur usage (over 23 times) had a significant effect on ΔT, which exceeded 47 °C. One thousand (1000) RPM had the least effect in both modes. The 3.0 and 4.0 burs in the CCW mode drastically increased the temperature and produced significant chatter.

IntroductionThe human-derived amnion-chorion membrane (ACM) has endogenous antimicrobial properties, which are important for preventing the colonization and survival of oral bacteria on exposed membranes. This project aimed to decipher the underlying mechanism by identifying the components of ACM that confer antibacterial properties. In addition, the antimicrobial efficacy of these identified components on oral bacteria was assessed.MethodsFour antimicrobial proteins, histone H2A/H2B, cathelicidin LL-37, lactoferrin, and lysozyme, were identified via mass spectrometry in ACM. These proteins were then assessed for their efficacy in killing Streptococcus gordonii Challis. Log-phased bacterial cells were cultured with the commercially available proteins that were identified in ACM, either individually or in combination, at different concentrations. After incubation for 8 or 24 hours, the bacteria were stained with a live/dead viability kit and analyzed via confocal microscopy.ResultsThe combination of these proteins effectively killed S. gordonii in a dose-dependent fashion after 8 or 24 hours of incubation. When each protein was tested individually, it killed S. gordonii at a much lower efficacy relative to the combinations. The synergistic effects of the antimicrobial protein combinations were also observed in both the viable cell count recovery and minimum inhibitory concentration assays.DiscussionBy shedding light on the mechanisms in the ACM’s antimicrobial property, this study may raise more awareness of the potential benefit of utilization of a membrane with endogenous antimicrobial properties in regeneration surgeries.

AIM:This randomized controlled trial aimed to investigate the efficacy of soft-tissue augmentation (STA) with a subepithelial connective tissue graft (SCTG) or an acellular dermal matrix (ADM) on reducing tissue alterations at an immediate implant site.MATERIALS AND METHODS:This trial had three groups: (i) immediate implant with SCTG (ICT group); (ii) immediate implant with ADM (IAD group); (iii) immediate implant without STA (control group). Forty-six patients were randomly assigned to each group. Implants were placed at the maxillary anterior or premolar areas and restored after the 6-month visit. Clinical outcomes, including buccal soft-tissue contour, peri-implant mucosal level, soft-tissue thickness and keratinized tissue width, were measured at baseline and at 3-, 6- and 12-month follow-up visits. Radiographic bone levels were measured at baseline and at 6- and 12-month follow-up visits. Patient-reported outcomes were also collected.RESULTS:STA procedures increased peri-implant mucosal thickness and maintained buccal soft-tissue contours. Compared to the control group, STA groups did not prevent peri-implant mucosal recession or interproximal bone resorption. Generally, no significant differences in clinical outcomes were detected between the ICT and IAD groups. Most patients were highly satisfied with the immediate implant procedure and outcomes without significant differences between groups.CONCLUSIONS:STA at immediate implant sites enhanced soft-tissue thickness and maintained soft-tissue contours but did not prevent peri-implant mucosal recession or interproximal bone resorption. Long-term follow-up should be performed since these results were reported for only up to 1 year.

ObjectivesPeriodontitis disproportionately affects different racial and ethnic populations. We have previously reported the higher levels of Porphyromonas gingivalis and lower ratios of Streptococcus cristatus to P. gingivalis may contribute to periodontal health disparities. This prospective cohort study was designed to investigate if ethnic/racial groups responded differently to non-surgical periodontal treatment and if the treatment outcomes correlated to the bacterial distribution in patients with periodontitis before treatment.MethodsThis prospective cohort pilot study was carried out in an academic setting, at the School of Dentistry, University of Texas Health Science Center at Houston. Dental plaque was collected from a total of 75 African Americans, Caucasians and Hispanics periodontitis patients in a 3-year period. Quantitation of P. gingivalis and S. cristatus was carried out using qPCR. Clinical parameters including probing depths and clinical attachment levels were determined before and after nonsurgical treatment. Data were analyzed using one-way ANOVA, the Kruskal–Wallis test, the paired samples t-test and the chi-square test.ResultsThe gains in clinical attachment levels after treatment significantly differed amongst the 3 groups–Caucasians responded most favorably, followed by African-Americans, lastly Hispanics, while numbers of P. gingivalis were highest in Hispanics, followed by African-Americans, and lowest in Caucasians (p = 0.015). However, no statistical differences were found in the numbers of S. cristatus amongst the 3 groups.ConclusionDifferential response to nonsurgical periodontal treatment and distribution of P. gingivalis are present in different ethnic/racial groups with periodontitis.

