Aesthetic satisfaction in lip and palate clefts: a comparative study between secondary and tertiary bone grafting

Lip and palate cleft represent one of the most frequently occurring congenital deformity, which includes dental anomalies, such as variation in tooth number and position. In case of hypodontia implant-prosthetic rehabilitation offers significant advantages in terms of function, aesthetics and quality of life and bone graft is usually needed. Secondary bone grafting, generally performed in the mixed dentition phase (years 8-11) seems to be the most successful method to allow for rehabilitation. It's often necessary to perform a tertiary bone grafting in adult age in order to achieve better bone quantity and quality before implant placement. Aim of this retrospective study was to evaluate the aesthetic perception that patients had of themselves comparing dental implants placed in tertiary grafted alveolar cleft sites with a previous secondary grafting to only secondary grafting. Between 2009 and 2012, fourteen alveolar cleft were treated with implant rehabilitation and eleven of them received tertiary bone grafting six months prior to implant placement. All patients were questioned to give a score from 1 to 10 their aesthetic satisfaction of their smile before and after implant rehabilitation and during pre-surgery provisional rehabilitation. At the end of their prosthesis rehabilitation patients who received tertiary bone grafting resulted more satisfied than those who had secondary bone grafting only (9.5 vs 8)

Halcyornis toliapicus (aves: Lower Eocene, England) indicates advanced neuromorphology in Mesozoic Neornithes

Our recent X-ray micro computer-tomographic (μCT) investigations of Prophaethon shrubsolei and Odontopteryx toliapica from the Lower Eocene London Clay Formation of England revealed the avian brain to have been essentially modern in form by 55 Ma, but that an important vision-related synapomorphy of living birds, the eminentia sagittalis of the telencephalon, was poorly developed. This evidence suggested that the feature probably appeared close to the end of the Mesozoic. Here we use μCT analysis to describe the endocranium of Halcyornis toliapicus, also from the London Clay Formation. The affinities of Halcyornis have been hotly debated, with the taxon referred to the Charadriiformes (Laridae), Coraciiformes (Alcedinidae, and its own family Halcyornithidae) and most recently that Halcyornithidae may be a possible senior synonym of Pseudasturidae (Pan-Psittaciformes). Unlike Prophaethon and Odontopteryx, the eminentia sagittalis of Halcyornis is strongly developed and comparable to that of living species. Like those London Clay taxa, the eminentia sagittalis occupies a rostral position on the telencephalon. The senses of Halcyornis appear to have been well developed. The length of the cochlear duct of the inner ear indicates a hearing sensitivity within the upper range of living species, and enlarged olfactory lobes suggest a reasonable reliance on sense of smell. The optic nerves were especially well developed which, together with the strong development of the eminentia sagittalis, indicates a high degree of visual specialization in Halcyornis. The advanced development of the eminentia sagittalis further supports a Mesozoic age for the appearance of this structure and associated neural architectural complexity found in extant Aves. The eminentia sagittalis of living Psittaciformes is situated caudally on the telencephalon, making a Pan-Psittaciformes relationship unlikely for Halcyorni

Different titanium surfaces modulate the bone phenotype of SaOS-2 osteoblast-like cells.

Commercially pure titanium implants presenting a relatively smooth, machined surface or a roughned endosseous surface show a large percentage of clinical successes. Surface properties of dental implants seem to be important with respect to bone cells response. Implant topography appears to modulate cell growth and differentiation of osteoblasts affecting the bone healing around the titanium implant. The aim of the present study was to examine the effects of three different titanium surfaces on cell morphology, adhesion and bone phenotypic expression of human osteoblast-like cells, SaOS-2. SaOS-2 cells were cultured on commercially pure titanium disks of 1 cm in diameter with three different surface roughness: smooth (S), sandblasted (SB) and titanium plasma sprayed (TPS). Differences in the cell morphology were found on the three surfaces showing an uniform monolayer of shaped cells on the S surfaces, and clusters of multilayered cells with an irregular shape on the rough surfaces. The adhesion of SaOS-2 cells, as measured after 3h of culture, was not affected by surface roughness. ECM components such as collagen I (CoI), fibronectin (FN), vitronectin (VN) and tenascin (TN) were secreted and organized only on SB and TPS surfaces while on S surfaces they remained in the cytoplasm. Osteopontin and BSP-II were largely detected on SB and TPS surfaces, while only minimal production was observed on S surfaces. These data show that titanium surface roughness affects bone differentiation of osteoblast like-cells, SaOS-2, indicating that surface properties may be able to modulate the osteoblast phenotype. These observations also suggest that the bone healing response around dental implants can be affected by surface topography

