Magnification in apical surgerymusing the endoscope: a review

Objective: A review is made to determine whether the use of the endoscope in endodontic surgery offers advantages in clinical practice, and whether it improves the clinical and radiographic outcomes of the procedure. Material and methods: The main search terms used were: endodontic surgery, apicoectomy, apical surgery, endoscope, and magnification devices . The authors searched the Medline database for articles published up to 1 September 2010. The review included experimental studies comparing endoscopic microstructural findings with the findings of the naked eye or other magnification devices, as well as prospective clinical trials comparing endodontic surgery with or without the use of an endoscope, or comparing the endoscope with some other magnification device. Results: Two experimental studies on the capability of the endoscope to identify microstructures and three prospective clinical trials were included in the review. The experimental studies showed the endoscope to be highly precise in application to intraoperative diagnoses in periapical surgery. There were no significant differences in the prognosis of periapical surgery when performed with or without endoscopy. Likewise, there were no significant differences among the use of endoscopy, magnifying lenses or the microscope. Conclusion: Experimental studies have demonstrated the usefulness of the endoscope in identifying microstructures during periapical surgery. However, further randomized and controlled clinical trials are needed to determine whether these advantages in clinical practice imply improved outcomes for periapical surgery

Immediate loading with fixed full-arch prostheses in the maxilla: review of the literature

Objectives: To critically review the evidence-based literature on immediate loading of implants with fixed full- arch prostheses in the maxilla to determine 1) currently recommended performance criteria and 2) the outcomes that can be expected with this procedure. Study Desing: Studies from 2001 to 2011 on immediate loading with fixed full-arch maxillary prostheses were reviewed. Clinical series with at least 5 patients and 12 months of follow-up were included. Case reports, studies with missing data and repeatedly published studies were excluded. In each study the following was assessed: type of study, implant type, number of patients, number of implants, number of implants per patient, use of post-extrac - tion implants, minimum implant length and diameter, type of prosthesis, time until loading, implant survival rate, prosthesis survival rate, marginal bone loss, complications andmean follow-up time. Criteria for patient selection, implant primary stability and bone regeneration were also studied. Results: Thirteen studies were included, reporting a total of 2484 immediately loaded implants in 365 patients. Currently accepted performance criteria regarding patient and implant selection, and surgical and prosthetic pro - cedures were deduced from the reviewed articles. Implant survival rates went from 87.5% to 100%, prosthesis survival rates from 93.8% to 100% and radiographic marginal bone loss from 0.8 mm to 1.6 mm.No intraoperative complications and only minor prosthetic complications were reported. Conclusions: The literature on immediate loading with fixed full-arch prostheses in the maxilla shows that a successful outcome can be expected if adequate criteria are used to evaluate the patient, choose the implant and perform the surgical and prosthetic treatment. Lack of homogeneity within studies limits the relevance of the con - clusions that can be drawn, and more controlled randomized studies are necessary to enable comparison between the immediate and the conventional loading procedures

Replantation of a maxillary second molar after removal of a third molar with a dentigerous cyst: Case report and 12-month follow-up

The aim of this study was to describe the replantation of a maxillary second right molar, which had been removed for surgical reasons in order to remove a dentigerous cyst associated with the adjacent third molar, and the case's 12-month follow-up. A 51-year-old man presented swelling in the right maxillary area. Radiographic examination showed a large radiolucency in close proximity to the third molar, suggesting a follicular cyst. The third molar was extracted and the cyst underwent curettage. The second molar had to be extracted to enable complete removal of the cyst and to achieve primary closure of the wound, which would have been impossible without repositioning the molar. With this objective, extraoral endodontic treatment was performed, the root-end was resected and prepared with ultrasonic retrotips, and root-end filling was accomplished with MTA before the molar was replanted. At the 12-month follow-up, the tooth showed no clinical signs or symptoms, probing depth was no greater than 3 mm and radiographic examination showed no evidence of root resorption or periapical lesion

Association between maxillary sinus pathology and odontogenic lesions in patients evaluated by cone beam computed tomography. A systematic review and meta-analysis