OBJECTIVES:Some commonly used models utilized for teaching periodontal surgical techniques to dental students include pig mandible and periodontal typodonts. Currently, no study compares the learning and teaching outcomes following the use of one model to the other. This study is aimed at evaluating the effectiveness of the preclinical laboratory component on student understanding of concepts taught in the periodontal surgical course and assessing students' and faculty members' satisfaction with the instructional models.METHODS:As part of the surgical periodontics course, 98 students took the final exam, with eighty students participating in only the pig mandible session and twenty-three students participating in both the pig jaw mandible and an additional session utilizing periodontal typodonts under the supervision of ten periodontal faculty members. Examination scores of students attending or not attending the laboratory session were analyzed by a two-sample t-test. A questionnaire evaluating the effectiveness of both models was given to faculty members and students who participated in both laboratory sessions. These results were analyzed by paired t-test.RESULTS:Participation in the laboratory sessions did not significantly impact the final exam scores (p = 0.722). Students who had better didactic performance in the course performed better in the final exam, irrespective of laboratory participation. Both students and faculty members preferred typodont to the pig mandibles in learning or teaching periodontal surgical concepts, but both felt gaining flap management and flap refection experience to be better with the pig mandible model without statistical significance (p = 0.119 and p = 0.070, respectively).CONCLUSION:Within the limitations of this study, we can conclude that laboratory sessions did not significantly improve student performance on the exam. Students and faculty members generally gave positive feedback on both instructional models. Periodontal typodont could be an alternative model for teaching dental students, periodontal surgical concepts.

(1) Background: Ridge augmentations either horizontal (HRA) or vertical (VRA) in the posterior mandible are very challenging regenerative procedures. To attain and retain tension-free primary closure, buccal periosteal and mylohyoid muscle releases should be performed. The purpose of the present study was to review, analyze and discuss the three different techniques for the mylohyoid muscle release (MMR) in VRA and HRA surgeries on a clinical and human cadaver level. (2) Presentation of the techniques: Three different techniques are described in the literature regarding the lingual flap management: (i) the finger sweep technique (FST), (ii) the release of the mylohyoid muscle attachment on the lingual flap (MMALF), and (iii) the mylohyoid preservation technique (MPT) in three key anatomical zones. All three techniques, even though they use a different approach, can achieve similar amount of horizontal and vertical mylohyoid muscle release although MPT showed statistically significant higher flap advancement. The human cadaver analyses revealed that all three techniques are considered safe since they do not approximate vital anatomical structures. (3) Conclusions: All three techniques are considered safe, but they are not free of limitations or complications; therefore, they should be performed only by highly experienced and trained clinicians. MPT achieved statistically significant higher flap advancement.