The impact of loads on standard diameter, small diameter and mini implants: A comparative laboratory study

Objectives: While caution in the use of small-diameter (≤3.5 mm) implants has been advocated in view of an increased risk of fatigue fracture under clinical loading conditions, a variety of implant designs with diameters <3 mm are currently offered in the market for reconstructions including fixed restorations. There is an absence of reported laboratory studies and randomized-controlled clinical trials to demonstrate clinical efficacy for implant designs with small diameters. This laboratory study aimed to provide comparative data on the mechanical performance of a number of narrow commercially marketed implants. Materials and methods: Implants of varying designs were investigated under a standardized test set-up similar to that recommended for standardized ISO laboratory testing. Implant assemblies were mounted in acrylic blocks supporting laboratory cast crowns and subjected to 30° off-axis loading on an LRX Tensometer. Continuous output data were collected using Nexygen software. Results: Load/displacement curves demonstrated good grouping of samples for each design with elastic deformation up to a point of failure approximating the maximum load value for each sample. The maximum loads for Straumann (control) implants were 989 N (±107 N) for the 4.1 mm RN design, and 619 N (±50 N) for the 3.3 mm RN implant (an implant known to have a risk of fracture in clinical use). Values for mini implants were recorded as 261 N (±31 N) for the HiTec 2.4 mm implant, 237 N (±37 N) for the Osteocare 2.8 mm mini and 147 N (±25 N) for the Osteocare mini design. Other implant designs were also tested. Conclusions: The diameters of the commercially available implants tested demonstrated a major impact on their ability to withstand load, with those below 3 mm diameter yielding results significantly below a value representing a risk of fracture in clinical practice. The results therefore advocate caution when considering the applicability of implants ≤3 mm diameter. Standardized fatigue testing is recommended for all commercially available implants

A radiographic study on the visualization of the anterior loop in dentate subjects of different age groups

The anterior loop is defined as where the mental neurovascular bundle crosses anterior to the mental foramen then doubles back to exit the mental foramen. It cannot be seen clinically but can be detected in 11-60 of panoramic radiographs. As this anatomical structure is important in determining the placement position of endosseous implants in the mandibular premolar region, a pilot study was undertaken to determine its visibility on dental panoramic radiographs in dentate subjects of various age groups. One or more anterior loops were visible in 39 (40.2) radiographs encompassing 66 sites (34.4). Interestingly, anterior loops were most commonly observed bilaterally, followed by on the right side of the mandible only. An anterior loop on the left side only was observed in just 1 radiograph. Visibility of anterior loops reduced as the age of subjects increased. More than half (58.1) of subjects aged 20-29 years exhibited at least one anterior loop; this gradually reduced to only 15 percent of subjects aged 50 and older. There was no association between visualization of the anterior loop and subject gender

A review on the prevention of inflammatory periimplant diseases

Background: An impressive number of dental implants are inserted worldwide. Evolution in dental implants and simplification of surgical techniques allowed a significant increase in the number of dentists involved in implant surgery. Most of them are general dentists, are not always sufficiently formed and experienced, frequently use low-quality implants, do not adopt the proper patient selective criteria, do not adequately monitor and maintain the inserted implants, and do not report their own statistics to the dental community. Consequently, the incidence of inflammatory periimplant diseases (IPDs) has progressively increased to values significantly higher than those previously indicated by the scientific literature. Materials and Methods: Two main literature searches were undertaken in October 2018 in the PubMed Website database. Only articles written in English and published from 2008 onward were considered; 'Clinical Trial,' 'Meta analysis,' 'Observational study,' 'Review,' and 'Validation study' were selected as article type filters. The following keywords were used in the searches: 'Peri implantitis prevention' and 'Dental implant failure prevention.'Results: Preventive measures are analyzed according to the different factors that can favor the occurrence of an infection. The factors are divided into (i) implant dependent, (ii) patient dependent, and (iii) surgeon dependent. Conclusions: Scientific and clinical data confirm that when materials are selected with care, patients are carefully evaluated for factors of risk and attitude to adhere to the necessary maintenance program, and operative protocols and maintenance programs are respected dental implants can be attractive and effective tools for oral rehabilitation. Nevertheless, dentists and patients should have greater awareness that in many cases the decision to utilize dental implants cannot be taken lightly

Quantitative analysis of bone reactions to relative motions at implant-bone interfaces

