Full-thickness Mucoperiosteal Flap Research Articles

Clinical Outcomes of Titanium Zirconium and Titanium Dental Implants under Immediate Functional Loading in Posterior Mandibular Region.

Studies comparing the clinical performance of titanium zirconium (Ti-Zr) and titanium (Ti) dental implants subjected to immediate loading in the posterior mandibular region where occlusal forces are higher are sparse in the current literature. Hence, the study aimed to evaluate and compare the clinical outcomes of Ti-Zr and Ti dental implants under immediate functional loading in the mandibular posterior region. Forty participants fulfilling the predetermined selection criteria were randomly grouped based on dental implant used; Titanium zirconium (Ti-Zr):20, and Titanium (Ti):20. Dental implants were placed through a standard full-thickness mucoperiosteal flap approach and loaded immediately fulfilling the principle of implant protective occlusion. Clinical parameters including crestal bone loss (CBL), modified plaque index (MPI), probing depth (PD) and modified sulcular bleeding index (MSBI) were measured at baseline and follow-up visits (4, 8, and 12 months). Obtained data were compared with standard tests such as the t-test, Chi-square test, and Mann-Whitney U test. On intergroup comparison, CBL was more in the Ti-Zr group as compared to the Ti group at 4 months (0.72 ± 0.16 mm versus 0.70 ± 0.13 mm), but it was less at 8 months (1.08 ± 0.16 mm versus 1.13 ± 0.13 mm) and 12 months (1.19 ± 0.17 mm versus 1.24 ± 0.12 mm) but the difference was not statistically significant (P > 0.05). Mann-Whitney test also revealed no statistically significant difference in MPI, PD and MSBI at 4 months, 8 months and 12 months recall (P > 0.05). CBL and periodontal parameters of Ti-Zr dental implants were found similar to Ti dental implants under immediate loading in the posterior mandibular region. However, further studies are needed to determine its long-term efficacy and cost-effectiveness.

Minimally invasive flapless approach in dental implant – A review

Dental implants are surgically placed into or on top of the jawbone of the patients. They are considered to be an important contribution to dentistry as they have revolutionized the way by which missing teeth are replaced with a high success rate. Before dental implants, dentures and bridges were used, but dental implants have become a very popular solution due to the high success rate and predictability of the procedure, as well as its relatively few complications. A full thickness mucoperiosteal flap is used in a typical dental implant placement procedure to expose the alveolar ridge. Dental implants are then inserted in the bone, and the flaps are adapted using sutures. Over the past three decades there have been several alterations to this flap design, now integrating esthetic considerations in the critical esthetic zones of the dentition. Flapless implant surgery is one of these alterations that is quickly rising in popularity. This review will highlight about the techniques, advantages and disadvantages of flapless implant surgery over the traditional implant surgery.

Post-operative histogenesis in the allogeneic dura mater placement area in a laboratory rat experiment: laboratory and histomorphological research

Relevance. Gum recession is a pathology often encountered both in Russia and worldwide. Modern surgical methods allow for the complete elimination of recession signs when adequately choosing strategy, tactics, methodology and surgical treatment protocol; for complication prevention and stable long-term outcome. Autograft and allogeneic dura mater as a grafting material for creating/increasing the volume of the attached gingiva in recession treatment have comparable results in all clinical indications. The reason for result stability and the absence of relapse is poorly studied; the data are scarce and do not give a full understanding. In the scientific literature, we did not encounter histological tissue composition analysis in the graft placement area. In recession coverage, the graft is partially placed subperiosteally (in the tooth root area) and partially in the thickness of the soft tissues of the gum. Purpose. The study aimed to determine the histological composition of tissues in the dura mater placement area, to compare with the control group without a graft, and to assess follow-up changes in the graft and surrounding tissue reaction as a result of cellular-level surgery.Material and methods. A laboratory histomorphological examination involved 60 laboratory rats. All underwent surgery adequate to gum recession surgical treatment technique: the control group had no graft, and the study group had allogeneic dura mater. The samples were collected on the 3rd, 7th, 14th, 28th, 90th and 107th days after surgery.Results. In all cases, the tissue complex regenerated, and the reaction to the operation was the same. The plastic material replacement was at the same period. Bone tissue replaced subperiosteally placed graft, connective tissue intragingivally. Gingival biotype thickening was considerably due to the surgical trauma, less – from the graft material. Allogeneic dura mater stimulated earlier ossification.Conclusion. In all cases, the use of grafting material for surgical gum recession coverage is justified if placed subperiosteally, forming a full-thickness mucoperiosteal flap surgically (with a scalpel) to preserve the cambium periosteum on the flap. Bone volume and buccal cortical plate reconstruction/ regeneration support soft tissues of the newly formed ligament of the tooth and prevent recurrent recession formation. The formation of bone and connective tissues in the dura mater placement area determines the result stability of gingival recession surgical treatment and a long-term favourable prognosis without complications and relapse.

