Elevation Of Mucoperiosteal Flap Research Articles

Clinical Management of Choanal Atresia

Choanal atresia (CA) is a rare congenital anomaly of the nasal airway with an incidence of 1/5000 to 1/9000, which may occur unilateral (uCA) or bilateral (bCA). bCA manifests as an acute emergency immediately after birth by airway obstruction and paradoxical cyanosis, whereas uCA may present with a heterogeneous clinical picture in addition to unilateral nasal airway obstruction. Fiber endoscopic examination and cranial computed tomography are the gold standard in the diagnosis of CA. CA often occurs in association with congenital malformation syndromes, among which CHARGE syndrome stands out. Due to cardiopulmonary instability and difficult intubation conditions, syndromic CA patients should be considered as a separate risk group. After securing the airway, bCA must be treated surgically without delay, whereas correction of uCA should not be performed until after six months of age. Endoscopic techniques are the surgical standard in the treatment of CA. Different approaches can be distinguished: transnasal puncture of the atresia plate with subsequent extension medially and laterally, creation of a septal window with subsequent resection of the posterior vomer and atresia plate, and elevation of mucoperiosteal flaps with subsequent opening of the atresia plate. The transpalatal approach should only be employed in anatomically complex cases. The use of conventional choanal stents in the primary treatment of CA is increasingly rejected and should be reserved for high-risk constellations. Similarly, local application of mitomycin C should be avoided.

MINIMALLY INVASIVE TOOTH EXTRACTIONS- THE NEWER ADVANCEMENTS TO THE CONVENTIONAL TECHNIQUES

Dental extractions are considered to be one of the procedures that can make a patient quite anxious. However, newer advancements have come to the rescue. Most of the extractions that are being done involve some extent of soft tissue trauma. Due to the damage that occurs to the adjacent tissues while removing the tooth, the rehabilitation and restoration of the tooth has become quite difficult and time consuming. From the crux of the traditional techniques, surgeons realised the importance of preserving the soft tissue and dentofacial complex in the course of tooth implantation. This led to the evolution of the new idea, the Minimally invasive dentistry and the Minimally invasive extraction. Few minimally invasive atraumatic extractions, certain methodsdeveloped are already being used by the clinicians to extract the teeth such as Periotome, Piezotome, Benex vertical extractor, rubber band extraction, extraction using implant drills. Easy Xtrac system is one such procedure which is claimed to be based on cork screw principle is used in tooth extractions. Keywords: Atraumatic Extraction, Preservation of alveolar bone, Absolute healing, Minimally invasive technique, Mucoperiosteal flap elevation.

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.

Computer Evaluation of the Changes of the Vestibular Bone Plate after Classical and Computer-Guided Delayed Implantation in Esthetic Zone

BACKGROUND: The buccal bone plate as one of the key anatomical structures is of great importance for the success of implant therapy in the frontal maxilla and is particularly prone to changes that occur post-extraction. The condition of the buccal bone plate and its dimensions in the horizontal and vertical direction directly affects the method of implantation, the position of the implant, and the long-term results of the implant treatment. AIM: The aim of the study is to compare the differences and changes of the buccal bone plate in the anterior maxilla, during delayed implantation with and without the use of a surgical guide, which implies the use of different surgical techniques. Furthermore, the aim of this study is to determine their advantages and disadvantages. MATERIALS AND METHODS: To achieve the set goal, through CBCT images and computer software, changes in 40 patients divided into two groups were analyzed in three time periods: 20 patients who underwent delayed implantation in the anterior maxilla without a surgical guide and the second group of 20 patients who underwent delayed implantation using a surgical guide, which means that in the second group of patients, there was no mucoperiosteal flap elevation. RESULTS: The analysis of changes in the buccal bone plate showed that the biggest changes were in patients who underwent delayed implantation according to the classical method and approach. The greatest changes in the horizontal dimension in the first group of patients (MI) were in positions 1, 3, and 6. Namely, for position 1, from an average horizontal dimension of 1.54 mm, the dimensions decreased to 0.26 mm during 12 months. On the contrary, in the second group, these dimensions recorded a slight decrease from 2.37 to 2.2 mm on average. At position 3, there was also a more developed resorption in the first group, from 1.54 mm to 0.88 mm, and in the second group, the resorption was insignificant and for the same period of 12 months, the horizontal dimension decreased from 2.27 mm to 2.12 mm, in which, clinically, it was not evident. Regarding the vertical dimension for 12 months in the first group, the resorptive changes ranged from 1.1 to 3.3 mm on average, while in the second group, changes in the vertical dimension were not observed, and they did not exist in the examined patients. The bone density in both groups decreased only in position 0 and much more in the first group where it decreased in a period of 12 months from 742 Hu to 150 Hu, while the decrease in the second group was from 1080.5 Hu to 1080 Hu. For all other dimensions, there is an increase in density in all time periods, higher in the second group. CONCLUSION: The obtained results showed that the greatest changes in the buccal bone plate in all dimensions occur during delayed implantation with a classical approach. This is mainly due to the position of the implants, as well as the disruption of the blood supply to the bone plate, which follows the creation of the flap.