Connective soft tissues at the interface between implants and bone, such as in human joint replacements, can endanger the stability of the implant fixation. The potential of an implant to generate interface bone resorption and form soft tissue depends on many variables, including mechanical ones. These mechanical factors can be expressed in terms of relative motions between bone and implant at the interface or deformation of the interfacial material.\ud \ud The purpose of this investigation was to determine if interface debonding and subsequent relative interface motions can be responsible for interface degradation and soft tissue interposition as seen in experiments and clinical results. A finite element computer program was augmented with a mathematical description of interface debonding, dependent on interface stress criteria, and soft tissue interface interposition, dependent on relative interface motions. Three simplified models of orthopaedic implants were constructed: a cortical bone screw for fracture fixation plates, a femoral resurfacing prosthesis and a straight stem model, cemented in a bone. The predicted computer configurations were compared with clinical observations. The computer results showed how interface disruption and fibrous tissue interposition interrelate and possibly enhance each other, whereby a progressive development of the soft tissue layer can occur.\ud \ud Around the cortical bone screw, the predicted resorption patterns were relatively large directly under the screw head and showed a pivot point in the opposite cortex. The resurfacing cup model predicted some fibrous tissue formation under the medial and lateral cup rim, whereby the medial layer developed first because of higher initial interface stresses. The straight stem model predicted initial interface failure at the proximal parts. After proximal resorption and fibrous tissue interposition, the medial interface was completely disrupted and developed an interface layer. The distal and mid lateral side maintained within the strength criterion.\ud \ud Although the applied models were relatively simple, the results showed reasonable qualitative agreement with resorption patterns found in clinical studies concerning bone screws and the resurfacing cup. The hypothesis that interface debonding and subsequent relative (micro)motions could be responsible for bone resorption and fibrous tissue propagation is thereby sustained by the results

Endosseous dental implant fractures an analysis of 21 cases

Implant fracture is an infrequent cause of implant failure. The present study evaluates 21 fractured implants, with an analysis of patient age and sex, the type, length and diameter of the implant, positioning in the dental arch, the type of prosthetic rehabilitation involved, the number of abutments and pontics, the presence or absence of distal extensions or cantilevers, and loading time to fracture. Implant fracture was more common in males than in females (15:4), and the mean patient age was 56.9 years. Most cases (n = 19) corresponded to implant-supported fixed prostheses - 16 with cantilevers of different lengths ? while only two fractured implants were supporting overdentures instead of fixed prostheses. The great majority of fractured implants (80.9%) were located in the molar and premolar regions, and most fractured within 3-4 years after loading. It is important to know and apply the measures required to prevent implant fracture, and to seek the best individualized solution for each case - though complete implant removal is usually the treatment of choice

The effect of smoking on survival and bone loss of implants with a fluoride-modified surface: a 2-year retrospective analysis of 1106 implants placed in daily practice

Aim: To compare survival and peri-implant bone loss of implants with a fluoride-modified surface in smokers and nonsmokers. Materials and Methods: Patient files of all patients referred for implant treatment from November 2004 to 2007 were scrutinized. All implants were placed by the same experienced surgeon (BC). The only inclusion criterion was a follow-up time of at least 2 years. Implant survival and bone loss were assessed by an external calibrated examiner (SV) comparing digital peri-apical radiographs taken during recall visits with the post-operative ones. Implant success was determined according to the international success criteria (Albrektsson et al. 1986). Survival of implants installed in smokers and nonsmokers were compared using the log-rank test. Both non-parametric tests and fixed model analysis were adopted to evaluate bone loss in smokers and nonsmokers. Results: 1106 implants in 300 patients (186 females; 114 males) with a mean follow-up of 31 months (SD 7.15; range 24-58) were included. 19 implants in 17 patients failed, resulting in an overall survival rate of 98.3% on implant level and 94.6% on patient level. After a follow-up period of 2 years, the CSR was 96.7% and 99.1% with the patient and implant as statistical unit respectively. Implant survival was significantly higher for nonsmokers compared to smokers (implant level p = 0.025; patient level p = 0.017). The overall mean bone loss was 0.34 mm (n = 1076; SD 0.65; range 0.00-7.10). Smokers lost significantly more bone compared to nonsmokers in the maxilla (0.74 mm; SD 1.07 vs 0.33 mm; SD 0.65; p < 0.001), but not in the mandible (0.25mm; SD 0.65 vs 0.22mm; SD 0.50; p = 0.298). Conclusion: The present study is the first to compare peri-implant bone loss in smokers and nonsmokers from the time of implant insertion (baseline) to at least 2 years of follow-up. Implants with a fluoride-modified surface demonstrated a high survival rate and limited bone loss. However, smokers are at higher risk to experience implant failure and more prone to show peri-implant bone loss in the maxilla. Whether this bone loss is predicting future biological complications remains to be evaluated