A Multi-Centre Randomized Controlled Trial Comparing Connective Tissue Graft with Collagen Matrix to Increase Buccal Soft Tissue Thickness: A Cone-Beam CT Analysis.

(1) Aim: a cross-linked porcine-derived collagen matrix (CMX) has been developed for soft tissue augmentation. Although this grafting material does not require a second surgical site, recent findings have indicated deeper pockets, more marginal bone loss and more midfacial recession in the short term when compared to connective tissue graft (CTG). Hence, the aim of the present study was to evaluate the safety of CMX based on buccal bone loss over a one-year period. (2) Methods: Patients who were missing a single tooth in the anterior maxilla were included, in whom the failing tooth had been removed at least 3 months prior and who presented a horizontal mucosa defect. All sites had a bucco-palatal bone dimension of at least 6 mm as assessed on Cone-Beam Computed Tomography (CBCT) to ensure complete embedding of an implant by bone. All patients received a single implant and an immediate implant restoration using a full digital workflow. Sites were randomly allocated to the control (CTG) or test group (CMX) to increase buccal soft tissue thickness. All surgeries were performed by means of full thickness mucoperiosteal flap elevation, placing CTG and CMX in contact with the buccal bone wall. Safety was assessed by evaluating the impact of CTG and CMX on buccal bone loss over a one-year period using superimposed CBCT scans. (3) Results: thirty patients were included per group (control: 50% females, mean age 50; test: 53% females, mean age 48) and 51 (control: 25; test: 26) could be analyzed for buccal bone loss. At 1 mm apical to the implant-abutment interface (IAI), most horizontal resorption was found pointing to 0.44 mm in the control group and 0.59 mm in the test group. The difference of 0.14 mm (95% CI: -0.17-0.46) was not statistically significant (p = 0.366). At 3 mm and 5 mm apical to the IAI, the difference between the groups was 0.18 mm (95% CI: -0.05-0.40; p = 0.128) and 0.02 mm (95% CI: -0.24-0.28; p = 0.899), respectively. Vertical buccal bone loss amounted to 1.12 mm in the control group and 1.14 mm in the test group. The difference of 0.02 mm (95% CI: -0.53-0.49) was not statistically significant (p = 0.926). (4) Conclusions: In the short term, soft tissue augmentation with CTG or CMX results in limited buccal bone loss. CMX is a safe alternative to CTG. Longer follow-up is needed to assess the impact of soft tissue augmentation on buccal bone.

A Novel Method to Fix Paediatric Mandibular Fracture using 2-0 Polyglactin Suture: A Technical Note.

Reduction and stabilisation of fractures at the earliest is valuable in the paediatric age groups. This novel technique focuses on stabilisation of the fracture fragments using vicryl, which has an added advantage to conventional plating and wiring. This study aimed on a novel cost-effective technique of stabilising the paediatric mandibular fracture using 2-0 resorbable polyglactin 910 suture with minimal trauma to tooth buds and bone and adequate stability. After raising a full-thickness mucoperiosteal flap, the fracture segments are identified and reduced. 1.6mm drill bit is used to make holes through the buccal cortex on either side of the fractured segment in an anteroposterior direction. The patency of holes is checked by passing a long 26-gauge wire. The proximal end of the wire is bent into a loop, a 2-0 resorbable polyglactin suture (vicryl) is passed through this loop and the loop is pressed in place to lock the suture. The wire with the attached suture is pulled through the distal end. Once the suture is secure in place, the 26G wire is cut, and the two ends of sutures are knotted and stabilised. The mucoperiosteal flap is then closed. A novel method of stabilisation of paediatric fracture without hampering the tooth and jaw growth, especially in the financially unstable population. 2-0 polyglactin 910 suture is cost-effective, $2 US, compared to resorbable plates costing about $150 US, and easily available. Polyglactin 910 takes 40-60 days for resorption, and half-life tensile strength is 2 weeks; thus, it gives adequate stability and time for callus formation and does not damage the tooth buds or bone by cutting through them.

