Asymmetry of the alveolar ridge in Class II maxillary defects reconstructed by an osseo-myocutaneous flap: A CBCT evaluation.

Successful implant placement in the posterior mandible often requires augmentation of narrow ridges. This study aimed to compare the primary stability of dental implants placed using the conventional ridge split technique and the osseodensification method in narrow posterior mandibular ridges. A randomized controlled trial was conducted involving 14 patients, with a total of 28 implants divided equally between two groups. Group I underwent conventional ridge splitting, and Group II received implant site preparation via osseodensification. Primary stability was evaluated immediately after implant placement using the Osstell Mentor device (Osstell AB, Gothenburg, Sweden) to obtain implant stability quotient (ISQ) values. Data was analyzed, and mean ISQs were compared using independent t-tests. Implants placed using the osseodensification technique exhibited significantly higher ISQ values compared to those placed using the conventional ridge split technique (p < 0.001). No significant difference in stability was observed between the lower first and second molar sites bilaterally within each group. The results indicated that osseodensification offered superior primary stability. Both the conventional ridge split and osseodensification techniques effectively enabled implant placement in narrow posterior mandibular ridges. However, the osseodensification technique demonstrated significantly greater primary stability, suggesting its potential advantage in clinical practice for achieving predictable outcomes in compromised ridge scenarios.

The horizontally insufficient posterior mandibular ridge frequently restrains dental implant insertion. A modified ridge split procedure was innovated to separate, convey laterally, and fix the buccal cortical plate in 20 patients with posterior horizontal mandibular alveolar deficiency. Meanwhile, the intercancellous space was obliterated with autogenous bone particulates for the test group patients and Anorganic bone bovine mineral (ABBM) for those of the control group. Following a comparison of the horizontal bone gain and the histomorphometric bone area percent among both groups after 6 months of graft consolidation, 40 implants were inserted during the second surgical stage. All of the grafts were consolidated. A statistically insignificant difference was found between the control group's mean 6-month postoperative horizontal bone width of (8.10 ± 0.83) and that of the study one of (7.90 ± 0.77). The control group's mean bone gain was recorded (4.76 ± 0.81) versus (4.63 ± 0.78) for the study group, with a statistically insignificant difference. Both groups showed histological evidence of a moderate number of osteoblasts, mature trabecular bone, and lamellae encircling large fatty marrow spaces. A statistically significant difference (p = 0.021) was found between the control group's mean bone area percentage of new bone formation (38.83% ± 1.17%) and that of the study group (34.40% ± 3.71%). The modified ridge split with either autogenous or (ABBM) graft was deemed reliable for reconstructing the horizontally deficient posterior alveolar ridge with appropriate volumetric stability and bone quality. The study was registered on www. gov (Registration #: NCT05286541).

Background: The function of mastication, phonetic, and aesthetic of fully edentulous patient can be restored by complete denture treatment. The use of semi-adjustable articulator, suction effective impression method and neutral zone technique are important to enhanced a stable and retentive complete denture with good occlusion. Semi- adjustable articulator and suction effective method ensures the dentures constructed according to patient’s physiological movements and denture’s border seal captured according to patient’s anatomy. Neutral zone technique ensures the teeth arrangement in the space where the displacing forces of the lips tongue and cheeks are balanced. Those three approaches are expected to provide optimal prosthetic integration. Purpose: This case report aimed to describe the management of complete denture treatment in a resorbed mandibular with suction effective method and neutral zone technique using a semi-adjustable articulator. Case: A 67-year-old female patient wanted dentures because of all the mandibular teeth already extracted five months prior to the patient’s arrival. The mandibular posterior alveolar ridge showed dextral and sinistral tapering. Case Management: A complete denture with an acrylic base was fabricated with suction effective method and neutral zone technique using a semi-adjustable articulator. Conclusion: Resorbed mandibular ridge case management using a semi-adjustable articulator with suction effective method and neutral zone technique can improve complete denture retention and stability.

