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Ulu M, Yasin M, Şahin O, Akçay H. A Finite Element Analysis to Study the Stress Distribution on Distal Implants in All-on-Six Treatment Concepts as Affected Tilted and Short Implant. J ORAL IMPLANTOL 2024; 50:245-253. [PMID: 38641913 DOI: 10.1563/aaid-joi-d-23-00092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
The number of implants and their respective configurations for implant-supported treatment modalities have been studied for 4 implant-supported prostheses; however, it is not yet clear whether the use of tilting or short implants in rehabilitation would result in substantially improved bone/implant/prosthesis biomechanics in all-on-six concepts. This study compared the biomechanical behavior of tilted long implants and axially short implants to support fixed prostheses in an atrophic maxilla with all-on-six treatment concepts. Three different implant configurations were planned, and six models were obtained with posterior maxilla D3 and D4 bone densities in this study. Implants proper for the all-on-four concept were placed in all models. In models 1 and 2, the short implant was placed; in models 3 and 4, 30°, the mesial-angled implant was placed; and in models 5 and 6, 45°, the mesial-angled implant was placed to the molar region. In the models created, 200 N vertical and 150 N oblique (45° angled buccopalatal direction) forces were implemented to the bilateral tooth regions 4-5-6 on the rigid titanium-supported fixed hybrid prosthesis made on these models. When the stress values in the models were investigated, the oblique forces had higher stress values than the vertical forces did. When the stresses created by oblique forces were assessed, the highest values were observed in the models created with short implants, and the lowest stress values were observed in the models made with 30° angle to mesial. When bone densities were assessed, more stress values were noted in models with D4 bone density. It has been shown that mesial tilted long implants placed in the posterior molar region, in addition to all four implant treatment concepts, create less stress against undesirable oblique forces compared with short implants.
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Affiliation(s)
- Murat Ulu
- Deparment of Oral and Maxillofacial Surgery, Faculty of Dentistry, İzmir Katip Çelebi University, İzmir, Türkiye
| | - Mikail Yasin
- Deparment of Oral and Maxillofacial Surgery, private practice, İstanbul, Türkiye
| | - Onur Şahin
- Deparment of Oral and Maxillofacial Surgery, Faculty of Dentistry, İzmir Katip Çelebi University, İzmir, Türkiye
| | - Hüseyin Akçay
- Deparment of Oral and Maxillofacial Surgery, private practice, İzmir, Türkiye
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Fan X, Feng Y, Tao B, Shen Y, Wu Y, Chen X. A hybrid robotic system for zygomatic implant placement based on mixed reality navigation. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 249:108156. [PMID: 38555744 DOI: 10.1016/j.cmpb.2024.108156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUNDS Zygomatic implant (ZI) placement surgery is a viable surgical option for patients with severe maxillary atrophy and insufficient residual maxillary bone. Still, it is difficult and risky due to the long path of ZI placement and the narrow field of vision. Dynamic navigation is a superior solution, but it presents challenges such as requiring operators to have advanced skills and experience. Moreover, the precision and stability of manual implantation remain inadequate. These issues are anticipated to be addressed by implementing robot-assisted surgery and achieved by introducing a mixed reality (MR) navigation-guided hybrid robotic system for ZI placement surgery. METHODS This study utilized a hybrid robotic system to perform the ZI placement surgery. Our first step was to reconstruct a virtual 3D model from preoperative cone-beam CT (CBCT) images. We proposed a series of algorithms based on coordinate transformation, which includes image-phantom registration, HoloLens-tracker registration, drill-phantom calibration, and robot-implant calibration, to unify all objects within the same coordinate system. These algorithms enable real-time tracking of the surgical drill's position and orientation relative to the patient phantom. Subsequently, the surgical drill is directed to the entry position, and the planned implantation paths are superimposed on the patient phantom using HoloLens 2 for visualization. Finally, the hybrid robot system performs the processed of drilling, expansion, and placement of ZIs under the guidance of the MR navigation system. RESULTS Phantom experiments of ZI placement were conducted using 10 patient phantoms, with a total of 40 ZIs inserted. Out of these, 20 were manually implanted, and the remaining 20 were robotically implanted. Comparisons between the actual implanted ZI paths and the preoperatively planned ZI paths showed that our MR navigation-guided hybrid robotic system achieved a coronal deviation of 0.887 ± 0.213 mm, an apical deviation of 1.201 ± 0.318 mm, and an angular deviation of 3.468 ± 0.339° This demonstrates significantly better accuracy and stability than manual implantation. CONCLUSION Our proposed hybrid robotic system enables automated ZI placement surgery guided by MR navigation, achieving greater accuracy and stability compared to manual operations in phantom experiments. Furthermore, this system is expected to apply to animal and cadaveric experiments, to get a good ready for clinical studies.
