Loss Of Bone Height Research Articles

Cephalometric radiographic comparison of alveolar bone height changes between adolescent and adult patients treated with premolar extractions: A retrospective study

In orthodontic treatment, indication of dental extractions is very common and frequently used in adult patients. This situation is a recurrent concern among orthodontists, since age and extraction treatment are factors that may increase periodontal support loss. Therefore, this study aimed to evaluate adolescent and adult patients, orthodontically treated with maxillary premolar extractions, and compare both groups regarding the changes in alveolar bone height loss, retrospectively. Fifty-five patients were selected from the files of an Orthodontic Department and divided into 2 groups. The adolescent group comprised 30 patients with a mean age of 12.7 years (SD=1.4) and the adult group comprised 25 patients with a mean age of 25.0 years (SD=1.8). Periapical radiographs obtained at pre-treatment (T1) and posttreatment (T2) were evaluated. Wilcoxon tests were used to analyse intragroup treatment changes. Mann-Whitney tests were used to compare intergroup and inter-sex initial and final statuses and treatment changes. P<0.05 is considered to be statistically significant. Statistically significant increases in alveolar bone height loss of the maxillary central incisors were observed on the right and left sides of the adolescent (P=0.001 and P=0.002, respectively) and of the adult (P=0.001 and P<0.001, respectively) groups, during treatment. There were no significant differences in alveolar bone height between initial and final state, in treatment effects between adolescent and adult patients, in extraction patterns, and between males and females. Significant increase in alveolar bone height loss was found in both adult and adolescent patients orthodontically treated with maxillary premolar extractions. However, no significant differences were found regarding alveolar bone height changes after extraction orthodontic treatment between adolescent and adult patients.

Peri-implant marginal bone height changes in implant-retained overdentures constructed by CAD/CAM or conventional processing technique- A one-year clinical follow-up.

Abstract Objective: To evaluate and compare the peri-implant marginal bone height changes in two implant retained overdentures constructed by either CAD/CAM technology or conventional processing techniques. Background: The digital denture using CAD/CAM technology has proved high beneficial to the elders and/or the compromised edentulous patient, as it can help decrease the treatment burden on the patient by reducing the clinical procedures, number of visits, treatment time, and incurred costs. Materials and Methods: Twenty completely edentulous patients participated in this study. The patients were randomly allocated to two equal groups of patients (Group A and group B). Group A patients received complete dentures constructed by conventional heat cured technique. Group B patients received complete dentures constructed by CAD/CAM technology. All the patients received two root form implants bilaterally in the canine regions following delayed loading protocol. Locator attachment was then used to retain the overdenture after 3 months healing period. Marginal bone height was radiographically evaluated at baseline, 6 and 12 months after implant loading. Results: There was a significant loss in marginal bone height around the supporting implants in each study group. However, no significant differences in marginal bone height were recorded between the study groups over the observation period (P > 0.05). Conclusion: Peri-implant marginal bone height changes with overdentures fabricated by CAD/CAM technique are not different from those changes with overdentures fabricated by a conventional heat curd technique.

Impact of piezocision-assisted orthodontics on root resorption and alveolar bone: a prospective observational study.

To assess the impact of orthodontic treatment combined with piezocision (OT-PC) on root structure and alveolar bone. Twelve adults were treated with OT-PC. Pre- and post-treatment CBCT examinations evaluated apical root resorption (ARR) and alveolar bone height and thickness changes. Pre- and post-treatment differences were compared using one-sample t test and Wilcoxon signed-rank test. ARRs were generalized and significantly more severe in both anterior sextants compared with posterior sextants. Bone thickness decreased significantly in the maxilla at mid-root and apex areas. The majority of mandibular alveolar bone dehiscences occurred on the buccal aspect at the mid-root level, especially where thickness was less than 0.3mm. Overall bone height decreased twice as much on the buccal aspect (1.43mm, P < 0.001) compared with the lingual aspect (0.67mm, P = 0.001), most significantly in the lower incisors, where the average median loss was 2.10mm (P = 0.003). OT-PC causes minor negative effects on both alveolar bone and root resorption. Orthodontic treatment combined with piezocision causes minor negative effects on periodontal support. Nevertheless, mild bone height loss on the buccal aspect of the mandibular teeth and root resorption in both anterior sextants have been detected with this new treatment.