Immediate implant placement with flap or flapless surgery: A systematic review and meta-analysis.

To assess the impact of mucoperiosteal flap elevation for single immediate implant placement (IIP) on buccal hard and soft tissue changes, and on clinical, aesthetic and patient-reported outcomes. Two independent reviewers conducted an electronic literature search in Pubmed, Web of Science, Embase and Cochrane databases as well as a manual search to identify eligible clinical studies up to June 2022. Randomized controlled trials (RCTs) comparing IIP without flap elevation to IIP with flap elevation were included for a qualitative and quantitative analysis. The primary outcome was horizontal buccal bone change. Secondary outcomes were implant survival, vertical buccal bone change, pain, and clinical and aesthetic parameters. Out of 1029 records, 5 RCTs were selected reporting on 140 patients who received 140 single immediate implants (flapless: 68; flap: 72). Patients had a mean age ranging from 30 to 67 years and were followed between 6 and 12 months. Four RCTs pertained to (nearly) intact alveoli. Risk of bias assessment yielded low risk for two RCTs and high risk for three RCTs. Meta-analysis demonstrated a mean difference of 0.48 mm (95% confidence interval [CI] [0.13, 0.84], p= .007) in horizontal buccal bone change between surgical approaches, favouring flapless surgery. Meta-analysis failed to demonstrate a significant difference in implant survival between the groups (RR 1.00, 95% CI [0.93, 1.07], p= .920). Given the scarcity of data, meta-analyses could not be performed on other secondary outcomes. Available studies were consistent in the direction of the effect favouring flapless surgery for vertical buccal bone change as well as for pain. Clinical and aesthetic parameters were underreported. Based on CBCT data, flapless surgery resulted in more buccal bone preservation at immediate implants. However, the clinical relevance of this finding is unclear, since clinical and aesthetic outcomes were underreported.

Gossypiboma as a rare complication of septoplasty procedure: case report and review of literatures

BackgroundForeign body granuloma due to retained surgical sponge is also called gossypiboma. Only one case of nasal septum gossypiboma has been reported.In this report, we present a case of retained surgical sponge at the septoplasty site.Case presentationA 16-year-old male patient came to our emergency department complaining of nasal obstruction associated with low-grade fever. With past history of septoplasty 3 months ago. Endoscopic examination of the nasal cavity revealed bilateral smooth swelling of the nasal septum, no fluid was detected with aspiration. A CT scan of the nose and paranasal sinuses revealed significant posterior septal swelling. A consent had been taken from the parents, and the patient was prepared for endoscopic exploration under general anesthesia. Elevation of bilateral mucoperichondrial and mucoperiosteal flaps was done. There was a firm swelling with intense reaction all around, after meticulous dissection of this lesion and was delivered with Blakesley forceps. On closer examination it was a missed cotton ball. The patient follow-up for 12 months was excellent with complete disappearance of his complaints.ConclusionsRetained surgical items should be considered in the differential diagnosis of post-operative nasal septum swellings. Sponges used for nasal surgery should be of appropriate size and attached to a thread and should be counted.

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.

Multivariate outcome evaluation of furcation‐involved molars treated with non‐surgical mechanical therapy alone or combined with open flap debridement: A retrospective study

This retrospective study assessed the effect of non-surgical and surgical mechanical therapy for furcation-involved molars. Furcation defects treated and followed for at least 1 year were selected. Data relative to the clinical outcomes were recorded. The immediate (3- to 6-month) clinical outcomes and the long-term survival of the treated molars were assessed. The potential variables influencing the treatment outcomes through multi-level regression analysis, and Cox Proportional-Hazards Models were also analyzed. One hundred and eighty-four molars were included with an average follow-up of 7.52 years. At the 3- to 6-month re-evaluation 1.39 ± 0.99 mm pocket depth reduction, 0.88 ± 1.29 mm clinical attachment gain, and a 0.51 ± 1.13 mm increase in recession was observed. The 5- and 10-year survival rates were 88.3% and 61.3%, respectively. The horizontal and vertical extent of furcation involvement, baseline probing depth, mucoperiosteal flap elevation, and the frequency of supportive periodontal therapy influenced the clinical outcomes and tooth survival. Non-surgical and surgical mechanical root debridement is a viable treatment for the management of furcation involved molars with shallow horizontal and vertical components.

