Minimally invasive rehabilitation of a severely atrophic and fully edentulous maxilla using 4-mm-ultrashort implants: A case report with 1-year follow-up

This case report describes an alternative minimally invasive treatment option using 4-mm-long ultrashort implants placed to rehabilitate a severely atrophic edentulous maxilla. The patient, coming from a full removable denture, asked for an implant prosthesis avoiding reconstructive surgeries and expensive procedures. Considering that the mean available bone was about 4.8 mm in height on Cone Beam Computed Tomography (CBCT) scans, 6 implants were placed where bone volumes were sufficient to receive 4-mm-ultrashort implants. Six months after implant placement an implant-supported bar-retained overdenture prosthesis was delivered. The healing process was uneventful and 1 year after loading the result appears clinically and radiographically stable and the patient is fully satisfied. The described approach, despite some prosthetic compromises, within all the limitations of this case report, might be applied in selected cases, reducing rehabilitative times, possible complications and costs. However, longer follow-ups on large number of patients coming from Randomised Controlled clinical Trials (RCTs) are necessary before making more reliable recommendations

A proposed protocol for ordinary and extraordinary hygienic maintenance in different implant prosthetic scenarios

Prevention of peri-implantitis involves the early diagnosis of peri-implant mucositis. This article presents a protocol of hygienic maintenance in different implant prosthetic scenarios: single crown, fixed partial prosthesis, fixed full-arch, and overdentures. Others clinical conditions have to be taken into consideration: patient compliance; history of periodontitis; implants placed in augmented bone; short, zygomatic, pterygoid, and tilted implants; and complex prosthesis with false gingiva. Two levels of implant maintenance are described: ordinary, performed by dental hygienist, and extraordinary, carried out by both dentist and hygienist. Extraordinary maintenance also involves the removal and decontamination of the prosthetic structure. To obtain an effective prevention of peri-implantitis, one must plan ordinary and extraordinary hygiene in relation to the type of rehabilitation and clinical parameters

Current state of terrestrial ecosystems in the joint Norwegian, Russian and Finnish border area

Appendix 15/15 of the publication "State of the environment in the Norwegian, Finnish and Russian border area 2007" (The Finnish Environment 6/2007)

Soil faunal and structural responses to the settlement of a semi- sedentary earthworm Lumbricus terrestris in an arable clay field

We studied the soil community and habitat consequences of introducing a deep-burrowing, sedentary life-style earthworm, Lumbricus terrestris (dew-worm) into arable zero-till clay. Seventeen years after introduction, which was originally aimed at improving the macroporosity and permeability of the heavy clay soil, we returned to the gradient of L. terrestris dispersal (well established, more recent and no settlement) and investigated the temporal development of the ecosystem engineering impacts on different faunal groups (earthworms, enchytraeids and nematodes) and soil porosity. The faunal re- sponses were examined both at L. terrestris midden scale (individual living site) and field scale. We found that L. terrestris middens sustained elevated densities of all three faunal groups. In the case of earth- worms, there was evidence for temporal development of the engineering impact as the difference be- tween the midden and non-midden areas was more pronounced in the well-established areas than close to the leading edge of dispersal. The earthworm community composition was not altered at L. terrestris midden sites. The settlement of L. terrestris had no discernible effects on field-scale earthworm and nematode abundances, but enchytraeids were practically absent beyond the leading edge of the dispersal. This effect might, however, be partly explained by a gradient of increasing clay content. Soil macroporosity at L. terrestris midden sites did not increase with the age of L. terrestris settlement. Our results suggest that L. terrestris settlement in a clay soil can significantly increase the spatial patchiness of soil fauna, but may not, except in the case of enchytraeids, affect their field-scale abundances or the macroporosity of the soil in the vicinity of L. terrestris living sites

Minimally invasive rehabilitation of a severely atrophic and fully edentulous maxilla using 4-mm-ultrashort implants: A case report with 1-year follow-up