A study is made of the association between maxillary sinus pathology and odontogenic lesions in patients evaluated with cone beam computed tomography. A literature search was made in five databases and OpenGrey. Methodological assessment was carried out using the Newcastle-Ottawa tool for observational studies. The random-effects model was used for the meta-analysis. Twenty-one studies were included in the qualitative review and 6 in the meta-analysis. Most presented moderate or low risk of bias. The periodontal disease showed to be associated with the thickening of the sinus membrane (TSM). Mucous retention cysts and opacities were reported in few studies. The presence of periapical lesions (PALs) was significantly associated to TSM (OR=2.43 (95%CI:1.71-3.46); I2=34.5%) and to odontogenic maxillary sinusitis (OMS) (OR=1.77 (95%CI: 1.20-2.61); I2=35.5%). The presence of PALs increases the probability of TSM and OMS up to 2.4-fold and 1.7-fold respectively. The risk differences suggests that about 58 and 37 of out every 100 maxillary sinuses having antral teeth with PALs are associated with an increased risk TSM and OMS respectively. The meta-evidence obtained in this study was of moderate certainty, and although the magnitude of the observed associations may vary, their direction in favor sinus disorders appearance, would not change as a result

Comparación de carga inmediata frente a carga convencional de implantes inmediatos con prótesis fijas de arco completo