Evaluation of Bone Regeneration around Implants with and without Flap Elevation

Background:The aim of this study is to clinically evaluate and compare the clinical success and the relative bone healing of the implants which are placed using a flapless procedure and compare it to those placed by the conventional flap technique.Materials and Methods:This study was conducted with ten patients that were randomly divided into two groups. Group A included patients with immediately placed implants after extraction with flap elevation. Group B included patients with immediately placed implants after extraction without any flap elevation. The clinical parameters recorded were Plaque index, Modified Gingival Index, Early Wound Healing Index, Buser's criteria, Distance between implant shoulder and the crestal bone (DIB), and Radiographic Examination in a standardized manner to evaluate changes for the DIB values.Results:There was an improvement in Plaque Score from baseline to 1 month and baseline to abutment placement (6 months), which was statistically significant, but the plaque score from 3 months to abutment placement (6 months) was statistically nonsignificant in both the group. There was an increase in modified gingival score from baseline to 3 months, baseline to abutment placement (6 months), and 3 months to abutment placement (6 months), which was statistically significant in both the groups. The DIB scores in Group A recorded at baseline to 6 months were 2.80 ± 0.57 and 1.90 ± 0.42, respectively, showing a mean difference of −0.90 and P = 0.001 in comparison. Whereas, the DIB scores in Group B at baseline to 6 months were 3.20 ± 0.57 and 2.50 ± 0.50, respectively, showing a mean difference of −0.70 and P = 0.001 in comparison. The DIC scores in Group A at baseline to 6 months were 1.60 ± 0.54 and 0.00 ± 0.00, respectively, showing a mean difference of −1.60 and P = 0.003 in comparison, Whereas the DIC scores in Group B at baseline to 6 months were 1.40 ± 0.54 and 0.00 ± 0.00, respectively, showing a mean difference of −1.40 and P = 0.005 in comparison.Conclusion:Implants placed in fresh extraction sockets with and without mucoperiosteal flap elevation can be successfully done with augmentation procedures. Short-term survival rates and clinical outcomes of both groups were similar and appeared to be predictable treatment modalities.

Single-flap versus double-flap approach for periodontal pocket reduction in supraosseous defects: a comparative study.

PurposeThe single-flap approach (SFA) is a minimally invasive technique with limited mucoperiosteal flap elevation to gain access to the buccal/palatal aspects, thus limiting post-surgical complications. The purpose of the present study was to gain insights into the impact of the SFA over the double-flap approach (DFA) on periodontal flap treatment outcomes and patient compliance in terms of discomfort and time taken for surgical procedures.MethodsTwenty patients with persistent probing pocket depths of ≥5 mm were scheduled for the SFA (test site) and for the DFA (control site). All the clinical periodontal parameters were recorded at baseline, 3 months, and 6 months. Radiographic bone level (cone-beam computed tomography) was evaluated at baseline and 6 months. Patients' postoperative pain perception and wound healing were also assessed.ResultsThe SFA showed a significant reduction in periodontal pocket depth, gain in clinical attachment level (CAL), and gain in bone level when compared with the DFA. The SFA substantially improved wound healing and induced less postoperative pain than the DFA.ConclusionsThe SFA resulted in substantial improvement in the composite outcome measures, as shown by a reduction in pocket depth with minimal gingival recession, gain in CAL, early wound healing, less postoperative discomfort, and better patient-centered outcomes.Trial RegistrationClinical Trials Registry-India Identifier: CTRI/2018/05/013562

Custom-Made Cleft Palate Models to Teach V-Y Pushback Palatoplasty.