PRIMARY INTRAOSEOUS CARCINOMA - CASE REPORT

ORAL INVOLVEMENT IN DISSEMINATED HISTOPLASMOSIS - A CASE REPORT

AMELOBLASTOMA IN THE POSTERIOR MAXILLA: A CASE REPORT

RESUMEN La sobredentadura retenida por dos implantes es una opción para la rehabilitación del edentulismo, pero no se ha estudiado a profundidad su efecto sobre el mantenimiento de la altura del reborde alveolar posterior. El objetivo de este trabajo fue determinar los cambios en altura del reborde alveolar posterior mandibular después de 7 años del uso de una sobredentadura mandibular. Este estudio descriptivo consideró 17 pacientes. Cada paciente había recibido una sobredentadura mandibular retenida por dos implantes no ferulizados cargados de forma inmediata y unidos mediante ajustes en bola. Se realizaron mediciones en dos radiografías panorámicas (una tomada antes de la inserción de la sobredentadura [T0] y otra siete años después [T7]),para los trazos, el área se expresó como un triángulo posterior formado por el gonion, el borde inferior del agujero mental y un punto que fue el centro del triángulo gonion - foramen mental - muesca sigmoidea. El área medida se comparó con el área triangular en el mismo lado. Los resultados en mm con significancia estadística (p&lt; 0.05) fueron: área de referencia ósea “X”( [T0]:494.3- [T7]:431.6) área de referencia ósea izquierda ([T0]:502.0 -[T7]:405.3) y el índice de área posterior([T0]:1.4-[T7]:1.2).Los resultados en mm sin significancia estadísticas(p&gt;0.05)indicaron: área de referencia ósea “X” derecha([T0]:486.1 - [T7]:458.0), área de referencia en “Y” izquierda ([T0]:354.8-[T7]:360.6), derecha ([T0]:361.9-[T7]:375.6) y promedio de longitud del reborde maxilar ([T0]:35.4-[T7]:36.9). La reabsorción del reborde alveolar posterior a los 7 años estuvo dentro de los parámetros normales, no existiría ningún efecto nocivo de la sobredentadura sobre este reborde.

One of the most popular treatment modalities in routine implantology practice is extraction followed by immediate or delayed implant insertion. Teeth removal alone is insufficient, particularly in the maxillary anterior region of the jaw. Patients may experience several issues after tooth extractions. Due to trauma and the loss of periodontal ligaments, post-extraction alveolar ridge resorption cannot be prevented. Atraumatic extraction, socket preservation, grafting, and implant placement immediately after the extraction are some of the procedures that are carried outto minimize or prevent the resorption ofalveolarbone. Osseointegration is essential for keeping the clinical effectiveness of dental implants. If the supporting tissues at an implant site resorb and are worsened by risk factors for recession, there may be considerable esthetic and functional failure. Implant placement at the retained root structure preserves the buccal bone resulting in an excellent emergence profile. Resorption in the posterior alveolar ridge may result in a decrease in attached keratinized tissue and a decrease in vestibular depth. This might have a negative impact on the stability of the implant and leads to peri-implantitis resulting in the failure of the implant. Without papilla loss or arch collapse, partial extraction therapy has resulted in effective esthetic outcomes. The socket shield technique is a minimally invasive surgical procedure that helps to maintain both soft and hard tissues by preserving a small section of the root. It lessens the necessity for surgeries on bone and mucogingival grafts, cutting the length of the overall recovery process and reducing the treatment time.When soft and hard tissue grafts are used to fill the socket before applying pressure with pontics, it is known as the pontic shield procedure. However, there is no published study that explains partial extraction therapy in a straightforward and clear manner that can guide a practitioner in determining a shield design with a proven track record of success. This review article focuses on the partial extraction procedure which is very helpful for preserving soft and hard tissues in cases involving immediate implant insertion post-extraction. It has long-term therapeutic success with implant and pontic therapy. This review article will also be helpful for clinicians to understand shield design in different case scenarios and help to learn step-wise procedures carried out in partial extraction therapy.

Background: Complete dentures can improve the quality of life of edentulous patients. The selection of a suitable articulator and an impression technique is important to construct a stable and retentive complete denture with good occlusion. The use of a semiadjustable articulator ensures that the dentures can be constructed such that their movement closely resembles the patient’s physiological movements. The effective suction method can ensure the development of the border seal according to the patient’s anatomical condition. The use of a semi-adjustable articulator along with an effective suction method is expected to provide good results in the construction of a complete denture. Purpose: This report aimed to describe the management of individual complete dentures in the flat mandibular ridge using a semi-adjustable articulator along with an effective suction method. Case: A 69-year-old female patient came with a chief complaint of her old dentures being unusable and wanted new dentures made. The patient’s general condition was good, and the last extraction was done three months prior to the patient’s arrival. The mandibular posterior alveolar ridge showed dextral tapering and sinistral flatness. Case Management: A complete denture with an acrylic base was fabricated using a semi-adjustable articulator along with an effective suction method. Conclusion: Flat ridge case management using a semi-adjustable articulator with an effective suction method can improve complete denture retention and stability.

