Vestibular Aspect Research Articles

ISQ as a Diagnostic Tool in Implants Affected with Bone Loss: An In Vitro Experimental Study.

To determine the relationship between bone loss that occurs during the peri-implantitis process and variations in implant stability using resonance frequency analysis (RFA) measurement methods. Forty selftapping implants were placed in cow ribs, and study scenarios were established according to the affected implant side and bone loss depth (n = 10 implants per group): Case 1 = bone loss on one side (vestibular); Case 2 = bone loss on two opposite sides (buccal and lingual); Case 3 = bone loss on two adjacent sides (buccal and mesial); and Case 4 = foursided bone loss (circumferential). For each group of 10 implants, first a bone loss of 0 mm was evaluated, then 4-mm defects (simulating 1/3 of bone loss) were created and evaluated, and finally 8-mm defects (simulating 2/3 of bone loss) were created and evaluated. Osteotomy measurements were made with a periodontal probe. For each implant, RFA was measured by the same operator using the Beacon system (Osstell). The initial implant stability quotient (ISQ) values of the 40 implants exceeded 70, reflecting an average of 73 in the buccolingual (VL) and 74.8 in the mesiodistal (MD) directions. ISQ measurements in the 10 implants in which bone dehiscence was performed on the vestibular aspect reflected a decrease in ISQ values as bone loss increased. When generating bone loss in two opposite sides (buccal and lingual), a greater decrease in ISQ values was observed when 2/3 of the implant were affected. The average VL ISQ measurement was less than 70 when at sites with 2/3 of bone loss. When bone loss occurs on only one side of the implant, the ISQ values decrease, but the implant maintains good stability. The same occurs when two opposite sides of the implant are affected, as the unaffected side has the least decrease in ISQ value.

Aesthetic Chin Lines: A Novel Clinical Assessment for Diagnosis and Treatment of Chin Deformities

The chin represents an important component in facial aesthetics. A wide range of facial deformities may alter the chin’s position and may bring along aesthetic and functional implications. It is imperative to consider the current aesthetic ideals, while diagnosing and creating a patient’s treatment plan, instead of using the usual cephalometric analysis. The principal objective of this study was to evaluate the chin’s position in a group of male individuals considered to be facially attractive. Material and methods: This is an observational, longitudinal, and descriptive study, in which 100 high quality photographs of male individuals were collected. Images included a lateral facial view of the subject with the head oriented in a natural position and smiling until exposing at least the upper central incisive teeth. The models were described as facially attractive on specialized web site. Exclusion criteria included excessive facial hair and the presence of jewelry or accessories that made it difficult to identify facial landmarks. Two true vertical lines were traced in each photo, the first one passed through the Subnasale and the other one passed through the vestibular aspect of the upper central incisor, these lines were named “Aesthetic Chin Lines,” subsequently the position of the Pogonion was determined in relation to both lines. Results: In 84 cases (84%) the Pogonion was found between the Aesthetic Chin Lines. In 15 cases (15%) it was found behind the Upper Central Incisor line, and in 1 case (1%) it was found in front of the Subnasal line. Conclusion: With the results obtained in this study, we can determine that the “Aesthetic Chin Lines” described in this manuscript are a diagnostic resource than may help with the treatment plan of dentofacial and chin deformities in male patients.

Morphological and radiological mapping of dental cusps in relation to spatial constraints on tooth shape of one-humped camel (Camelus dromedarius)

A significant number of researches in veterinary study have been focused on dental structure; however, there are few on the orientation and identification of their cusps. Therefore, the present article aimed to spotlight the arrangement pattern of dental cusps in the camel as a folivorous and graminivorous animal. This study was conducted on eight heads of adult, healthy camels of both sexes, collected from slaughter houses. To determine the exact orientation of cusps of molar teeth, additional radiological and CT scans were performed on the mandible as a landmark that should facilitate the reading of the cusps map. It was evident that the cusps are arranged in crescentic appearance, selenodontal form, with two cusps on each side, paracone and hypocone on the lingual surface and protocone and metacone on the vestibular aspect. Thus, camels cannot wear bite like equines, which would interfere with their constant chewing method. The camels’ dental cusps provide some of the finest examples of convergent evolution, which offer insights both into correlates between form and function, and into the ability of euthomorphic cusps in intrapability and stabilization of food items and their comminution between formidable cusps and occlusal spillway in between. Further studies should be done on the brachydont teeth and tropospheric cusps to fill the functional anatomy gap of teeth, in addition to diversity of cusps form. This study is considered a basic comparative anatomical study for normal healthy dentition and forensic practice, in addition to its importance in detection of more local aspects of dental problems in camels.