We developed custom-made cleft palate (CP) models to teach V-Y pushback palatoplasty, with a focus on design and mucoperiosteal elevation.A model (23 cm wide, 30 cm long, and 13 cm high) was made using silicone (model 1; M1). On the palate of a skull model, 2 layers of colored rubber clay were applied to represent the superficial oral mucoperiosteum and deep nasal mucosa (model 2; M2). From the greater palatine foramen, threads of dental floss were inserted inside the clay, representing the greater palatine artery. In a workshop, a mouth gag was applied on M1, and participants designed 2-flap palatoplasty and 4-flap palatoplasty. On the palate of M2, incisions were made with a #15 blade. On M2, a mucoperiosteal flap (rubber clay over the hard palate) was elevated using a periosteal elevator, avoiding injury to the dental floss mimicking the greater palatine artery. Six participants were recruited for the workshop and were asked to rate their satisfaction with the outcome on a Likert scale.For CP design, participants answered that they had learned useful knowledge from this workshop, reflecting a significant improvement (4.0 ± 1.1 for incomplete CP, 4.2 ± 1.2 for complete CP). They became confident in this skill after the workshop (4.2 ± 0.8 for incomplete CP, 3.8 ± 0.8 for complete CP). For cleft mucoperiosteal flap elevation, they likewise learned useful knowledge (4.7 ± 0.5 for incomplete CP, 4.5 ± 0.5 for complete CP) and became confident in this skill (3.8 ± 0.8 for incomplete CP, 4.0 ± 0.6 for complete CP.)These models can be useful for V-Y pushback palatoplasty training for medical personnel.

Surgical or non-surgical treatment of peri-implantitis — what is the verdict?,

• The aim was to compare ST and NST in relation to peri-implantitis. • Indexed databases were searched. • Only one experimental study addressed the focused question. • Standardized protocols are needed in this regard. It remains unclear whether treatment of peri‑implantitis should be performed surgically after mucoperiosteal flap elevation or non-surgically. The aim of the present evidence-based literature review was to assess whether surgical or non-surgical treatment should be performed for the treatment of peri‑implantitis. The focused question was “Should peri‑implantitis be treated surgically or non-surgically?”. Clinical and experimental studies on animal-models were included. In-vitro studies, letters-to-the-Editor, reviews and commentaries were excluded. Indexed databases were searched up to and including May 2020 using guidelines of the preferred reporting guidelines for systematic reviews and meta-analysis. Hand searching was also performed. Initially, 588 studies were identified out of which, 587 were excluded. One split-mouth study on dogs with 3-months’ follow-up was included. In this study, test- and control-sites underwent surgical and non-surgical treatment, respectively. There was no statistically significant difference in bleeding on probing, probing depth and crestal bone loss between the test- and control-sites. Histomorphometic results that new bone formation was significantly higher at the most apical part of the peri‑implant defects in the test- than control-sites. Clinical attachment levels were significantly higher in the test- versus control-sites. In conclusion, due to the lack of clinical comparative studies, the selection of the therapeutic protocol (surgical or non-surgical) for the treatment of peri‑implantitis remains unclear. Hence, evidence-based protocols are needed to determine whether peri‑implantitis treatment should be performed surgically or non-surgically.

CBCT analysis of bone density in bicortical defects after augmentation with alloplastic and xenogeneic bone substitutes: A study on domestic pigs

Background/Aim. A significant benefit in bicortical defects healing can be achieved by guided tissue and guided bone regeneration. The aim of this study was a cone-beam computed tomography (CBCT) radiographic bone density analysis of bicortical defects healing when treated with guided bone regeneration and two bone substitutes ? bovine xenograft and alloplastic bone substitute. Methods. The research was performed on domestic pigs in two phases. In the first phase, extraction of all teeth in the intercanine sector was performed in the lower jaw and postextraction wounds were sutured. In the second phase, after the period required for healing, bicortical defects were formed ? following the elevation of mucoperiosteal flaps from the vestibular and lingual side in the area of the previously extracted teeth, surgical removal of the cambium layer of periosteum was performed in the area of future defects with sharp surgical scissors and curette. Two defects, 10 mm in diameter, on the left and right side of the medial line were formed and filled with alloplastic bone substitute on the left and xenograft on the right side afterward. After augmentation, the defects were covered by a collagen resorptive membrane on both sides, and the flap was repositioned and sutured. After 12 weeks, experimental animals were sacrificed. The surrounding native bone was used as a control. Results. Analysis of bone tissue density showed a statistically significant difference between the examined bone substitutes (p < 0.01), with a better effect achieved by the use of alloplastic bone substitute. After applying Bonferroni correction, the difference was still statistically significant. Conclusion. Both bone substitutes used in the study showed good osteoconductive properties in the treatment of bicortical defects. Bone tissue density in defects filled with alloplastic bone graft was statistically significantly higher than that in the defects filled with xenograft.

