Posterior Alveolar Ridge Research Articles

PRIMARY INTRAOSEOUS CARCINOMA - CASE REPORT

A 65-year-old patient, melanoderma, smoker since 10 years old, came to the oral and maxillofacial service complaining of pain in the jaw on the right side for one year. The intraoral physical examination revealed an ulcerated, leukoplasic and erythematous lesion in the region of the right posterior alveolar ridge. Imaging exams showed a radiolucent, unilocular lesion, with a well-circumscribed, radiopaque halo in the posterior mandibular region on the right side. Hematological examination was requested and an incisional biopsy was performed. The histopathology revealed a fragment of malignant neoplasm of epithelial origin characterized by the proliferation of tumor cells arranged in islands growing inside the connective tissue and a fragment of a cystic lesion of odontogenic origin characterized by the presence of a pathological cavity lined by stratified epithelium, with a consistent diagnosis of primary intraosseous carcinoma. The patient was referred to the oncology service. A 65-year-old patient, melanoderma, smoker since 10 years old, came to the oral and maxillofacial service complaining of pain in the jaw on the right side for one year. The intraoral physical examination revealed an ulcerated, leukoplasic and erythematous lesion in the region of the right posterior alveolar ridge. Imaging exams showed a radiolucent, unilocular lesion, with a well-circumscribed, radiopaque halo in the posterior mandibular region on the right side. Hematological examination was requested and an incisional biopsy was performed. The histopathology revealed a fragment of malignant neoplasm of epithelial origin characterized by the proliferation of tumor cells arranged in islands growing inside the connective tissue and a fragment of a cystic lesion of odontogenic origin characterized by the presence of a pathological cavity lined by stratified epithelium, with a consistent diagnosis of primary intraosseous carcinoma. The patient was referred to the oncology service.

ORAL INVOLVEMENT IN DISSEMINATED HISTOPLASMOSIS - A CASE REPORT

Histoplasmosis is a systemic mycosis. Oral involvement is very rare, usually present in cases of disseminated disease. A 71-year-old man complained of a painful mouth sore, with a 2-month duration. The patient reported a history of heavy tobacco consumption and alcoholism. Clinical examination revealed a large ulceration extending from the hard palate to the left alveolar ridge. Computed tomography revealed involvement of the alveolar bone, showing irregularity of the left posterior alveolar ridge. The clinical diagnosis was oral squamous cell carcinoma, and an incisional biopsy was performed. Histopathological examination showed inflammatory cells in the lamina propria and numerous, small round-shaped yeast-like bodies in the interior of vacuolated macrophages. Periodic Acid-Schiff and Grocott's methenamine silver stains disclosed positive results for round bodies, confirming the diagnosis of oral histoplamosis. The patient was hospitalized, and in a short period of time, he contracted disease-related systemic complications and died. Histoplasmosis is a systemic mycosis. Oral involvement is very rare, usually present in cases of disseminated disease. A 71-year-old man complained of a painful mouth sore, with a 2-month duration. The patient reported a history of heavy tobacco consumption and alcoholism. Clinical examination revealed a large ulceration extending from the hard palate to the left alveolar ridge. Computed tomography revealed involvement of the alveolar bone, showing irregularity of the left posterior alveolar ridge. The clinical diagnosis was oral squamous cell carcinoma, and an incisional biopsy was performed. Histopathological examination showed inflammatory cells in the lamina propria and numerous, small round-shaped yeast-like bodies in the interior of vacuolated macrophages. Periodic Acid-Schiff and Grocott's methenamine silver stains disclosed positive results for round bodies, confirming the diagnosis of oral histoplamosis. The patient was hospitalized, and in a short period of time, he contracted disease-related systemic complications and died.