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Affiliation(s)
- Xingqi Fan
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Yuan Feng
- Institute of Mechatronics and Logistics Equipment, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Baoxin Tao
- Department of Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yihan Shen
- Department of Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiqun Wu
- Department of Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaojun Chen
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China; Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai, China.
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Şahin O, Rizaj X, Bilge O, Çelik S, Hacilar M, Bakar O. Zygomatic Implant Length Measurement Without Excessive Flap Release: A Human Cadaver Study. J Craniofac Surg 2024:00001665-990000000-01499. [PMID: 38709068 DOI: 10.1097/scs.0000000000010196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 03/07/2024] [Indexed: 05/07/2024] Open
Abstract
One of the most important steps in zygomatic implant surgery is to determine the implant length. This cadaver study aims to identify an alternative technique for determining the length of the implant in zygoma surgery without excessive elevation of the flap. A total of 30 cadavers were included in this study. Measurements were made with a probe by seeing the exit point of the drills from the lateral aspect of the zygomatic bone. Secondly, without excessive flap release, the distance that the depth probe first raises the skin over the lateral border of the zygoma is measured. The average difference between the measurements made without excessive elevation of the flap and with a retractor placed on the zygomaticofrontal notch was found to be 5.41 ± 0.94 mm (range: 5-7.5 mm). According to the results of this study, the zygomatic implant should be placed at least 5 mm shorter than the length at which the depth probe first raises the skin over the lateral border of the zygomatic bone.
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Affiliation(s)
- Onur Şahin
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, İzmir Katip Çelebi University, İzmir, Türkiye
| | - Xhini Rizaj
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Albanian University, Tirana, Albania
| | - Okan Bilge
- Department of Anatomy, Faculty of Medicine, Ege University
- Department of Anatomy, Ege Interventional Anatomy and Plastination Center (EGEGAPUM), Ege University, İzmir
| | - Servet Çelik
- Department of Anatomy, Faculty of Medicine, Ege University
- Department of Anatomy, Ege Interventional Anatomy and Plastination Center (EGEGAPUM), Ege University, İzmir
| | - Mustafa Hacilar
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, İzmir Katip Çelebi University, İzmir, Türkiye
| | - Olcay Bakar
- Department of Periodontology, Private Practice, İstanbul, Turkey
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Herce-López J, Pingarrón MDC, Tofé-Povedano Á, García-Arana L, Espino-Segura-Illa M, Sieira-Gil R, Rodado-Alonso C, Sánchez-Torres A, Figueiredo R. Customized Subperiosteal Implants for the Rehabilitation of Atrophic Jaws: A Consensus Report and Literature Review. Biomimetics (Basel) 2024; 9:61. [PMID: 38275459 PMCID: PMC10812919 DOI: 10.3390/biomimetics9010061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
(1) Background: The aim was to perform a literature review on customized subperiosteal implants (CSIs) and provide clinical guidelines based on the results of an expert consensus meeting held in 2023. (2) Methods: A literature search was performed in Pubmed (MEDLINE) in July 2023, including case series and cohort studies with a minimum follow-up of 6 months that analyzed totally or partially edentulous patients treated with CSIs. Previously, an expert consensus meeting had been held in May 2023 to establish the most relevant clinical guidelines. (3) Results: Six papers (four case series and two retrospective cohort studies) were finally included in the review. Biological and mechanical complication rates ranged from 5.7% to 43.8% and from 6.3% to 20%, respectively. Thorough digital planning to ensure the passive fit of the CSI is mandatory to avoid implant failure. (4) Conclusions: CSIs are a promising treatment option for rehabilitating edentulous patients with atrophic jaws; they seem to have an excellent short-term survival rate, a low incidence of major complications, and less morbidity in comparison with complex bone grafting procedures. As the available data on the use of CSIs are very scarce, it is not possible to establish clinical recommendations based on scientific evidence.