Three-dimensional changes of a porcine collagen matrix and free gingival grafts for soft tissue augmentation to increase the width of keratinized tissue around dental implants: a randomized controlled clinical study

BackgroundEmerging clinical data points to the relevance of the presence of keratinized tissue (KT). Although apically positioned flap/vestibuloplasty along with free gingival graft (FGG) is considered as a standard intervention for augmenting KT, substitute materials appear to be a viable treatment alternative. So far, there is a lack of data investigating the dimensional changes at implant sites treated with soft-tissue substitutes or FGG.AimThe present study aimed at comparing three-dimensional changes of a porcine derived collagen matrix (CM) and FGG for increasing KT at dental implants over a 6-month follow-up period.Materials and MethodsThe study enrolled 32 patients exhibiting deficient KT width (i.e., < 2 mm) at the vestibular aspect who underwent soft tissue augmentation using either CM (15 patients/23 implants) or FGG (17 patients/31 implants). The primary outcome was defined as tissue thickness change (mm) at treated implant sites between 1- (S0), 3- (S1), and 6-months (S2). Secondary outcomes considered changes of KT width over a 6-month follow-up period, surgical treatment time, and patient-reported outcomes.ResultsDimensional analyses from S0 to S1 and from S0 to S2 revealed a mean decrease in tissue thickness of − 0.14 ± 0.27 mm and − 0.04 ± 0.40 mm in the CM group, and − 0.08 ± 0.29 mm and − 0.13 ± 0.23 mm in the FGG group, with no significant differences noted between the groups (3 months: p = 0.542, 6 months: p = 0.659). Likewise, a comparable tissue thickness decrease was observed from S1 to S2 in both groups (CM: − 0.03 ± 0.22 mm, FGG: − 0.06 ± 0.14 mm; p = 0.467). The FGG group exhibited a significantly greater KT gain after 1, 3 and 6 months compared to the CM group (1 month: CM: 3.66 ± 1.67 mm, FGG: 5.90 ± 1.58 mm; p = 0.002; 3 months: CM: 2.22 ± 1.44; FGG: 4.91 ± 1.55; p = 0.0457; 6 months: CM: 1.45 ± 1.13 mm, FGG: 4.52 ± 1.40 mm; p < 0.1). Surgery time (CM: 23.33 ± 7.04 min.; FGG: 39.25 ± 10.64 min.; p = 0.001) and postoperative intake of analgesics were significantly lower in the CM group (CM: 1.2 ± 1.08 tablets; FGG: 5.64 ± 6.39 tablets; p = 0.001).ConclusionsCM and FGG were associated with comparable three-dimensional thickness changes between 1 and 6 months. While a wider KT band could be established with FGG, the use of CM significantly reduced surgical time and patients´ intake of analgesics.Graphical abstract

Prospective study assessing three-dimensional changes of mucosal healing following soft tissue augmentation using free gingival grafts.

The present study aimed to assess the three-dimensional changes following soft tissue augmentation using free gingival grafts (FGG) at implant sites over a 3-month follow-up period. This study included 12 patients exhibiting deficient keratinized tissue (KT) width (i.e.,<2mm) at the vestibular aspect of 19 implants who underwent soft tissue augmentation using FGG at second stage surgery following implant placement. Twelve implants were considered for the statistical analysis (n=12). The region of interest (ROI) was intraorally scanned before surgery (S0), immediately post-surgery (S1), 30 (S2) and 90 (S3) days after augmentation. Digital scanned files were used for quantification of FGG surface area (SA) and converted to standard tessellation language (STL) format for superimposition and evaluation of thickness changes between the corresponding time points. FGG shrinkage (%) in terms of SA and thickness was calculated between the assessed time points. Mean FGG SA amounted to 91 (95% CI: 63 to 119), 76.2 (95% CI: 45 to 106), and 61.3 (95% CI: 41 to 81) mm2 at S1, S2, and S3, respectively. Mean FGG SA shrinkage rate was 16.3% (95% CI: 3 to 29) from S1 to S2 and 33% (95% CI: 19 to 46) from S1 to S3. Mean thickness gain from baseline (S0) to S1, S2, and S3 was 1.31 (95% CI: 1.2 to 1.4), 0.82 (95% CI: 0.5 to 1.12), and 0.37 (0.21 to 0.5) mm, respectively. FGG thickness shrinkage was of 38% (95% CI: 17.6 to 58) from S1 to S2 and 71.8% (95% CI: 60 to 84) from S1 to S3. Dimensional changes from S1 to S3 were statistically significant, P<0.017. Soft tissue healing was uneventful in all patients. The present three-dimensional assessment suggests that FGG undergo significant dimensional changes in SA and thickness over a 3-month healing period.