Comparison between Osseo densification burs and osteotome technique for closed sinus lift in partially edentulous maxilla (clinical and radiological study)

Dental implants are considered the first choice to replace lost or non-restorable teeth. However, the posterior maxilla remains a challenge in its management because of the quality of bone in the posterior maxilla. Osseo densification (OD) concept has been proposed in the literature to improve primary implant stability, which is an important aspect of osseointegration. Densah bur is novel drills specially designed to enhance a bone density by Osseo densification, which in turn increases primary stability. This present study was conducted to assess crestal sinus floor elevation by osteotome in comparison to Densah bur in the posterior atrophic maxilla. This was a randomized controlled clinical trial conducted on 20 patients to evaluate available crestal bone height loss, implant stability after implant placement in healed posterior maxillary alveolar ridge, whole bone height, Schneiderian membrane trauma, and post-operative complication.

English

Complex crown root fracture has been reported to be 5 % among the traumatic injuries to permanent teeth. In children, when fracture line extended sub gingivally, the treatment option remained was the extraction of tooth. This extraction led to alveolar bone loss and compromised the outcome of final prosthesis. Root submergence is one of the treatments options which can prevent bone loss and prepare future pontic site in a better way. In children, this technique can prevent not only bone loss but also the occurrence of space loss and development of tongue thrusting habit. Crown-root fracture is defined as a fracture involving enamel, dentin and cementum. It is reported in about 5 % of dental trauma to young children where root completion has not occurred.1 Treatment of these complex tooth fractures in aesthetic zone in growing age is always challenging for the paedodontists. The treatment should not interfere with the growth and development. Depending upon the extension of the fracture line which can result in exposure of the pulpal tissue, the crown-root fracture can be divided into two groups: complicated and uncomplicated. 2 Treatment options in cases of complicated crownroot fractures are complex, and require a multidisciplinary approach. Dental traumatology guideline and American Academy of Paediatric Dentistry has suggested fragment reattachment, orthodontic or surgical extrusion of apical portion followed by post placement, root submergence and extraction. 3 Factors like extension and direction of fracture line, pulpal involvement, tooth maturity and the length of root remaining in the alveolus govern the treatment choice. 4,5 Among above mentioned factors, position of facture line is the most important. As in case of subgingival facture line, risk of bacterial contamination is present and further this may result in gingival inflammation.6 When crown root fracture to permanent tooth occurs in mixed dentition period, goals of treatment are to preserve the tooth in arch without disturbing the growth &amp; development of root and arch. But in case of complicated crown root fracture, when extraction is the only choice of treatment, future complications like space loss, crowding, habits like tongue thrusting and importantly loss of alveolar bone height should be kept in mind. Goals of treatment plan in such cases should be elimination of space loss, development of deleterious habit and maintenance of alveolar ridge for future pontic or implant site. Root submergence is the technique with which we can achieve these goals, keeping this in mind this case was planned and reported.

Different Techniques For Sinus Floor Elevation: A Review Part II – Indirect Techniques

The bone available for implant placement may be limited by the presence of the maxillary sinus togetherwith loss of alveolar bone height and it may be increased by augmentation. Minimally invasive sinusaugmentation is an effective solution for this problem. This review explains indirect sinus augmentationprocedures which are less invasive and highly successful if done using prescribed technique.

A 2-plane micro-computed tomographic alveolar bone measurement approach in mice.