Comparación de carga inmediata frente a carga convencional de implantes inmediatos con prótesis fijas de arco completo. OBJETIVOS El propósito del estudio fue evaluar las diferencias entre los protocolos de carga inmediata y carga convencional para rehabilitar a pacientes con el maxilar o la mandíbula parcialmente desdentados en los que esté indicada la extracción de todos los dientes remanentes, con prótesis fijas de arco completo sobre implantes dentales inmediatos y no inmediatos, en cuanto a: 1. Dolor e inflamación postoperatorios durante la primera semana tras la cirugía de implantes. 2. Satisfacción del paciente antes del tratamiento y a los 3 y 12 meses de la colocación de los implantes. Se evalurán la satisfacción global y la específica en cuanto a estética, masticación, fonación, comodidad, autoestima, facilidad de higiene y duración del tratamiento. 3. Éxito de los implantes inmediatos y los colocados en hueso maduro tras 12 meses de seguimiento. En el grupo de carga inmediata, también determinar el éxito del tratamiento protético provisional. 4. Pérdida ósea marginal radiográfica de los implantes tras 12 meses de seguimiento. 5. Complicaciones biológicas y protésicas. METODOLOGÍA Diseño del estudio Se realizó un estudio clínico prospectivo no aleatorizado en la Unidad de Cirugía Oral de la Facultad de Medicina y Odontología de la Universidad de Valencia (España) entre abril de 2008 y febrero de 2013. Se seleccionaron para el estudio los pacientes con necesidad de rehabilitación con implantes de la arcada maxilar o mandibular que cumplieron una serie de criterios de inclusión y exclusión predefinidos. Se diferenciaron dos estudios paralelos, uno en el maxilar y otro en la mandíbula. Treinta pacientes con pronóstico seriamente desfavorable de su dentición maxilar remanente y 36 pacientes en la misma situación para su dentición mandibular, para los que estuviera indicada la rehabilitación con prótesis fijas implantosoportadas de arco completo fueron seleccionados de acuerdo a los criterios de inclusión y exclusión que vienen detallados en el siguiente apartado. El protocolo de carga utilizado lo determinó el tratamiento estándar para este tipo de pacientes en la Unidad de Cirugía Oral en el momento en el que el estudio fue realizado. De ese modo, 15 pacientes consecutivos para el maxilar y 18 para la mandíbula fueron tratados siguiendo el protocolo de carga convenCional (grupo control) hasta julio de 2009. Simultáneamente, tuvo lugar un periodo de aprendizaje sobre carga inmediata entre los miembros de la Unidad de Cirugía Oral y, a partir de septiembre de 2009, se aplicó el protocolo de carga inmediata. Los siguientes 15 pacientes para el maxilar y 18 para la mandíbula que cumplieron los criterios de inclusión y exclusión fueron tratados según ese protocolo (grupo experimental). Fase quirúrgica Todas las cirugías de colocación de implantes fueron realizadas por el mismo operador experto bajo anestesia local con articaina al 4% con adrenalina 1:100.000 (Articaina; Laboratorios Inibsa, Barcelona, Spain) y sedación consciente intravenosa con solución de propofol al 1% (Diprivan; Astra Zeneca farmaceutica Spain, SA, Madrid, Spain) y midazolam (Dormicum; Roche Farma SA, Madrid, Spain), administrados por vía intravenosa por un anestestista. Se extrajeron algunos dientes, conservando hasta 4 dientes siempre que fue posible para estabilizar la férula durante la toma de impresiones. Las extracciones se realizaron de la manera más atraumática posible. Los implantes inmediatos postextracción se colocaron realizando una incisión intrasulcular en los dientes y crestal en los tramos edéntulos, elevando un colgajo de espesor completo. Para colocar los implantes en hueso maduro se practicaron incisiones crestales o en semiluna y se levantaron colgajos mucoperiósticos para exponer la cresta alveolar. Se colocaron seis a ocho implantes Kohno® (Sweden&Martina, Due Carrare, Italy) en el maxilar y de 4 a 6 en la mandíbula. La estabilidad primaria se evaluó con los valores del torque de inserción de los implantes, obtenidos del motor quirúrgico o utilizando una carraca dinamométrica. En el caso de que más de dos implantes no alcanzasen un torque de 35 Ncm el paciente fue excluido del estudio y tratado con un protocolo de carga convencional. Se prescribió a todos los pacientes: amoxicilina 1 g (Clamoxyl; GlaxoSmithKline, Madrid, Spain), 2 veces al día durante 6 días, empezando 1 hora antes de la cirugía; ibuprofeno 600 mg (Bexistar; laboratorio Bacino, Barcelona, Spain), 3 veces al día durante 5 días; y enjuagues con clorhexidina al 0,12% (GUM; John O. Butler Co, A SunStar Company, Chicago, USA) 3 veces al día durante 7 días. Fase protética Grupo experimental (carga inmediata) La posición de los implantes se registró de forma intraoperatoria ferulizando con resina DuraLay® (Dental Mfg. Co., Worth, Illinois, USA) los postes de impresión a una férula acrílica de impresión. Una vez fraguada la resina DuraLay® se desaflojaron los tornillos de los poste, se retiró de la boca del paciente la férula de impresión, se extrajeron los dientes remanentes, se colocaron pilares de cicatrización y se suturaron los tejidos blandos. El técnico de laboratorio trasladó la posición de los implantes al modelo diagnóstico utilizando la férula de impresión. Se confeccionaron prótesis provisionales fijas de arco completo de resina con refuerzo de metal