Introduction: After the confirmation and publication of the phenomenon known as osseointegration by Brånemark, dental implants have been used to repair total and partial edentulous jaws. However, the implants were long and had to be longer than 11 mm to be considered functional. Short implants compared to long ones require less remaining bone, reducing the patient's exposure to surgeries for bone grafting, the elevation of the maxillary sinus mucosa, and repositioning of the inferior alveolar nerve. Added to this, several dental treatments have benefited from this digital advance. Objective: To review the literature on short implants installed in both dental arches, evaluating their advantages, disadvantages, indications, and contraindications in the context of virtual surgery. Methods: The present study followed a systematic review model (PRISMA). The search strategy was performed in the PubMed, Scielo, Cochrane Library, Web of Science and Scopus, and Google Scholar databases. Results: A total of 110 articles were found, 64 articles were evaluated and 35 were rejected for not meeting the GRADE classification, and only 29 articles were used in this study to compose the textual part. Based on these findings, it was found that in remote years, authors reported that regions with reduced bone height are favored with the use of short implants not only because of their dimensions but also because of their surface treatment, which suggests that it is an important factor for achieving 100% success rates. The advantages of short implants are related to the simplicity of the technique, installation of implants in remaining bone, avoidance of bone grafts that present questionable results in the increases in height of the posterior alveolar ridge of the mandible, reduction of treatment time, and reduction of costs for the patient. A systematic review and meta-analysis studies analyzed the accuracy of implant placement using computer-guided surgery. A randomized study compared the precision of guided planning of new computer-assisted implant placement techniques, based on models that use CAD/CAM. Conclusion: It was concluded that short implants are a reliable, safe, and practical alternative to be used in any necessary location or situation. They do not show bone loss or resorption over the years, nor are they at risk of fracture or any damage to patients. They are safe to use, as long as they have an adequate design, therefore, fundamental tools in the dental clinic.

Soft palate tumors pose the challenge during reconstructive and rehabilitating procedures. Surgical resection of these tumors leads to velopharyngeal insufficiency (VPI). The primary effects of VPI are hypernasality and air-flow escape, while the secondary effects are abnormalities in speech articulation. Surgical revision along with speech therapy is a common approach to the treatment of VPI. Prosthetic management by means of speech aid prosthesis helps to reduce resonance, nasal emission and consonants errors. This clinical report describes the different stages of rehabilitation of velopharyngeal insufficiency defect following resection of malignant melanoma of left posterior alveolar ridge and soft palate. The speech aid prosthesis helped to rehabilitate the velopharyngeal insufficiency defect and aided in the diagnosis of extent of speech function improvement by perceptual and objective methods.

Myofibroma is a benign fibrous tumour that occurs predominantly in the head and neck region followed by the trunk and extremities. However, cases occurring in the oral cavity are rare, presenting with a variable clinical appearances and wide differential diagnosis. We reported a case of a 7-year-old girl who was referred to the Department of Paediatric Dentistry, Tengku Ampuan Rahimah Hospital with a progressively enlarging painless swelling on the left posterior region of the mandible over the past 3 months. The swelling was associated with ulceration and displaced lower left first permanent molar. Radiographic investigations reported well-defined radiolucency at molar area, alveolar expansion and bone resorption of the left posterior alveolar ridge of the mandible. Complete surgical excision of the lesion was performed under general anaesthesia. Histopathological examination revealed proliferation of spindle shaped cells with biphasic growth pattern. Immunohistochemical staining showed strong positivity with vimentin and smooth muscle actin whilst negative for desmin, S100 and CD34 establishing the diagnosis of myofibroma. Although rare, myofibroma should be considered as a differential diagnosis for solitary firm swelling in the oral cavity. Histopathological examination together with immunohistochemical analysis is essential for an accurate diagnosis.

PURPOSETo investigate the biomechanical effect of marginal bone resorption (MBR) on the mandibular mini implant (MI)-retained overdenture (MI-OD) on the edentulous model.MATERIALS AND METHODSThe experimental mandibular edentulous model was modified from a commercial model with 2 mm thick artificial soft tissue under denture base. Two MIs (Φ2.6 mm × 10 mm) were bilaterally placed between the lateral incisor and the canine area and attached with magnetic attachments. Three groups were set up as follows: 1) alveolar bone around the MI without MBR (normal group), 2) with MBR to 1/2 the length of the implant (resorption group), and 3) complete denture (CD) without MI (CD group). Strain around the MI, pressure near the first molar area, and displacement of denture were simultaneously measured, loading up to 50 N under bilateral/unilateral loading. Statistical analysis was performed using independent-samples t test and one-way ANOVA (α=.05).RESULTSThe strain around the MI with MBR was approximately 1.5 times higher than that without MBR. The pressure in CD was higher than in MI-ODs (P <.05), while there was no statistical difference between the normal and resorption group (P >.05). Similarly, the CD demonstrated a greater displacement of the denture base than did the MI-ODs during bilateral and unilateral loadings (P <.05).CONCLUSIONThe strain around the MI with MBR was approximately 1.5 times higher than that without MBR. The pressure on posterior alveolar ridge and denture displacement of MI-ODs significantly decreased compared to CDs, even when MBR occurs. Bilateral balanced occlusion was recommended for MI-ODs, especially when MBR occurred.

