Trephine Drill Research Articles

The Effect of Different Separated File Retrieval Strategies on the Biomechanical Behavior of a Mandibular Molar: A Finite Element Analysis Study

IntroductionThis study evaluated the effects of retrieval strategies of separated nickel-titanium files on the biomechanical behavior of endodontically treated teeth by finite element analysis. MethodsSix FE models were created: intact tooth; simulated a scenario where the apical 3 mm of a nickel-titanium file is separated and retained; TD, simulated application of a trephine drill to expose 1 mm of the separated file; simulated troughing of 180° at the inner wall of root canal for an extra 1 mm of the separated file beyond the staging platform; simulated circumferential ultrasonic troughing done for an extra 1 mm after the TD; and PM, simulated iatrogenic perforation sealed using MTA. Occlusal loading followed the occlusal fingerprint of the tooth before maximum von Mises stresses, maximum principal stresses, safety factor, and number of cycles till failure were determined. The cervical region of the teeth and mid-root sections including the separated file was chosen as the areas of interest for further analysis. ResultsIntact tooth recorded the highest number of cycles till failure and safety factor. Other models showed a narrow range of variation in all aspects with the PM recording the lowest number of cycles till failure. The highest von Mises stress was recorded at the mesiobuccal line angle of the PM near its cervical margin, while the lowest was found at the intact tooth. ConclusionUnder the limitation of this study, various file retrieval strategies removing the surrounding root dentin within the amounts of general guidelines do not affect the biomechanical behavior of the tooth.

Comparison of Four Different Dental Implant Removal Techniques in Terms of the Weight and Volume of Bone Loss.

Several approaches have been suggested for implant removal. However, further research is necessary to review data regarding the amount of bone removed and the duration of removal time for different procedures. This study evaluates and compares various implant removal techniques. Materials and methods: A polyurethane block was scanned to create an implant surgical guide. Afterward, implant-guided surgery was performed on 60 simulated bone blocks. The implants were then separated into four groups and removed utilizing the counter-torque ratchet, trephine drills, burs, and piezosurgery. For the weight of bone loss, there were significant differences in the median between the counter-torque ratchet technique (CTRT) and trephine (p < 0.01), CTRT and bur (p < 0.01), trephine and piezo (p < 0.01), and bur and piezo (p = 0.04). All groups, except CTRT and the piezo group, demonstrated a statistically significant difference (p < 0.01) in the procedure durations. Regarding the volume of bone loss, a statistically significant difference (p < 0.01) was found between each group. Conclusions: CTRT showed the least amount of bone loss. On the other hand, the trephine technique was demonstrated to be the fastest. It is essential to consider the limitations and risks when choosing the approach for implant removal.

Topography of root-end surface after freehand and three-dimensional-guided apicoectomy procedure: A scanning electron microscope study.

Dentinal microcracks formed during apical resection may lead to increased susceptibility to root fracture and improper sealing of apical preparation that may negatively influence the outcome of endodontic microsurgery. This study was performed to analyze the root-end surface for dentinal microcracks using a scanning electron microscope (SEM) after resection with high-speed bur and trephine drill. Thirty extracted single-rooted maxillary premolar teeth were selected and randomly distributed into two groups (n = 15). Working length was established using a #15 K-type file. Canals were prepared with a rotary Ni-Ti system to size 30/0.06 using endomotor, irrigated with 3% sodium hypochlorite, dried with paper points, and obturated with gutta-percha cones using a single-cone technique. All samples were mounted on preformed molds and poured using a mixture of sawdust and gypsum. In Group A; tungsten carbide bur was used to perform a freehand apicoectomy. In Group B; a trephine drill was used with a three-dimensional guide to perform 3 mm of root resection. Apicoectomy was performed in both groups under a dental operating microscope. Resected root ends were inspected for microcracks using SEM. The Shapiro-Wilk and Mann-Whitney U-test were used for statistical analysis. Microcracks were observed in all samples in both study groups. Trephine drill produced more microcracks on the resected root surface compared to the use of high-speed tungsten carbide bur with a statistically significant difference (P < 0.05). The trephine drill used during targeted endodontic microsurgery produced more microcracks on the resected root dentine surface compared to the high-speed tungsten carbide bur used during freehand apicoectomy.