PurposeThis study introduces a standardized 2-plane approach using 8 landmarks to assess alveolar bone levels in mice using micro-computed tomography.Materials and MethodsBone level differences were described as distance from the cemento-enamel junction (CEJ) to alveolar bone crest (ABC) and as percentages of vertical bone height and vertical bone loss, comparing mice infected with Porphyromonas gingivalis (Pg) to controls. Eight measurements were obtained per tooth: 2 in the sagittal plane (mesial and distal) and 6 in the coronal plane (mesiobuccal, middle-buccal, distobuccal, mesiolingual, middle-lingual, and distolingual).ResultsSignificant differences in the CEJ-to-ABC distance between Pg-infected mice and controls were found in the coronal plane (middle-lingual, mesiobuccal, and distolingual for the first molar; and mesiobuccal, middle-buccal, and distolingual for the second molar). In the sagittal plane, the distal measurement of the second molar was different. The middle-buccal, mesiobuccal, and distolingual sites of the first and second molars showed vertical bone loss relative to controls; the second molar middle-lingual site was also different. In the sagittal plane, the mesial sites of the first and second molars and the distal site of the second molar showed loss. Significantly different vertical bone height percentages were found for the mesial and distal sites of the second molar (sagittal plane) and the middle-lingual and distolingual sites of the first molar(coronal plane).ConclusionA reliable, standardized technique for linear periodontal assessments in mice is described. Alveolar bone loss occurred mostly on the lingual surface of the coronal plane, which is often omitted in studies.

Noninflammatory Stress-Induced Remodeling of Mandibular Bone: Impact of Age and Pregnancy

The impact of noninflammatory stress, such as aging and pregnancy, on human long bone remodeling is well-established, but little is known about the impact of these stressors on oral bones, including the mandibular bone. To begin to fill this gap in our knowledge, we utilized a mouse mandibular model to evaluate the impact of noninflammatory simple stressors, ie, aging and pregnancy, on bone mandibular architecture and bone density in the mandible using micro-CT. For the present study, mandibles were obtained from both aged and pregnant C57BL/6 mice and analyzed using micro-CT technology. Micro-CT metrics included bone volume fraction (BVF), total volume (TV), tissue density, and apparent density in the mandible on the mandibular area of compact and trabecular bone, in which the teeth are embedded. All bone-related metrics data from aged and pregnant mice were analyzed using ANOVA analysis and visualized in boxplots. Age-dependent bone remodeling occurred over 4 to 18weeks of age, ie, increases in BVF, TV, BV/TV, as well as tissue and bone density. Evaluation of bone remodeling in breeder mice (repeated pregnancy model) and virgin mice (age-matched controls) at 37 weeks of age demonstrated that breeder mice had a dramatic decline in all bone metrics measured. This study underscores the need for more research on noninflammatory stress-related mandibular bone remodeling (eg, age and pregnancy), which compromises bone strength and tooth anchoring. The data also underscores loss of alveolar bone height, as in periodontitis, is an important metric for a more complete assessment of bone loss. This report on mice provides essential data that can be applied for oral-maxillofacial surgeons and periodontists when planning for dental implants in patients with such stressors. Periodontitis related bone loss occurs independent of skeletal homeostasis, although osteoporosis may adversely affect alveolar bone height in humans.