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.

Accelerated orthodontic treatment using corticotomies: what are the minimally invasive alternatives?

The duration of orthodontic treatment in adults remains a barrier for some patients. Some surgical techniques have been developed in order to accelerate orthodontic tooth movement. The technique of corticotomies is effective in decreasing the orthodontic treatment time but remains invasive, leading to significant postoperative consequences. Minimally invasive techniques without muco-periosteal flap elevation have been developed: corticision, micro-osteoperforations, piezopuncture and piezocision. The piezocision procedure seems to be the best compromise to accelerate orthodontic tooth movement while respecting a specific surgical and orthodontic protocol. The piezocision surgery allows the addition of biomaterials in cases of dehiscence and/or fenestration on the alveolar bone associated with moderate to severe overcrowding. According to current publications, minimally invasive corticotomy techniques can be viewed as a new therapeutic tool in the acceleration of orthodontic tooth movement.

Palatogingival groove: A pathway to periodontal destruction

Palatogingival or radicular groove is another developmental aberration known to maximally affect the palatal surfaces of maxillary lateral incisors but is often missed during a routine. It is a malformation which presents as a groove or channel that begins in the central fossa, crosses the cingulum of the tooth and extends apically to or beyond the cementoenamel junction at varying distances and directions along the root surface. It serves as a perfect bacterial harbor predisposing to pocket formation, concomitant bone loss and pulpal involvement, thereby encouraging the development of endodontic-periodontal lesions. Depending on severity, the groove may render a direct communication between the periodontium and pulp cavity promoting effortless bacterial invasion. It creates an area where plaque accumulation can be difficult, if not impossible to control using oral hygiene measures. The diagnosis of these grooves is quite difficult, as they cannot be differentiated in the X-ray images. The treatment procedures employed for treating palatogingival grooves will include pulpectomy if the tooth is nonvital along with odontoplasty of the groove or restoration of the groove with glass ionomer cement after the elevation of mucoperiosteal flap. Bone defects around the involved teeth also have to be treated with grafts and membrane. This case report describes the diagnosis and treatment of a palatogingival groove on maxillary lateral incisor.

Open flap versus flapless placement of dental implants. A randomized controlled pilot trial.

The aim of this study was to compare the immediate postoperative period of participants rehabilitated with dental implants placed with a conventional technique or with a minimally invasive technique, without a mucoperiosteal flap elevation (flapless). Participants who needed implant placement were divided into two groups: one group was operated using a mucoperiosteal flap elevation (G_A), and the other with a flapless surgical technique (G_B). Objective clinical parameters including oral hygiene, mouth opening, inflammation (facial perimeter), surgical time and analgesic consumption, as well as subjective parameters of pain and degree of satisfaction with the procedure, were evaluated. 48 implants were placed in 30 participants (15 participants per group). Oral hygiene index, maximum interincisal opening, pain and analgesic consumption values had a significant difference between groups favoring the flapless technique at 24h and 7days but at the 15days' follow-up the differences were only significant for oral hygiene and pain (P<0.05); there were no statistically significant differences between groups in terms of facial perimeter values and surgical time (P>0.05). Average on the degree of satisfaction was of 2.6 (SD 0.8) for G_A and 3.6 (SD 1.02) for G_B (P=0.06). One implant placed in G_A (2.0%) failed before prosthetic loading due to mobility and pain at 3months' follow-up. Participants operated for implant placement with flapless surgical technique go through less postoperative discomfort. Both techniques show high success rates, but to perform a flapless technique patients must be properly selected.

Prevalence of dehiscences and fenestrations in human cadavers

Objetivo: o objetivo do presente estudo foi avaliar a prevalência de deiscências e fenestrações em uma amostra de conveniência de cadáveres humanos para fornecer uma identificação precisa dos defeitos ósseos. Material e Métodos: vinte cadáveres humanos, com idade variando de 20 a 40 anos, foram avaliados quanto a deiscências e fenestrações, verificadas após a elevação do retalho mucoperiosteal. Resultados: a prevalência de deiscências e fenestrações nos espécimes foi confirmada como sendo 40%, representando 5% dos dentes com lesões. As lesões mais prevalentes foram deiscências, enquanto apenas um único caso de fenestração maxilar foi observado. Conclusão: o planejamento de qualquer cirurgia plástica periodontal realizada na região anterior deve levar em consideração a possibilidade de defeitos periodontais. Portanto, considerando a alta prevalência de defeitos ósseos com potencial impacto no resultado estético, a manipulação dos tecidos moles deve ser feita com cautela, principalmente em pacientes com periodonto fino.