Fenestration of the Mandibular Buccal Cortex by the Inferior Alveolar Bundle: A Case Report

A precise knowledge of the anatomy of the Mandibular Canal is essential while performing oral surgical procedures in order to avoid any risk of injury to the inferior alveolar neurovascular bundle. The presence of anatomical variations associated with the mandibular canal has great clinical implications during such surgical procedures.
 Various anatomical variations may not be well appreciated entirely in two-dimensional images like Orthopantomograph (OPG). In such cases, Cone Beam Computed Tomography (CBCT) plays a crucial role in facilitating the localization of anatomic structures, their significant variations and provides data concerning bone morphology.
 In this case report, A 27 year old male patient reported with the chief complaint of intermittent pain in left lower back region of the mouth. Clinical and radiographic examination (OPG) revealed impacted lower third molar in the left back region of the jaw. While raising a full thickness mucoperiosteal flap, we encountered fenestration of the left mandibular buccal cortex by the inferior alveolar nerve which is a 6th reported case without pathology.
 The aim of this article is to add on a rare anatomical variation in the existing literature i.e. fenestration of the mandibular buccal cortex by the inferior alveolar bundle, encountered accidently during exposing mandibular third molar and confirmed by cone beam computed tomography (CBCT).

Impacted Maxillary Canine with Curved Apex: Three-Dimensional Guided Protocol for Autotransplantation

IntroductionMaxillary canines play a crucial role in dental and facial aspect, arch expansion, and efficient occlusion. When surgical exposure measures cannot be executed or the patient does not agree to take the treatment, autotransplantation should be considered. The aim of this case report was to describe a novel surgical technique using virtually planned three-dimensional (3D)-printed templates for guided apicoectomy and guided drilling of the recipient site for autotransplantation of an impacted maxillary canine with a curved apex. MethodsA 42-year-old man complaining of pain and increased mobility in the maxillary left primary canine came to the clinic. Autotransplantation of the impacted canine was completed using altered methods from guided implant surgery to manufacture 3D-printed templates. After a full-thickness mucoperiosteal flap elevation, the surgical template for the guided osteotomy and apicoectomy was inserted. This 3D-printed guide allowed the clinician to perform a quick and precise removal of the curved apex, providing an atraumatic extraction of the impacted canine throughout the cyst. Three further 3D surgical guides for implant burs and a 3D replica tooth were printed to modify the recipient socket. After the final position, the tooth was semi-rigid splinted to the adjacent teeth. ResultsFollow-up at 2 years showed complete regeneration of the palatal defect and remodeling of the bone surrounding the maxillary canine. ConclusionsDigitally planned procedures can facilitate the complex execution of an autotransplantation, reducing the treatment chair time and the morbidity for the patient as well as increasing the predictability of the result.

Evaluation of Preventive Treatment Protocols for Patients under Antiresorptive Therapy Undergoing Tooth Extraction at a Swiss University Clinic.

Antiresorptive agent-related osteonecrosis of the jaw (ARONJ) is a dreaded complication in patients with compromised bone metabolism. The purpose of the present study was to examine the occurrence of ARONJ and its related factors among patients with a history of antiresorptive therapy undergoing tooth extraction using preventive protocols at a Swiss university clinic. Data were retrospectively pooled from health records of patients having received a surgical tooth extraction between January 2015 and April 2020 in the Clinic of Cranio-Maxillofacial and Oral surgery, University of Zurich. A total of 970 patients received an extraction with flap elevation or wound closure during this period. A total of 104 patients could be included in the study. Furthermore, variables including age, gender, smoking, risk profile, choice, indication and duration of antiresorptive therapy, number of extractions, extraction site, surgical technique, choice and duration of antibiotics as well as the presence of postoperative inflammatory complications were assessed. Overall, 4 patients developed ARONJ (incidence of 3.8%) after tooth extraction at the same location, without previous signs of osteonecrosis. Preventive methods included predominantly primary wound closure using a full thickness mucoperiosteal flap and prolonged perioperative antibiotic prophylaxis. In accordance with current literature, the applied protocol showed a reliable outcome in preventing ARONJ when a tooth extraction is required.