MAXILLARY SINUS LIFT WITH AND WITHOUT SELF HARDENING BIPHASIC CALCIUM PHOSPHATE AND SIMULTANEOUS IMPLANT PLACEMENT

Introduction: Resorption of the upper alveolar bone occurs due to loss of maxillary posterior teeth with subsequent pneumatization of the maxillary sinuses. This bone atrophy may jeopardize the osseointegration of dental implants, therefore it is recommended to increase the bone volume by augmentation of the maxillary sinus floor in order to allow dental implant placement. Sinus lift with biphasic calcium phosphate which is a reliable sinus grafting materials and sinus lift with blood clot only as filling material are two applicable modalities. Objectives: This study was carried out to compare the outcome of sinus lift without grafting material, versus the use of moldable, self hardening calcium phosphate biomaterials with simultaneous implant placement. Materials and methods: This study was designed as a randomized controlled clinical trial, the study population consisted of 20 patients with missing maxillary posterior teeth and residual bone height 5-7mm. The sample was selected conveniently according to a list of inclusion and exclusion criteria, the participants were allocated randomly into two equal groups. All patients had sinus lift using piezosurgery device with simultaneous implant placement. In group I, no grafting material was used. In group II, moldable, self-hardening calcium phosphate was the filling material. Clinical and radiographic evaluations were done through 6 months postoperatively. Results: 6 months postoperatively, Cone beam computerized tomography showed insignificant difference between both groups regarding bone height, density and marginal bone loss. Conclusion: The difference was insignificant regarding bone height, density and marginal bone loss between sinus lift with and without biphasic calcium phosphate.

Etiologia e tratamento das doenças peri-implantares

Objetivo: O propósito do presente estudo foi discutir, através de uma revista da literatura, a etiologia, e os protocolos de tratamento mais indicados para peri-implantite. Métodos: a pesquisa foi realizada nas seguintes base de dados: Scielo e Medline via Pubmed. Como estratégia de busca, foram utilizados os seguintes descritores “Decs”: ‘implantes dentários’, ‘Peri-implantite’, ‘Periodontite’ e ‘Osseointegração’ no Scielo, bem como os meshes no Pubmed: ‘dental implants’, ‘peri-implantitis’ e ‘osseointegration’. Por fim, 24 estudos relacionados ao assunto foram selecionados. Resultados: Os implantes osseointegrados vêm sendo cada vez mais utilizados nas reabilitações orais. Apesar da alta taxa de sucesso e longevidade desse tratamento, alguns casos podem ser acometidos por doenças peri-implantares. A peri-implantite é uma doença infecciosa bacteriana que afeta tecidos moles e duros em torno do implante, podendo ocasionar a perda da osseointegração. Vários fatores são apontados como causadores da perda óssea peri-implantar. Por ser de caráter multifatorial, pode exacerbar a perda de altura óssea, dificultar a cicatrização após cirurgia, e causar a falha do implante. Considerações finais: Os métodos de tratamentos das doenças peri-implantares são os mais diversos possíveis, incluindo modalidades cirúrgicas e não cirúrgicas, além de terapias fotodinâmicas e regenerativas. Por ser uma doença relativamente nova, ainda não há consenso entre os profissionais sobre qual o melhor protocolo de tratamento. Faz-se necessária a realização de novos estudos que possam viabilizar a elaboração de protocolos clínicos para controle e tratamento da peri-implantite.

Instalação de implantes dentários simultâneo a realização de Sinus Lift: Relato de Caso

Devido à perda dentária precoce, a reabsorção alveolar durante toda a vida, assim como a redução de tamanho do rebordo alveolar. A perda de altura óssea leva ao aplainamento do palato, isto leva a pneumatização dos seios maxilares junto com a expansão de suas câmaras, fator este que dificulta o sucesso na fixação de elementos implantáveis. O estudo em questão tem o objetivo de relatar um caso de uma paciente que foi submetida a realização de uma cirurgia de levantamento de seio maxilar e instalação de implantes em área posterior da maxila (ausência dos elementos 15 e 16). A técnica de Sinus Lift foi optada cumprindo a indicação baseada na altura do osso residual, que fora 4mm, feito deslocamento da membrana sinusal e preenchimento da cavidade com enxerto ósseo xenógeno Bio-Oss large 1g, fora feita instalação simultânea dos implantes Neodent Gran Morse 3.5x11.5. Após a realização dos procedimentos será aguardado um período de 6 meses para reabilitação final com a prótese fixa sobre os implantes. Sendo esta diminuição do tempo para reabilitação um dos pontos positivos desta técnica simultânea.

