PURPOSE:To assess the advantages and disadvantages of the stackable guided approach through a retrospective analysis of 43 edentulous arches rehabilitated with or without bone grafts using a stackable guided approach and an immediate loading protocol. MATERIALS AND METHODS:A total of 284 implants were placed with a fully digital workflow using stacked guides, which aided the design of provisional protheses loaded immediately after implant placement. The primary outcome measure was the survival rate of the implants at 4 months. RESULTS:After a 4-month follow-up period, 10 implants (3.5%) exhibited no osseointegration and were subsequently replaced, resulting in an overall success rate of 96.5%. After 1 year of follow-up, a prosthetic success rate of 100% was observed, with all patients being able to progress to the permanent fixed dentures stage. CONCLUSIONS:Our findings support the use of this protocol for all patients, whether they require bone grafting or not. However, a long term follow-up is essential for a comprehensive evaluation of these treatment outcomes.

Las comunicaciones buconasosinusales son comunicaciones patológicas entre la cavidad oral, el seno maxilar y/o las fosas nasales. La gran mayoría se producen después de la extracción de un diente maxilar. Las otras causas principales son la cirugía de resección de tumores maxilares, la enucleación de quistes maxilares y la cirugía implantológica y preimplantológica. Pueden provocar una sinusitis unilateral crónica que es discapacitante para el paciente. Esta entidad requiere un tratamiento medicoquirúrgico especializado. Las pruebas de imagen ocupan un lugar importante en el diagnóstico, la planificación de la cirugía y también en la prevención de la aparición de comunicaciones buconasosinusales. Existen diferentes técnicas quirúrgicas, que dependen de la localización y del tamaño del orificio.

Le comunicazioni oro-naso-sinusali sono delle comunicazioni patologiche tra il cavo orale, il seno mascellare e/o la cavità nasale. La stragrande maggioranza di esse si verifica in seguito all’avulsione di un dente mascellare. Le altre cause principali sono l’intervento chirurgico per asportare tumori mascellari, l’enucleazione di cisti mascellari e la chirurgia implantare e preimpianto. Possono causare una sinusite cronica unilaterale invalidante per il paziente. Questa entità richiede un trattamento medico e chirurgico specializzato. Gli esami di imaging svolgono un ruolo importante nella diagnosi, nella pianificazione dell’intervento chirurgico ma anche nel prevenire l’insorgenza di comunicazioni oro-naso-sinusali. Esistono diverse tecniche chirurgiche che dipendono dalla posizione e dalle dimensioni dell’orifizio.

The primary objective of this retrospective study was to determine whether patients with a reported allergy to penicillin have an increased risk of postsurgical infections after sinus lifts and onlay grafts. A retrospective cohort study was performed on patients who underwent bone reconstruction procedures between October 2018 and December 2020. Data from all patients operated in one University Hospital for sinus lift or onlay grafts were collected. All surgical procedures studied were performed under preoperative and postoperative antibiotic coverage with either amoxicillin +/- clavulanic acid or clindamycin for patients with reported penicillin allergy. Bone graft-associated infections were recorded. Graft failures were also reported. In this study, 111 patients received bone reconstructions (89 sinus lift, 148 onlay grafts). Among sinus lift, infections occurred in 5 of 89 sites (5.6 %). However, the infection rate was 28.5 % (7 graft sites) for clindamycin and only 3.9 % (82 graft sites) for amoxicillin. Among onlay graft procedures, infections occurred in 25 of 148 sites (16.8 %). However, the infection rate was 56 % (18 graft sites) for clindamycin and only 12 % for amoxicillin (130 graft sites). Penicillin-allergic patients taking clindamycin had a higher risk of infection with an odd ratio of 7.8 (95 % CI 1.1-54.8, P=0.04) and 4.8 (95 % CI 1.9-12.3, P=0.001) compared with non-allergic patients taking amoxicillin for onlay grafts and sinus lift. Penicillin allergy labelling resulting in a clindamycin use after sinus lift and procedures were associated with a higher rate of infection and may be a risk factor for complications related to bone reconstruction surgery. Our data on postoperative infections are consistent with the literature. Penicillin-allergy de-labelling strategy prior to surgery may impact these infection and is now implemented in our center Aucun lien d'intérêt

Aim: To present a technical note on intra-sinusal bone ring concomitant with Le Fort 1 osteotomy. Material and method: A 57-year-old man was referred to our Department for full-mouth rehabilitation. Oral examination identified: uncompensated multiple tooth loss and a class 3 skeletal malocclusion. The treatment plan consisted in a Le Fort 1 osteotomy and short-arch dental implant rehabilitation. Intra-sinusal bone ring technique associated with Le Fort 1 osteotomy were carried out under general anaesthesia. Result: High primary retention was clinically observed of both the implant and the bone graft. Radiographic follow-up demonstrated satisfactory healing of the graft and implant osseointegration. Conclusion: Bone ring technique concomitant with Le Fort 1 osteotomy seems to be appropriate to correct jaw discrepancy associated to a single tooth loss of the upper molar region with residual bone height of at least 3 mm to ensure implant primary stability. (C) 2020 Elsevier Masson SAS. All rights reserved.