Treatment Modalities for Multiple Gingival Recession– A New Prospects

This case series reports the various treatment modalities to treat the multiple recessions. Gingival recession is a widespread clinical manifestation affecting single or multiple root surfaces at all teeth types. Periodontal reconstructive surgery consists of various mucogingival procedures. The primary goal of these procedures is to benefit periodontal health through the reconstruction of lost hard and soft tissues, or by preventing its additional loss, and also enhancing the esthetic appearance. Platelet-rich fibrin is a second generation platelet concentrate and is defined as an autologous leukocyte and platelet-rich fibrin biomaterial. Care was taken not to extend the incisions till the tip of the interdental papilla. A full thickness mucoperiosteal flap was reflected, extending beyond the mucogingival junction. A wide range of surgical techniques has been proposed for the treatment of the gingival recessions, each with its advantages and disadvantages. To provide predictable and long-term results, it is of paramount importance that the surgical technique is individually selected, taking into account several crucial factors such as the size of the defect, the width of the keratinised gingiva apical to the defect and the thickness of the flap.

Socket preservation and reconstruction: A case report with follow up of 9 months

Progressive bone resorption after extraction of tooth may lead to prosthetic-driven and surgical difficulties when a dental implant has to be placed after extraction of tooth. This case report discusses an irreparable upper right first premolar with a dehiscence on buccal wall. A conservative tooth extraction was performed and the dehiscence was exposed after reflecting a full thickness mucoperiosteal flap. The socket and the dehiscence were then grafted using Nova bone putty and amnion membrane. After a healing period of 3 months and 9 months a CBCT analysis was done to check for regeneration in the grafted site. It can be concluded that grafting technique can lessen the alveolar bone resorption in the socket with dehiscence.

Alveolar ridge split technique and immediate implant placement in atrophic maxilla. Case series

Background: Alveolar ridge split technique (ARST) is a surgical procedure performed for horizontal ridge augmentation in cases of narrow crestal ridges. It is a biologically oriented technique, taking advantage of the osteogenic and osteoconductive dynamic of the native bone. Recently, the utilization of devices such as thin diamond disks or piezoelectric cutting devices has enhanced ARST success rate, reduced surgical time and patient's morbidity, regardless of bone quality. Aim/Hypothesis: The purpose of this poster is to present and discuss our experience in a series of clinical cases where ARST was performed for horizontal bone augmentation with simultaneous implant placement, using classical or piezoelectric-assisted surgical procedures. Materials and Methods: ARST was performed in 6 patients with 10 sites of horizontal defects. Under local anesthesia, a crestal incision was performed and a full thickness mucoperiosteal flap was reflected. Initial osteotomy was done using the classical technique in 6 cases (diamond disk, rotary burs), while a piezoelectric device was used to the remaining 4 cases. Osteotomes and chisels with gradually increasing dimensions were used to expand the alveolar ridge to facilitate the immediate placement of 18 implants, approximately 2 mm subcrestally in order to prevent marginal bone loss. The remaining space between bony plates was filled with allograft or xenograft and covered with collagen membrane in 9 cases, while in one case no bone graft or membrane were used. Primary closure without tension was achieved with periosteum releasing incisions of the buccal flap. Post-operative instructions included administration of antibiotic and analgesic, chlorhexidine solution, smoke cessation and thorough oral hygiene. Results: Sutures were removed 10 days postoperatively. Follow up was uneventful for 5 out of 6 patients. One patient did not comply with the postoperative instructions, applying poor oral hygiene and continuing smoking as before which resulted in exposure of the collagen-membrane the second week, leading to secondary wound closure compromising the augmentation. A new CBCT was performed 4 months following the split which revealed successful bone augmentation and implant osseointegration without any significant bone loss around the implants. Oral rehabilitation with either fixed or removable prosthetics was accomplished and the patients remain under systematic review. Conclusions and Clinical Implications: ARST is a predictable and reliable procedure characterized by its low invasiveness and morbidity. The major advantage is the simultaneous bone augmentation- implant placement, which provides reduced treatment time and cost. Piezoelectric devices make the split technique easier and safer, decreasing the risk of complications in the treatment of extremely atrophic crests. ARST's success and efficacy depends greatly on patient selection in order for the basic anatomical criteria to be fulfilled. Keywords: ridge splitting, horizontal bone augmentation, piezoelectric device

The Effect of Using Full Thickness Mucoperiosteal Flap versus Low Level Laser Application on Orthodontic Tooth Movement Acceleration