colado y sin cantiléver distal, y se colocaron a las 24-48 horas de la cirugía con un torque de 15 Ncm. Las prótesis de carga inmediata no fueron retiradas durante al menos ocho semanas, cuando se comenzó la fabricación de la prótesis definitiva. Grupo control (carga convencional) Inmediatamente tras la cirugía se entregó a los pacientes la prótesis completa removible provisional ajustada, cuidadosamente aliviada a nivel de los implantes, y adaptada con material de rebase. Estos pacientes utilizaron la prótesis removible hasta la entrega de la prótesis fija de arco completo definitiva metal-cerámica a las 12 semanas de la colocación de los implantes. Seguimiento y recogida de datos Los pacientes acudieron a visitas de control a la semana, y al mes, dos, tres, seis y doce meses desde la colocación de los implantes. De cada paciente se recogieron la edad (en el momento de la colocación de los implantes), el sexo, el consumo de tabaco (nº cigarrillos por día), el tipo de antagonista (dentición natural o prótesis fija dentosoportada / prótesis fija implantosoportada / prótesis removible), y el motivo de extracción de los dientes remanentes (caries no restaurables / fracaso endodóntico con patología periapical crónica / enfermedad periodontal). Se registraron la fecha de la cirugía, el número de implantes colocados y, de cada implante, la posición, la longitud, el diámetro y el tipo de implante según el momento de la colocación (inmediato postextracción o no inmediato). En la visita anterior a la cirugía se evaluó la satisfacción general de los pacientes, y la satisfacción específica con respecto a 5 parámetros -estética, masticación, fonación, comodidad y autoestima- utilizando escalas analógicas visuales (EAV) de 10 cm graduadas con los términos “nada satisfecho” y “totalmente satisfecho” en los extremos izquierdo y derecho respectivamente. Tres meses y 12 meses después de la colocación de los implantes, antes de la entrega de la prótesis definitiva, se pidió a los pacientes que completaran un cuestionario similar pero incluyendo dos factores adicionales: facilidad de higiene y duración del tratamiento. A cada paciente se le explicó y entregó un cuestionario para registrar el dolor y la inflamación diariamente durante la primera semana tras la cirugía. El dolor y la inflamación se evaluaron con EAV de 10 cm en las que el extremo izquierdo se describía por escrito como “ausencia de dolor” y el extremo derecho como “dolor máximo imaginable”. Se determinaron las tasas de éxito de los implantes y de las prótesis fijas de arco completo tras 12 meses de seguimiento. Para valorar el éxito de los implantes se utilizaron los criterios clínicos y radiológicos de Buser (91): 1) ausencia de movilidad clínicamente detectable, 2) ausencia de dolor o cualquier sensación subjetiva, 3) ausencia de infección periimplantaria recurrente y 4) ausencia de radiolucidez continua alrededor del implante después de 3, 6 y 12 meses de la carga protésica. El tratamiento protético fue considerado un éxito siempre que la prótesis no sufriera fracturas que obligasen a cambiarla por otra, y pudiese funcionar independientemente de la pérdida de algún implante, permitiendo a los pacientes llevar a cabo las funciones orales (estética, fonación, alimentación) de forma satisfactoria y con comodidad. Se obtuvieron radiografías periapicales digitales tras la colocación de los implantes y a los 12 meses de seguimiento utilizando el sistema intraoral XMIND® (Groupe Satelec-Pierre Rolland, Merignac, France) y un receptor intraoral digital RVG (Dürr Dental, Bietigheim-Bissingen, Germany). Las radiografías se realizaron con la técnica de paralelismo con la ayuda de anillos de paralelización Rinn XCP® (DentsplyRinn, Elgin, IL, U.S.A). Para realizar las mediciones se utilizó el programa informático de análisis de imagen Cliniview® versión 5.1 (Instrumentarium Imaging, Tuusula, Finlandia). Cada imagen se calibró utilizando la longitud del implante que era conocida. Se midió la distancia vertical desde el cuello del implante (punto de referencia) al punto de contacto hueso-implante más coronal redondeando a 0,1 mm (93). La pérdida de hueso marginal periimplantaria se evaluó en mesial y distal de cada implante a partir del cambio de nivel entre la radiograífa inicial y la del control de 12 meses; para cada pareja de mediciones se utilizó el mayor. Se registraron las complicaciones biológicas y protésicas en las visitas programadas y en quejas puntuales. Se consideró que los implantes con enrojecimiento, inflamación, sangrado al sondaje y ausencia de pérdida ósea radiográfica presentaban mucositis. Aquellos implantes en los que la afectación de tejidos blandos estaba acompañada por pérdida ósea marginal y, en ocasiones, con supuración y/o profundidad de sondaje aumentada se consideraron afectados de periimplantitis. Las prótesis provisionales de carga inmediata y las prótesis definitivas se revisaron en busca de fracturas, aflojamiento de tornillos y correcto esquema oclusal. Análisis estadístico Se realizó un Análisis Bivariante englobando todos los contrastes estadísticos necesarios para responder a los objetivos planteados. Se utilizaron las pruebas de Chi2 y de Mann-Whitney (MW) para estudiar la homogeneidad entre los 2 grupos en cuanto a parámetros demográficos y clínicos. Se utilizó la prueba de MW para estudiar las diferencias entre los protocolos de carga en cuanto a las variables primaria (satisfacción, dolor e inflamación, éxito y pérdida ósea), y para estudiar las diferencias en éxito y pérdida ósea entre el tipo de implante (inmediato post-extracción / no inmediato). Se utilizó la prueba de Wilcoxon para estudiar cambios en la satisfacción de los pacientes entre los diferentes tiempos (inicio / 3 meses / 12 meses). Se utilizó la prueba de Kruskal-Wallis para estudiar las diferencias en éxito de los implantes entre los grupos formados considerando el protocolo de carga y el tipo de implante simultáneamente. El nivel de significatividad empleado en todos los análisis bivariantes fue del 5% (α=0.05). BIBLIOGRAFÍA BÁSICA 1. Brånemark PI. Osseointegration and its experimental background. J Prosthet Dent 1983;50:399-410. 