Management of Postpartum Rectovestibular Fistula with Vaginal and Rectal Mucosal Advancement Flap

Women with acquired rectovestibular fistula following obstetric injuries were treated with excision of fistulous tract and reconstruction by a different technique. Four women with acquired rectovestibular fistula underwent excision of fistulous tract and the resulting defect was repaired. The resulting muscular defect was closed, posterior vaginal wall mobilised and sutured to cover the vestibular aspect of the fistula, and the anterior rectal wall was mobilised and sutured to cover the rectal aspect of the fistula. The combined advancement of rectal and vaginal mucosa provides sound protection to the sutured muscle defect in the fistulous area both on the vestibular and rectal sides, thus preventing recurrence. In spite of fewer number of patients, follow-up for five years have shown no recurrence following this novel procedure in women with postpartum H-type of rectovestibular fistula. Though rectal mucosal advancement has been well documented, the addition of vaginal mucosal advancement is emphasised to prevent recurrence.

Single tooth morse taper implant placement and restoration immediately after extraction

ABSTRACT Objective: to analyze aesthetic and functional outcomes of the rehabilitation of single tooth morse taper implant restoration with single crown prosthesis immediately after tooth extraction. Methods: Retrospective longitudinal clinical study of 57 patients submitted to an oral rehabilitation protocol with morse taper (Ankylos® Classic) dental implants, without performing incision, grafts nor suture, followed by the placement of a provisional prosthesis immediately after tooth removal in the anterior maxillary region. The pre-and post-operative clinical data (alveolar bone contour at vestibular aspect, soft tissue contour at cervical aspect and papillae level) and postoperative radiographic findings (bone height / implant ratio) were submitted to descriptive statistics (mean and standard deviation) and Fisher’s Exact Test. Results: the implant success rate was 98.25%. The alveolar bone vestibular aspect was maintained in 69.6% of the cases. There was no soft tissue retraction on the cervical aspect and the papillae height was preserved in 89.3% of the cases.The bone level remained above the implant neck in 92.8% of the cases. There was no significant association between implant diameter and soft tissue retraction (p = 0.910) or retraction of the interproximal papilla (p = 0.148) or resorption of the alveolar bone crest (p = 0.610). Conclusion: This protocol is characterized by the application of minimally traumatic techniques, reducing rehabilitation time and offering positive aesthetic and functional results.

Evaluation of a new tricalcium phosphate for guided bone regeneration: an experimental study in the beagle dog.

This study compared the in vivo behavior of two biomaterials, xenograft (Bio-Oss®) and alloplastic tricalcium phosphate (Sil-Oss®), vs a control (no biomaterial) in beagle dogs treated with guided bone regeneration (GBR). Six male adult beagle dogs were included. The third and fourth mandibular premolars and first mandibular molars (3P3, 4P4 and 1M1) on both sides were extracted. After 12weeks of healing, Straumann implants (3.3 × 8mm) were placed, performing standardized defects (3.3 × 6mm) in the vestibular aspect of the alveolar bone. The defects were surgically treated by randomized placement of xenograft (Bio-Oss®), alloplastic tricalcium phosphate (Sil-Oss®) or no biomaterial and covered with a resorbable collagen membrane (BioGide®). After an additional 12-week healing period, the lower jaws were dissected. Total area regenerated in the region of interest, total volume, bone to implant contact in the regenerated area, and volumetric changes were measured through histological, histomorphometrical and microcomputed tomography (microCT) techniques. The negative control group showed bone ingrowth inside the defect, with a partial collapse of the buccal bone. This was not observed in the biomaterial-treated groups. Defects treated with the xenograft showed 51.40% (SD 19.83) newly mineralized tissue, while those treated with alloplastic tricalcium showed 62.54% (SD 11.54) newly mineralized tissue; the control showed 71.52% (SD 6.46). Alloplastic tricalcium phosphate modified with monetite and zinc showed similar features in alveolar regeneration of defects to those treated with the xenograft or conventional GBR, but it showed an ideally higher rate of new mineralized tissue formation and accelerated resorption.