Periodontitis is a commonly occurring inflammatory oral disease affecting a large proportion of global and US adults and is characterized by the destruction of the tooth-supporting apparatus. Its etiology is multifactorial, and type 2 diabetes and diet play critical roles in its remission and progression. However, few studies have addressed nutritional and serum vitamin D status in adults with periodontitis in the presence of diabetes. A cross-sectional study (n = 78), and a sub-set of age- and BMI-matched case–control studies (n = 50), were conducted to examine differences in dietary and cardiometabolic variables, and serum vitamin D in adults with periodontitis with or without diabetes. Participants provided fasting blood samples and 24-h diet recalls on at least two different days. Data on health history, body weight, height, nutritional habits, and clinical features of periodontitis were also collected. The Mann–Whitney U Test (with exact p-value estimation by Monte Carlo simulation) was used to examine differences by diabetes status in continuous and ordinal variables. Results revealed significantly lower serum vitamin D, and dietary intake of fruits, vegetables, dairy, vitamins A and C in adults with periodontitis with vs. without diabetes in the sub-study (all p < 0.05). In the overall sample, adults with diabetes presented with higher caries risk measures and lower numbers of teeth than those without diabetes; plaque and bleeding scores did not differ by diabetes status. Finally, a significant associations of food habits was observed, especially consuming protein-rich foods twice a day with a lower bleeding score, and daily consumption of fried or fast foods with a fewer number of teeth present (all p < 0.05). The present findings show significant dietary and serum vitamin D inadequacies among adults with periodontitis, and diabetes further aggravates the observed malnourishment and oral health.

The purpose of the present review was to discuss the success and predictability of vertical ridge augmentation (VRA) with the use of guided bone regeneration (GBR). Weighted mean gains in vertical heights of 8.04 mm (distraction osteogenesis), 4.18 mm (GBR), and 3.46 mm (block grafts) were reported for the specific VRA procedures; however, a superior technique was not identified. VRA with GBR is a technique-sensitive procedure with the potential of regenerating significant heights of vital bone, which should be performed by highly experienced clinicians due to the potential for severe complications. Regardless of the technique used for VRA, two important factors for a successful and predictable outcome are (i) the defect morphology and (ii) the proper flap management/advancement to obtain and retain a tension-free primary closure.

OBJECTIVE The objective of this cross-sectional study is to investigate alveolar bone gene expression in health and diabetes through ribonucleic acid (RNA) sequencing and bioinformatics analysis. BACKGROUND It is relatively unknown how type 2 diabetes modulates gene expression in alveolar bone in humans. Clinical concern regarding increased implant failure rate in patients with diabetes has been discussed in the literature. Previous studies in animal models and humans have suggested an imbalance between the genes regulating bone formation with data suggesting bone resorption in diabetes. However, there is lack of data regarding a comprehensive gene expression from human alveolar bone in diabetes. METHODS Alveolar bone was collected from healthy and type 2 diabetic subjects undergoing periodontal and implant surgeries. The homogenized RNA sample was then extracted and analyzed for quantity and quality. RNA samples were further purified using ribosomal RNA depletion technique and processed for RNA sequencing and analysis. Expression levels for mRNAs were performed by calculating FPKM ([total_exon_fragments/mapped reads (millions) × exon length (kB)]), and differentially expressed mRNAs were selected with log2 (fold change) >1 or log2 (fold change) ≤1 and with a parametric F test comparing nested linear models. RESULTS Eighteen bone samples (10 healthy, 8 patients with diabetes) were analyzed for gene expression. The mean age and HbA1c% of healthy versus diabetic subjects were as follows: age (55.3 ± 17.5 vs 63.9 ± 8.7 years) and HbA1c% (5.6 ± 0.29 vs 7.3 ± 2.4), respectively. Sequencing analysis showed that expression of genes that regulate bone turnover like TGFB1, LTBP4, IGF1, BMP2, BMP4, BMP6, SMAD1, RUNX2, MCSF, and THRA was significantly downregulated in diabetes samples compared with healthy controls with overall reduced expression of genes in the bone regulation pathway in patients with diabetes. Bioinformatics analysis for the altered genes highlighted several pathways related to bone homeostasis and inflammation in diabetes. Periodontitis did not affect the gene expression pattern based on diabetes status. CONCLUSIONS Altered expression of genes due to downregulation of certain pathways that are involved in bone turnover and inflammation suggests that overall wound healing and bone homeostasis may be compromised in type 2 diabetes.

