Flap Reflection Research Articles

Minimally Invasive Sinus Augmentation: A Systematic Review.

Technology improvement and a better understanding of sinus anatomy and wound healing in the past decade have allowed the development of minimally invasive surgical techniques. This systematic review focused on identifying and describing these techniques for vertical and lateral sinus augmentation (VSA and LSA). Electronic and hand search were conducted to screen the literature published from January 2003 to May 2024. The selected studies had to include detailed techniques for minimally invasive SA. Data extraction included the study types, sample size, technique/instrument details, and outcome measurements. A total of 36 articles (27 VSA, 8 LSA with an additional 1 article included both procedures) with 2732 sinus augmentation met the inclusion criteria. Minimally invasive VSA includes the use of modified rotary instruments with stopper, balloon, hydraulic pressure, digital planning, endoscope, and operating microscope. These techniques aim for conservative flap reflection, precise sinus window preparation, and/or controlled sinus membrane elevation. Most of the selected studies (n = 15) did not report the incidence of sinus membrane perforation. Within the limitations of this review, minimally invasive VSA and LSA achieved sufficient sinus augmentation and implant success with the potential advantages of reduced surgical complications and morbidity. Comparative studies with defined outcomes are encouraged to further validate these useful minimally invasive techniques for SA.

Reconstructive surgical therapy of peri-implant defects with ribose cross-linked collagen matrix and crosslinked hyaluronic acid – a prospective case series

ObjectiveTo investigate the efficacy of ribose-crosslinked collagen (RCLC) matrices functionalized by crosslinked hyaluronic acid (xHya) for reconstructive treatment of class I and III (b-c) peri-implantitis lesions in a transmucosal healing mode.Materials and methodsThirteen patients presenting with 15 implants were included in this prospective case series. Upon flap reflection, the implants were thoroughly decontaminated employing glycine powder air polishing and adjunctive sodium hypochlorite. For defect augmentation, xHyA was administered to the bony defect walls, exposed implant surfaces, and the RCLC matrix before defect grafting. The full-thickness flap was readapted and sutured around the implant neck for transmucosal healing. Baseline and respective values at the 12 months post-op evaluation were recorded for the clinical parameters peri-implant probing depth (PPD), buccal soft tissue dehiscence (BSTD) and bleeding on probing (BoP). Furthermore, two independent investigators analyzed radiographic changes in the defect area. The mean changes for all variables were analyzed with a paired t-test.ResultsThe initial mean PPD was 7.2 ± 1.9 mm, and BoP was present in 63% of sites. After 12 months, PPD at the latest visit was 3.2 ± 0.66 mm, which amounted to a respective 3.9 ± 1.85 mm reduction, while the BoP frequency dropped to 10% at all sites. Radiographic bone fill was accomplished for 62.8% of the former defect area, accompanied by a mean MBL gain of 1.02 mm around the treated implants (all p < 0.001).ConclusionsWithin the limits of this case series, we conclude that the proposed treatment sequence substantially improved peri-implant defects and offered a simplified but predictive technique.Clinical relevanceReconstructive treatment approaches for peri-implantitis are effective but remain non-superior to open flap debridement. Further research on novel biomaterial combinations that may improve reconstructive treatment outcomes are warranted. Ribose-crosslinked collagen matrices biofunctionalized by hyaluronic acid used in this study yield improved clinical and radiographic peri-implant conditions after 12 months.Graphical

Minimally Invasive Surgery: A Paradigm Shift in Surgical Procedures

Minimally Invasive Surgery (MIS) and microsurgery have significantly transformed periodontal treatment by reducing tissue trauma and improving patient outcomes. MIS focuses on minimizing flap reflection and tissue manipulation, preserving blood supply, and ensuring the stability of blood clots at the wound site, which collectively reduce postoperative complications such as shrinkage and discomfort. Microsurgery, enabled by advancements in surgical microscopes, enhances visual acuity and allows for precise surgical interventions. In periodontology, the integration of MIS and microsurgery has led to refined surgical techniques that prioritize minimal tissue disruption, passive wound closure, and the use of specialized microsurgical instruments. These approaches offer significant advantages over conventional flap surgeries, which were often associated with extensive tissue damage, prolonged healing times, and aesthetic compromises. The evolution of MIS in periodontology represents a shift from resection-based procedures to those focused on regeneration, emphasizing the importance of skill enhancement and the adoption of advanced technologies. As MIS techniques continue to develop, they hold the potential to become the standard of care, providing patients with effective, less invasive treatment options that result in better clinical and aesthetic outcomes. The current article's goal was to gather and record different minimally invasive periodontology techniques. Peer-reviewed materials from journals, Medline/PubMed, Google Scholar, and other reviews served as the foundation for the research.

