Histologic evaluation of bone healing of adjacent alveolar sockets grafted with bovine- and porcine-derived bone: a comparative case report in humans

To evaluate and compare histomorphometrically the bone response to two xenografts, one bovine and the other porcine, grafted in adjacent extraction sockets in a human. In this case report, two adjacent maxillary premolars were extracted, and the sockets were filled with two different xenogeneic bone substitutes (first premolar with bovine bone, and second premolar with porcine bone) to counteract post-extraction volume loss. Following 6 months bone core specimens were harvested during the placement of implants at the regenerated sites. Histomorphometrically, for the bovine xenograft the percentage of newly formed bone (osteoid) was 26.85%, the percentage of the residual graft material was 17.2% and the percentage of connective tissue 48.73%, while for the porcine xenograft, newly formed bone (osteoid) represented 32.19%, residual graft material was 6.57% and non-mineralized connective tissue was 52.99%. Histological results indicated that both biomaterials assessed in this study as grafts for socket preservation technique are biocompatible and osteoconductive. Bovine bone derived demonstrated to be less resorbable than porcine bone derived. Both xenogenic biomaterials did not interfere with the normal bone reparative processe

Clinical, radiographic, and histologic evaluation of maxillary sinus lift procedure using a highly purified xenogenic graft (Laddec(®))

The aim of this study was to evaluate the clinical, radiographic and histologic results when a highly purified xenogenic bone (Laddec(®)) was used as grafting material in maxillary sinuses

Guided Zygomatic Implantology for Oral Cancer Rehabilitation: A Case Report

Oral rehabilitation after maxillary oncological resection is challenging. This case report presents the rehabilitation of a 65-year-old Caucasian male adenoid cystic carcinoma patient using a myo-cutaneous thigh flap, zygomatic implant placement, and an immediate fixed provisional prosthesis made with computer-aided technologies. The patient presented complaints of asymptomatic enlarged swelling of 5-mm on the right hard hemi-palate. There was an oro-antral communication deriving from a previous local excision. Preoperative radiographs showed the involvement of the right maxilla, maxillary sinus, and nose with a suspect involvement of the maxillary division of the trigeminal nerve. Treatment was planned through a fully digital workflow. A partial maxillectomy was performed endoscopically, and maxilla was reconstructed using an anterolateral thigh free flap. Two zygomatic implants were inserted simultaneously. A provisional fix full-arch prosthesis was manufactured preoperatively through a fully digital workflow and was placed in the operating room. Following post-operative radiotherapy, the patient received a final hybrid prosthesis. During the follow-up period of two years, the patient reported good function, aesthetics, and significant enhancement in quality of life. According to the results of this case, the protocol represented can be a promising alternative for oral cancer patients with large defects, and can lead to an improved quality of life

A plaster cast contact scan method to assess the accuracy of full-arch computer-aided implant surgery

Purpose: The aim of this study was accuracy assessment of placed implants in full-arch cases using specific software and hardware to perform static computer-assisted implantology and immediately loaded prostheses. The degree of deviation existing between planned and achieved implants was carried out by a new noninvasive measurement procedure of the implant position performed on stone casts. Materials and methods: Fourteen stone casts retrieved from 14 full-arch fully guided implant treatments were selected to perform the study. Each cast, manufactured for the surgical treatment by using a specific laboratory kit, was obtained from the respective surgical guide. A sleeve for each implant was embedded into the guide, which helped the examiners to manufacture a stone cast per guide containing the implant analogs, which was used to recover the final position of the planned implants. A total sample of 60 implants were assessed. The postoperative casts, poured to produce the immediate prostheses, were then processed by a contact (or tactile) scanner, and the generated standard tessellation language (STL) files were overlapped (best-fit alignment) using engineering software that revealed all the measured discrepancies. In terms of accuracy, differences relating to arch, assessed bone quality, implant length, and drill length (prolongation short or long) were reported. Results: The use of a noninvasive tactile scanner revealed mean entry point horizontal deviations of 0.30 mm (SD: 0.39 mm), mean entry point vertical deviations of 0.20 mm (SD: 0.25 mm), mean apical horizontal deviations of 0.50 mm (SD: 0.73 mm), and mean apical vertical deviations of 0.24 mm (SD: 0.28 mm). The frontal and lateral angular deviations were investigated, and corresponding mean values of 1.99 degrees (SD: 2.30 degrees) and 1.80 degrees (SD: 2.44 degrees) were detected. Conclusion: The reported results demonstrate that the contact tactile scan is a viable and biologic way to assess implant deviations

Relevance of the Operator’s Experience in Conditioning the Static Computer-Assisted Implantology: A Comparative In Vitro Study with Three Different Evaluation Methods

The present study aimed to evaluate the influence of manual expertise on static computer-aided implantology (s-CAI) in terms of accuracy and operative timings. After the cone-beam CT (CBCT) scanning of eleven mandibular models, a full-arch rehabilitation was planned, and two different skilled operators performed s-CAI. The distances between the virtual and actual implant positions were calculated considering the three spatial vectorial axes and the three-dimensional Euclidean value for the entry (E) and apical (A) points, along with the axis orientation differences (Ax). These values emerged from the overlapping of the pre-op CBCT to post-op CBCT data (method 1), from scanning the data from the laboratory scanner (method 2), and from the intra-oral scanner (method 3) and were correlated with the operators’ expertise and operative timings. The mean values for accuracy from the three methods were: E = 0.57 (0.8, 0.45, 0.47) mm, A = 0.6 (0.8, 0.48, 0.49) mm, and Ax 1.04 (1.05,1.03,1.05) ° for the expert operator; and E = 0.8 (0.9, 0.87, 0.77), A = 0.95 (1.02, 0.95, 0.89), and Ax =1.64 (1.78, 1.58, 1.58) for the novice. The mean value of the operative timings was statistically inferior for the expert operator (p p < 0.05) emerged between method 1 and methods 2 and 3 for seven of the nine variables, without differences between the evaluations from the two scanners. The support from digital surgical guides does not eliminate the importance of manual expertise for the reliability and the shortening of the surgical procedure, and it requires a learning pathway over time