Maxillary Anterior Area Research Articles

Dental Cone Beam Computed Tomography Analyses of the Anterior Maxillary Bone Thickness for Immediate Implant Placement.

We evaluated the thickness of the facial alveolar bone wall at the maxillary incisors based on cone beam computed tomography (CBCT) images. The CBCT images of 60 patients were collected. We measured the distance between the cemento-enamel junction to alveolar bone crest (CEJ-ABC) and the facial alveolar bone width at levels 1 (P1), 2 (P2) and 5 (P3) mm apical to the bone crest. The P2 and P3 scores had a statistically significant negative relationship with age, and the CEJ-ABC scores had a statistically significant positive relationship with age for all samples. Regarding the CEJ-ABC scores, there were no statistically significant differences between genders. However, the P1 values of tooth 11 and 21 were statistically significantly greater for female patients, and the P2 value of tooth 22 was statistically significantly greater for male patients. The bone in the anterior maxillary area is very thin, only rarely meeting the minimum of 2 mm necessary for optimal aesthetic and functional results. Thus, for most patients, adjunctive augmentation procedures may be needed for implant treatment.

MAKSİLLER OVERDENTURELARDA KULLANILAN İKİ FARKLI BAĞLANTI SİSTEMİNİN DEĞERLENDİRİLMESİ: İKİ OLGU SUNUMU

The prosthetic rehabilitation of edentulous patient has been a major challenge for dentists. The complete removable denture is commonly used for edentulous maxillary and mandibular denture. However, this situation has drawbacks such as lack of retention and stability. Implants are a good alternative for the treatment of edentulous maxilla. In this case report is described the two completely edentulous maxillary patients were inserted 4 dental implants in the edentulous anterior maxillary area. In this two cases are planned two different connection systems (locator and custom-made bar) used for implant-retained maxillary complete overdentures. The final restorations provided satisfactory aesthetic and functional results

Three‐Dimensional Finite Element Analysis of Anterior Single Implant‐Supported Prostheses with Different Bone Anchorages

The aim of this study was to evaluate the stress distribution of monocortical and bicortical implant placement of external hexagon connection in the anterior region of the maxilla by 3D finite element analysis (FEA). 3D models were simulated to represent a bone block of anterior region of the maxilla containing an implant (4.0 × 10.0 mm) and an implant-supported cemented metalloceramic crown of the central incisor. Different techniques were tested (monocortical, bicortical, and bicortical associated with nasal floor elevation). FEA was performed in FEMAP/NeiNastran software using loads of 178 N at 0°, 30°, and 60° in relation to implant long axis. The von Mises, maximum principal stress, and displacement maps were plotted for evaluation. Similar stress patterns were observed for all models. Oblique loads increased the stress concentration on fixation screws and in the cervical area of the implants and bone around them. Bicortical technique showed less movement tendency in the implant and its components. Cortical bone of apical region showed increase of stress concentration for bicortical techniques. Within the limitations of this study, oblique loading increased the stress concentrations for all techniques. Moreover, bicortical techniques showed the best biomechanical behavior compared with monocortical technique in the anterior maxillary area.

Prediction of the alveolar bone level after the extraction of maxillary anterior teeth with severe periodontitis.

