Application of 3D printed titanium mesh and digital guide plate in the repair of mandibular defects using double-layer folded fibula combined with simultaneous implantation

Fibula transplantation plays an irreplaceable role in restoring the function and morphology of the defected mandible. However, the complex load-bearing environment of the mandible makes it urgent to accurately reconstruct the mandible, ensure the position of the condyle after surgery, and restore the patient's occlusal function and contour. The intervention of digital design and three-dimensional (3D) printed titanium mesh provides a more efficient method and idea to solve this problem. Digital design guides the accurate positioning, osteotomy, and simultaneous implant placement during surgery, and 3D printed titanium mesh ensures stable condyle position after surgery, restoring good mandibular function. The double-layer folded fibula maintains the vertical height of the mandible and a good facial contour, and simultaneous implant placement can establish a good occlusal relationship. This study conducted a retrospective analysis of five patients with jaw defects who underwent digital fibula reconstruction over the past 3 years. It was found that the surgical protocol combining digital design, 3D printed intraoperative guides, 3D printed titanium mesh, free fibula flap, immediate implant, and occlusal reconstruction to repair jaw defects had more ideal facial appearance and biological function. It will provide a more reliable surgical protocol for clinical management of large mandibular defects.

Biological and esthetic outcome of immediate dental implant with the adjunct pretreatment of immediate implants with platelet-rich plasma or photofunctionalization: A randomized controlled trial

Aim

The purpose of the study was to assess biological and esthetic outcomes of immediate dental implant in esthetic zone with the adjunct pretreatment of immediate implants with photofunctionalization or platelet-rich plasma in comparison to standard tapered root form implant without pretreatment.

Settings and Design

Patients visiting department of Prosthodontics of a tertiary care health Institution. Design of the study was randomized controlled trial.

Materials and Methods

Ninety subjects who required replacement of maxillary anterior teeth immediately after extraction were selected and randomly divided into three groups: control group and two case groups. Two case groups were treated with immediate implants with pretreatment with Photofunctionalization (PF group) or platelet-rich plasma (PRP group). Delayed loading protocol was followed with prosthesis given after 6 months. Follow-up was performed at 2nd and 4th weeks and 2, 4, 6, and 12 months (P < 0.05). Biological outcomes (mean marginal bone loss, implant stability), esthetic outcome (pink esthetic score and white esthetic score), and success and survival rate were evaluated.

Statistical Analysis Used

Outcomes were compared using one-way ANOVA, while intragroup changes with baseline and follow up were assesed using repeated-measures ANOVA. Statistical analyses were performed using Statistical Package for Social Sciences version 25.0 (SPSS Inc., Chicago, IL, USA). The level of significance was set at <.05.

Results

Mean marginal bone loss was not significantly different in PF group and PRP group than the control group. PF group and PRP group showed significantly greater implant stability as compared to the control group. Pink and white esthetic scores were not significantly different among groups.

Conclusion

Pretreatment of commercial dental implants with PF or PRP exhibited a statistically significant difference in implant stability but not with other outcomes.

Clinical and radiographic evaluation of jumping distance management using a collagen matrix in flapless immediate implant placement

BACKGROUND

Improvement in implant design has made implant dentistry a challenging treatment modality worldwide.

OBJECTIVES

This study aimed to investigate the efficacy of a xenogeneic collagen matrix in managing 3-4-millimeter gaps in flapless immediate implant placement.

MATERIAL AND METHODS

Twenty-two patients received 39 immediate implants via the flapless approach. Patients with intact bony walls, buccal bone thickness ≥2 mm and a jumping distance of 3-4 mm were included in this study. The gap between the implant and the socket walls was filled with a xenogeneic collagen matrix (Collacone®). The final clinical and radiographic evaluations were performed at least 24 months following functional loading.

RESULTS

There was no early or late failure, and the implants showed a 100% survival rate. The mean mesial (0.28 ±0.39 mm) and distal (0.28 ±0.39 mm) marginal bone loss (MBL) at the site of incisors was not significantly different from the values at the site of premolars and molars (0.30 ±0.42 mm and 0.34 ±0.48 mm, respectively). The evaluation of the implant success index (ISI) score revealed no difference between the mandible and the maxilla (p = 0.700), or incisors compared with premolars and molars (p = 0.420). The only significant difference was in terms of distal MBL, which was higher in the maxilla (0.39 ±0.49 mm) than in the mandible (0.12 ±0.23 mm) (p = 0.040).

CONCLUSIONS

Within the limitations of this study, it seems that the application of a xenogeneic collagen matrix to manage 3-4-millimeter gaps in carefully selected cases may bring promising outcomes.

A new classification of peri implant gaps based on gap location (A case series of 210 immediate implants)

Based on our collective experiences with gap management around immediate dental implants, we have proposed a classification of gap type based on the location in relation to implant periphery. Seven types are proposed, and all but one type should heal without gap grafting provided that flap-less surgery and atraumatic extraction have been achieved. The exception is our Type II gap where the implant has been placed too far buccally leaving a gap only on the lingual/palatal. In this case, the lingual/palatal gap need not be grafted, but the buccal aspect of the implant should best to augmented to avoid the complications.