Purpose: This study aimed to evaluate the effect of using full thickness mucoperiosteal flap (FTMPF) elevation only versus low level laser therapy (LLLT) on acceleration of orthodontic tooth movement. Material and Methods: This study was a split mouth design study included 32 side according to sample size calculation. Those sides were divided into 2 groups. Group 1divided into (group 1a: 8 sides with FTMPF, group 1b:8 sides control). Group 2 (group 2 a: 8 sides with LLLT, group 2b: 8 sides control). Extraction of the first maxillary premolars followed by canine retraction in the extraction space with maximum anchorage were indicated. FTMPF was elevated from the mesial interdental papilla of maxillary canine to the mesial interdental papilla of second maxillary premolar. LLLT was applied at the 3,7,14,28.56 days of retraction. During retraction study model for all patients were taken at 2nd, 6th, 14th,16th weeks and at the end of retraction (I1,I2,I3,I4,I5 or overall interval). 3D laser scanning and digital superimposition was done to measure the rate of canine retraction and anchorage loss. Results: Statistical analysis showed a significant difference in the distance moved by maxillary canine and weekly rate of retraction between the FTMPF and its control in I1, I2 and I5 and in I2, I3 and I5 LLLT and its control. The total retraction time was significantly decreased in both FTMPF and LLLT in comparison to control. Conclusions: FTMPF could accelerate orthodontic tooth movement with 25%, while LLLT could achieve 20% decrease with no significant difference between both techniques.

MANAGEMENT OF LATERAL PERIODONTAL CYST EMBEDDED IN BONE

Lateral periodontal cysts (LPCs) are odontogenic cysts with rare occurrence and developmental origin. A 46-year old female patient, chronic smoker with non-contributory medical history presented with dull pain/pressure in the left mandibular premolar region and the associated teeth were vital on pulp testing. Periapical radiograph revealed a well- circumscribed, radiolucent region measuring <1cm in diameter with loss of lamina dura in teeth, which were in contact with the lesion, and interproximal buccal bone loss. The clinical and radiographic features were suggestive of LPC and the patient was advised to undergo conservative surgical management of the cystic lesion. The full-thickness mucoperiosteal flap was elevated, complete debridement was done, and enucleation was performed using a surgical curette. The flaps were approximated and then sutured. Histological examination was performed on the tissue sample obtained during surgery and the findings confirmed the diagnosis of LPC. The post-operative follow-up was uneventful with no biological complications such as pain, swelling, or bleeding at the surgical site and periodontal healing was satisfactory.

Full Thickness Mucoperiosteal Flap Versus Low Level Laser in Orthodontic Tooth Movement Acceleration

Full Thickness Mucoperiosteal Flap Versus Low Level Laser in Orthodontic Tooth Movement Acceleration

Flap design: Comparison of ward’s flap versus modified ward’s flap in surgical extraction of impacted mandibular third molar.

To compare the Ward’s Flap Versus Modified Ward’s flap in relation to access, healing &amp; postoperative complications in surgical extraction of mandibular third molar impaction. Study Design: Comparative Cross Sectional. Setting: Department of Oral &amp; Maxillofacial Surgery LUMHS Jamshoro/Hyderabad: Period: March 2017 to November 2017. Materials and Methods: The history, clinical examination and radiographs (OPG and periapical) had done by team of researchers and recorded on proforma. After selection of patient into either group (Group A=Wards Flap, Group B Modified Wards), the surgical extraction was carried out under local anesthesia. For group A, a standard full thickness mucoperiosteal flap (ward’s flap) was raised. The incision was given mesial to the impacted lower third molar. For group B, a standard full thickness mucoperiosteal flap (Modified ward’s flap) was given mesial to second molar. At the end of the surgery, the flap design used for the extraction of impacted lower third molar tooth and the duration of each operation (from the first extraction maneuver to the completion of the last suture), Pain, Swelling and Trismus13 were recorded on the proforma. Every patient was called for follow up on the 3rd day and 7th day. Results: Mean age was found 27.93 years, with range of minimum 20 years and maximum 35 years. Male were found in the majority 72.3%. Majority of the cases 51.5% were found with class B, in class A 37.5% and 10.9% were found with class C. According to the impaction position 50% cases were in class I, and 50% cases were in class II. Preoperative pain measurement was done according VAS, 71.9% patients were found with mild pain, 9.4% were with moderate pain while 18.8% patients were without pain. Modified Wards flap showed good efficacy regarding duration of third molar extraction as compare to Ward’s flap P-value 0.018. Modified ward’s flap had showed less postoperative pain as compare to ward’s flap p-value 0.022. No significant difference was found between both groups on 3rd and 7th postoperative day in Mouth opening. Conclusion: This study concluded that both ward’s flap and modified ward’s flaps showed good efficacy, while duration of surgery and postoperative pain were significantly less in the modified ward’s flaps as compare to ward’s flap. More large sample size studies are required to evaluate more accurate findings.