Treatment of endo-periodontal lesion using leukocyte-platelet-rich fibrin. A case report.

Case Description: The main objective of this paper was to report the clinical effectiveness of leukocyte- platelet- rich fibrin (L-PRF) in the treatment of a combined endo-periodontal lesion of an upper first premolar. Clinical Findings: The tooth had a profound abfraction on the vestibular aspect and presented no mobility but revealed a deep pocket measuring of 11 mm on the mesial vestibular aspect and 14 mm on the mesial palatine aspect. The three dimensional image analysis showed total bone loss in the mesial aspect and an extensively bone loss of the vestibular aspect of the vestibular root. Treatment and Outcome: Endodontic treatment was performed and periodontal access surgery (surgical periodontal therapy) was done with the application of autologous L-PRF. Three month and 6 months after surgery, the cone beam computed tomography (CBCT) exams showed no bone regeneration in any aspect of the tooth. However, periodontal examination showed a significative improvement in the deepness of surcus. The mesial vestibular aspect had a deep pocket of 3 mm and 5 mm on the mesial palatine aspect showing a reduction in deepness of 8 mm and 9 mm, respectively.Clinical Relevance: The actual treatment for teeth with bad prognosis is the extraction and replacement with implants. Even though implants are capable of restore function and aesthetic, the abuse of this approach have led to the loss of teeth that could be successfully treated with a less invasive technique. The prognosis of teeth with endoperiodontal lesion is poor but could be enhanced with regenerative therapies. Until now there are no clinical trials and just four case report about the treatment of these teeth with platelet rich fibrin.

Treatment of endo-periodontal lesion using leukocyte- platelet- rich fibrin. A case report

Case Description: The main objective of this paper was to report the clinical effectiveness of leukocyte- platelet- rich fibrin (L-PRF) in the treatment of a combined endo-periodontal lesion of an upper first premolar.Clinical Findings: The tooth had a profound abfraction on the vestibular aspect and presented no mobility but revealed a deep pocket measuring of 11 mm on the mesial vestibular aspect and 14 mm on the mesial palatine aspect. The three dimensional image analysis showed total bone loss in the mesial aspect and an extensively bone loss of the vestibular aspect of the vestibular root.Treatment and Outcome: Endodontic treatment was performed and periodontal access surgery (surgical periodontal therapy) was done with the application of autologous L-PRF. Three month and 6 months after surgery, the cone beam computed tomography (CBCT) exams showed no bone regeneration in any aspect of the tooth. However, periodontal examination showed a significative improvement in the deepness of surcus. The mesial vestibular aspect had a deep pocket of 3 mm and 5 mm on the mesial palatine aspect showing a reduction in deepness of 8 mm and 9 mm, respectively.Clinical Relevance: The actual treatment for teeth with bad prognosis is the extraction and replacement with implants. Even though implants are capable of restore function and aesthetic, the abuse of this approach have led to the loss of teeth that could be successfully treated with a less invasive technique. The prognosis of teeth with endoperiodontal lesion is poor but could be enhanced with regenerative therapies. Until now there are no clinical trials and just four case report about the treatment of these teeth with platelet rich fibrin.

Long-term outcomes of simultaneous guided bone regeneration using native and cross-linked collagen membranes after 8years.

To assess the clinical outcomes of simultaneous guided bone regeneration using native (CM) and cross-linked (VN) collagen membranes at 8years. A total of n=19 patients (19 implants) were available for the analysis. Each subject had received a simultaneous grafting of dehiscence-type defects using a natural bone mineral (NBM) and a random allocation to either CM and VN membranes (submerged healing of 4months). Clinical parameters (e.g., bleeding on probing - BOP, probing pocket depth - PD, mucosal recession - MR, clinical attachment level - CAL) were recorded at 8years after prosthesis installation. At 8years, CM and VN groups revealed comparable median BOP, PD, MR and CAL values at both vestibular and oral aspects. From 4 to 8years (n=14 patients), median CAL at the vestibular aspect improved in both groups; however, these changes were significantly higher at CM-treated sites (CM: 0.7mm vs. VN: 0.5mm). The clinical long-term outcomes at 8years were comparable in both VN and CM groups.