Microfragmented Fat and Biphasic Calcium Phosphates for Alveolar Cleft Repair: Protocol for a Prospective, Nonblinded, First-in-Human Clinical Study.

Biphasic calcium phosphates (BCP) may serve as off-the-shelf alternatives for iliac crest-derived autologous bone in alveolar cleft reconstructions. To add osteoinductivity to the osteoconductive BCPs to achieve similar regenerative capacity as autologous bone, a locally harvested buccal fat pad will be mechanically fractionated to generate microfragmented fat (MFAT), which has been shown to have high regenerative capacity due to high pericyte and mesenchymal stem cell content and a preserved perivascular niche. Our primary objectives will be to assess the feasibility and safety of the BCP-MFAT combination. The secondary objective will be efficacy, which will be evaluated using radiographic imaging and histological and histomorphometric evaluation of biopsies taken 6 months postoperatively, concomitant with dental implant placement. Eight patients with alveolar cleft (≥15 years) will be included in this prospective, nonblinded, first-in-human clinical study. MFAT will be prepared intraoperatively from the patient's own buccal fat pad. Regular blood tests and physical examinations will be conducted, and any adverse events (AEs) or serious EAs (SAEs) will be meticulously recorded. Radiographic imaging will be performed prior to surgery and at regular intervals after reconstruction of the alveolar cleft with the BCP-MFAT combination. Biopsies obtained after 6 months with a trephine drill used to prepare the implantation site will be assessed with histological and histomorphometric analyses after methylmethacrylate embedding and sectioning. The primary outcome parameter will be safety after 6 months' follow-up, as monitored closely using possible occurrences of SAEs based on radiographic imaging, blood tests, and physical examinations. For efficacy, radiographic imaging will be used for clinical grading of the bone construct using the Bergland scale. In addition, bone parameters such as bone volume, osteoid volume, graft volume, and number of osteoclasts will be histomorphometrically quantified. Recruitment started in November 2019, and the trial is currently in the follow-up stage. This protocol's current version is 1.0, dated September 15, 2019. In this first-in-human study, not only safety but also the histologically and radiographically assessed regenerative potential of the BCP-MFAT combination will be evaluated in an alveolar cleft model. When an SAE occurs, it will be concluded that the BCP-MFAT combination is not yet safe in the current setting. Regarding AEs, if they do not occur at a higher frequency than that in patients treated with standard care (autologous bone) or can be resolved by noninvasive conventional methods (eg, with analgesics or antibiotics), the BCP-MFAT combination will be considered safe. In all other cases, the BCP-MFAT combination will not yet be considered safe. Indonesia Clinical Trial Registry INA-EW74C1N; https://tinyurl.com/28tnrr64. DERR1-10.2196/42371.

Selective inhibition of interleukin 6 receptor decreased inflammatory cytokines and increased proteases in an experimental model of critical calvarial defect.