Background This study aimed to compare survival of single tooth implants (SI) to teeth receiving initial endodontic treatment (IET), non-surgical (NET), and surgical endodontic retreatments (SET). The secondary aim was to determine success rate and identify factors associated with the survival and success of implant and endodontic treatments. Methods A retrospective cohort study using electronic health records (January 1st, 1995 to April 30th, 2017) was conducted. Every case that qualified for the study in SI (n = 321), NET (n = 211), and SET (n = 79) was included and cases in IET (n = 642) were selected at random and with a 2 to 1 case ratio to SI for data extraction efficiency. Statistical analyses were conducted to compare survival rates and estimate success rates between the four groups adjusting for confounders. Results The 3 year survival rates for SI, IET, NET, and SET were 99.0%, 92.1%, 90.5%, and 89.5% while the 5 year survival rates for SI, IET, NET, and SET were 99.0%, 87.6%, 84.4%, and 81.1%, respectively. Generally, the SI group had the highest survival rate and the SET group had the lowest survival rate. Short implants (<= 8 mm) were significantly associated with implant failure (P < 0.01). Teeth with composite restoration had lower survival rates in IET and NET than other restorations (P < 0.01 and < 0.01). Conclusion Within the limitations of this study, single tooth implants and the endodontic treatments yielded predictable survival and success in the short term but the survival and success rates in endodontic treatments dropped more rapidly than single tooth implants during the longer follow-up period.

INTRODUCTION:Vertical ridge augmentation (VRA) is one of the most challenging procedures. This is the first case report to show 2-5 mm VRA after two unsuccessful GBRs around previously placed dental implants, with the use of an exposed d-PTFE membrane.CASE PRESENTATION:A 79-year-old ASA II Caucasian male presented after two previous GBR procedures on the LLQ. The second attempt left the site with two exposed implants, scar tissue, no keratinized tissue and lack of vestibular depth. VRA was attempted with the use of cortical perforations, tenting screws, dense PTFE membrane and a 50:50 mixture of anorganic bovine bone matrix and mineralized allograft. The site was left to heal in a secondary intention, leaving the d-PTFE membrane exposed. The membrane was removed 4 weeks postoperatively. The healing abutments were placed, the tenting screws were removed, and the site was allowed to heal for more than seven months. Radiographically, VRA was achieved ranging from 2 to 5 mm. A vestibuloplasty was performed using a diode laser and subsequent flap dissection. Four months after the vestibuloplasty, the tissue surrounding the implants showed adequate keratinization, and an elongated vestibular depth. In addition, in both implants, the emergence profile buccal and lingual was more than 3 mm and the patient was referred to his prosthodontist for the fabrication of the final restorations.CONCLUSIONS:VRA around dental implants was achieved with the use of a nonresorbable dense PTFE membrane, which was left exposed to heal in a secondary intention, tenting screws and a combination grafting technique to correct two previously failed GBRs.

Statement of problem. Evidence to validate the routine use of angled screw-channel abutments in the anterior maxilla is sparse. If properly planned, they might provide surgical and prosthetic benefits. Purpose. The purpose of this observational study was to determine the prevalence of digitally placed implants in the anterior maxilla that would allow screw-retained implant-supported restorations with either a straight or an angled screw-channel abutment. Material and methods. Two hundred cone beam computed tomography (CBCT) scans met the inclusion criteria for retrospective analysis and digital implant planning. Virtual implants were planned for randomly selected anterior maxillary teeth by using the anatomic crown and root position. Virtual abutments of varying angulation were attached to the implants to determine the ability to screw retain a restoration with either a straight or an angled screw-channel abutment. Results. One hundred fifty-two (76%) sites required an angled screw-channel abutment to enable screw retention. Forty-eight (24%) sites allowed screw retention with a straight abutment. The percentage of implants requiring angled or straight abutments varied significantly among anterior teeth (P<.005). One hundred nine (71.7%) angled screw-channel abutment sites required a 5-degree abutment, 41 (26.9%) required a 10-degree abutment, and 2 (1.3%) required a 15 -degree abutment. Among the anterior teeth, lateral incisors presented a greater need for angled screw-channel abutments. None of the implants in the present study needed cement-retained restorations. Conclusions. Angled abutments allowed for screw-retained restorations on digitally planned implants in the anterior maxilla. The required angular correction to a screw-retained restoration was <15 degrees. Screw-retained restorations were frequently achievable (76%) with the use of angled screw-channel abutments or with straight abutments (24%), and lateral incisors presented a greater need for angled screw-channel abutments. (J Prosthet Dent 2022;128:443-9)