2. Adell R, Eriksson B, Lekholm U, Brånemark PI, Jemt T. Long-term follow-up study of osseointegrated implants in the treatment of totally edentulous jaws. Int J Oral Maxillofac Implants 1990;5:347-59. 3. Jemt T, Lekholm U. Implant treatment in edentulous maxillae: a 5-year follow-up report on patients with different degrees of jaw resorption. Int J Oral Maxillofac Implants 1995;10:303-11. 4. Fiske J, Davis DM, Frances C, Gelbier S. The emotional effects of tooth loss in edentulous people. Br Dental J 1998;184:90-3. 5. Strassburger C, Kerschbaum T, Heydecke G. Influence of implant and conventional prostheses on satisfaction and quality of life: A literature review. Part 2: Qualitative analysis and evaluation of the studies. Int J Prosthodont 2006;19:339-48. 6. Esposito M, Grusovin MG, Achille H, Coulthard P, Worthington H V. Interventions for replacing missing teeth: different times for loading dental implants. Cochrane Database Syst Rev 2009;21(1):CD003878. doi: 10.1002/14651858.CD003878.pub4. 7. Degidi M, Piattelli A, Felice P, Carinci F. Immediate functional loading of edentulous maxilla: a 5-year retrospective study of 388 titanium implants. J Periodontol 2005;76:1016-24. 8. Balshi SF, Wolfinger GJ, Balshi TJ. A prospective study of immediate functional loading, following the Teeth in a Day protocol: a case series of 55 consecutive edentulous maxillas. Clin Implant Dent Relat Res 2005;7:24-31. 9. Gillot L, Cannas B, Buti J, Noharet R. A retrospective cohort study of 113 patients rehabilitated with immediately loaded maxillary cross-arch fixed dental prostheses in combination with immediate implant placement. Eur J Oral Implantol 2012;5:71–9. 10. Gallucci GO, Morton D, Weber HP. Loading protocols for dental implants in edentulous patients. Int J Oral Maxillofac Implants 2009;24 Suppl:132-46. 11. Peñarrocha-Diago M a, Maestre-Ferrín L, Demarchi CL, Peñarrocha-Oltra D, Peñarrocha-Diago M. Immediate versus non-immediate placement of implants for full-arch fixed restorations: a preliminary study. J Oral Maxillofac Surg 2011;69:154-9. 12. Papaspyridakos P, Mokti M, Chen C-J, Benic GI, Gallucci GO, Chronopoulos V. Implant and Prosthodontic Survival Rates with Implant Fixed Complete Dental Prostheses in the Edentulous Mandible after at Least 5 Years: A Systematic Review. Clin Implant Dent Relat Res 2013 Jan 11. doi: 10.1111/cid.12036. [Epub ahead of print] 13. Pjetursson BE, Karoussis I, Bürgin W, Brägger U, Lang NP. Patients’ satisfaction following implant therapy. A 10-year prospective cohort study. Clin Oral Implants Res 2005;16:185-93. 14. Crespi R, Capparè P, Gherlone E, Romanos GE. Immediate occlusal loading of implants placed in fresh sockets after tooth extraction. Int J Oral Maxillofac Implants 2007;22:955-62. 15. Dierens M, Collaert B, Deschepper E, Browaeys H, Klinge B, De Bruyn H. Patient-centered outcome of immediately loaded implants in the rehabilitation of fully edentulous jaws. Clinical Oral Implants Research 2009;20:1070-7. 16. Erkapers M, Ekstrand K, Baer RA, Toljanic JA, Thor A. Patient satisfaction following dental implant treatment with immediate loading in the edentulous atrophic maxilla. Int J Oral Maxillofac Implants 2011;26:356-64. 17. Van Steenberghe D, Glauser R, Blombäck U, Andersson M, Schutyser F, Pettersson A, Wendelhag I. A computed tomographic scan-derived customized surgical template and fixed prosthesis for flapless surgery and immediate loading of implants in fully edentulous maxillae: a prospective multicenter study. Clin Implant Dent Relat Res 2005;7 Suppl 1:S111-20. 18. Cannizzaro G, Torchio C, Leone M, Esposito M. Immediate versus early loading of flapless-placed implants supporting maxillary full-arch prostheses: a randomised controlled clinical trial. Eur J Oral Implantol 2008;1:127-39. 19. Fischer K, Stenberg T. Three-year data from a randomizd, controlled study of early loading of single-stage dental implants supporting maxillary full-arch prostheses. Int J Oral Maxillofac Implants 2006;21:245-52. 20. Pieri F, Aldini NN, Fini M, Corinaldesi G. Immediate occlusal loading of immediately placed implants supporting fixed restorations in completely edentulous arches: a 1-year prospective pilot study. J Periodontol 2009;80:411-21. 21. Strietzel FP, Karmon B, Lorean A, Fischer PP. Implant-prosthetic rehabilitation of the edentulous maxilla and mandible with immediately loaded implants: preliminary data from a retrospective study, considering time of implantation. Int J Oral Maxillofac Implants 2010;26:139-47. 22. Grunder U. Immediate functional loading of immediate implants in edentulous arches: two-year results. Int J Periodontics Restorative Dent 2001;21:545-51. 