Considering the lack of consensus related to the impact of selective IL-6 receptor inhibition on bone remodeling and the scarcity of reports, especially on large bone defects, this study proposed to evaluate the biological impact of the selective inhibitor of interleukin-6 receptor (tocilizumab) in an experimental model of critical calvarial defect in rats. In this preclinical and in vivo study, 24 male Wistar rats were randomly divided into two groups (n=12/group): defect treated with collagen sponge (CG) and defect treated with collagen sponge associated with 2 mg/kg tocilizumab (TCZ). The defect in the parietal bone was created using an 8-mm diameter trephine drill. After 90 days, the animals were euthanized, and tissue samples (skull caps) were evaluated through micro-CT, histological, immunohistochemistry, cytokines, and RT-qPCR analyses. Tocilizumab reduced mononuclear inflammatory infiltration (P<0.05) and tumor necrosis factor (TNF)-α levels (P<0.01) and down-regulated tissue gene expression of BMP-2 (P<0.001), RUNX-2 (P<0.05), and interleukin (IL)-6 (P<0.05). Moreover, it promoted a stronger immunostaining of cathepsin and RANKL (P<0.05). Micro-CT and histological analyses revealed no impact on general bone formation (P>0.05). The bone cells (osteoblasts, osteoclasts, and osteocytes) in the defect area were similar in both groups (P>0.05). Tocilizumab reduced inflammatory cytokines, decreased osteogenic protein, and increased proteases in a critical bone defect in rats. Ninety days after the local application of tocilizumab in the cranial defect, we did not find a significant formation of bone tissue compared with a collagen sponge.

A systematic review on removal of osseointegrated implants: un update

BackgroundToday dental implants represent an effective therapy in case of partial or total edentulism, with an excellent success rate. Despite the results obtained, there may be biological or mechanical complications during the therapy, which lead to the loss of the implant. This systematic review aims to evaluate the current state of the art in the literature on techniques used for the removal of dental implants. Various aspects will be analyzed, such as the success of the technique, any complications, and the advantages and disadvantages of their use.MethodsTwo reviewers conducted a literature analysis (PubMed, Embase, Web of Science) of the last 20 years (2003–2023). The main criterion analyzed was the success of the technique, while secondary outcomes such as complications and risks of the technique were also analyzed. 258 articles were identified in the various search databases. 42 eligible articles were subsequently identified after an article screening. Only 18 full texts were subsequently included in the review.ResultsA total of 18 articles were selected and 1142 implants and 595 patients were included. The main techniques used were the Counter-Torque Ratchet Technique (CTRT), Piezoelectric bone surgery (PBS), trephine drills, carbide burs, Erbium, Chromium, Yttrium, Scandium, Gallium, Garnett (Er:Cr:YSGG) laser and carbon dioxide (CO2) laser. Combined uses of techniques have been identified such as: PBS and trephine burs or carbide burs, trephine burs with the use of a 3d-printed guide, CTRT and trephine burs. The technique with the highest success rate, less morbidity for the patient, and less removal of bone appears to be the CTRT.ConclusionsThe use of conservative techniques, especially CTRT, in bone removal is useful to allow for immediate implant placement in the removal area. However, further studies with a high sample size are needed to be performed on all techniques, particularly new randomized controlled trials (RCTs) that allow for the analysis of the success of alternative techniques such as Laser and Piezosurgery, which appear to be very promising.

It's Hip to Go Home: An Evaluation of Outpatient Alveolar Bone Grafting in Patients With Cleft Palate.

Secondary alveolar bone grafting (ABG) is a common procedure performed at cleft care centers used to fill the alveolar cleft. The advent of techniques such as minimally invasive trephine drill harvest and placement of continuous-infusion pain pumps at the donor site has made outpatient ABG an increasingly feasible and cost-effective procedure. However, enhanced recovery after surgery protocols to maximize pain control and recovery times for this patient population have not been well established. A retrospective single-institution review was conducted of pediatric patients with cleft palate who underwent iliac crest bone graft ABG at a large urban academic children's hospital from 2017 to 2022. Patient age, alveolar cleft repair laterality, pain scores, surgery duration, hospital LOS, readmissions, and re-operations within 30 days were examined. Fifty-four patients met our inclusion criteria. Fifty patients (92.6%) received a pain pump during the operation. The median duration of surgery and LOS in the post-anesthesia care unit were 1.28 and 1.75 hours, respectively. Fifty-two patients (96.3%) were discharged on the same day as their surgery whereas 2 patients (3.7%) stayed in the hospital overnight. The median pain score at the time of discharge was 0 (interquartile range 0, 0). There were 6 (11.1%) minor complications including 5 pain pump malfunctions and 1 recipient site wound breakdown. There was 1 readmission (1.9%) for development of a surgical site infection at the hip and no re-operations within 30 days of surgery. The described outpatient ABG protocol demonstrates effective postoperative pain control, short hospital LOS, and few complications requiring hospital readmission or reoperation.