A critical challenge for clinicians is not the detection of periodontal disease but rather the identification of patients with an elevated risk of experiencing active and progressing disease. Dr. Gellibolian is a cofounder and the chief executive officer, CellectGen, Pasadena, CA. Dr. Miller is a professor of oral health research and the chief, Division of Oral Diagnosis, Oral Medicine and Oral Radiology, University of Kentucky College of Dentistry, Lexington, KY. Dr. Markaryan is a cofounder and the chief research officer, CellectGen, Pasadena, CA. Dr. Weltman is a professor in residence, University of Nevada Las Vegas School of Dental Medicine, Las Vegas, NV. Dr. Van Dyke is the vice president and senior member of staff, Forsyth Institute and professor, Oral Medicine, Infection and Immunity, Faculty of Medicine, Harvard University, Boston, MA. Dr. Ebersole is a professor and the interim chair of biomedical sciences and the associate dean for research, University of Nevada Las Vegas School of Dental Medicine, Las Vegas, NV.

(1) Background: Several studies showed a sustained temperature of 47 °C or 50 °C for one minute resulted in vascular stasis and bone resorption with only limited bone regrowth over a 3–4-week healing period. The purpose of the present study was to evaluate the temperature changes (ΔΤ) that occur during the preparation of dental implant osteotomies using MIS® straight drills versus Densah® burs in a clockwise (cutting) drilling protocol. (2) Methods: Two hundred forty (240) osteotomies of two different systems’ drills were prepared at 6 mm depth at 800, 1000, and 1200 revolutions per minute (RPM), in fresh, unembalmed tibiae, obtained by a female cadaver. ΔΤ was calculated by subtracting the baseline temperature on the tibial surface, from the maximum temperature-inside the osteotomy (ΔT = Tmax − Tbase). The variables were evaluated both for their individual and for their synergistic effect on ΔΤ with the use of one-, two-, three- and four-way interactions; (3) Results: An independent and a three-way interaction (drill design, drill width, and RPM) was found in all three RPM for the Densah® burs and at 1000 RPM for the MIS® straight drills. As Densah® burs diameter increased, ΔΤ decreased. The aforementioned pattern was seen only at 1000 RPM for the MIS® straight drills. The usage of drills 20 times more than the implant manufacturers’ recommendation did not significantly affect the ΔΤ. A stereoscopic examination of the specimens confirmed the findings. (4) Conclusions: The independent and synergistic effect of drills’ diameter, design and RPM had a significant effect on ΔΤ in human tibiae, which never exceeded the critical threshold of 47 °C.

Vertical ridge augmentation (VRA) is one of the most challenging procedures. This is the first case report to show 2–5 mm VRA after two unsuccessful GBRs around previously placed dental implants, with the use of an exposed d-PTFE membrane. A 79-year-old ASA II Caucasian male presented after two previous GBR procedures on the LLQ. The second attempt left the site with two exposed implants, scar tissue, no keratinized tissue and lack of vestibular depth. VRA was attempted with the use of cortical perforations, tenting screws, dense PTFE membrane and a 50:50 mixture of anorganic bovine bone matrix and mineralized allograft. The site was left to heal in a secondary intention, leaving the d-PTFE membrane exposed. The membrane was removed 4 weeks postoperatively. The healing abutments were placed, the tenting screws were removed, and the site was allowed to heal for more than seven months. Radiographically, VRA was achieved ranging from 2 to 5 mm. A vestibuloplasty was performed using a diode laser and subsequent flap dissection. Four months after the vestibuloplasty, the tissue surrounding the implants showed adequate keratinization, and an elongated vestibular depth. In addition, in both implants, the emergence profile buccal and lingual was more than 3 mm and the patient was referred to his prosthodontist for the fabrication of the final restorations. VRA around dental implants was achieved with the use of a nonresorbable dense PTFE membrane, which was left exposed to heal in a secondary intention, tenting screws and a combination grafting technique to correct two previously failed GBRs.