Permanent unilateral visual loss and orbital compartment syndrome following unilateral frontal craniotomy: illustrative case.

Vision loss following supine craniotomy is an unexpected and devastating complication for the patient and the operating team. Postoperative vision loss (POVL) is commonly associated with cardiac, spinal, neck, and prone head surgeries, as they share common risk factors, such as a prone position, intraoperative hypotension, a longer anesthesia duration, and the use of vasopressors. Herein, the authors report a case of irreversible vision loss following a frontal craniotomy in the supine position together with a review of the literature. All published cases in the literature since the first reported case in 1970 are summarized. Possible etiologies and proposed preventive measures are discussed. Different pathologies, such as vascular, intra-axial, and extra-axial lesions, are associated with POVL and have similar clinical courses and nonrecovery rates, which raises the question of whether POVL begins during the exposure part of these surgeries. Preventive measures could include avoiding direct ocular pressure during flap reflection, the use of elastic bands or fishhooks to avoid stretching the orbital contents and impairing venous outflow, and a careful review of the venous drainage of frontal tumors, which could help avoid unnecessary large venous thrombi or waxing. The role of intraoperative visual neurophysiological monitoring in predicting POVL requires further exploration. https://thejns.org/doi/10.3171/CASE2434.

Evaluation of minimally invasive esthetic crown lengthening using an open flap versus flapless surgical approach: A randomized controlled clinical trial.

Esthetic crown lengthening (ECL) is commonly advocated to treat patients with altered passive eruption (APE). Since the introduction of the minimally invasive surgical concept, a limited number of studies have investigated this technique in a standardized manner, with further studies required to verify the validity and predictability of the minimally invasive FL-technique. The current randomized trial compares a minimally invasive (ECL), using piezosurgery with flapless-approach (FL), versus an open-flap (OF) approach in the management of patients with APE Type 1B. Twenty-four patients diagnosed with APE Type 1B were randomly assigned into test (FL) with tunneling approach or control (OF) group with minimally invasive flap reflection (n = 12/group). Postoperative pain was assessed during the first 48 h. Gingival margin (GM) level relative to a custom-made stent (rGM) and patient satisfaction were assessed preoperative, immediately after surgery, at 3 and 6 months postsurgically. Postoperative swelling was reported for the first week postsurgically. Plaque index (PI), bleeding on probing (BoP), clinical attachment level (CAL), pocket depth (PD) and pink esthetic score (PES), were evaluated at baseline and 6 months. Linear regression analysis was conducted for pain. OF-group reported significantly higher pain and swelling scores than FL-group during the first 48 h (p < 0.05). FL-group showed no significant differences regarding rGM between 3 and 6 months, in contrast to OF-group, where a significant decrease in rGM was notable (p < 0.05). No significant differences in PI, BoP, CAL, PD, PES, and patient satisfaction scores were evident between groups (p > 0.05). Regression analysis demonstrated that treatment and gender were significant predictors for pain (p < 0.05). Within the current study's limitations, piezo-surgical ECL with FL-approach presented significantly lower postoperative pain, swelling, and early GM stability compared to OF-approach. Piezosurgical ECL with a FL-approach can be considered a predictable technique with advantages over the OF-approach in the management of patients with APE Type1B.

Clinical and Radiographic Evaluation of Calcium Phosphate-Poly(lactide-co-glycolide) Graft in Regeneration of Intrabony Defects: Randomized Control Trial.