Comparative Study of Alloplastic and Xenogeneic Biomaterials Used for in Dentistry

Biomaterials are routinely used in dentistry for tissue engineering. The purpose of the present work is to compare the performance of a new alloplastic biomaterial (Blue-Bone®), xenogeneic biomaterial (Bio-Oss®), and a mixture of both biomaterials with 50% of autogenous bone. 32 Wistar rats underwent a surgical procedure in which a circular disc of bone was removed from the calvaria with a trephine drill 10 mm in diameter to create a critical bone defect, which was filled with the biomaterials under study. After 40 days, the animals were euthanized and the calvaria was removed for processing and analysis. Histomorphometric determination of vital mineralized tissue (VMT), no-vital mineralized tissue (NVMT), and on-mineralized tissue (NVMT) was performed. The results showed that, while cavities filled with Bio-Oss® needed to be mixed with an autogenous bone to present better performance, Blue-Bone® biomaterial does not need to be mixed with an autogenous bone to promote a more cellular and vascularized bone matrix.

Evaluation of the regenerative capacity of stem cells combined with bone graft material and collagen matrix using a rabbit calvarial defect model.

The purpose of this study was to evaluate the regenerative capacity of stem cells combined with bone graft material and a collagen matrix in rabbit calvarial defect models according to the type and form of the scaffolds, which included type I collagen matrix and synthetic bone. Mesenchymal stem cells (MSCs) were obtained from the periosteum of participants. Four symmetrical 6-mm-diameter circular defects were made in New Zealand white rabbits using a trephine drill. The defects were grafted with (1) group 1: synthetic bone (β-tricalcium phosphate/hydroxyapatite [β-TCP/HA]) and 1×105 MSCs; (2) group 2: collagen matrix and 1×105 MSCs; (3) group 3: β-TCP/HA, collagen matrix covering β-TCP/HA, and 1×105 MSCs; or (4) group 4: β-TCP/HA, chipped collagen matrix mixed with β-TCP/HA, and 1×105 MSCs. Cellular viability and cell migration rates were analyzed. Uneventful healing was achieved in all areas where the defects were made at 4 weeks, and no signs of infection were identified during the healing period or at the time of retrieval. New bone formation was more evident in groups 3 and 4 than in the other groups. A densitometric analysis of the calvarium at 8 weeks post-surgery showed the highest values in group 3. This study showed that the highest regeneration was found when the stem cells were applied to synthetic bone along with a collagen matrix.

Systemic and local inflammatory response after implantation of biomaterial in critical bone injuries.

To evaluate inflammatory response in critical bone injuries after implantation of the biomaterial composed of hydroxyapatite (HA)/poly (lactic-coglycolic acid) (PLGA)/BLEED. Forty-eight male Wistar rats (280 ± 20 grams) were divided into two groups: control group (CG), in which the animals do not receive any type of treatment; and biomaterial group (BG), in which the animals received the HA/PLGA/BLEED scaffold. Critical bone injury was induced in the medial region of the skull calotte with the aid of a trephine drill 8 mm in diameter. The biomaterial was implanted in the form of 1.5-mm thick scaffolds. Serum and calotte were collected at one, three and seven days. Biomaterial had a significant effect on the morphological structure of the bone, accelerating osteoblast activation within three days, without causing exacerbated systemic inflammation. In addition, quantitative real-time polymerase chain reaction (qRT-PCR) analysis showed that BG induced upregulation of osteogenic genes such as runt-related transcription factor 2, and stimulated genes of inflammatory pathways such as tumor necrosis factor-α, on the first day without overexpressing genes related to bone matrix degradation, such as tissue inhibitor of metalloproteinases-1 and matrix metalloproteinase-9. The HA/PLGA/BLEED® association can be used as a bone graft to aid bone repair, as it is capable of modulating expression of important genes at this stage of the repair process.