Dynamics of red fluorescent dental plaque during experimental gingivitis—A cohort study

ObjectivesThe dynamics of red fluorescent plaque (RFP) in comparison to clinical plaque and bleeding scores were studied during an experimental gingivitis protocol in a cohort of healthy participants. MethodsForty-one participants were monitored for RFP before (24h plaque), during 14 days plaque accumulation (days 2, 5, 9, 14) and after 7 days recovery (24h plaque). RFP was assessed on fluorescence photographs of the vestibular aspect of the anterior teeth (cuspid to cuspid) in the upper and lower jaw. Clinical plaque and bleeding were assessed at days −14, 0, 14 and 21. ResultsRFP of 24h plaque was reproducible (days −14, 0), then increased during 14 days plaque accumulation and returned to baseline after 7 days recovery. Groups of low, moderate and high RFP formers were statistically significantly different at all times even already at baseline. The individual RFP response during 14 days plaque accumulation correlated well with RFP of 24h plaque (days −14, 0). RFP correlated moderate to well with clinical plaque at days −14, 0, 14 and 21. From day 2 of the gingivitis challenge RFP correlated with bleeding at day 14. ConclusionsRFP provided an objective measure of oral hygiene status. Given the correlation with clinical parameters found, the amount of RFP after 24h plaque accumulation was indicatory for the inflammatory response during a prolonged period of no oral hygiene. This trial was registered at the public trial register ​of the Central Committee on Research Involving Human Subjects (CCMO) under number NL51111.029.14 Clinical significanceThis paper shows the association between RFP after 24h plaque accumulation and inflammatory response after a prolonged period of no oral hygiene. Red plaque fluorescence can be used to identify subjects at risk for developing gingival inflammation.

Horizontal mucosal thickness at implant sites as it correlates with the integrity and thickness of the buccal bone plate.

To histologically assess the association between the horizontal mucosal thickness (MT) at implant sites with the integrity and thickness of the buccal bone plate in a canine model. Two-piece titanium implants were placed at chronic-type lateral ridge defects. The resulting vestibular dehiscence-type defects (vertical dimensions of 2-8mm) were left untreated. After a submerged healing period of 2 and 8weeks (n=6 fox hounds each), dissected blocks were processed for histomorphometrical analyses [e.g. MT, bone thickness (BT) and residual defect length]. Linear regression revealed significant associations between vestibular MT and BT values after 2 (R2 =0.22, B=-0.37, P<0.0001) and 8weeks (R2 =0.37, B=-0.45, P<0.001) of healing. The present analysis has pointed to an inverse relationship between horizontal MT and BT values at the vestibular aspect of submerged titanium implants. MT was most pronounced in the absence of a buccal bone plate.

Novel Model of Mono Cortical Bone Defect in Rat Mandible: An Interesting Tool for Osseous Investigations

Novel Model of Mono Cortical Bone Defect in Rat Mandible: An Interesting Tool for Osseous Investigations Yuri Slusarenko da Silva, Maria Cristina Zindel Deboni, Victor Elias Arana-Chaves, Maria da Graça Naclério-Homem Abstract Introduction: biomaterials are worldwide tested in healthy sciences disciplines to be further applied in human patients and these tests ought to be conducted in small animals before they can be safely applied in human clinical research. Objectives: describe in detail a novel model of a mandible defect in Wister rats to provide the researchers the possibility to easily test their biomaterials when the mandible is the fundamental object of study. Materials and Methods: eighteen adults’ male Wister rats were operated for the creation of this mandible defect to locally apply a medication used as a complementary treatment of odontogenic tumor surgery. Results: if properly executed, the vestibular aspect of mandible body of Wister rats is the unique region possible to create a real monocortical defect, preserving the lingual table. Bottom surface and space between internal margins of the defect allow placement of substances in a consistency of cements, powders, and liquids. Conclusions: this novel model will allow the researchers to easily test their biomaterials at the peculiar mandible region, obtain the results in short periods under laboratory conditions, and use less animals, applying the principle of 3 Rs in animal research (replacement, reduction and refinement). Full Text: PDF DOI: 10.15640/ijhs.v4n2a8

Comparative analysis of the blood flow values of patients with type 2 diabetes mellitus presenting with chronic periodontitis, patients with chronic periodontitis only and healthy individuals.