This case report describes an alternative minimally invasive treatment option using 4-mm-long ultrashort implants placed to rehabilitate a severely atrophic edentulous maxilla. The patient, coming from a full removable denture, asked for an implant prosthesis avoiding reconstructive surgeries and expensive procedures. Considering that the mean available bone was about 4.8 mm in height on Cone Beam Computed Tomography (CBCT) scans, 6 implants were placed where bone volumes were sufficient to receive 4-mm-ultrashort implants. Six months after implant placement an implant-supported bar-retained overdenture prosthesis was delivered. The healing process was uneventful and 1 year after loading the result appears clinically and radiographically stable and the patient is fully satisfied. The described approach, despite some prosthetic compromises, within all the limitations of this case report, might be applied in selected cases, reducing rehabilitative times, possible complications and costs. However, longer follow-ups on large number of patients coming from Randomised Controlled clinical Trials (RCTs) are necessary before making more reliable recommendations

An ancient science to improve today’s clinical practice: oral surgery meets human anatomy

Human body dissection was a ubiquitous practice in the past, to better understand anatomy and to develop medicine. Today, its role could still be important to answer everyday clinical queries and help surgeons. The example of the possible lack of anesthesia during symphysis surgeries can emphasize the usefulness of dissection. The mandibular symphysis usually receives innervation from inferior alveolar nerve terminations, but, in some rare cases, a particular anastomosis involves the lingual nerve and the nerve to the mylohyoid. The anatomical knowledge resulting from body dissections could help oral surgeons to understand the reason why the patient could feel pain during the surgery, and ensure performance of the right lingual nerve block to obtain complete anesthesia. This clinical situation shows the educational role of an ancient, yet still valid, practice, human dissection, and the importance of anatomical studies to improve surgical skills, to provide better treatment for the patient

Post-extractive implants: Clinical indications and literature analysis

OBJECTIVES: The aim of this study is to evalua-te the current state of the art in the management of the patient with the need for implant placement immediately after the extraction of the dental element. The advantages and disadvantages of the different therapeutic options in the fixed implant rehabilitation of the post-extractive socket have been analyzed. Authors\u2019 clinical experience will be taken also into consideration to better support scientific evidence. MATERIALS AND METHODS: Taken into consideration the recent literature and scientific evidence, the current studies with the highest scientific impact have been exami-ned. In particular, the different im-plant insertion timings, contextual to the extraction of the dental ele-ment (immediate), after 6-8 weeks (immediate-delayed) and the clas-sic approach after 4-6 months (de-layed) were evaluated. The management of the bone to implant gap and the need to sur-gically preserve the post-extrac-tion site have been also analyzed. RESULTS: No statistically significant differences emerged between the various implant placement timings, in terms of failures, complications and patient satisfaction. However there seems to be a tendency for failure and complications in immediate and immedia-te-delayed implant placement, which are also technically more demanding. On the other hand, patients whom rehabilitation times are considera-bly reduced tend to be more sati-sfied. Moreover, immediate implant placement does not seem to prevent considerable loss of bone volume, while the use of bone grafts in the bone to implant gap seems to decrease the physiologi-cal buccal bone resorption, even if there are no statistically signifi-cant differences in the studies ta-ken into consideration. Additionally, the alveolar ridge preservation, compared to extraction alone, reduces the need for a surgical session in order to recon-struct the bone. No particular differences emerged by comparing various types of bio-materials or membranes, however, the application of biomaterial in as-sociation with resorbable membranes seems to achieve good results in terms of loss of bone volumes. CONCLUSIONS: According to the current literature and the authors\u2019 experience, post-extractive implants are nowadays considered as an alternative to tra-ditional procedures because they can have important benefits for both the patient and the clinician. However, there are a tendency for more failures and complications associated with this procedure. If the clinician decides to place post-extractive implants or delay-ed implants, in either cases, our suggestion is to fill the bone to im-plant gap with biomaterial in as-sociation with a resorbable mem-brane in order to prevent loss of bone volumes. However, larger studies, especial-ly Randomised Controlled Clinical Trials (RCTs) with longer follow-ups are needed to better evaluate these alternatives. CLINICAL SIGNIFICANCE: Post-extractive implant placement can be an option for those patients requiring a reduction in re-habilitative times. However, the potential disadvantages, such as failures and complications should be always clarified and discussed with the patient along with possible therapeutic alternatives