Evaluation of trephine osteotomy technique in direct sinus lifting with simultaneous implant placement

BackgroundRecently, in implant dentistry, trephine drills have been used instead of conventional drills to conserve the bone during osteotomy. Aim of the studyTo evaluate the effectiveness of trephine osteotomy for lateral sinus lifting technique associated with sinus floor augmentation using the autogenous bone resulting from implant drilling using specialized trephine drills. Materials and method12 Patients were included and have been subjected to lateral sinus lifting using trephine osteotomy with simultaneous implant placement with delay loading. A bone graft used in sinus floor augmentation has been prepared using autogenous bone resulting from implant site preparation in addition to β-tricalcium phosphate. ResultsAfter 6 months, the difference between the primary stability and implant stability was statistically significant p-value ≤ 0.05. After 6 months, the mean vertical bone height reached 11.71 ± 0.72 mm. The mean volume of the newly formed bone of the grafted area recorded after 6 months was 1126.7 ± 82.94 mm3. ConclusionTrephine osteotomy technique in both lateral approach of sinus lifting, and implant site preparation allows preservation of autogenous bone. Moreover, the trephine osteotomy technique in the lateral approach of sinus lifting eliminates the use of an absorbable membrane.

Intraoperative evaluation of the resected bone margin in mandibular cancers using a trephine drill and frozen section analysis

The objective of this study was to evaluate the accuracy and feasibility of intraoperative frozen section analysis of samples harvested with a trephine drill from the bone resection margins to identify malignancy. Thirty-five patients who were diagnosed with locally advanced oral squamous cell carcinoma involving the mandible were included in this study. After tumour resection, bone samples were collected from the resection margin of the specimen using a trephine drill. Sampling yielded a cylindrical specimen of bony tissue that included both cortical and cancellous areas. A second sample was obtained from the area where bone invasion was evident; this was used as a positive control. Frozen section analysis was performed intraoperatively to check for malignancy. The sensitivity of this technique was found to be 81.8%, with specificity of 87.5%, a positive predictive value of 75%, negative predictive value of 91.3%, and accuracy of 85.7% when compared to standard histopathology as the gold standard. In conclusion, the evaluation of bone margins using the trephine drill technique and frozen section analysis proved to be fast and reliable.

Proximate and mineral composition of Japanese quail egg and its possible role in bone healing

Quail eggs are known to be highly nutritious. In the first study, the nutritional and mineral composition of quail eggs was evaluated by determining the proportion of moisture, total ash, lipids, nitrogen, crude protein and carbohydrate in the egg. The second phase was to determine the role of quail eggs in bone healing. Freshly laid Japanese quail eggs were purchased from a research institute in Plateau state, Nigeria. Five eggs were randomly selected and used for the evaluation of the nutritional and mineral composition of eggs. They were subjected to different methods to obtain the proximate and nutritive content. The moisture content in the egg was 65.5 %, total ash was 8.5 %, lipid was 1.5 %, nitrogen was 0.75 %, crude protein was 4.72 %, and carbohydrate was 19.78 %. For the mineral content, sodium was 42.5 mg, potassium was 80 mg, phosphorus was 6.49 mg, calcium was 0.9 mg, and magnesium was 1.3 mg. In the second study, 12 male New Zealand white rabbits with an average age of 7–8 months were used. They were separated into 2 groups comprising 6 rabbits per group. Rabbits in group A had a cylindrical trephine drill to create a 3.5 mm diameter defect on the lateral distal epicondyle of the left femur and were monitored for 12 weeks. Faster healing was observed in the group administered quail egg. At week 10, the radiographic score of the quail egg treated group [4(3-4)] was significantly (P &lt; 0.05) higher compared to the control group with 2(2-3). At week 12, complete healing was observed in the quail egg group [4(4-4)]; this was different from the control group that had 2 rabbits yet to be healed. The study shows that Japanese quail egg is nutritious and rich in essential nutrients including calcium and phosphorus and as such it can serve as a nutritional supplement to enhance bone healing.