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Affiliation(s)
- Javier Herce-López
- Oral and Maxillofacial Surgeon, Virgen Macarena University Hospital, 41009 Seville, Spain;
| | | | - Álvaro Tofé-Povedano
- Oral and Maxillofacial Surgeon, Puerta del Mar University Hospital, 11009 Cádiz, Spain;
| | - Laura García-Arana
- Oral and Maxillofacial Surgeon, San Francisco de Asís University Hospital, 28002 Madrid, Spain;
| | | | - Ramón Sieira-Gil
- Oral and Maxillofacial Consultant, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain;
| | | | - Alba Sánchez-Torres
- Professors of Oral Surgery, Faculty of Medicine and Health Sciences, Researchers at the IDIBELL Institute, University of Barcelona (Spain), 08907 Barcelona, Spain;
| | - Rui Figueiredo
- Professors of Oral Surgery, Faculty of Medicine and Health Sciences, Researchers at the IDIBELL Institute, University of Barcelona (Spain), 08907 Barcelona, Spain;
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Deng H, Wang J, Liu L, Li Y. Feasibility and accuracy of a task-autonomous robot for zygomatic implant placement. J Prosthet Dent 2023:S0022-3913(23)00710-2. [PMID: 38016868 DOI: 10.1016/j.prosdent.2023.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/27/2023] [Accepted: 10/27/2023] [Indexed: 11/30/2023]
Abstract
STATEMENT OF PROBLEM Zygomatic implants (ZIs) should be placed accurately as planned preoperatively to minimize complications and maximize the use of the remaining bone. Current digital techniques such as static guides and dynamic navigation are affected by human error; therefore, new techniques are required to improve the accuracy of ZI placement. PURPOSE The purpose of this clinical study was to assess the feasibility and accuracy of a task-autonomous robot for ZI placement. MATERIAL AND METHODS Patients indicated for ZI placement were enrolled, and an appropriate surgical positioning piece was selected based on the presence of natural teeth in the maxilla. Preoperative cone beam computed tomography (CBCT) scanning was performed with the surgical positioning piece, and virtual implant design and socket preparation procedures were initiated. Implant socket preparation and placement were automatically performed by the robot according to the preoperative plan under the supervision of the surgeon. Postoperative CBCT scanning was performed to evaluate deviations between the virtual and actual implants. All quantitative data were expressed as standardized descriptive statistics (mean, standard deviation, minimum, maximum, and 95% confidence interval [CI]). The Shapiro-Wilk test was used to assess the normal distribution of all variables (α=.05). RESULTS Six participants were enrolled, and 8 ZIs were inserted. No intraoperative or postoperative complications were observed. Robotic ZI placement showed a global coronal deviation of 0.97 mm (95% CI: 0.55 to 1.39 mm), a global apical deviation of 1.27 mm (95% CI: 0.71 to 1.83 mm), and an angular deviation of 1.48 degrees (95% CI: 0.97 to 2.00 degrees). CONCLUSIONS Task-autonomous robots can be used for ZI placement with satisfactory accuracy. Robotic ZI surgery can be an alternative to static guidance and dynamic navigation to improve the accuracy of implant placement.