PurposeAfter extraction, the alveolar bone tends to undergo atrophy in three-dimensions. The amount of alveolar bone loss in the horizontal dimension has been reported to be greater than the amount of bone loss in the vertical dimension, and is most pronounced in the buccal aspect. The aim of this study was to monitor the predictive alveolar bone level following the extraction of anterior teeth seriously involved with advanced chronic periodontitis.MethodsThis study included 25 patients with advanced chronic periodontitis, whose maxillary anterior teeth had been extracted due to extensive attachment loss more than one year before the study. Periapical radiographs were analyzed to assess the vertical level of alveolar bone surrounding the edentulous area. An imaginary line connecting the mesial and the distal ends of the alveolar crest facing the adjacent tooth was arbitrarily created. Several representative coordinates were established in the horizontal direction, and the vertical distance from the imaginary line to the alveolar crest was measured at each coordinate for each patient using image analysis software. Regression functions predicting the vertical level of the alveolar bone in the maxillary anterior edentulous area were identified for each patient.ResultsThe regression functions demonstrated a tendency to converge to parabolic shapes. The predicted maximum distance between the imaginary line and the alveolar bone calculated using the regression function was 1.43±0.65 mm. No significant differences were found between the expected and actual maximum distances. Likewise, the predicted and actual maximum horizontal distances did not show any significant differences. The distance from the alveolar bone crest to the imaginary lines was not influenced by the mesio-distal spans of the edentulous area.ConclusionsAfter extraction, the vertical level of the alveolar ridge increased to become closer to the reference line connecting the mesial and distal alveolar crests.

Contour changes in human alveolar bone following tooth extraction of the maxillary central incisor.

The purpose of this study was to apply cone-beam computed tomography (CBCT) to observe contour changes in human alveolar bone after tooth extraction of the maxillary central incisor and to provide original morphological evidence for aesthetic implant treatment in the maxillary anterior area. Forty patients were recruited into the study. Each patient had two CBCT scans (CBCT I and CBCT II), one taken before and one taken three months after tooth extraction of maxillary central incisor (test tooth T). A fixed anatomic reference point was used to orient the starting axial slice of the two scans. On three CBCT I axial slices, which represented the deep, middle, and shallow layers of the socket, labial and palatal alveolar bone widths of T were measured. The number of sagittal slices from the start point to the pulp centre of T was recorded. On three CBCT II axial slices, the pulp centres of extracted T were oriented according to the number of moved sagittal slices recorded in CBCT I. Labial and palatal alveolar bone widths at the oriented sites were measured. On the CBCT I axial slice which represented the middle layer of the socket, sagittal slices were reconstructed. Relevant distances of T on the sagittal slice were measured, as were the alveolar bone width and tooth length of the opposite central incisor. On the CBCT II axial slice, which represented the middle layer of the socket, relevant distances recorded in CBCT I were transferred on the sagittal slice. The height reduction of alveolar bone on labial and palatal sides was measured, as were the alveolar bone width and tooth length of the opposite central incisor at the oriented site. Intraobserver reliability assessed by intraclass correlation coefficients (ICCs) was high. Paired sample t-tests were performed. The alveolar bone width and tooth length of the opposite central incisor showed no statistical differences (P<0.05). The labial alveolar bone widths of T at the deep, middle, and shallow layers all showed statistical differences. However, no palatal alveolar bone widths showed any statistical differences. The width reduction of alveolar bone was 1.2, 1.6, and 2.7 mm at the deep, middle, and shallow layers, respectively. The height reduction of alveolar bone on labial and palatal sides of T both showed statistical differences, which was 1.9 and 1.1 mm, respectively.

English

This clinical report describes an interdisciplinary approach for the coordinated treatment of a patient diagnosed with peg-shaped maxillary lateral incisors, short clinical crowns, excessive gingival display, and orthodontic malocclusion. The patient's specific esthetic expectations for the anterior maxilla were successfully met through phased treatment, including orthodontic tooth movement, and porcelain laminate veneers. Porcelain laminates can mimic the translucency of natural tooth structure and can provide colour and contour stability with minimal risk of gingival irritation, provided that proper oral hygiene and plaque control are maintained.Such coordinated interdisciplinary evaluation and treatment are necessary for improved aesthetic results in maxillary anterior areas aesthetically compromised in several aspects.