Laser Doppler flowmetry (LDF) is a non-invasive technique used for various reasons in medicine and dentistry. There are many reports of vascular and microcirculatory changes in patients with diabetes mellitus. The aim of the study was to assess the gingival blood flow (GBF) measurements in patients with chronic periodontitis (Group 1), patients with chronic periodontitis and Type 2 diabetes mellitus (Group 2) and healthy controls (Group 3). Forty-eight individuals were included in the study and divided into three groups. Gingival blood flow measurements were taken from 16 points in the upper vestibular aspect of six anterior teeth using LDF probe. In addition, plaque index (PI), gingival index (GI), probing depth (PD) and attachment loss (AL) were registered to determine the periodontal status. Results showed a significant correlation (p < 0.05) in clinical indices and GBF among the groups. Moreover, in Group 1, there was a correlation between GI and AL and between PD and AL. In Group 2, a correlation was observed between PI and AL and between GI and GBF. The results revealed an increase in GBF value in the chronic periodontitis group with Type 2 diabetes mellitus compared with the group with chronic periodontitis only. Diabetes can also affect GBF due to the nature of the disease, which affects the microcirculatory status.

Computer-assisted flapless implant surgery in edentulous elderly patients: a 2-year follow up.

The rehabilitation of edentulous mandibles with implant-supported overdentures is a state-of-the-art contemporary implant treatment. Computer-assisted flapless surgery is associated with decreased chairside treatment time, as well as significant reduction in patient postoperative morbidity and discomfort. The aim of this study was to evaluate the protocol of computer-guided surgery in the treatment of edentulous mandibles with overdentures supported by four intraforaminal implants and retained by Locator® attachments in elderly patients, both from a clinician's and a patient's perspective, as well as to assess the stability of the results in a 2-year period. 15 patients presenting edentulous mandibles and discomfort while wearing conventional overdentures were enrolled in the study. Careful presurgical and computer-assisted 3D treatment planning was performed. Patients were treated with four intraforaminal implants using a computer-assisted flapless approach. All patients were prosthetically rehabilitated with overdentures. Clinical parameters such as peri-implant probing depth (PPD), Plaque Index (PI), and bleeding on probing (BOP) were evaluated. Patients' perceptions regarding the outcome were assessed on visual analog scales (VAS). Out of 15 patients consecutively included in the study, only 10 patients could be treated with the designed protocol. A total of 40 Camlog implants were placed. No implant was lost over a 2-year period. BOP was negative in 82% of sites; mean PPD was 2.34 mm; 8 of the 40 implants showed the absence of keratinized tissue on the lingual or the vestibular aspect. The VAS score of 9.9 demonstrated the satisfaction of the patients. Within the limitations of this study, the data demonstrate that in a significant number of cases this protocol could not be used for anatomical or technical reasons. In the cases where it could be used, the computer-assisted protocol appeared suitable for treating elderly patients with mandibular edentulism and restoring them with an overdenture in a minimally invasive way. The possibility of placing implants outside the borders of the keratinized tissue is relevant.

Effect of lingual plates on generating intra-oral pressure during swallowing: an experimental study in healthy subjects

BackgroundAlthough palatal augmentation prostheses (PAPs) can improve dysphagia, their application is compromised in the absence of maxillary abutment teeth. Experimental lingual plates (ELPs) used for raising the tongue may be employed as alternative to PAPs.MethodsInfluence of different ELP designs, plateau (P–type) and drop-shaped (D–type), on the intra–oral pressure during swallowing were tested. Eleven healthy dentate volunteers, with a mean age of 35.5±10.5 years, participated in this study. Tongue pressure on the hard palate was measured using an ultra-thin sensor sheet with five measuring points, whilst performing dry, 5–ml and 15–ml water swallows, with and without the ELPs in situ. Additional pressure sensors were installed in the lingual aspects of the ELPs, and on the vestibular aspect of the lower molars for measuring sublingual and oral vestibule pressures, respectively. Each measurement was recorded thrice. A repeated measures ANOVA was employed to verify differences in duration, maximal magnitude and integrated value for the different experimental situations. Tukey’s post hoc test was performed for comparison testing. Statistical significance was set at p<0.05.ResultsThe sequence of tongue–palate contact on the median line of the hard palate without ELPs was maintained, except for the 15 ml P–type swallow. Tongue pressure started earlier with the D–type but reached its peak nearly at the same time as without ELPs. The peak magnitude and cumulative tongue pressure against the hard palate decreased by wearing ELPs (p<0.05), but was inconsistent between the two types of ELPs and for the different swallowing volumes. Both, maximum and cumulative vestibular pressures were mostly similar or larger with P–type than that with D–type.ConclusionD-type and P-type ELPs seem to have the inverse effect of PAPs on the palatal tongue pressure during swallowing. These first counterintuitive findings do not yet justify rejecting the basic rationale of using ELPs for the treatment of dysphagia; hence a rather biologically designed piezographic lingual plate may be more appropriate.