Evaluating systemic administration effect of propranolol on osseointegration around titanium implants: A histomorphometric study in dogs

Dental implants are known as a widely accepted and predictable method to replace missing teeth. Many factors, including using a class of drugs, such as β-blockers, can improve the osseointegration of dental implants. This study aimed to investigate the relationship between administrating propranolol and osseointegration in dental implants. This experimental animal study was performed on four native male street dogs of 11-13 kg of weight and 16-20 months of age. The specimens underwent teeth extraction. After that, the dogs were randomly divided into two groups. The first group contains two control dogs which would receive oral saline. The second contains two dogs which would receive oral tablets of propranolol daily. After a period of healing, three titanium implants were inserted in each of speciments' left mandibular quadrant, and treatment was resumed with propranolol and saline administration in case and control group, respectively. After 4 weeks, one of control group dogs and one of case group were anesthetized, and dental implants were removed alongside the peripheral bone marrow using a trephine drill. Meanwhile, the other two dogs (1 control and 1 propranolol administered dogs) were anesthetized after 9 weeks of implant placement, and the same procedure was carried out. Due to the histomorphometric assessment, the mean score of bone implant contact (BIC) in week 4 was significantly higher in case group compared to control one (68.33% vs. 20.22%). In week 9, the mean BIC score was higher in case group compared to control group (68.60% vs. 50.17%); meanwhile, in contrast to week 4, it was not statistically significant. In both case and control groups, the formation of woven and lamellar bone was more significant in week 4 rather than week 9. Administration of systemic β-blockers can improve dental implants osseointegration process.

Effect of single-dose locally applied lactoferrin on autograft healing in peri-implant bone in rat models

Immediate dental implant installation into fresh extraction sockets has become a common surgical technique and yields successful clinical results. In addition, complete contact may not be possible with this procedure cause of defects between the bone wall and the implant surface. Therefore, different graft materials have been used in the literature to increase the peri‑implant bone volume. The aim of the present study was to evaluate the effect of single-dose and locally applied lactoferrin on autograft healing in peri‑implant area and bone implant contact value. Twenty-four Sprague-Dawley rats were included in this study. Firstly, a trephine drill was used for creating a cylindrical bony defects (6.5 mm in diameter and 3 mm in depth) under sterile saline irrigation in the lateral side of the femur. Subsequently, implant beds –2.5 mm diameter and 6 mm depth – were prepared in the middle of each defect with special implant drills. All of the implants were installed and primary stability was achieved. Rats were randomly divided into 3 groups (n = 8 each): Group-1 had empty defects, Group-2 had defects filled with autograft, and Group-3 had defects filled with autograft and lactoferrin solution (100 μg/ml) combination. All of the rats were sacrificed at postoperative 4th week and samples were analyzed with micro-computed tomography, histomorphometry and immunohistochemistry respectively. It was found that Group 3 had the least area of fibrous tissue (6.75±0.83mm2) according to the other 2 groups (p<0.001). On the other hand, Group 3 had the highest osteoblast number (25.50±3.29), osteoclast number (21.25±1.03), newly formed bone area (20.50±1.30 mm2), total healing area (22.62±0.93 mm2), defect closure rate (80.37±1.40%), bone implant contact value (23.2%±0.6%), and percentage bone volume (18.2%±0.3%) (p<0.001). Matrix metalloproteinase-3 expression was found to be highest in Group 3 by immunohistochemistry analysis. In this study it was observed that the results of the different analysis techniques supported each other. According to these findings it can be stated that a single-dose and locally applied lactoferrin solution plays an important role in the autograft healing in peri‑implant area and increasing bone implant contact value. These findings will shed light on further clinical studies of implant osseointegration.