Bilaminar technique for treatment of multiple Miller’s class III recession defects in the mandibular frontal area. A case report

Introduction: Gingival recessions at anterior teeth can be an aesthetic problem for the patients who complain of crown lengthening and can be accompanied by lack of attached gingiva and tooth hypersensitivity. Different surgical techniques (pedicle and free soft-tissue grafting) are proposed for treatment of the exposed root surfaces in the aesthetic zone of dentition. The objective of mucogingival periodontal surgery in the treatment of recession type defects is a complete root coverage and fulfilment of the patient’s aesthetic demands. A bilaminar technique is a suitable technique that can be used for root coverage in the treatment of gingival recessions of a single tooth as well as for root coverage in multiple teeth. The literature survey reports that this technique shows good results in the treatment of Miller’s class I, class II and class III gingival recessions with adequate thickness and height of apical keratinized tissues to the exposed root surface and has high predictability for root coverage. Aim: The aim of this case report is to present the satisfactory aesthetic outcome of bilaminar technique for multiple recession defects of Miller’s class III in the frontal segment of the mandibula. Materials and Methods: Miller’s class III gingival recessions, affecting tooth 41 and tooth 31, were established. A bilaminar technique (connective tissue graft and coronally advanced flap) was used for root coverage of established recessions. Results: The bilaminar technique resulted in complete root coverage and gain of clinical attachment level and keratinized width of gingival tissues. Conclusion: The proposed bilaminar technique presents satisfactory aesthetic outcome in case of thin gingival tissues, interproximal attachment loss, and loss of interdental bone height in the zone between lower central incisors.

Effects of transverse bodily movements of maxillary premolars on the surrounding hard tissue

This experimental study was designed to (1) produce buccal translation of maxillary premolars and (2) evaluate the effects on the buccal alveolar bone. A randomized split-mouth study was designed based on 7 adult male beagle dogs. The experimental side received a custom cantilever appliance fabricated to produce a translatory force through the maxillary second premolar's center of resistance. The contralateral second premolar received no appliance and served as the control. The premolars underwent 6-7weeks of buccal translation, followed by 3weeks of fixed retention. Biweekly tooth movements were evaluated using intraoral and radiographic measurements. Pretreatment and posttreatment models were measured to assess tipping. Three-dimensional microscopic tomography was used to quantify the amount and density of buccal bone. Bone formation and turnover were assessed using fluorescent labeling, hematoxylin and eosin staining, tartrate-resistant acid phosphatase staining, and bone sialoprotein immunostaining. The applied force (100g of force) translated (1.4mm) and minimally tipped (4°) the experimental teeth. Lateral translation produced dehiscences at the mesial and distal roots, with 2.0mm and 2.2mm loss of vertical bone height, respectively. Bone thickness decreased significantly (P<0.05) at the apical (∼0.4mm), midroot (∼0.4mm), and coronal (∼0.2mm) levels. Fluorescent imaging, hematoxylin and eosin staining, and immunostaining for bone sialoprotein all showed new bone formation extending along the entire periosteal surface of the second premolar's buccal plate. Tartrate-resistant acid phosphatase staining demonstrated greater osteoclastic activity on the experimental than that of control sections. New buccal bone forms on the periosteal surface during and after tooth translation, but the amount of bone that forms is less than the amount of bone loss, resulting in a net decrease in buccal bone thickness and a loss of crestal bone.

Photobiomodulation as an adjunctive therapy for alveolar socket preservation: a preliminary study in humans.