This study aims to evaluate the efficacy of calcium phosphate-poly(lactide-co-glycolide) composite graft in the regeneration of intrabony defects in chronic periodontitis patients over a period of 12 months. A total of 11 systemically healthy chronic periodontitis patients with 22 graftable sites were treated with calcium phosphate cement (CPC) bone graft (control group) and CPC-poly(lactic-co-glycolic acid)(PLGA) composite (test group) after flap reflection and debridement. Clinical parameters such as probing pocket depth (PPD) and clinical attachment level (CAL) were recorded at baseline and 3, 6, 9, and 12 months. Bone probing depth (BPD) and radiographic parameters such as defect depth (DD), changes in alveolar crest level (ALR), defect depth reduction (DDR), and percentage in defect depth reduction (PDDR) were calculated at baseline, and 6 and 12 months. The data were recorded and statistically analyzed. On intragroup comparison, there was a significant improvement in all the parameters over a period of 1 year (clinically and radiographically). However, there was no statistically significant difference between the two groups in any of the parameters though there was a slightly higher bone fill noted in the test group. Even though the CPC-PLGA composite bone graft showed a slight improvement in clinical and radiographic parameters as compared to the CPC graft, it was not statistically significant. A major drawback of Calcium Phosphate cements as bone grafts is their poor degradability. The PLGA microspheres degrade to expose macropores and interconnected pores in the graft substrate which in turn would promote the ingrowth of osteoblasts. Also, this composite graft is mouldable, and resorbable and has been shown to snugly fit into the defects making them a suitable scaffold material. How to cite this article: Ojha M, Pawar Chandrashekara Rao D, Gowda V. Clinical and Radiographic Evaluation of Calcium Phosphate-Poly(lactide-co-glycolide) Graft in Regeneration of Intrabony Defects: Randomized Control Trial. J Contemp Dent Pract 2023;24(12):921-927.

Comparison of Buccal and Lingual-Based Triangular Flap During Mandibular Third Molar Extraction for Reducing Postoperative Complications: A Randomized Controlled Trial.

Surgical removal of the mandibular third molar requires reflection of the mucoperiosteal flap. Several studies have suggested different varieties and innovative designs for flap reflection. We have designed a randomized controlled trial (RCT) to check the feasibility of two flap designs: lingual-based triangular flap (LBTF) and buccal-based triangular flap (BBTF) by calculating the duration of surgery and evaluating postoperative complications such as pain, swelling, and trismus. It was a non-inferiority parallel-group RCT. The trial was registered in the Control Trial Register of India (CTRI/2021/10/037182) and was performed according to Consolidated Standards of Registered Trial (CONSORT) guidelines. Intraoperative surgery time and postoperative pain, swelling, and trismus were measured and analyzed by a two-sample t test. The Chi-square test was used to measure gender distribution in the study. Of the total of 88 required subjects, gender distribution and performed surgical time were statistically insignificant with a p-value of 0.76 and 0.48, respectively. The pain was significantly higher in the LBTF group in the 5th and 7th postoperative days with a p-value of 0.02 and 0.028. The swelling was statistically higher during all the follow-ups except for the 28th day in the LBTF group with values of 0.006, 0.002 and 0.003, respectively. There was no significant difference in inter-incisional distance (IID) between the groups during postoperative check-ups. LBTF shows no edge over BBTF during mandibular third molar disimpaction.

Comparative Evaluation of Efficacy of Platelet Rich Plasma (PRP) and Platelet Rich Fibrin (PRF) in Bone Regeneration after Surgical Removal of Impacted Bilateral Mandibular Third Molars - A Comparative Study.

Aims and Objectives: To compare the efficacy of platelet rich plasma (PRP) and platelet rich fibrin (PRF) in bone regeneration after removal of impacted bilateral third molars. Materials and Methods: The study was carried out as an open clinical trial on 20 patients chosen from the ones referred to the department of Oral & Maxillofacial Surgery for surgical removal of bilateral mandibular third molar. Patients were prepared for surgical procedure, Inferior alveolar nerve block given using 2% lignocaine hydrochloride with 1:2,00,000 adrenaline. Third molar were removed by flap reflection and bone drilling. Finally, PRF in lower left mandibular third molar region and PRP in lower right mandibular third molar region was inserted and wound closure was done. Cone bean computer tomography (CBCT) was made on 1st postoperative day and 4 months after surgery to evaluate alveolar bone height and density. Result: Alveolar bone height and bone density at post-operative 1st day and 4 months were compared between PRP and PRF group. The bone density and bone volume were analyzed, and there was no significant difference between bone density in PRP and PRF at day 1 and 4th month. Conclusion: As per our study and evaluation, in our postoperative follow up there was no statistically significant differences in bone regeneration by placement of PRP and PRF in extracted socket of third molar. Thus, with this study we can conclude that PRF, would be a good option to Oral and Maxillofacial Surgeons in the near future due to ease of extraction.