Two procedures for ridge preservation of molar extraction sites affected by severe bone defect due to advanced periodontitis

To evaluate and to compare dimensional alterations of hard and soft tissues in molar extraction sites with irregular deficiency of bone plates due to advanced periodontitis receiving two different procedures, namely the flapped and flapless techniques with Bio-Gide membrane covering the Bio-Oss material for ridge preservation. Twenty-three patients with 24 infected-molar extraction sites received ridge preservation procedure, the first consecutive 12 sites belonged to the flap group (a full thickness mucoperiosteal flap and primary soft tissue closure) and the following 12 sites belonged to the flapless group (minimal flap with a collagen sponge and a secondary soft tissue closure). Width of keratinized tissue was evaluated before tooth extraction and after 6-month healing. Parallel periapical radiographs were taken immediately and 6 months after extraction to evaluate vertical bone changes. The width of the ridge was measured in the center of the ridge at the time of tooth extraction and after 6 months at implant placement. After 6 months, width of keratinized tissue decreased (1.6±1.5) mm in the flap group (P=0.004) when compared with (0.3±1.6) mm in the flapless group (P>0.05). Both groups showed increases in ridge height from the central aspect, (5.53±4.20) mm for flap group and (7.70±4.35) mm for flapless group. These differences between the groups were not statistically significant (P=0.226). The ridge widths were (9.5±2.2) mm for flap group and (9.3±1.0) mm for flapless group at the time of implant insertion, and no statistical significance was observed between the flap and flapless groups. The study points out that both ridge preservation techniques were effective in increasing ridge height and minimizing ridge resorption after tooth extraction, and the ridge width allowed the placement of implants 6 months after ridge preservation. The flapless technique gave positive outcome in terms of the keratinized gingival width than that of the flap technique.

A Straightforward Technique to Repair a Residual Oronasal Fistula in Bilateral Cleft Lip and Palate Patients

An anterior palatal oronasal fistula in a bilateral cleft lip and palate is a challenging clinical dilemma. The purpose of this article is to present a 2-stage technique to repair the fistula in consistent fashion. The technique was developed to avoid more complicated procedures that had greater morbidity for larger oronasal defects that could not be treated in a single procedure. This is a retrospective study performed over 15years using this technique in a private practice setting. From 2002 to 2017, 15 7- to 12-year-old patients (11 boys and 4 girls) were treated. They were seen in a multispecialty clinic for anterior residual fistulae, and impressions were obtained. Then, they were scheduled for first-stage closing of the fistulae. Data were retrospectively analyzed. The first stage started with closing the central portion of the fistulae. For the second stage 6months later, the residual nasoalveolar cleft was closed and grafted in standard fashion. The first stage involved posteriorly reflecting a full-thickness mucoperiosteal flap and inserting it into the palatal soft tissue and stabilizing the segment with a splint for 3weeks. The premaxillary segment was left denuded. Fourteen of 15 patients (93%) had the central portion of the oronasal fistulae successfully closed. One patient had partial breakdown when the splint was prematurely removed at 2weeks. The patient underwent successful closure by the same procedure at a later date. All patients had successful second-stage grafting of their nasoalveolar clefts. An alternative technique is presented to treat clinically challenging oronasal fistulae. This 2-stage closure of a palatal fistula is straightforward, allows consistent closure of soft tissue defects, and avoids complex alternative procedures with serious surgical morbidities.