The success of osseointegration depends on many factors. With temperatures beyond a 47 °C threshold over 1 min, bone survival may be impaired. The purpose of the study was to evaluate, in fresh human cadaver tibiae, the temperature changes during osteotomy preparations using two straight and two tapered implant systems’ drills, external irrigation, and varying revolutions per minute (RPM). The tibiae from a fresh female cadaver were harvested bilaterally. Two tapered and two straight design drills were assessed. Two-hundred and forty osteotomies were prepared at 6 mm depth following the drill sequence of the manufacturers’ protocol for each drilling speed. Difference in temperature (ΔΤ) was calculated by subtracting the baseline from the maximum temperature (ΔT = Tmax − Tbase). Drill design and drill diameter, as independent variables or synergistically, had a significant effect on ΔΤ. Tapered drills: As the drill diameter increased, ΔΤ increased at all RPM. Straight drills: As the drill diameter increased, ΔΤ remained constant or slightly decreased at all RPM. Drill diameter and design had a significant effect on ΔΤ in human tibiae, which never exceeded the critical threshold of 47 °C. Tapered drills caused significantly greater heat production compared to straight drills.

OBJECTIVE:The purpose of the present study was to present vertical ridge augmentation (VRA) with the use of cross-linked resorbable membrane, tenting screws, and a combination grafting technique.REPORT:Three cases are presented. Case 1: A 67-year-old ASA II patient required VRA at the areas of the mandibular left second premolar and first molar. Flap management was performed with the use of periosteal release on the buccal aspect and 23 mm of mylohyoid muscle release on the lingual aspect. VRA was completed with the use of four self-tapping tenting screws, and 1:1 mix of anorganic bovine bone matrix (ABBM) and particulate mineralized bone allograft. A cross-linked resorbable membrane was placed over the buccal and lingual aspect, and a double line of suturing was performed to secure the tension-free closure. Twelve months postoperatively, 4 mm of VRA was confirmed with CBCT. Two implants were placed with >35 Ncm primary stability. Case 2: A 64-year-old ASA I patient required VRA at the area of the maxillary first premolar. Flap management was performed with the use of periosteal release on the buccal aspect and VRA was performed with a 9-mm self-tapping screw, 1:1 mix of ABBM and particulate mineralized bone allograft, a cross-linked resorbable membrane, and a double line of suturing. Twelve months postoperatively, VRA of 6.2 mm on the buccal aspect and 7.9 mm on the lingual aspect were confirmed with CBCT. An implant was placed with > 35 Ncm primary stability in combination with horizontal ridge augmentation. Case 3: A 70-year-old ASA II patient required horizontal and VRA at the area of the mandibular left canine. Following extraction, a lateral pedicle sliding flap was completed to enhance the soft tissue volume of the site. After 6 weeks, flap management was performed with the use of buccal periosteal release, VRA was completed with two self-tapping screws, 1:1 mix of ABBM and particulate mineralized bone allograft, a cross-linked resorbable membrane, and a double line of suturing. Eight months postoperatively there was 5.3 mm of bone regeneration on the vertical dimension and 3.9 mm on the horizontal dimension. An implant was placed with primary stability of 45 Ncm.CONCLUSION:Successful VRA can be achieved with proper flap management to achieve tension-free closure, a cross-linked collagen membrane, tenting screws, and a combination grafting technique. The VRA ranged from 4.0 to 7.9 mm.