Abstract INTRODUCTION Retroperitoneal leiomyosarcoma is a relatively rare disease, with infrequent metastatic spread to the CNS. We present the first report of radiosurgical treatment of this disease. METHODS A 49-year-old woman developed leiomyosarcoma of the inferior vena cava and retroperitoneum with lung metastases on diagnosis. Following multiple courses of systemic and operative treatment, she developed a tender ulcerating mass in the left upper maxillary incisor associated with numbness along the upper gum, lip, and premaxillary area. CT revealed a 3.0 cm left posterior alveolar ridge gum lesion with bone invasion, for which she elected to undergo palliative radiation therapy (30 Gy in 10 fractions). Due to potential maxillary nerve involvement altering the intended radiation therapy treatment fields, an orbit/face MRI was performed to better delineate the lesion. On this MRI, two frontal lobe lesions were visualized; subsequent dedicated brain MRI revealed a total of five metastases (0.9 cm right superior frontal gyrus, 0.9 cm left middle frontal gyrus, 0.9 cm right postcentral gyrus, 0.7 cm right occipital, and 1.6 cm left occipital). Consequently, the decision was made to treat the brain metastases with linear accelerator (LINAC) stereotactic radiosurgery (SRS) to allow simultaneous treatment of the maxillary lesion and brain metastases. RESULTS A single CT simulation was performed for her intracranial and extracranial disease, using the Encompass face mask to allow for simultaneous head immobilization and optimal SRS targeting accuracy. LINAC SRS was delivered simultaneously during maxillary lesion radiation therapy to all five lesions (22 Gy to the 80% isodose line) in a single fraction with a 0.2 cm planning target volume (PTV) margin for each lesion. CONCLUSIONS The first reported case of metastatic retroperitoneal leiomyosarcoma brain metastases treated with SRS demonstrates the flexibility of LINAC (rather than Gamma Knife) SRS in allowing for simultaneous treatment of intracranial and extracranial metastatic disease.

Background: This study was designed to evaluate bone augmentation of posterior alveolar mandibular ridge using 3D computer guided ceramic Sheets as a membrane in GBR . Methods: Seven patients were included in the present study. Preoperative clinical evaluation, and CBCT scan for ridge evaluation and planning, all patient clinically suffering from severed resorbed posterior alveolar ridge of the mandible. Measuring height and width of right and left residual alveolar ridge was performed in CBCT software viewer base on this digital model 3D zirconia sheet was designed and plan on patient CBCT then milled on CAD/ CAM 5 axis machine to the desired macroscopic shape. After surgery, clinical evaluations were done at intervals of 2 weeks, first month, 3rd and 6th month and directed toward the observation of the healing process, sings of inflammation, infection soft tissue dehiscence, Zr exposure or any complications of wound. 2nd surgical intervention to remove the screws and Zr sheet and CBCT evaluation to measuring alveolar ridge on both sides. Results: Results of the current showing that customized Zr sheet can use successfully to obtain vertical and horizontal bone augmentation well compatible with soft tissue without exposure. Conclusion: Customized Zr sheet act as a perfect barrier and space maintaining in GBR procedures with precise fit. Good soft tissue acceptance to Zirconia. Customized Zr sheet reduce chairing time and amount of graft. More predictable results can obtained by using xenograft under Zr sheet.

INTRAORAL PLEOMORPHIC ADENOMA: A REPORT OF 3 CASES WITH UNCOMMON HISTOPATHOLOGIC FEATURES

CLEAR CELL ODONTOGENIC CARCINOMA: A CASE REPORT

A GIANT COMPLEX ODONTOMA ASSOCIATED WITH OSTEOMYELITIS: AN UNCOMMON PRESENTATION

Xenograft bone substitutes are commonly used to increase bone volume and height in the deficient posterior maxilla. The addition of enamel matrix derivate (Emdogain) could increase the efficiency of the bone healing process. The aim of this prospective randomized, controlled split-mouth design study was to compare the percentage of newly formed bone in sinus floor augmentation with deproteinized bovine bone mineral with or without the addition of enamel matrix derivative after 6 months of healing. Sixteen bilateral sinus floor augmentation procedures were performed. Deproteinized bovine bone mineral combined with enamel matrix derivative (test) and deproteinized bovine bone mineral alone (control) groups were randomly allocated within each patient. Six months after augmentation and concurrent to implant placement, bone biopsies were taken for histomorphometric analysis. Additionally, implant survival and peri-implant bone levels were radiographically assessed at baseline and 24 months after functional loading. Histomorphometric analysis revealed a significantly higher amount of newly formed bone in the test group compared with the control group (22.6% and 15.5%, respectively; P = .033). No significant differences in the amount of remaining graft or connective tissue was found. Enamel matrix derivative added to deproteinized bovine bone mineral particles significantly increased new bone formation in sinus lift procedures in edentulous or partially edentulous patients with deficient bilateral posterior alveolar ridges requiring augmentation for implant placement.