CBCT Compared to Transgingival Probing as a Tool for Estimating Alveolar Bone Crest Level in Patients with Altered Passive Eruption.

Alveolar bone crest level is essential in determining the need for bone removal in subjects with altered passive eruption (APE). This study assessed the validity of Cone Beam Computed Tomography (CBCT) and transgingival probing. Patients presenting with APE were assessed. Transgingival probing was performed to clinically assess the distance between the cementoenamel junction (CEJ) and the crest of the bone at the mid-point of upper anterior teeth. CBCT was used to assess this distance at the same point. Upon reflection of a full mucoperiosteal flap the actual distance was measured. Similar actual and CBCT measurements of the distance between the CEJ and bone crest at upper right 3, upper left 2 and upper left 3 (P>0.05) were recorded. However, in upper right 2, upper right 1 and upper left 1 the distance was significantly greater on CBCT (P<0.05). No significant difference was detected between transgingival probing and the actual distance at all teeth assessed. Careful transgingival probing provides an accurate measure of the distance between the CEJ and crest of the Bone. CBCT gives an accurate estimate, However, it might not be justified for each patient in the presence of safer methods.

Flap versus Flapless Immediate Implants with Bone Augmentation: A Novel Study.

This study aimed to equate implants placed using a traditional flap elevation technique with implants placed using a flapless process regarding bone healing and success in clinical conditions. Sixty subjects were included in this research work. The participants were randomly divided into two groups. Patients in group A underwent implant placement with the flap elevation technique. Similarly, group B patients underwent implant placement without flap reflection. Parameters such as plaque index, wound healing index, crestal bone loss, and radiograph were considered to estimate the effectiveness of the two techniques. Plaque indexes were improved in both groups. The modified gingival index also improved in all the phases of healing. The flapless method showed a better crestal bone. It can be concluded that this study showed that with the right augmentation techniques, implants could be successfully performed immediate extraction sockets, both with and without elevation of the mucoperiosteal flap.

The Influence of Cone Beam Computed Tomography-Derived 3D-Printed Models on Endodontic Microsurgical Treatment Planning and Confidence of the Operator

IntroductionCurrently, there are no studies evaluating the impact of 3-dimensional (3D) printed models on endodontic surgical treatment planning. The aims of this study were: 1) to determine if 3D models could influence treatment planning; and 2) to assess the effect of 3D supported planning on operator confidence. MaterialsEndodontic practitioners (n = 25) were asked to analyze a preselected cone beam computed tomography (CBCT) scan of an endodontic surgical case and answer a questionnaire that elucidated their surgical approach. After 30 days, the same participants were asked to analyze the same CBCT scan. Additionally, participants were asked to study and to perform a mock osteotomy on a 3D printed model. The participants responded to the same questionnaire along with a new set of questions. Responses were statistically analyzed using chi square test followed by either logistic or ordered regression analysis. Adjustment for multiple comparison analysis was done using a Bonferroni correction. Statistical significance was set at ≤0.005. ResultsThe availability of both the 3D printed model and the CBCT scan resulted in statistically significant differences in the participants' responses to their ability to detect bone landmarks, predict the location of osteotomy, and to determine the following: size of osteotomy, angle of instrumentation, involvement of critical structures in flap reflection and involvement of vital structures during curettage. In addition, the participants’ confidence in performing surgery was found to be significantly higher. ConclusionsThe availability of 3D printed models did not alter the participants’ surgical approach but it significantly improved their confidence for endodontic microsurgery.

Dynamic navigation for zygomatic implant placement: A randomized clinical study comparing the flapless versus the conventional approach