AMELOBLASTOMA IN THE POSTERIOR MAXILLA: A CASE REPORT

A 61-year-old male patient presented a painless, well-defined, expansive tumor on the left maxillary edentulous alveolar ridge, which had 18 months of evolution. The lesion measured 30 × 20 mm, had a soft consistency, and was covered by healthy mucosa, though with a localized ulcer. Medical history revealed type II diabetes, hypertension, and pulmonary tuberculosis. Panoramic radiograph showed an unilocular, radiolucent image expanding into the left maxillary sinus, with corticated margins. Cone-beam computed tomography revealed a well-defined, expansive, hypodense image involving the posterior alveolar ridge and extending into the maxillary sinus. Under a clinical hypothesis of mesenchymal neoplasia or fibro-osseous lesion, a puncture was performed, with a negative result. An incisional biopsy was undertaken and the histopathological diagnosis was ameloblastoma. The lesion was resected under general anesthesia, with clear margins. The final diagnosis was conventional (solid) ameloblastoma and the patient has been free of recurrence for 5 months. Support: CAPES. A 61-year-old male patient presented a painless, well-defined, expansive tumor on the left maxillary edentulous alveolar ridge, which had 18 months of evolution. The lesion measured 30 × 20 mm, had a soft consistency, and was covered by healthy mucosa, though with a localized ulcer. Medical history revealed type II diabetes, hypertension, and pulmonary tuberculosis. Panoramic radiograph showed an unilocular, radiolucent image expanding into the left maxillary sinus, with corticated margins. Cone-beam computed tomography revealed a well-defined, expansive, hypodense image involving the posterior alveolar ridge and extending into the maxillary sinus. Under a clinical hypothesis of mesenchymal neoplasia or fibro-osseous lesion, a puncture was performed, with a negative result. An incisional biopsy was undertaken and the histopathological diagnosis was ameloblastoma. The lesion was resected under general anesthesia, with clear margins. The final diagnosis was conventional (solid) ameloblastoma and the patient has been free of recurrence for 5 months. Support: CAPES.

Resorption of the posterior alveolar ridge after 7 years of wearing a mandibular overdenture

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< 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>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.

Partial Extraction Therapy for Implant Placement: A Newer Approach in Implantology Practice.

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.

Management of a complete denture in the flat mandibular ridge using a semi-adjustable articulator along with an effective suction method

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.

Major clinical findings of short implants and virtual surgery: a systematic review

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.

Comparison of Gonial Angle and Alveolar Bone Height Changes in Panoramic and Lateral Cephalometry Radiography in Growing Patients

Background: This study aimed to compare the gonial angle and alveolar bone height changes between panoramic and lateral cephalometry radiographic images in class II malocclusion patients before and after orthodontic treatment. Methods: The obtained radiographic images were selected from among 120 class 2 malocclusion cases. The gonial angle and alveolar bone height were measured in the midline and molar regions of panoramic and lateral cephalometric radiographs using the software tools before and after the treatment of patients. Study data were analyzed by SPSS statistical software (version 21.0), and a significance level was set to 0.05 for all statistical tests. Results: Based on the results, no significant difference was found regarding the gonial angle before and after treatment on the right and left sides in panoramic radiography and the gonial angle changes before and after treatment in cephalometric radiography (P>0.05). However, the obtained results for posterior and anterior alveolar ridge height were significant in panoramic and cephalometric radiographs (P<0.05). Moreover, the comparison of the measured gonial angle values before treatment in panoramic and cephalometric radiography represented a significant level (P<0.05). Eventually, the statistical results suggested that the alveolar bone height differences between panoramic and cephalometry radiography were significantly different in both anterior and posterior regions after treatment (P<0.05). Conclusions: The findings indicated that only measurements obtained from the panoramic radiography were valid for the gonial angle. However, panoramic and cephalometry radiography procedures cannot be replaced for assessing the anterior and posterior alveolar bone height.