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Affiliation(s)
- Huanze Deng
- Doctoral student, Department of Stomatology, Fourth Medical Centre, Chinese PLA General Hospital, Beijing, PR China; and Medical School of Chinese PLA, Beijing, PR China
| | - Jing Wang
- Head Nurse, Department of Stomatology, Fourth Medical Centre, Chinese PLA General Hospital, Beijing, PR China
| | - Le Liu
- Attending, Department of Stomatology, Fourth Medical Centre, Chinese PLA General Hospital, Beijing, PR China
| | - Yanfeng Li
- Professor, Department of Stomatology, Fourth Medical Centre, Chinese PLA General Hospital, Beijing, China, Beijing, PR China; and Medical School of Chinese PLA, Beijing, PR China.
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Şahin O. Treatment of Severely Atrophic Maxilla by Using Zygomatic, Pterygoid, and Transnasal Implants. J Craniofac Surg 2023:00001665-990000000-01223. [PMID: 37982810 DOI: 10.1097/scs.0000000000009896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 10/19/2023] [Indexed: 11/21/2023] Open
Abstract
For many decades the success of dental implants has been considered to be dependent predominantly on the quality and quantity of the patient's alveolar bone. Grafting procedures have been commonly used to rehabilitate severely atrophic jaws but these procedures have disadvantages such as long treatment duration, major surgery, the risk of morbidity in the donor area, and high treatment costs. Recently, the use of 4 zygomatic implants has become an important treatment option in the rehabilitation of extremely atrophic maxilla. The quad zygoma technique is a method applied in cases where conventional implants cannot be used in the anterior maxilla. However, the technique has some difficulties and requires surgical experience. An alternative to the use of quad zygomatic implants is the placement of transnasal with zygomatic implants and subperiosteal implants. The aim of this case report was to present the treatment of a patient with severely atrophic maxilla with zygomatic, pterygoid, and transnasal implants.
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Affiliation(s)
- Onur Şahin
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, İzmir Katip Çelebi University, İzmir, Türkiye
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Kämmerer PW, Al-Nawas B. Bone reconstruction of extensive maxillomandibular defects in adults. Periodontol 2000 2023; 93:340-357. [PMID: 37650475 DOI: 10.1111/prd.12499] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 05/21/2023] [Accepted: 05/26/2023] [Indexed: 09/01/2023]
Abstract
Reconstruction of significant maxillomandibular defects is a challenge that has been much discussed over the last few decades. Fundamental principles were developed decades ago (bone bed viability, graft immobilization). Clinical decision-making criteria are highly relevant, including local/systemic factors and incision designs, the choice of material, grafting technique, and donor site morbidity. Stabilizing particulated grafts for defined defects-that is, via meshes or shells-might allow significant horizontal and vertical augmentation; the alternatives are onlay and inlay techniques. More significant defects might require extra orally harvested autologous bone blocks. The anterior iliac crest is often used for nonvascularized augmentation, whereas more extensive defects often require microvascular reconstruction. In those cases, the free fibula flap has become the standard of care. The development of alternatives is still ongoing (i.e., alloplastic reconstruction, zygomatic implants, obturators, distraction osteogenesis). Especially for these complex procedures, three-dimensional planning tools enable facilitated planning and a surgical workflow.