A clinical study of the effect of modified corticotomy on periodontium

To evaluate the effect of modified corticotomy on periodontal parameters in the treatment of Class III surgical patients facilitated by accelerated osteogenic orthodontics. Nine Class III surgical patients at the age of 18-30 (7 females and 2 males) who were systematically and periodontally healthy were involved in the study, including 72 teeth and 216 sites. The modified corticotomy (piezotome) and bone graft (tricalcium phosphate, TCP) in maxillary anterior area were conducted after aligning and leveling the dental arch to facilitate the closing of space in upper dentition. Measurements such as plaque index (PLI), probing depth (PD), bleeding index (BI), recession (REC), keratinized gingiva width (KEG), biotype (BIO) were recorded pre-operation, 1, 2, 4 and 8 weeks post-operation. The differences of PD, BI and REC before and after operation were not statistically significant (P > 0.05). The median value of PLI before and after operation was 0. The percentage of thin biotype and thick biotype teeth was 74% (53/72) and 26% (19/72) pre-operation respectively. The difference of KEG between pre-operation [(5.1 ± 1.4) mm] and 8 weeks post-operation [(5.1 ± 1.2) mm] was not statistically significant (P = 0.658), but the mean value of KEG in other post-operation groups [1 week: (5.7 ± 1.3) mm, 2 weeks: (5.8 ± 1.3) mm, 4 weeks: (5.6 ± 1.4) mm] was significantly higher than those of pre-operation (F = 12.087, P = 0.000). Modified corticotomy in the treatment of Class III surgical patients facilitated by accelerated osteogenic orthodontics is safe to periodontium.

Soft tissue augmentation of ridge defects in the maxillary anterior area using two different methods: a randomized controlled clinical trial

To test whether or not vascularized interpositional periosteal-connective tissue grafts are as successful as free subepithelial connective tissue grafts in augmenting volume defects in the anterior maxilla. Twenty subjects with Seibert class 1 ridge defects in the anterior maxilla were randomly, equally assigned to augmentation by vascularized interpositional periosteal-connective tissue graft (test) or free subepithelial connective tissue graft (control). Clinical periodontal parameters at teeth adjacent to the gap were recorded, and conventional impressions were taken prior to surgery (baseline = t(0)) and 1 (t(1)), 3 (t(3)) and 6 (t(6)) months after surgery. The casts were optically scanned, digitized and analyzed for ridge contour changes in the augmented area. Data were subjected to nonparametric statistics. The contour changes in labial distance between baseline and follow-up for the control group were (median, range) 1 mm, 0.37-1.45 (t(0)-t(1)); 1.18 mm, 0.39-1.40 (t(0)-t(3)); and 0.63 mm, 0.28-1.22 (t(0)-t(6)) and for test group 1.21 mm, 0.74-2.47 (t(0)-t(1)); 1.26 mm, 0.50-1.71 (t(0)-t(3)); and 1.18 mm, 0.16-1.75 (t(0)-t(6)). Significantly less shrinkage of the graft was observed in the test group after 6 months (P = 0.03). Clinical periodontal parameters at the neighboring teeth were stable over the follow-up period and did not differ between groups. Augmentation of single tooth gaps with moderate ridge defects in the anterior maxilla was successfully performed using both techniques. However, after 6 months, sites treated by the pediculated graft were superior in maintaining the initially augmented volume and showed less shrinkage of the graft. This could be attributed to better perfusion of the pediculated graft.

Buccal bone deficiency in fresh extraction sockets: a prospective single cohort study

The purpose of this prospective single cohort study was to evaluate the use of xenograft and collagen membranes in treating full or partial buccal bone defects of fresh extraction sockets in the esthetic zone. Thirty-three patients requiring tooth extraction in the anterior maxillary area and showing a complete or partial buccal bone plate deficiency (more than 2 mm) were consecutively enrolled and treated. Corticocancellous porcine bone and platelet-rich fibrin (PRF) with a collagen membrane were used to graft the extraction sockets, and the membranes were left exposed to the oral cavity with a secondary soft tissue healing. The outcome variables were as follows: width of keratinized mucosa, facial soft tissue levels, clinical bone changes (measured with a clinical splint), implant and prosthesis failures, and peri-implant marginal bone changes. All treated sites allowed the placement of implants; the width of keratinized mucosa at the mid-facial aspect showed an increase of 2.3 mm 5 months after the grafting procedure, and its value was 3.2 ± 0.6 mm at 1-year follow-up. The mean values of the facial soft tissue level indicated an increase over time. The bone level showed an improvement of 0.8 ± 0.1 mm and 0.7 ± 0.1 mm at mesial and distal sites, respectively, when compared to the baseline measurements. Finally, in the palatal area, no bone changes were observed. No implant failed during the entire observation period. Findings from this study showed that xenograft and PRF, used for ridge preservation of the extraction sockets with buccal bone plate dehiscence in the esthetic zone, can be considered effective in repairing bone defects before implant placement. The secondary soft tissue healing over the grafted sockets did not compromise bone formation; moreover, the soft tissue level and the width of keratinized gingiva showed a significant improvement over time.