Full vestibular approach in pre-prosthetic surgery: retrospective evaluation of 90 patients and literature review

Atrophy of the jaws could represent a challenge in maxillofacial and oral surgery. The correction of bone defects due to the atrophic process is frequently achieved by means of onlay bone grafting. In the present note, a technique of flap designing to approach the alveolar atrophic crest will be discussed. The primary incision is sculpted in the vestibular aspect of the oral fornix, apically to the mucogengival junction. A full thickness mucosal flap is then lifted to expose the maxillary or mandibular lateral wall, and the alveolar crest is reached after the deglovement of the atrophic edentulous crest. This technique aims to decrease the incidence of dehiscence and consequent infection in the area of bone grafts, in order to provide a feasible and safe procedure to perform bone grafting and preserve the overlying soft tissues. This technique of flap design has been applied on 90 cases (167 sites) to face mild to severe jaw atrophy obtaining good results in comparison with the traditional crestal incision technique.

Dentointegration of a titanium implant: a case report

This case illustrates a pulp tissue-induced dentointegration of a titanium implant. One commercially available titanium implant with a sand-blasted and acid-etched surface was placed in the maxilla of a foxhound where the palatinal root of the previously (i.e., 8 weeks) removed first molar was unintentionally retained. After 8 weeks of nonsubmerged healing, the dissected block was prepared for immunohistochemical (osteocalcin) and histomorphometrical analysis. A reparative hard tissue had formed within the artificially opened pulp canal. Also, the external layer of the exposed dentin due to the root fracture during tooth removal further developed into an atubular reparative dentin thus establishing a close contact with the adjacent titanium implant surface. The entire contact zone was demarcated by an intense osteocalcin antigen reactivity. A thin layer of osteocementum originated from the root surface and superimposed implant integration in the peripheral areas. Mean contact of osteodentin/osteocementum to the implant surface was 67.4 %, whereas bone-to-implant contact at the vestibular aspect was 63.5 %. The present case report provides the first histological evidence for a pulp tissue-induced dentointegration of a titanium implant.

Stabilization of Mobile Mandibular Segments in Mandibular Reconstruction: Use of Spanning Reconstruction Plate

The fibular free flap is the gold standard for mandibular reconstruction. Accurate 3-dimensional contouring and precise alignment of the fibula is critical for reestablishing native occlusion and facial symmetry. Following segmental mandibulectomy, the remaining mandibular fragments become freely mobile. Various stabilization methods including external fixation, intermaxillary fixation, and preplating with reconstruction plate have been used. We describe a modification to the preplating technique. After wide resection of buccal squamous cell carcinoma, our patient had an 11-cm mandibular defect from the angle of the left mandible to the right midparasymphyseal region. A single 2.0-mm Unilock® (Synthes, Singapore) plate was used to span the defect. This was placed on the vestibular aspect of the superior border of the mandibular remnants before resection. Segmental mandibulectomy was then performed with the plate removed. The spanning plate was then reattached to provide rigid fixation. The fibular bone was contoured with a single osteotomy and reattached. The conventional technique involves molding of the plate at the inferior border of the mandible. This is time-consuming and not possible in patients with distorted mandibular contour. It is also difficult to fit the osteotomized fibula to the contoured plate. In comparison, the superiorly positioned spanning plate achieve rigid fixation of the mandible while leaving the defect completely free and unhampered by hardware, allowing space for planning osteotomies and easier fixation of the neomandible. Using this modified technique, we are able to recreate the original mandibular profile with ease.