Implant stability and new bone microarchitecture in atrophic maxillae reconstructed with allogenic grafts: A pilot trial

ObjectiveRehabilitation of atrophic maxilla with allografts could be sometimes challenging in the choice. The present pilot clinical trial aimed to compare the change in stability over time of implants placed in particulate demineralized freeze-dried bone (DFDBA) or fresh-frozen bone (FFB) allografts in the posterior maxilla and to examine the microarchitecture of new bone formation. MethodsHealthy adult patients of both genders underwent bilateral maxillary sinus lifts. Only patients that presented with maxillary sinus pneumatization and who on tomographic examination were determined to have a residual bone height of less than 7 mm were eligible for inclusion. Each side was randomly grafted with DFDBA or FFB. Six to nine months after grafting, at the time of dental implant installation bone core biopsies, 10 mm in length, were obtained using a 2 mm short trephine drill. The bone biopsies were fixed in buffered formalin and randomly and blindly submitted to microcomputed tomography and histomorphological analysis. Implant stability was measured using resonance frequency equipment at three time points: immediately, 6, and 12 months after dental implant installment. ResultsA total of 10 patients were finally included. An increased bone volume was observed tomographically for all allografted regions. Implants placed in FFB show a significant enhanced stability after six months. Specially after one-year implant stability was significantly greater in FFB than in DFDBA grafts. Microtomographic analyses revealed that bone morphometric parameters were similar between allografts. ConclusionBoth allogenic grafts can be used to successfully rehabilitate the atrophic maxilla for implant placement.

Demineralized freeze-dried bone allograft vs biphasic calcium phosphate: A comparison of two graft materials in sinus augmentation procedures - A pilot study

ObjectiveTo compare the bone quality histologically and radiologically using two graft materials i.e. demineralized freeze-dried bone allograft (DFDBA) and biphasic calcium phosphate (BCP) along with platelet-rich plasma (PRP) as an adjuvant in both; for bilateral maxillary sinus lift procedures. Material and methodsThis split mouth pilot study consisted of 5 healthy patients who required bilateral sinus lift procedures in 10 sites. Allocation concealment for site selection was done. Site A was DFDBA with PRP and site B was BCP with PRP. Evaluation of bone density was done as per Misch criteria-preoperatively and 6 months postoperatively with CBCT scans. 6 months after the augmentation procedure, implants were placed and a trephine drill biopsy was taken, for histological evaluation of bone quality. Patients were followed up for 18 months after implant placement. ResultsFive patients with a mean age of 47 ± 9.27 years (range of 35–60 years) underwent 10 maxillary sinus augmentation procedures. Radiologically, the bone density showed no statistically significant differences between site A: D4 and site B: D5; pre and post operatively. Histologically, the average value calculated for the percentage of marrow spaces was: site A, mean 40.92 ± 2.41 SD; site B mean: 31.48 ± 7.97 SD (t = 2.56, p = 0.03). The architecture of bone formed for all the 5 cases at site A was 100% trabecular pattern of bone, site B had 40% trabecular pattern of bone and 60% compact bone formation. ConclusionDemineralized freeze-dried bone allograft with platelet rich plasma exhibited a superior quality of bone formation and a higher percentage of marrow spaces, it satisfied and met the evaluation parameters for bone quality. Clinical relevance: The conclusive findings of this research could guide clinicians towards utilising the amalgamation of DFDBA and PRP for bone augmentation procedures-as a safe and dependable option.