ObjectivesThe assessment of the accuracy of flapless placement of zygomatic implants in edentulous maxilla using dynamic navigation. MethodsA randomized controlled trial was carried out on 20 patients. Patients were randomized into two groups, the flapless (Group 1; n=10) and the conventional (Group 2; n=10). In each case two zygomatic implants were inserted under local anaesthesia, one on the right and one on the left side guided by a dynamic navigation system. The surgical procedure was identical in the two groups except for the reflection of the mucoperiosteal flap which was eliminated in the flapless cases. Postoperative CBCT scans were used to assess the accuracy of the placement of zygomatic implants. ResultsOsseointegration was achieved for all the implants, except one case in the flapless group. Statistically significant differences in the accuracy of the position of the zygomatic implants was found between the flapless and the conventional groups, measured at the apex and the entry points of the implants (p < 0.01). The average apical and coronal deviations were 5 mm and 3 mm, respectively; the angular deviation was 6°, and 2 mm vertical apical disparity was detected between the planned and the achieved surgical position. Perforation of the Schneiderian membrane was noted in three cases, one in flapless group and two in the conventional group. ConclusionsFlapless placement of zygomatic implants guided by dynamic navigation offered satisfactory safety and accuracy. Clinical significanceThis is the first clinical trial to prove the feasibility and accuracy of flapless placement of zygomatic implant with minimal morbidity. The study highlights the innovative reflection of the Schneiderian membrane under guided surgical navigation. The procedure can be performed under local anaesthesia, which offers clinical advantages. Adequate training on the use of dynamic navigation is mandatory before its use in clinical cases.

Efficacy of Celecoxib and Diclofenac Sodium in the Management of Postoperative Pain, Swelling and Mouth Opening after Surgical Removal of Impacted Third Molars: A Split-mouth Randomised Clinical Study

Introduction: The surgical removal of mandibular third molars is generally followed by complaints of pain, trismus, and swelling. The duration of surgery and the reflection of a mucoperiosteal flap have been shown to affect the intensity and frequency of postoperative complaints. Pain from third molar surgery typically begins within one to three hours after surgery and ranges in intensity from moderate to severe. Numerous analgesics have been used to minimise pain and discomfort following the surgical removal of impacted third molars. Commonly used agents include ibuprofen, diclofenac sodium, paracetamol, or their combinations. Newer drugs, such as selective COX inhibitors, have not been extensively used for minor oral surgical procedures. Aim: To compare the clinical efficacy of celecoxib and diclofenac sodium on pain, swelling, and mouth opening after the surgical removal of impacted mandibular third molars. Materials and Methods: A split-mouth randomised controlled clinical trial was conducted in the Department of Oral and Maxillofacial Surgery at BharatiVidyapeeth DU Dental College and Hospital, Pune, Maharashtra, India. The study duration was six months, from August 2022 to January 2023. A total of 21 subjects (11 males and 10 females) who required surgical extraction of an impacted mandibular third molar were selected. All subjects were randomly allocated to receive one of the following treatments twice a day for five days after surgery: celecoxib 200 mg (n=11) or diclofenac sodium 75 mg (n=10). Pain scores were evaluated using the Visual Analogue Scale (VAS) on postoperative day one, two, and three. Swelling and mouth opening were evaluated on Postoperative Day (POD) two and seven. Intergroup comparison was done using Student’s t-test. Results: The mean age of the study participants was 28±1.5 years, and the mean VAS score for pain evaluation with celecoxib was 6.61, 5.38, and 5.00 on day 1 (p=0.027), 2 (p=0.972), and 3 (p=0.809), respectively. The difference in swelling values for the celecoxib group was significant, while there were no significant differences in the values of mouth opening. Conclusion: It was concluded that celecoxib 200 mg is a better analgesic and anti-inflammatory compared to diclofenac sodium 75 mg. Celecoxib was easily tolerable and comfortable for the patients. There was no significant difference in the values of mouth opening.

Facial implant gingival level and thickness changes following maxillary anterior immediate tooth replacement with scarf-connective tissue graft: A 4-13-year retrospective study.