Bone remodeling results in loss of alveolar bone height and thickness. Photobiomodulation (PBM) based on photochemical stimulation by low-intensity lasers emerges as an adjunctive therapy for alveolar socket preservation. Our study aimed to evaluate the effects of PBM therapy on alveolar bone repair. Twenty healthy patients in need of bilateral extraction of lower molars were enrolled in this split-mouth randomized and blind clinical trial. The extraction sites were randomly selected to receive either the PBM therapy with a CW GaAIAs diode laser (808nm; 0.028mm2; 0.1W; 3.6W/cm2; 89J/cm2; 2.5J/point) or no treatment (Control). Bone biopsies were harvested 45days after the dental extraction and evaluated using micro-computerized tomography (μCT), morphometric, and histological analysis. Data were compared using the paired t test, and the level of significance was set at 5%. Bone surface (p = 0.029), bone surface/total volume (p = 0.028), trabecular number (p = 0.025), and connectivity density (p = 0.029) were higher at the PBM group compared with Control. The histological observations confirmed the μCT findings. PBM samples exhibited higher number of organized and connected bone trabeculae along with higher density of blood vessels than Control. Control samples displayed a dense and highly cellular connective tissue at the central area accompanied by the presence of immature bone trabeculae at the periphery. Our results indicated that the PBM therapy improved the newly bone trabeculae formation and their connectivity which increased bone surface, indicating the positive effect of the laser on alveolar human socket repair.

Split Crest Technique with Immediate Implant to Treat Horizontal Defects of the Alveolar Ridge: Analysis of Increased Thickness and Implant Survival.

To assess bone thickness augmentation and implant survival in ridges with horizontal atrophy managed through split crest technique with concomitant installation of dental implants. Thirteen patients with maxillary bone atrophy underwent surgery and had their bone thickness assessed through cone beam computed tomography 6months pre- and postoperatively. Comparative measurements of initial and final bone height and thickness were taken using Dolphin Imaging® 11.5 software. The distance between the nasal fossa floor or the maxillary sinus and the alveolar crest determined the bone height, while the measurement of bone thickness took into account the distance between the vestibular cortical bone and the palatal cortical bone at the crest level, and at 5mm and 10mm from it. The bone height loss of 0.68mm was statistically significant (p = 0.01). The average horizontal bone gain was 3.45mm at ridge level, 3.03mm at 5mm from it and 2.42mm at 10mm from it. The mean horizontal gain for the three regions was 2.97mm, and the values were statistically significant for all three regions assessed (p < 0.01). No complications were associated with the surgical procedures, and 23 implants were installed following the surgical expansion. No implants were lost (100% survival). The split crest technique proved to be viable and predictable, enabling a significant increase in ridge thickness and a high percentage of implant survival.

Cone-beam CT analysis on the treatment efficacy in the vertically impacted maxillary central incisors

Objective: To analyze the treatment efficacy in the vertically impacted maxillary central incisors using cone-beam CT (CBCT) and explore the treatment timing and the influence of orthodontic traction on the root development and alveolar bone height in the mixed dentition. Methods: Twenty-two patients with vertically impacted maxillary central incisor who were admitted to the Department of Orthodontics, Stomatological Hospital affiliated to Nanjing Medical University from December 2012 to December 2017 were selected [12 males and 10 females, (9.2±0.9) years]. Based on the dental age, patients were classified as early treatment group (teeth ranging from a third to two thirds of root formation, n=12) and late treatment group (teeth with nearly or fully complete root formation, n=10). The contralateral maxillary central incisor was used as the control. Three-dimensional reconstruction of CBCT before treatment, after treatment and one year after treatment was carried out to measure root length, tooth surface area, tooth volume, labial and lingual apical alveolar bone thickness, the loss of labial alveolar bone height and intraosseous root ratio. The clinical crown length was measured in the mouth. The difference values of the measurement variables between the impacted teeth and the control teeth were calculated and analyzed(measurement values of impacted teeth were subtracted from control values). Results: The values of root length difference beween the impacted teeth and the control teeth in the early and late treatment group were (1.58±1.56) mm and (2.57±1.00) mm, respectively after the treatment and the values were significantly less than those corresponding values before treatment [(3.47±1.40) and (3.36±0.79) mm] (P<0.05). After the treatment, the values of the surface area and volume difference between the impacted teeth and the control teeth in the early treatment group [(0±34) mm(2) and (-10±44) mm(3)] were significantly less than those corresponding values before treatment [(38±31) mm(2) and (55±70) mm(3)] (P<0.05). The value differences of any measurement variables between the early and late treatment group were not significantly different after the treatment (P>0.05). The root length and intraosseous root ratio of the impacted teeth after the treatment in the early and late treatment group were significantly less than those of the control teeth after the treatment (P<0.05). The clinical crown length, the loss of labial alveolar bone height of the impacted teeth after the treatment were significantly larger than those of the control teeth after the treatment (P<0.05). Conclusions: Orthodontic traction promoted the root growth and development of the vertically impacted maxillary central incisors. However, the root length and alveolar bone height still cannot reach the normal level after treatment. Treatment timing had no effect on root development and alveolar bone height of vertically impacted maxillary central incisors in mixed dentition.