A segmental osteotomy with 3D virtual planning to move a malpositioned dental implant

BackgroundCorrect positioning and alignment of dental implants are crucial to successfully meet the aesthetic and functional criteria in implant-prosthetic rehabilitation. When an implant is in the wrong position, especially in the esthetical zone, there are limited options to solve it. Some techniques have been described to reposition implants, such as reverse torque, trephine drills, and segmental osteotomies; current approaches aim to reduce the damage of the periimplant tissues.Case presentationA 20-year-old man with good general health was referred to the oral and maxillofacial surgery department of the CES University, Medellin Colombia in 2017, He had undergone a previous camouflage orthodontic therapy for a dental Class III, which finished in 2014, posteriorly a dental implant was placed in 2015 to replace upper right lateral incisor (1.2) before vertical growth of maxilla was complete; therefore, the implant was retained in a coronal position. A segmental osteotomy was suggested to reposition the implant in a more caudal position, a 3D surgical cut guide obtained by virtual planning was used to increase osteotomy accuracy and lower human error, to avoid the risk of damaging the adjacent tissues and to achieve a predictable result.ConclusionsThe segmental alveolar osteotomy is an effective alternative to reposition an implant; however, it must be carefully planned because human error remains a possibility that may affect the final result. Therefore, 3D planning is a better way to minimize these mistakes during the surgical procedure and the final position of the implant.

Comparison Study of the Histomorphometric Results after Socket Preservation with PRF and Allograft Used for Socket Preservation-Randomized Controlled Trials.

The aim of the present clinical study was to assess and compare the histomorphometric results and efficacy of freeze-dried bone allograft (FDBA) in combination with platelet-rich fibrin (PRF), and PRF as a sole grafting material for socket preservation. Ninety patients in need of tooth extraction and implant restoration were included in this study. The participants were randomly divided into three groups based on post-extraction clinical protocol: socket preservation procedure with allograft in combination with a PRF membrane (PRFm), PRF as a sole grafting material, and a control group. A total of 90 implants were placed four months post-extraction. During the surgical re-entry a bone biopsy was harvested with a trephine drill. Histological samples were prepared and analyzed for percentage vital bone and connective tissue. One-way ANOVA with Bonferroni post-hoc analysis were used to assess the results. Both test groups revealed a significantly higher percentage of vital bone formation compared to the control group. No statistically significant differences regarding vital bone formation and connective tissue quantity between the tested groups were observed (FDBA + PRFm: 3.29 ± 13.03%; and PRF: 60.79 ± 9.72%). From a clinical and histological point of view, both materials in the test groups are suitable for the filling of post-extraction sockets without bone defects. Both of the tested groups revealed a significantly higher percentage of vital bone formation compared to the control group.

Free Gingival–Bone Graft in the Anterior Maxilla: A Clinical Case Report

To present the healing, development, and long-term clinical results after a combined gingival-bone graft as an alternative treatment for the management of critical extraction sites in the esthetic zone. To enhance the knowledge of in vivo soft and hard tissue remodeling, in this case report, we observed the healing, development, and long-term clinical results after a case of a combined gingival-bone graft as an alternative treatment for the management of critical extraction sites. Autogenous grafts of gingival and bone tissue were placed in a 56-year-old female patient, where a hopeless upper left central incisor with an evident loss of both the buccal and the palatal bony plates and with endodontic problems was due for extraction. In order to obtain enough autogenous tissue for filling the defect, a cylindrical free gingival and bone graft was retrieved from the retromolar area with a trephine drill, to obtain hard and soft tissues for grafting the postextraction defect. After 6 months, following soft tissue maturation and once esthetic and natural gingival contours were achieved, the surgical site was prosthetically restored with a porcelain fused to a metal bridge and scheduled for regular follow-up. No complications were observed either from the donor site or from the recipient site. The post-treatment result was esthetically pleasing, based upon successful architectural stability of both hard and soft tissues. Although more studies are needed to confirm the beneficial use of this approach, the procedure can be considered a viable option in the management of soft and hard tissue remodeling in esthetically compromised cases. The gingival-bone graft may be considered as an alternative treatment for the management of critical extraction sites in the esthetic area. How to cite this article: Signore A, Stepanov M, Angelis ND, et al. Free Gingival-Bone Graft in the Anterior Maxilla: A Clinical Case Report. J Contemp Dent Pract 2021;22(5):568-571.