23. Cannizzaro G, Leone M, Esposito M. Immediate functional loading of implants placed with flapless surgery in the edentulous maxilla: 1-year follow-up of a single cohort study. Int J Oral Maxillofac Implants 2007;22:87-95. 24. Peñarrocha-oltra D, Covani DDSU, Aparicio A, Ata-ali J, Peñarrocha-diago M, Peñarrocha-diago M. Immediate versus conventional loading for the maxilla with implants placed into fresh and healed extraction sites to support a full-arch fixed prosthesis: nonrandomized controlled clinical study. Int J Oral Maxillofac Implants 2013;28:1116-24. 25. Esposito M, Grusovin MG, Loli V, Coulthard P WH. Does antibiotic prophylaxis at implant placement decrease early implant failures? A Cochrane systematic review. Eur J Oral Implantol 2010;3:101-10. 26. Strassburger C, Heydecke G, Kerschbaum T. Influence of prosthetic and implant therapy on satisfaction and quality of life: a systematic literature review. Part 1--Characteristics of the studies. Int J Prosthodont 2004;17:83-93. 27. McGrath C, Lam O, Lang N. An evidence-based review of patient-reported outcome measures in dental implant research among dentate subjects. J Clin Periodontol 2012;39 Suppl 1:193-201. 28. Michaud P-L, de Grandmont P, Feine JS, Emami E. Measuring patient-based outcomes: is treatment satisfaction associated with oral health-related quality of life? J Dent 2012;40:624-31. 29. Brennan M, Houston F, O’Sullivan M, O’Connell B. Patient satisfaction and oral health-related quality of life outcomes of implant overdentures and fixed complete dentures. Int J Oral Maxillofac Implants 2009;25:791-800. 30. Zitzmann NU, Marinello CP. Treatment outcomes of fixed or removable implant-supported prostheses in the edentulous maxilla. Part I: patients’ assessments. J Prosthet Dent 2000;83:424-33. 31. Awad MA, Rashid F, Feine JS. The effect of mandibular 2-implant overdentures on oral health-related quality of life: an international multicentre study. Clin Oral Implants Res 2013 Jun 4. doi: 10.1111/clr.12205. [Epub ahead of print] 32. Thomason JM. The use of mandibular implant-retained overdentures improve patient satisfaction and quality of life. J Evid Based Dent Pract 2012;12:182-4. 33. Al-Omiri M, Hantash RA, Al-Wahadni A. Satisfaction with dental implants: a literature review. Implant Dent 2005;14:399-406. 34. Sandberg G, Stenberg T, Wikblad K. Ten years of patients’ experiences with fixed implant-supported prostheses. J Dent Hyg 2000;74:210-8. 35. Peñarrocha M, Carrillo C, Boronat A, Martí E. Level of satisfaction in patients with maxillary full-arch fixed prostheses: zygomatic versus conventional implants. Int J Oral Maxillofac Implants 2007;22:769-73. 36. Hashem AA, Claffey NM, O’Connell B. Pain and anxiety following the placement of dental implants. Int J Oral Maxillofac Implants 2006;21:943-50. 37. Al-Khabbaz AK, Griffin TJ, Al-Shammari KF. Assessment of pain associated with the surgical placement of dental implants. J Periodontol 2007;78:239-46.Aim To compare immediate and conventional loading protocols for fixed full-arch prostheses supported by implants placed in healed and post-extraction sites. Patient-centered (satisfaction, postoperative pain and swelling) and treatment-centered (implant success, prosthetic success, marginal bone loss and biological and prosthetic complications) were assessed. Materials and methods A prospective controlled non-randomized study with twelve-month follow-up included thirty consecutive patients requiring fixed full-arch prostheses in the maxilla and thirty-six in the mandible. Six to eight implants were placed in the maxilla and four to six in the mandible. The first fifteen maxillary patients and 18 mandibular patients were treated following a conventional loading protocol (control group) and the next 15 and 18 following an immediate loading protocol (test group). Implants with insertion torque <35 Ncm were conventionally loaded and excluded from the analysis. Patient overall satisfaction and specific satisfaction with esthetics, chewing, speaking, comfort, self-esteem, ease of cleaning and treatment duration were assessed before the treatment and after three and twelve months. Post-operative pain and swelling were studied daily during the first week. Ten-cm visual analogue scales were used as assessment tools for these patient-reported variables. Implant success, biological and prosthetic complications, success of the immediately loaded provisional prostheses and marginal bone loss were also assessed. Statistical analysis was performed with non-parametric tests (Chi2, Mann-Whitney and Kruskal-Wallis) setting an alpha value of 0.05. Results One test group maxillary patient and two control group mandibular patients failed to attend recall visits and were excluded. Sixteen maxillary implants and twelve mandibular implants did not achieve an insertion torque of 35 Ncm and were excluded. In this way, the final sample consisted of 29 patients and 193 implants (test: 94; control: 99) in the maxilla and of 34 patients and 183 implants (test: 98; control: 85) in the mandible. Between baseline and three months, in both maxillary and mandibular test groups, general satisfaction and all specific satisfactions increased significantly with the exception of speech. In both maxillary and mandibular control groups overall satisfaction and self-esteem did not vary, whil