Assessment of Skeletal Stability After Counterclockwise Rotation of the Maxillomandibular Complex in Patients With Long-Face Pattern Subjected to Orthognathic Surgery

The aim of this study was to evaluate the long-term skeletal stability of counterclockwise maxillomandibular complex rotation in patients undergoing orthognathic surgery for long-face pattern. This retrospective study consisted of 10 patients who underwent the procedure between September 2002 and April 2008. To assess the skeletal stability, 30 preoperative (T1), recent postoperative (T2), and late postoperative (T3) cephalometric radiographs of the 10 patients were digitized and traced. To measure the stability in the occlusal plane and mandibular plane, the cephalometric points and planes were determined 3 times. In the long term, on average, the A-point moved 0.21 mm backward (AYT3-AYT2), the B-point moved 0.57 mm backward (BYT3-BYT2), and the posterior nasal spine moved 0.31 mm backward (PNSYT3-PNSYT2). On average, the anterior maxillary area (A-point) moved 0.14 mm downward (AXT3-AXT2), the mandible (B-point) moved 0.07 mm downward (BXT3-BXT2), and the posterior nasal spine moved approximately 0.18 mm upward (PNSXT3-PNSXT2). The occlusal plane increased by 0.75 degrees (OPT3-OPT2), and the mandibular plane increased by 0.45 degrees (MPT3-MPT2). It was observed that the counterclockwise rotation of the maxillomandibular complex produces stable results in patients with long-face pattern undergoing orthognathic surgery.

Optimizing Maxillary Aesthetics of a Severe Compromised Tooth through Orthodontic Movement and Dental Implants

Treatment of severe compromised tooth in the maxillary anterior area still poses great challenge to the clinicians. Several treatment modalities have been proposed to restore the function and aesthetics in teeth with advanced periodontal disease. The present study aims to report a case of traumatic injury of a left-maxillary central incisor with ridge preservation, orthodontic movement, and implant therapy. A 45-year-old woman underwent the proposed treatment for her left central incisor: basic periodontal therapy, xenogenous bone graft, and guided bone regeneration (GBR). Six months after the graft procedure, orthodontic movement by means of alignment and leveling was made and a coronal displacement of the gingival margin and vertical bone apposition could be observed after 13 months of active movement. Afterwards, a dental implant was placed followed by a connective tissue graft and immediate provisionalization of the crown. In conclusion, orthodontic movement was effective to improve the gingival tissue and alveolar bone prior to implant placement favoring the aesthetic results. Six years postoperatively, the results revealed height and width alveolar bone gain indicating that the treatment proposed was able to restore all the functional and aesthetic parameters.