THE DIFFERENCES BETWEEN ACQUA AND CONVENTIONAL DENTAL IMPLANTS

INTRODUCTION: Missing teeth were a problem in the 1950s and 1960s till the real use of titanium dental implants to restore teeth. Scientists tried hard over many years to improve the surface treatment of the dental implant in order to improve the function and longevity of it and to reduce the chances of its failure. New materials and techniques are used to change the surface texture, component, and its surface energy. OBJECTIVES: Evaluation of the delayed placement of ACQUA dental implant versus the conventional type for replacement of maxillary premolar teeth. MATERIALS AND METHODS: Study was conducted on 14 patients. Patients were divided equally into two groups. Group “A” patients received ACQUA Alvium Neodent dental implant while group “B” patients received conventional Alvium dental implants. All Patients had missing maxillary premolars teeth. Patients were between 27- 48 years old. All patients were operated under local anesthesia. The surgical stent was checked for proper seating in the planned site of the dental implant. A full thickness mucoperiosteal flap was performed. Follow-up was done daily for the first week, then weekly for the first month, then monthly for six months. RESULTS: Clinically no edema was shown in all patients. Other clinical parameters were recorded during the follow-up period as the gingival index, implant stability, and presence or absence of infection. Radiographic results showed that there was a significant difference between ACQUA and conventional Alvium dental implant which proved the higher initial stability of ACQUA Alvium Implants compared to conventional ones. Marginal bone height did not show any significant difference between ACQUA implants and conventional implants. CONCLUSIONS: ACQUA dental implant showed more primary stability than conventional Alvium implant. Additionally, ACQUA showed more bone intensity compared to the other type

Closed vs open surgical exposure of palatally displaced canines: surgery time, postoperative complications, and patients' perceptions: a multicentre, randomized, controlled trial.

Closed and open surgical techniques are two different main approaches to surgical exposure of palatally displaced canines (PDCs). Because there is insufficient evidence to support one technique over the other, there is a need for randomized controlled trials. To compare surgery time, complications and patients' perceptions between closed and open surgical techniques in PDCs. The trial was a multicentre, randomized, controlled trial with two parallel groups randomly allocated in a 1:1 ratio. Study participants were 119 consecutive patients from 3 orthodontic centres, with PDCs planned for surgical exposure, randomly allocated according to a computer-generated randomization list, using concealed allocation. Full-thickness mucoperiosteal flap was raised, and bone covering the canine was removed in both interventions. In closed exposure, an attachment with a chain was bonded to the canine and the flap was sutured back with the chain penetrating the mucosa. In open exposure, a window of tissue around the tooth was removed and glass ionomer cement placed on the canine crown, to prevent gingival overgrowth during spontaneous eruption. Patient perceptions were assessed with two questionnaires, for the evening on the day of operation and 7 days post-surgery. It was not possible to blind either patients or care providers to the interventions. The outcome assessors were blinded and were unaware of patients' intervention group. Seventy-five girls and 44 boys, mean age 13.4 years (SD 1.46) participated in the study and got either of the interventions (closed exposure, n = 60; open exposure, n = 59). Surgery time did not differ significantly between the interventions. Complications though were more severe in bilateral cases and the patients experienced more pain and impairment in the open group. There were no statistically significant differences regarding surgery time between the groups. Postoperative complications were similar between the groups in unilateral PDCs, but more common in the open group in bilateral cases. More patients in the open group experienced pain and impairment compared to the closed group. Trial registration: ClinicalTrials.gov, ID: NCT02186548 and Researchweb.org, ID: 127201.

Evaluation of Buccal Bone Concavity in the Esthetic Zone: A Cadaver Study.

The primary aim of this study was to evaluate the buccal bone concavity position and depth in the anterior maxilla. The accuracy of cone beam computed tomography (CBCT) to measure the buccal bone concavity was also investigated. Eleven fresh cadaver heads were used in this study. CBCT images were first acquired, on which the location and depth of the buccal bone concavity were measured in maxillary incisors and canines. After full-thickness mucoperiosteal flap reflection, the corresponding measurements were made directly on cadavers. The accuracy and correlations between direct and image-derived measurements were analyzed statistically. A total of 53 sites were measured. The mean depths were 2.88 ± 1.37 mm and 2.40 ± 1.29 mm (with direct and CBCT measurement, respectively). The deepest concavities were found in the lateral incisors sites (3.15 ± 1.32 mm). There was a statistically significant underestimation of the depth of concavity (0.2 to 0.6 mm) by CBCT. Nevertheless, there is a high statistical correlation (r = 0.8) between the direct and CBCT measurements. Within the limitations of this study, it can be concluded that buccal bone concavity is the most prominent at the lateral incisor sites. The CBCT readings were highly correlated but underestimated to the direct measurements.