Maxillary sinus lift performed using ultrasound. Evaluation of 21 patients

Purpose: The aim of the present study was to evaluate the sinus membrane perforations that occurred during a sinus lift procedure using the ultrasound technique, and to evaluate the bone gain obtained. Materials and methods: In 21 patients, 26 sinus lifts were performed using ultrasound and filled with bone graft material. The bone height and the bone gain obtained were observed in postoperative orthopantomographs, correcting for previous distortion. Results: Of the 26 maxillary sinus lifts, 4 Schneiderian membrane perforations were observed. The average bone height prior to the intervention was 3.5 mm (scale 0.6- 8.7 mm ) and the average postsurgical bone height was 10.8 mm (scale 7.5- 15.6 mm). An average bone gain of 7.2 mm was observed (range 2.5- 11.7 mm). Conclusions: Based on the results of this study, during ultrasound sinus lift, few Schneiderian membrane perforations occurred and all were small

Dental implants with versus without peri-implant bone defects treated with guided bone regeneration

Background: The guided bone regeneration (GBR) technique is highly successful for the treatment of peri-implant bone defects. The aim was to determine whether or not implants associated with GBR due to peri-implant defects show the same survival and success rates as implants placed in native bone without defects. Material and Methods: Patients with a minimum of two submerged dental implants: one suffering a dehiscence or fenestration defect during placement and undergoing simultaneous guided bone regeneration (test group), versus the other entirely surrounded by bone (control group) were treated and monitored annually for three years. Complications with the healing procedure, implant survival, implant success and peri-implant marginal bone loss were assessed. Statistical analysis was performed with non-parametric tests setting an alpha value of 0.05. Results: Seventy-two patients and 326 implants were included (142 test, 184 control). One hundred and twenty-five dehiscences (average height 1.92±1.11) and 18 fenestrations (average height 3.34±2.16) were treated. At 3 years post-loading, implant survival rates were 95.7% (test) and 97.3% (control) and implant success rates were 93.6% and 96.2%, respectively. Mean marginal bone loss was 0.54 (SD 0.26 mm) for the test group and 0.43 (SD 0.22 mm) for the control group. No statistically significant differences between both groups were found. Conclusions: Within the limits of this study, implants with peri-implant defects treated with guided bone regeneration exhibited similar survival and success rates and peri-implant marginal bone loss to implants without those defects. Large-scale randomized controlled studies with longer follow-ups involving the assessment of esthetic parameters and hard and soft peri-implant tissue stability are neede