Esthetic Outcomes Following Immediate and Early Implant Placement in the Anterior Maxilla—A Systematic Review

The objectives of this systematic review are (1) to quantitatively estimate the esthetic outcomes of implants placed in postextraction sites, and (2) to evaluate the influence of simultaneous bone augmentation procedures on these outcomes. Electronic and manual searches of the dental literature were performed to collect information on esthetic outcomes based on objective criteria with implants placed after extraction of maxillary anterior and premolar teeth. All levels of evidence were accepted (case series studies required a minimum of 5 cases). From 1,686 titles, 114 full-text articles were evaluated and 50 records included for data extraction. The included studies reported on single-tooth implants adjacent to natural teeth, with no studies on multiple missing teeth identified (6 randomized controlled trials, 6 cohort studies, 5 cross-sectional studies, and 33 case series studies). Considerable heterogeneity in study design was found. A meta-analysis of controlled studies was not possible. The available evidence suggests that esthetic outcomes, determined by esthetic indices (predominantly the pink esthetic score) and positional changes of the peri-implant mucosa, may be achieved for single-tooth implants placed after tooth extraction. Immediate (type 1) implant placement, however, is associated with a greater variability in outcomes and a higher frequency of recession of > 1 mm of the midfacial mucosa (eight studies; range 9% to 41% and median 26% of sites, 1 to 3 years after placement) compared to early (type 2 and type 3) implant placement (2 studies; no sites with recession > 1 mm). In two retrospective studies of immediate (type 1) implant placement with bone graft, the facial bone wall was not detectable on cone beam CT in 36% and 57% of sites. These sites had more recession of the midfacial mucosa compared to sites with detectable facial bone. Two studies of early implant placement (types 2 and 3) combined with simultaneous bone augmentation with GBR (contour augmentation) demonstrated a high frequency (above 90%) of facial bone wall visible on CBCT. Recent studies of immediate (type 1) placement imposed specific selection criteria, including thick tissue biotype and an intact facial socket wall, to reduce esthetic risk. There were no specific selection criteria for early (type 2 and type 3) implant placement. Acceptable esthetic outcomes may be achieved with implants placed after extraction of teeth in the maxillary anterior and premolar areas of the dentition. Recession of the midfacial mucosa is a risk with immediate (type 1) placement. Further research is needed to investigate the most suitable biomaterials to reconstruct the facial bone and the relationship between long-term mucosal stability and presence/absence of the facial bone, the thickness of the facial bone, and the position of the facial bone crest.

A Multicenter Clinical Study on the Survival and Success Rates of Two Commercial Implants of Korea according to Loading Period

Purpose: The purpose of this study was to evaluate the survival and success rates of Korean Osstem implants US II Plus, GS II following loading period. Materials and Methods: Dental records were obtained in total 201 patients who were treated with Korean Osstem implants US II Plus, GS II on both maxillary and mandibular anterior and posterior areas in six different clinics for 2 years from January 2007 to December 2008. Total 430 implants were evaluated clinically and radiographically using predefined success criteria prospectively and following results were obtained. Result: US II Plus, GS II implants showed high survival rates of more than 99% and high success rates more than 90% independent of loading period. As a result of cross analysis to evaluate clinical significance between implant loading period and success rate, the P-value of US II Plus was 0.10 (P>0.05), and the P-value of GS II was 0.17 (P>0.05), which showed no statistical significance. Bone quality, smoking, and edentulous state are factors that can affect the survival and success rates following differently loaded implants, but did not significantly affect in this study. Conclusion: These results suggest that selection of loading period of Korean Osstem implants US II Plus, GS II would be done carefully considering implant install area, the quality alveolar bone, the state of edentulous ridge and experience of operator, though they showed clinically good results on both maxillary and mandibular anterior and posterior areas.

Preserving soft tissue after placing implants in fresh extraction sockets in the maxillary esthetic zone and a prosthetic template for interim crown fabrication: A prospective study