Comparative Evaluation of the Efficacy of Platelet-rich Fibrin and Calcium Phosphosilicate Putty alone and in Combination in the Treatment of Intrabony Defects: A Randomized Clinical and Radiographic Study.

Background:Combination of platelet-rich fibrin (PRF) and bone substitutes for the treatment of intrabony pockets is based on sound biologic rationale. The present study aimed to explore the clinical and radiographic effectiveness of autologous PRF and calcium phosphosilicate (CPS) putty alone and in combination in treatment of intrabony defects.Materials and Methods:A total of 45 intrabony defects were selected and randomly divided into three groups. In Group I, mucoperiosteal flap elevation followed by placement of PRF was done. In Group II, mucoperiosteal flap elevation followed by placement of CPS putty was done. In Group III, mucoperiosteal flap elevation followed by placement of PRF and CPS putty was done. Clinical parameters such as gingival index (GI), pocket depth (PD), clinical attachment level (CAL), gingival marginal position and radiographic parameters such as bone fill, changes in crestal bone level, and defect depth resolution were recorded at baseline and after 6 months postoperatively.Results:Statistically significant changes in GI, PD reduction, CAL gain, defect fill, and defect depth resolution from baseline to 6 months were seen in all the three groups (P < 0.05). On intergroup comparison, no statistically significant changes were seen in all clinical parameters. However, the difference in defect fill and defect depth resolution between the Groups I and III and Group II and III was significant.Conclusion:Within limitations of study, combination of PRF and CPS putty showed a significant improvement in PD reduction, CAL gain, and bone fill.

Abstract: Modified Furlow Palatoplasty Using Small Double-Opposing Z-Plasty for Patients with Cleft Lip and/or Palate

BACKGROUND: Since Furlow’s palatoplasty was first published, it has gained a high degree of popularity among cleft lip and palate surgeons, making the double-opposing Z-plasty one of the most commonly used techniques for primary palatoplasty.1 In our modification of the Furlow procedure we have used a smaller double-opposing Z-plasty in the soft palate than previously reported, and various lateral relaxing incisions in the hard palate selected according to the intraoperatively detected tension for midline wound closure. The purpose of this study is to assess the surgical outcome and the longitudinal speech function in the postoperative course using our modified procedure. 2 METHODS: The surgical technique included mucoperiosteal flap elevation in the hard palate, complete pedicle dissection and release, double-opposing Z-plasty using 5-mm limbs and muscle dissection in the soft palate, and the buccal fat pad covering lateral relaxing wounds. Retrospective chart review was conducted for 231 consecutive non-syndromic patients undergoing the modified palatoplasty from May 2007 to December 2014. The demographic, postoperative, and follow-up data were collected. Statistical analyses were performed. RESULTS: Average age at palatoplasty was 8.3 months. Overall oronasal fistula rate was 0.4%, which occurred only in one case with bilateral cleft. Other complications included postoperative bleeding in 2 cases (0.8%), postoperative airway obstruction in 1 case (0.4%), obstructive sleep apnea in 1 case (0.4%), stitch abscess in 1 case (0.4%), and distal uvula dehiscence in 2 cases (0.8%). 127 patients had full speech evaluation. 110 (86.6%) patients were assessed as having adequate function, 10 (7.8%) had marginal velopharyngeal function, and 7 were diagnosed with inadequate function with performed or recommended velopharyngeal insufficiency (VPI) surgery (5.5%). There was no significant relationship between speech function or VPI surgery rate and the type of cleft palate (chi-square, p = 0.32 and p = 0.41 respectively). CONCLUSION: This modified palatoplasty using a small double-opposing Z-plasty provided adequate cleft palate closure with low fistula rate and satisfactory speech outcome. REFERENCES 1. Furlow LT, Jr. Cleft palate repair by double opposing Zplasty. Plast Reconstr Surg. 1986;78(6):724–738. 2. Yamaguchi K, Lonic D, Lo LJ. Modified Furlow palatoplasty using small double-opposing Z-plasty: Surgical technique and outcome. Plast Reconstr Surg. In press.