Effect Of Polyetheretherketone (PEEK) As Denture Base Material On Peri-Implant Bone Level Changes In Implant Bar Retained Overdenture Using CAD/CAM Technology

Objectives: This research was carried out to evaluate the effect of Polyetheretherketone (PEEK) as denture base material on peri-implant crestal bone level changes in edentulous patients rehabilitated with implant-supported primary-secondary bar overdenture and retained attachments attached the body of the bar constructed by CAD / CAM technology. Materials and Methods: Twenty completely edentulous patients complaining from insufficient retention of their mandibular denture were selected to participate in this study. All the patients were rehabilitated with an implant-supported bar overdenture. For All patients three implants (3.7mm) in diameter (11mm) in length were inserted in the interforamenal region using computer guided surgical template. Four months later, Cast bar with two semi precession attachment at the distal ends of the bar was constructed, The cast bar was scanned using bench laser scanner to obtain virtual model with the bar, the housing on the top of the bar and the female part of the attachment was designed using computer aided designing (CAD) the meld into wax by computer aided manufacturing (CAM). The CAD/ CAM wax pattern of housing and the female part of the attachments were transferred into acetal resin using the injection molded technique. Overdentures were constructed for all patients following the conventional technique. According to the denture base material, a toss coin was made to randomly divided the patients into two equal groups; group I received mandibular implant-retained overdenture were processed using heat cured acrylic resin, following the long curing cycle (heated at 78C° for eight hours), while for group II Polyetheretherketone (PEEK) lower overdenture was constructed, using the injection-molding technique. Radiographic evaluation of peri-implant bony changes was made using standardized long cone paralleling technique with custom made acrylic template and the Rinn-xcp at insertion, six, twelve and twenty four months were measured and statistically analyzed. The significant level was set at P ≤ 0.05P . ANOVA for repeated measures test was used to compare between follow up periods within groups and when statistically significant it was followed by simple main effect analysis with Bonferioni correction. One way ANOVA test was used to compare between groups at different follow up periods. Results. Both groups showed a statistically insignificant increase loss in crestal bone height around the implants. Although the data obtained from table1 revealed increase in the amount of bone changes for group I and Group II compared to group I during the follow up period statistical analysis of the data using ANOVA test for repeated measures revealed no significance difference(P ≥ 0.05) .Conclusion: CAD/ CAM technology and use of Polyetheretherketone (PEEK) as denture base material should be considered whenever possible to preserve the implant supporting structures in implant bar retained overdenture.

Molar inclination and surrounding alveolar bone change relative to the design of bone-borne maxillary expanders: A CBCT study.