The technique of immediate implant placement is said to have success rates similar to those of implantation into a healed socket. An implant-supported restoration in an esthetic area must achieve a harmonious balance of functional, esthetic, and biologic imperatives to be considered effective. The purpose of this clinical study was to assess the height of the interproximal gingival papillae adjacent to immediate implants with immediate loading. The hypothesis was that specific positioning of the proximal contact areas ofthe interim crowns would facilitate the maintenance or regeneration of the interproximal papilla. Twenty-eight participants were provided implants (n=36) in the anterior maxillary area that were loaded with a specifically contoured interim crown immediately after tooth extraction. The proximal contact areas of the interim crowns were positioned 5 to 6 mm incisal to the interproximal bony crest by using a prosthetic template. Papilla height was classified according to a previously described papilla index. A comparison was made between the papilla height before the extraction, at interim crown placement after the implant placement, and at 6 and 12 months postoperatively. Parametric and nonparametric tests were used when appropriate (Kolmogorov-Smirnov). Significance was expressed at the α=.05 level. Cross tables were used to describe the changes in the papilla index score. During the 1-year follow-up, the score of the distal and mesial papilla indices increased significantly (repeated-measures Friedman exact test; P=.035 and P=.002). This prospective study indicated that the use of a prosthetic template for positioning an interim crown on immediately placed implants and for ensuring that the proximal contact areas of the crown with adjacent teeth are 5 to 6 mm incisal to the interproximal bony crest does not seem to hinder the maintenance or regeneration of the height of the interproximal papillae.

Cyst-like periapical lesion healing in an orthodontic patient: a case report with five-year follow-up

AimTo report the orthodontic movement of two central incisors through the healing site of a maxillary cyst-like lesion of endodontic origin after nonsurgical treatment. Case summaryThis report shows the treatment of a 18-year old patient, male, with a Class II division 2 malocclusion. He came to our attention seeking for orthodontic treatment.Radiographic examinations revealed a large cyst-like lesion in the maxillary anterior area, extending from the mesial surface of tooth 12 to the distal surface of tooth 21. The two upper incisors were nonresponsive to pulp sensitivity tests. Endodontic treatment was performed first. One week after root canal treatment had been completed with gutta-percha fillings, orthodontic treatment was started while the bone lesion healing was still underway. At the end of the orthodontic treatment, incisor retroclination was corrected, periapical lesion healing was completed and there were no signs of root resorption. The five-year follow-up revealed that occlusal relationship and dental alignment were kept stable and excellent radiographic resolution of the periapical lesion was obtained.

Plasmablastic lymphoma of the oral cavity in a human immunodeficiency virus-negative patient: A case report with literature review

Plasmablastic lymphoma (PBL) is an aggressive diffuse large B-cell lymphoma variant that is most frequently observed in the oral cavity of human immunodeficiency virus (HIV)-infected individuals. However, in recent years, some cases have emerged in patients without HIV infection and involve other sites like stomach, lung, nasal cavity, and jejunum. We report a rare case of PBL in the maxillary anterior area of a 62-year-old man without HIV infection. The tumor cells were characterized by non-cohesive round or oval shape cells with eccentrically-placed nuclei with a prominent perinuclear halo. Immunohistochemical studies showed that the tumor cells were strongly positive for MUM1, VS38c, VMT, and κ light chain, focally positive for LCA and CD79a, and negative for CD3, CD20, CD56, λ light chain, CK-pan, EMA, and HMB45. The patient was treated with chemotherapy using cyclophosphamide, doxorubicin, vincristine, and prednisone. The lesion showed partial remission.

Transverse maxillary and mandibular growth during and after Bionator therapy: study with metallic implants

This study evaluated posteroanterior cephalograms before and after treatment and long term follow-up of Class II division 1 patients treated with bionator. The objective was to demonstrate the transverse growth of maxilla and mandible during and after bionator therapy. Measurement of transverse dimensions between posterior maxillary and mandibular implants, as well as the distances between the buccal, gonial and antegonial points were recorded. Measurements were analyzed at three periods: T1 - before bionator therapy, T2 - after bionator therapy and T3 - 5.74 years after T2. There was statistically significant transverse increase due to growth and/or treatment for all variables, except for the distance between the anterior maxillary implants. During the study period only the anterior maxillary area did not show transverse growth.

In selected sites, short, rough-surfaced dental implants are as successful as long dental implants: A critical summary of Pommer B, Frantal S, Willer J, Posch M, Watzek G, Tepper G. Impact of dental implant length on early failure rates: a meta-analysis of observational studies. J Clin Periodontol 2011;38(9):856-863.