A scarf-shaped connective tissue graft can be placed at the facial and proximal aspect of the peri-implant soft tissue zone during immediate implant placement and provisionalization (IIPP) procedures in the esthetic zone to optimize implant esthetics without the need of flap reflection. This retrospective study evaluated soft tissue stability after scarf-connective tissue graft (S-CTG) in conjunction with IIPP procedures in the esthetic zone. Patients who received IIPP with S-CTG with a minimum 1-year follow-up were evaluated. Mid-facial gingival level (MFGL) change and mid-facial gingival thickness (MFGT) change were measured and compared at the pre-op (T0), IIPP + S-CTG surgery (T1), follow up appointment with MFGT measurement (T2), and latest follow-up appointment (T3). Implant success rate and graft necrosis were also recorded. A total of 22 IIPP and S-CTG procedures in 20 patients were evaluated in the study. After a mean follow-up of 8.2 years (3.9-13.4) (T3), all implants remained osseointegrated (22/22 [100%]), with statistically insignificant mean midfacial gingival level change of -0.19 mm (-1.5 to 0.8). Statistically significant difference in midfacial gingival thickness (MFGT) was noted (2.5 mm [1.8-3.5 mm]) after a mean follow-up time (T2) of 2.3 years (1-8.6) when compared with MFGT at baseline (1.1 mm [0.6-1.3 mm]) (T1). Necrosis of S-CTG during initial healing phase was noted in 9% (2/22) of the sites. Within the confines of this study, scarf-connective tissue graft at time of immediate implant placement and provisionalization can thicken the gingiva and maintain the gingival level at the critical soft tissue zone. Managing the soft tissue zone is as important as that of the hard tissue zone for peri-implant esthetics. Connective tissue graft is one of the methods that can enhance the final esthetic outcomes. This retrospective study has demonstrated that Scarf-CTG technique is an effective treatment modality to maintain soft tissue stability.

Removal of Partially Impacted Mandibular Third Molars with and without Flap: A Comparison of Two Surgical Techniques

Objectives: To compare with and without flap removal of partially impacted mandibular third molars in terms of mean pain and mean swelling on the second post-operative day.&#x0D; Study Design: Quasi-experimental study.&#x0D; Place and duration of Study: Department of Oral and Maxillofacial Surgery, Armed Forces Institute of Dentistry, Rawalpindi Pakistan, from May to Nov 2021.&#x0D; Methodology: Sixty cases (30 in each Group) with partially impacted mandibular third molar with mesioangular impaction aged 18-45 years were included. Random allocation of patients was done to the removal with flap (Group-A) and without flap (Group-B). On the second post-operative day, the outcome of pain and swelling in patients was measured based on the Visual Analogue Scale (VAS between 0 to 10 cm points for pain and swelling on a scale of 0 to 3). &#x0D; Results: The mean pain score was 5.67±1.30 in Group-A (with flap) versus 2.97±1.25 in Group-B (without flap) (p-value,&lt;0.001). The mean swelling score was 5.40±1.16 for Group-A (with flap) versus 2.97±1.15 for Group-B (without flap) (p-value,&lt;0.001).&#x0D; Conclusion: The surgical extraction of the partially impacted mesioangular mandibular third molar without buccal flap reflection and bone ostectomy resulted in less post-operative pain and swelling than surgery with buccal flap reflection and bone ostectomy.

The Palatally Impacted Canine, Preorthodontic Uncovering Technique, and Spontaneous Eruption: A Case Series.

Maxillary canines are the second most commonly impacted teeth, with mandibular third molars being the most commonly impacted teeth. One-third of the impacted maxillary canines are labially impacted, and the remaining two-thirds are palatally impacted. Palatally impacted canines (PICs) comprise approximately 1% to 2.5% of the general population. These impactions can be managed with preventive, interceptive techniques or surgical uncovering. If preventive or interceptive measures are unsuccessful in allowing the canine to erupt, there are many techniques that can be employed to uncover the PIC. Canines that are very superficially impacted can be uncovered with a simple gingivectomy. Canines that are more deeply impacted will require flap reflection, bone removal, and the placement of some type of orthodontic bracket. Most often, the surgeon will attach a chain to the impacted tooth so the orthodontist can immediately begin movement with some form of traction device. The preorthodontic uncovering technique (POUT) allows spontaneous eruption of the impacted tooth without active orthodontic force. When this technique is employed early (approximately 6 months before orthodontic treatment is initiated), it will save considerable time and trauma in erupting these teeth. Research has shown that this technique decreases orthodontic treatment time to properly position these teeth. In addition, this technique has been shown to be healthier for the bone and root structure of the impacted tooth and surrounding teeth. This article elucidates the benefits of the POUT when uncovering simple and very complicated PICs.

Influence of apico-coronal positioning of tissue-level implants on marginal bone stability during supracrestal tissue height establishment: A multi-center prospective study.