To evaluate the molar inclination and skeletal and alveolar bone changes when comparing tooth bone-borne (MSE) and tissue bone-borne type maxillary expanders (C-expander) using cone-beam computed tomography (CBCT) in late adolescence. A sample of 48 late-adolescent patients were divided into two groups according to the type of expander: MSE group (n = 24, age = 19.2 ± 5.9 years) and C-expander group (n = 24, age = 18.1 ± 4.5 years). CBCT scans were taken before treatment and 3 months after expansion. Transverse skeletal and dental expansion, alveolar inclination, tooth axis, buccal alveolar bone height, thickness, dehiscence, and fenestration were evaluated on the maxillary first molar. Paired t-test, independent t-test, Pearson's chi-square test, and Spearman correlation analysis were performed. The MSE group produced greater dental expansion (P < .05), whereas skeletal expansion was similar in both groups (P = .859). The C expander group had more alveolar bone inclination change (P < .01), and the MSE group had more buccal tipping of the anchorage teeth (P < .01 or .001). Buccal alveolar bone height loss and thickness changes were greater in the MSE group (P < .01 or <.001). Formation of dehiscences was more frequent in the MSE group (P < .001), whereas for fenestrations, there were no significant differences between the two groups. Buccal bone height loss in the MSE group had a negative correlation with initial buccal bone thickness. The incorporation of teeth into bone-borne expanders resulted in an increase in the severity of side effects. For patients in late adolescence, tissue bone-borne expanders offer comparable skeletal effects to tooth bone-borne expanders, with fewer dentoalveolar side effects.

Vertebral Fracture Assessment Increases Use of Pharmacologic Therapy for Fracture Prevention in Clinical Practice.

The impact of vertebral fracture assessment (VFA) on lateral spine images in clinical practice on subsequent patient use of fracture prevention medication is unknown. Our objective was to determine the association of prevalent vertebral fracture identified on bone density lateral spine images (positive VFA) with subsequent use of fracture prevention therapy in usual clinical practice, using the Manitoba Bone Density Program database prospective observational cohort. Since 2010, targeted VFA imaging has been done at the time of bone densitometry in Manitoba for 21% of women and men meeting criteria based on age, bone mineral density (BMD), height loss, and glucocorticoid use. Among 6652 treatment-naive individuals with at least 90 days follow-up who had VFA imaging, 923 (13.9%) had one or more definite vertebral fractures identified using a modified algorithm-based qualitative (ABQ) method. For those with a positive VFA, their bone density reports stated the patient was at high risk of subsequent fracture and qualified for fracture prevention therapy. Subsequent osteoporosis treatment initiated within the next 12 months was identified using population-based pharmacy data. Logistic regression models were used to estimate the association of positive VFA with subsequent prescription (Rx), compared to negative VFA. Fracture prevention medication was started by 2127 (32%) individuals, 52.3% with positive versus 28.4% with negative VFA (p value <0.001). This association was substantially stronger in those designated (before VFA results were known) to have low or moderate fracture risk compared to high fracture risk (interaction p value <0.001), and in those with osteopenia (OR 4.51; 95% CI, 3.48 to 5.85) compared to those with osteoporosis by BMD criteria (OR 1.72; 95% CI, 1.43 to 2.08, interaction p value <0.001). Targeted VFA imaging at the time of bone densitometry substantially improves identification of those at high fracture risk and fracture prevention medication use among those with prevalent vertebral fracture. © 2019 American Society for Bone and Mineral Research. © 2019 American Society for Bone and Mineral Research.

REPLACEMENT AFTER RECONSTRUCTION - PROSTHETIC MANAGEMENT OF DISTRACTED MANDIBLE AFTER HEMIMANDIBULECTOMY: A CASE REPORT

Maxillary or mandibular defects due to pathological or traumatic reasons need to be managed with a clinical challenge in order to assure the psychological, esthetical and functional needs of the patient. Post mandibulectomy would result with loss of teeth, bone height, width and deviation of mandible to the affected side. The degree of deviation might be due to the type of surgery and soft tissue contracture. Distraction osteogenesis or osteodistraction is one of the accepted treatment modality for a mandibular defect in which the segments of natural bone distracted sequentially for bone formation by means of intraoral or extraoral device. Here, we report the case of prosthetic management of distracted mandible after hemimandibulectomy in a 27-year-old female. This case succinctly explains the management of post distraction hemimandibulectomy by simple removable prosthetic rehabilitation which assured patient demands. This simple conservative approach was cost-effective and promisable prosthetic replacement in a short period than other treatment options.