Comparative study between manual injection intraosseous anesthesia and conventional oral anesthesia

Objective: To compare intraosseous anesthesia (IA) with the conventional oral anesthesia techniques. Materials and methods: A simple-blind, prospective clinical study was carried out. Each patient underwent two anesthetic techniques: conventional (local infiltration and locoregional anesthetic block) and intraosseous, for res-pective dental operations. In order to allow comparison of IA versus conventional anesthesia, the two operations were similar and affected the same two teeth in opposite quadrants. Results: A total of 200 oral anesthetic procedures were carried out in 100 patients. The mean patient age was 28.6±9.92 years. Fifty-five vestibular infiltrations and 45 mandibular blocks were performed. All patients were also subjected to IA. The type of intervention (conservative or endodontic) exerted no significant influence (p=0.58 and p=0.62, respectively). The latency period was 8.52±2.44 minutes for the conventional techniques and 0.89±0.73 minutes for IA - the difference being statistically significant (p<0.05). Regarding patient anesthesia sensation, the infiltrative techniques lasted a maximum of one hour, the inferior alveolar nerve blocks lasted between 1-3 hours, and IA lasted only 2.5 minutes - the differences being statistically significant (p?0.0000, ?=0.29). Anesthetic success was recorded in 89% of the conventional procedures and in 78% of the IA. Most patients preferred IA (61%) (p=0.0032). Conclusions: The two anesthetic procedures have been compared for latency, duration of anesthetic effect, anesthetic success rate and patient preference. Intraosseous anesthesia has been shown to be a technique to be taken into account when planning conservative and endodontic treatments. © Medicina Oral S. L

Patient morbidity after impacted third molar extraction with different flap designs. A systematic review and meta-analysis

To review the literature on the effect of different surgical flaps upon patient morbidity (pain perception, trismus, swelling and osteitis) after impacted third molar extraction. An electronic and complementary search of main databases and grey literature was performed up to January 2019 to retrieve randomized clinical trials. The Cochrane risk of bias assessment tool was used for methodological appraisal. A random-effects meta-analysis was conducted of pain perception and trismus. From the initially 1314 screened studies, only 11 were included in the qualitative synthesis, and 5 in the meta-analysis. There were no statistically significant differences in pain between the envelope and triangular flap designs over time, except on the sixth postoperative day, when the envelope flap proved more painful. Regarding trismus, statistically significant differences were observed on the seventh postoperative day, with greater mouth opening in the envelope flap group than in the triangular flap group. There were no clear differences in swelling and osteitis among the flap designs. Despite its limitations, the present meta-analysis found no clear differences in patient morbidity between the different flap designs

The outcome of intraoral onlay block bone grafts on alveolar ridge augmentations: a systematic review

Aim: The purpose of this study was to systematically review clinical studies examining the survival and success rates of implants placed with intraoral onlay autogenous bone grafts to answer the following question: do ridge augmentations procedures with intraoral onlay block bone grafts in conjunction with or prior to implant placement influence implant outcome when compared with a control group (guided bone regeneration, alveolar distraction, native bone or short dental implants.)? Material and Method: An electronic data banks and hand searching were used to find relevant articles on vertical and lateral augmentation procedures performed with intraoral onlay block bone grafts for dental implant therapy published up to October 2013. Publications in English, on human subjects, with a controlled study design –involv- ing at least one group with defects treated with intraoral onlay block bone grafts, more than five patients and a minimum follow-up of 12 months after prosthetic loading were included. Two reviewers extracted the data. Results: A total of 6 studies met the inclusion criteria: 4 studies on horizontal augmentation and 2 studies on vertical augmentation. Intraoperative complications were not reported. Most common postsurgical complications included mainly mucosal dehiscences (4 studies), bone graft or membrane exposures (3 studies), complete failures of block grafts (2 studies) and neurosensory alterations (4 studies). For lateral augmentation procedures, implant survival rates ranged from 96.9% to 100%, while for vertical augmentation they ranged from 89.5% to 100%. None article studied the soft tissues healing. Conclusions: Survival and success rates of implants placed in horizontally and vertically resorbed edentulous ridges reconstructed with block bone grafts are similar to those of implants placed in native bone, in distracted sites or with guided bone regeneration. More surgical challenges and morbidity arise from vertical augmentations, thus short implants may be a feasible optio