Supracrestal tissue height establishment is a crucial factor influencing peri-implant marginal bone modifications prior to prosthesis delivery. If mucosal thickness is insufficient, peri-implant marginal bone resorption occurs to allow appropriate supracrestal tissue height formation. This study evaluates if marginal bone resorption occurring around tissue-level implants before prosthetic loading could be compensated by adapting apico-coronal positioning to mucosal thickness. Patients requiring placement of one single implant in the posterior mandible were treated with tissue-level implants with a 3-mm high transmucosal machined component and moderately rough implant body. Based upon vertical mucosal thickness measured after buccal flap reflection, implants were placed with the treated part: (group 1) 2 mm below crestal level in presence of thin mucosa (<2.5 mm); (group 2) 1 mm below the crestal level in presence of medium mucosa (2.5-3.5 mm); (group 3) at equicrestal level in presence of thick mucosa (>3.5 mm). Forty-nine implants, placed in 49 patients were included in final analysis (group 1: 18 implants; group 2: 16 implants; group 3: 15 implants). Mean marginal bone resorption after 5months of healing was 0.66 ± 0.49 mm, 0.32 ± 0.41 mm, and 0.22 ± 0.52 mm in groups 1, 2, and 3, respectively. Inter-group analysis highlighted significant differences between the three groups after ANOVA test (p=0.025). However, adaptation of apico-coronal implant positioning in relation to mucosal thickness, allowed to avoid early exposure of the treated surface in 100%, 93.7%, and 53.3% of the implants in groups 1, 2, and 3, respectively. During supracrestal tissue height formation, tissue-level implants inserted adapting apico-coronal positioning in relation to mucosal thickness exhibited greater marginal bone resorption at sites with thin mucosa than at sites with medium or thick mucosa. However, anticipating supracrestal tissue height establishment by adapting apico-coronal implant positioning in relation to mucosal thickness may effectively prevent unwanted exposure of treated implant surface.

Zygomatic implants using dynamic navigation

Over the decades, surgeons innovated a myriad of methods to assist patients with the replacement of missing teeth with fewer complications and accurate placement. A review of the literature confirmed that zygomatic implants are effective in maxillary reconstruction. Recently, dynamic navigation has proven effective in guiding the insertion of dental implants through the real-time tracking of the surgical instruments during surgery in relation to the planned position on the CBCT of the patients. This method helped improve the accuracy of insertion of dental implants. A prospective randomized control trial was conducted on zygomatic implants inserted using dynamic navigation. A test group and a control group with 20 implants each group were set. In the test group, dynamic navigation guided insertion of zygomatic implants with the reflection of the mucoperiosteal flap was performed. In the control group, flapless insertion of the zygomatic implants was performed. Flapless surgery is associated with less swelling, edema, erythema, and alteration in sensation. The patient could eat and maintain oral hygiene immediately from the very next day. No infections were reported postoperatively. Dynamic navigation-guided insertion of zygomatic implants was effective in maxillary rehabilitation.

Immediate tooth extraction, placement of a tapered implant, and provisionalization in the esthetic zone

Purpose: This clinical report describes an immediate tooth extraction, followed by placement and pro- visional restoration of a dental implant in the prepared socket of a left maxillary central incisor. Materials and Methods: The tooth was extracted with minimal hard and soft tissue trauma and without flap reflection. A flapless, transmucosal surgical approach was used to prepare the socket and insert a tapered implant. The implant was immedi ately restored with a provisional abutment and crown without occlusal contacts. Results: During the period of provisional progressive loading, no significant soft tissue contraction was observed related to noninvasive operating techniques and the immediate insertion of the provisional restoration. The patient exhibited no clinical or radiologic complications through 8 months of clinical moni toring after loading. Conclusion: The Pivot Morse Line® implant and all-ceramic restoration provided the patient with immediate esthetics, function, and comfort without any complications during the postloading follow-up period.

Management of endo perio lesion with class iii furcation defect –A case report

The primary aim of periodontal and endodontic therapy is to restore the lost periodontium and maintain the natural dentition. An ideal endodontic treatment involves removal of any infected pulp completely, preventing or minimizing any chances of reinfection, with proper irrigation and drying of canals, care to be taken not to break any file during cleaning and shaping of canals, proper obturation and not over or under filling of canals, proper sealing, proper restoration and an ideal crown placement. An ideal periodontal treatment involves scaling and root planing, proper reflection of flap to visualize the furcation areas, removal of diseased soft tissue surrounding the lesion and furcation areas and giving adequate oral hygiene instructions. Based on grade of furcation defects, suitable treatment modalities should be chosen. This case report aims at managing an endo-perio lesion involving class III furcation defect using tunneling technique.