Sequelae of congenital oropharyngeal teratoma in the oral cavity of the child

Congenital oropharyngeal teratoma is a rare tumor subtype with cells from the three germ layers, majorly being benign. Whereas teratoma develops early in intrauterine life, thus affecting the growth and development of adjacent structures, the purpose of this case report is to present the sequelae of this tumor in a child's oral cavity. Female child, 2 years and 3 months old referred by the otorhinolaryngologist for dental evaluation. The mother´s main complaint was the the child could not close her mouth. According to the child's medical record, at 34th week of gestation, during the routine ultrasound examination, the presence of the anechoic tumor mass was observed without Doppler signal, presenting a 3.2cm x 2.4cm diameter outside through the oral cavity. At 17 and 32 days of life, respectively, the excision of the largest and residual tumor located on the floor of the mouth was performed. Upon anatomopathological examination, the tumor with was classified as a mature teratoma. In the intraoral examination, a deep and atresia palate incomplete cleft palate, bone growth in the region of the posterior alveolar ridge of the maxilla, and in the posterior region of the mandible on the left side, "V" shaped mandible and microglossia, crowding were observed dental agenesis of the lower lateral incisors, absence of caries lesions, gingivitis and enamel development defects. The child will remain under the regular dental pediatric follow-up. Several sequelae were observed in the child's oral cavity and the need for multi-professional follow-up after excision of congenital oropharyngeal teratoma.

Role of Speech Aid Prosthesis as Diagnostic and Therapeutic Aid for Velopharyngeal Insufficiency Defect: A Case Report

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.

Intraosseous Myofibroma of the Mandible in a 7-Year-Old Patient: A Case Report

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.

Influence of marginal bone resorption on two mini implant-retained mandibular overdenture: An in vitro study.

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.

RADT-43. TREATMENT OF RETROPERITONEAL LEIOMYOSARCOMA BRAIN METASTASES WITH STEREOTACTIC RADIOSURGERY

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.

Evaluation of bone regeneration for augmentation of alveolar bone using 3D computer guided ceramic Sheets.

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

Pleomorphic adenoma (PA) is the most common benign salivary gland neoplasm, mainly involving the parotid followed by the minor salivary glands of the palate and the submandibular glands. The aim of this study is to report 3 cases of intraoral PA that presented uncommon histopathologic features. Case 1 occurred in the lower lip, case 2 occurred in the palate, and case 3 occurred in the posterior alveolar ridge. Clinically, all cases presented as an asymptomatic nodule. Microscopically, case 1 showed extensive bone metaplasia with few myoepithelial cells and ducts. Solid myoepithelial tumor with scant ducts was observed in case 2. Case 3 exhibited exuberant squamous metaplasia. In conclusion, PA can become a diagnostic challenge, and the knowledge of this diversity of microscopic pattern is essential to reach the correct diagnosis.

CLEAR CELL ODONTOGENIC CARCINOMA: A CASE REPORT

A 50-year-old woman with a previous diagnosis of ameloblastoma was referred to the School of Dentistry Brazil complaining of a symptomatic lesion in the body and ramus mandibular. Her medical history was unremarkable. The intraoral examination demonstrated an exophytic tumor mass in the right posterior alveolar ridge. Computed tomography revealed a lesion with irregular margins extending from first premolar to distal to second molar of the left side of the mandible. A provisional diagnosis of recurrent ameloblastoma was considered, and an incisional biopsy was performed. Histopathologic evaluation of the specimen showed nests, follicles, and cords of epithelial clear cells. In occasional follicles the central cells showed a reticulum-like pattern, and some central cells showed keratinization. Peripheral cells presented palisading and reverse nuclear polarity. Necrosis, cellular, and nuclear pleomorphism were also observed. Final diagnosis of clear cell odontogenic carcinoma was established. The patient was referred for treatment and is being followed up.