In adult patients, do short dental implants (< 10 millimeters) lead to failure rates similar to those for longer implants (≥ 10 mm) in the first year of loading? Two independent reviewers searched three electronic databases and 29 journals for articles published from January 1998 to January 2008. The authors included in the review only English-language, prospective observational studies in which the allocation decision occurred in the course of usual treatment. Also, implants must have been placed in nonaugmented healed jawbone after a conventional healing period of three to six months. The primary outcome measured was implant failure within the first year of prosthetic loading, determined on the basis of established criteria.1 A meta-analysis was carried out in which the authors compared the association between implant length and failure. In addition, the authors performed subgroup analyses of failure as a function of the implants’ diameter, surface texture and location in the maxillary or mandibular arch. Fifty-four trials, including 19,563 dental implants (with only a 2.4 percent dropout rate), met the inclusion criteria. The results of the meta-analysis, which consisted of 40 studies (2,223 short implants and 14,158 long implants), showed that shorter implants had an overall failure rate statistically significantly higher than that for long implants within the first year of loading (odds ratio [OR] = 1.8; 95 percent confidence interval [CI], 1.3-2.5). The results of subgroup analyses showed a statistically significant difference in failure rates for short and long implants in the maxilla, but no difference in the mandible. However, with the possible exception of the anterior maxilla, the failure rates for rough surfaced implants in the two groups (1,298 short implants and 7,544 long implants) were not statistically significantly different (OR = 1.1; 95 percent CI, 0.6-2.1). The authors found no association between implant diameter and failure rates within one year of prosthetic loading. With the possible exception of the maxillary anterior area, rough-surfaced short implants with a minimum length of 7 mm present no additional risk of failure within the first year of loading.

Primary malignant amelanotic melanoma of the maxilla: A rare case report

Malignant amelanotic melanomas of the posterior maxilla are very rare pathology disease. Most of these lesions have occurred on the maxillary anterior gingival area, particularly on the palatal and alveolar mucosa. Oral malignant melanomas are more aggressive and worse than cutaneous melanomas, and complex anatomy of this area makes complete surgical removal difficult. Thus, early diagnosis and treatment are important. We presented malignant amelanotic melanoma of the posterior maxilla in one case by histopathology examination and also immunohistochemical stain methods. In this paper, we reported an unusual clinical presentation of primary oral malignant amelanotic melanoma of the posterior maxilla in palatal and gingiva, which is very rare. Survival rates may be increased by early diagnosis and treatment.

Peri-implant hard tissue response to glow-discharged abutments: Prospective study. Preliminary radiological results

In the literature has been demonstrated that when an implant is placed in the oral environment, changes in peri-implant hard tissue level may occur. Several clinical procedures have been advocated to clinically minimize this bone resorption. However, minimal attention was paid to the soft- and hard-tissue abutment interaction. The present clinical preliminary study is intended to radiologically analyze the effect of glow-discharged abutments on hard tissue level changes after 18 months of prosthetic loading. Five patients needing an implant supported restoration in the anterior maxillary area with thin gingival tissue biotype and healed bone were recruited. An implant was inserted and a titanium abutment was glow-discharged with an Argon plasma treatment in a plasma reactor and, immediately after, definitively screwed at 30N. Provisional restoration was therefore positioned. Three months later, definitive restoration was performed. Digital periapical standardized radiographs were taken at the time of surgery, 6 and 18 months thereafter. Radiographic analysis was carried out using image analysis software. At baseline, interproximal radiographs revealed no bone defect around implants in both groups. After 6 months from baseline, the postoperative interproximal radiographs revealed an average bone loss of 0.09mm (range 0.0-0.3mm, SD=0.144mm). After 18 months from baseline, the periapical X-ray showed a stable condition of bone remodeling (mean value: 0.09, range 0.0-0.5mm, SD=0.08mm). Within the limit of this study, glow-discharged abutments have been demonstrated to positively affect hard tissue reaction to implant restoration.