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Affiliation(s)
- Peer W Kämmerer
- Department of Oral and Maxillofacial Surgery, University Medical Center Mainz, Mainz, Germany
| | - Bilal Al-Nawas
- Department of Oral and Maxillofacial Surgery, University Medical Center Mainz, Mainz, Germany
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8
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Al-Nawas B, Aghaloo T, Aparicio C, Bedrossian E, Brecht L, Brennand-Roper M, Chow J, Davó R, Fan S, Jung R, Kämmerer PW, Kumar VV, Lin WS, Malevez C, Morton D, Pijpe J, Polido WD, Raghoebar GM, Stumpel LJ, Tuminelli FJ, Verdino JB, Vissink A, Wu Y, Zarrine S. ITI consensus report on zygomatic implants: indications, evaluation of surgical techniques and long-term treatment outcomes. Int J Implant Dent 2023; 9:28. [PMID: 37698775 PMCID: PMC10497463 DOI: 10.1186/s40729-023-00489-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/25/2023] [Indexed: 09/13/2023] Open
Abstract
OBJECTIVES The aim of the ITI Consensus Workshop on zygomatic implants was to provide Consensus Statements and Clinical Recommendations for the use of zygomatic implants. MATERIALS AND METHODS Three systematic reviews and one narrative review were written to address focused questions on (1) the indications for the use of zygomatic implants; (2) the survival rates and complications associated with surgery in zygomatic implant placement; (3) long-term survival rates of zygomatic implants and (4) the biomechanical principles involved when zygoma implants are placed under functional loads. Based on the reviews, three working groups then developed Consensus Statements and Clinical Recommendations. These were discussed in a plenary and finalized in Delphi rounds. RESULTS A total of 21 Consensus Statements were developed from the systematic reviews. Additionally, the group developed 17 Clinical Recommendations based on the Consensus Statements and the combined expertise of the participants. CONCLUSIONS Zygomatic implants are mainly indicated in cases with maxillary bone atrophy or deficiency. Long-term mean zygomatic implant survival was 96.2% [95% CI 93.8; 97.7] over a mean follow-up of 75.4 months (6.3 years) with a follow-up range of 36-141.6 months (3-11.8 years). Immediate loading showed a statistically significant increase in survival over delayed loading. Sinusitis presented with a total prevalence of 14.2% [95% CI 8.8; 22.0] over a mean 65.4 months follow-up, representing the most common complication which may lead to zygomatic implant loss. The international experts suggested clinical recommendations regarding planning, surgery, restoration, outcomes, and the patient's perspective.
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Affiliation(s)
- Bilal Al-Nawas
- Department of Oral and Maxillofacial Surgery, Plastic Operations, University Medical Center Mainz, Mainz, Germany.
| | - Tara Aghaloo
- Section of Oral and Maxillofacial Surgery, UCLA School of Dentistry, Los Angeles, CA, USA
| | - Carlos Aparicio
- Indiana University School of Dentistry, Indianapolis, USA
- Hepler Bone Clinic, ZAGA Center Barcelona, Barcelona, Spain
| | - Edmond Bedrossian
- Department of Oral and Maxillofacial Surgery University of the Pacific, Dugoni School of Dentistry, San Francisco, CA, USA
| | - Lawrence Brecht
- Department of Dental Medicine and Oral and Maxillofacial Surgery, Northwell Health, New Hyde Park, New York, USA
- Division of Prosthodontics and Restorative Dentistry, NYC College of Dentistry, New York, USA
| | | | - James Chow
- Brånemark Osseointegration Center, Hong Kong SAR, China
| | - Rubén Davó
- Medimar International Hospital, Department of Implantology and Maxillofacial Surgery, Vithas Davó Instituto Dental, Alicante, Spain
| | - Shengchi Fan
- Department of Oral and Maxillofacial Surgery, Plastic Operations, University Medical Center Mainz, Mainz, Germany
- Second Dental Center, School of Medicine, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China
| | - Ronald Jung
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Peer W Kämmerer
- Department of Oral and Maxillofacial Surgery, Plastic Operations, University Medical Center Mainz, Mainz, Germany
| | - Vinay V Kumar
- Oral Rehabilitation Center, Bangalore, India
- Department of Surgical Sciences, Odontology and Maxillofacial Surgery, Medical Faculty, Uppsala University, Uppsala, Sweden
| | - Wei-Shao Lin
- Department of Prosthodontics, Indiana University School of Dentistry, Indianapolis, USA
| | - Chantal Malevez
- Department of Oral and Maxillofacial Surgery, Clinique Saint-Jean, Brussels, Belgium
| | - Dean Morton
- Department of Prosthodontics, Indiana University School of Dentistry, Indianapolis, USA
| | - Justin Pijpe
- Department of Oral and Maxillofacial Surgery, Special Care and Orthodontics, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Oral and Maxillofacial Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Waldemar D Polido
- Department of Oral and Maxillofacial Surgery, Indiana University School of Dentistry, Indianapolis, USA
| | - Gerry M Raghoebar
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Frank J Tuminelli
- Department of Veterans Affairs, New York Harbor Healthcare System, New York, USA
| | | | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
| | - Yiqun Wu
- Second Dental Center, School of Medicine, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China
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