A GIANT COMPLEX ODONTOMA ASSOCIATED WITH OSTEOMYELITIS: AN UNCOMMON PRESENTATION

Odontomas are odontogenic tumors/hamartomas composed of dental tissue in a variable proportion. They generally do not exceed 3 cm. The osteomyelitis is an acute or chronic process in the bone marrow or cortical space. Here we report an uncommon presentation and association between complex odontoma and osteomyelitis in a 30-year-old male patient. He reported to our service with a lesion of approximately 3.2 cm in length, yellowish color and hardened consistence, involving the left inferior posterior alveolar ridge, with 2 years’ of evolution. Physical exam also verified facial asymmetry. In the panoramic radiograph, a calcified mass with a radiolucent rim and heterogenous radiopacity, together with an impacted third molar, was seen measuring approximately 30 × 25 × 20 mm in the left posterior mandibular area with buccal cortical bone expansion and thinning. After the excisional biopsy and radiologic, tomographic, and histopathologic findings, the diagnosis of complex odontoma associated with osteomyelitis was confirmed. Odontomas are odontogenic tumors/hamartomas composed of dental tissue in a variable proportion. They generally do not exceed 3 cm. The osteomyelitis is an acute or chronic process in the bone marrow or cortical space. Here we report an uncommon presentation and association between complex odontoma and osteomyelitis in a 30-year-old male patient. He reported to our service with a lesion of approximately 3.2 cm in length, yellowish color and hardened consistence, involving the left inferior posterior alveolar ridge, with 2 years’ of evolution. Physical exam also verified facial asymmetry. In the panoramic radiograph, a calcified mass with a radiolucent rim and heterogenous radiopacity, together with an impacted third molar, was seen measuring approximately 30 × 25 × 20 mm in the left posterior mandibular area with buccal cortical bone expansion and thinning. After the excisional biopsy and radiologic, tomographic, and histopathologic findings, the diagnosis of complex odontoma associated with osteomyelitis was confirmed.

Maxillary Sinus Floor Elevation Surgery With BioOss Mixed With Enamel Matrix Derivative: A Human Randomized Controlled Clinical and Histologic Study.

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.

Computer-guided implant placement associated with computer-aided bone regeneration in the treatment of atrophied partially edentulous alveolar ridges: A proof-of-concept study

Background/purposeThe existing literature lacks information regarding the use of digital workflows during pre-surgical planning of implant rehabilitations in resorbed edentulous ridges. Thus, the aim was to evaluate the effectiveness of computer-guided implant placement and simultaneous computer-aided guided bone regeneration (GBR) in the treatment of atrophic posterior alveolar ridges. Materials and methodsPartially edentulous patients requiring GBR simultaneously to implant insertion were enrolled. Implant positions and the augmented missing bone were planned with specific software. A stereolithographic model of the grafted jaw was produced to transfer the virtual bone augmentation to the surgical field. A tooth-supported stent was used to guide implant insertion according to the virtual project. Visual analogue scales (VASs) were used to self-register postoperative pain, swelling, bleeding, and perception of the operation. Post-operative cone-beam computed tomography scan was superimposed to the virtual project to evaluate the accuracy of implant positions. ResultsOverall, 10 implants were placed in 5 patients. Healing proceeded uneventfully in all except one patient that showed a dehiscence of the lingual flap as early surgical complication. Nevertheless, complete filling of the bone defects was observed clinically and radiographically in all patients. Pain scored exceptionally high with respect to the other variables. Deviations of 0.73 ± 0.21 mm, 0.59 ± 0.28 mm, and 3.05° ± 1.22° were found at implant head, apex, and long-axis respectively. Distal implants showed higher angular deviations compared to mesial implants (p = 0.008). ConclusionComputer-guided approach provided encouraging results in terms of efficacy and accuracy. Conversely, patient-centered outcomes were below the expectations.

Comparative evaluation of biting force and chewing efficiency of all-on-four treatment concept with other treatment modalities in completely edentulous individuals.

Aim:To compare and evaluate biting force and chewing efficiency of all-on-four treatment concept, implant-supported overdenture, and conventional complete denture.Settings and Design:Invivo – comparative study.Materials and Methods:A total of 12 edentulous patients were included in the study and conventional complete dentures were fabricated. Patients were divided into two groups. In Group 1, complete dentures were replaced with implant-supported overdenture, and in Group 2, complete dentures were replaced with hybrid denture supported by all-on-four treatment concept. The biting force was assessed using a bite force sensor and electromyographic recordings were made by electromyogram for masticatory muscles when chewing three different consistencies of foods.Statistical Analysis Used:The data was statistically analyzed using software SPSS version 22.0. Paired t-test was used for intra-group comparison and unpaired t-test was used for intergroup comparison.Results:The difference in biting force and chewing efficiency for all-on-four treatment concept was statistically significant for overdenture and complete denture. The highest biting force and chewing efficiency were observed for all-on-four treatment concept, followed by implant-supported overdenture and complete denture.Conclusion:The study concluded that the completely edentulous individuals with atrophic posterior alveolar ridges can be rehabilitated successfully with improved biting force and chewing efficiency by All-on-four treatment concept.