Immediate dental implant placement with a horizontal gap more than two millimetres: a randomized clinical trial

The purpose of this study was to evaluate the horizontal dimensional changes in buccal alveolar bone immediately after dental implant placement in the upper premolar area with horizontal gaps >2mm. A total of 48 patients were enrolled in this randomized clinical trial and were randomly assigned to one of three groups. Group I (flap with graft; n=16) patients received an immediate implant with bone graft, membrane, and primary flap closure. Group II (flap without graft; n=16) patients received an immediate implant with primary flap closure only. Group III (flapless without graft; n=16) patients received an immediate implant without graft, membrane, or primary closure. Cone beam computed tomography (CBCT) scans were obtained preoperatively, immediately after implant placement, and at 6 months postoperative to evaluate horizontal dimensional changes in the buccal alveolar bone. Pain intensity was measured using a numerical rating scale. CBCT examinations revealed that bone had filled the horizontal gap in all three groups. Group II showed the greatest horizontal dimensional changes in the buccal alveolar bone, followed by group I. The least amount of change was recorded for group III. Furthermore, significantly less postoperative pain was recorded in group III when compared to the other groups. Short-term results suggest that the 'flapless without graft' technique shows similar results to the 'flap with graft technique' for immediate implant placement in the maxillary premolar extraction site with a horizontal gap >2mm, when the bone plate is intact.

Immediate dental implant placement with or without autogenous bone graft: A comparative study

Introduction

Immediate dental implants are the most accepted contemporary treatment option for the replacement of missing teeth. One pitfall of immediate implant use, however, is the inevitable residual space that remains between the implant and the socket wall, called the jumping distance, which may lead to bone resorption and formation of a bony defect, decreasing the implant stability. When this jumping distance is more than 2 mm, use of bone grafts is recommended. However, the use of grafts when the jumping distance is <2 mm is not defined in the literature.

Aim

To evaluate the peri-implant hard and soft tissue changes following immediately placed implants with a jumping distance of 2 mm with or without autogenous bone grafts.

Settings

The study was conducted between January 2016 and December 2017 in the Department of Oral and Maxillofacial Surgery.

Subjects and Methods

This was a prospective, single-center, two-arm, parallel, randomized study on patients undergoing replacement of missing anterior teeth with immediate implants. There were two groups: the study group which received bone graft and the control group which did not receive any graft. Temporary prosthesis was placed following implant placement which was replaced with definitive prosthesis 4 months later. Patients were followed up for a period of 9 months. The alveolar bone loss was evaluated radiologically using cone-beam computed tomography, and pain, suppuration, mobility, and periodontal probing depth were evaluated clinically.

Results

There were 16 participants in the study group and 17 in the control group. The alveolar bone loss was greater in the study group; however, pain, suppuration, and mobility showed no difference between the groups.

Conclusion

The immediate implants placed with or without bone grafts had similar alveolar hard and soft tissue changes when the jumping distance was <2 mm.

Open-Healing Socket Preservation with a Novel Dense Polytetrafluoroethylene (dPTFE) Membrane: A Retrospective Clinical Study

Background and objectives: Non-resorbable dense polytetrafluoroethylene (dPTFE) membranes are widely used for regeneration procedures, alone or in combination with particulate materials. The aim of this work was to examine the efficacy of a newly developed dPTFE membrane in the management of extraction socket healing. Materials and Methods: The extraction premolar sockets of 44 patients (20 men and 24 women) were preserved. One group received prosthetic rehabilitation with a fixed partial denture (FPD) (PROS group, N = 19) and a second group received immediate implant placement (IMPL group, N = 25). The PROS group sockets were augmented with a bovine derived xenograft and covered with a newly developed dPTFE membrane prior to FPD rehabilitation. Results: In the IMPL group, socket preservation was combined with immediate implant placement. Before (T0) and 6 months after surgery (T1), horizontal and vertical dimensions were measured with customized stents. No significant differences in alveolar bone loss from T0 to T1 were observed between the PROS and IMPL groups in the horizontal dimension for any tooth type. There was a significant difference in alveolar bone loss from T0 to T1 between the two groups for only single-rooted maxillary premolars in the vertical dimension. Conclusions: The use of the examined new dPTFE membrane consistently led to the preservation of hard tissue in the extraction sites.

Use of extracted anterior teeth as provisional restorations and surgical guide for immediate multiple implant placement: A clinical case report

OBJECTIVE

The aim of this article is to describe the use of natural anterior teeth as a surgical guide to implant placement and provisional restoration for a young patient with root resorption of upper central incisors and left-lateral incisor.

CLINICAL CONSIDERATIONS

Achieving soft tissue esthetics is quite a challenge in implant dentistry. Here, a case of immediate implant placement using the natural teeth of the patient as an immediate provisional restoration, which achieves satisfactory results in terms of soft tissue architecture.

CONCLUSIONS

Post-extraction implant placement in combination with immediate loading of dental implants has been evolving into an appropriate procedure for the treatment of partially edentulous anterior maxilla. Different techniques that include use of the own teeth as provisional implant supported restoration helps to maintain architecture of gingival contour, specially papilla.

CLINICAL SIGNIFICANCE

Natural architecture of anterior soft tissue is a big challenge in implant dentistry. Use of natural teeth as a surgical guide and provisional restorations might be helpful to obtain an optimal outcome.

Adipose-Derived Stem Cells as a Tool for Dental Implant Osseointegration: an Experimental Study in the Dog

The biological interaction between the jaw bones and dental implant is fundamental for the long-term success of dental implant placement. Nevertheless, the insufficient bone volume remains a major clinical problem, especially in case of immediate dental implant. Using a canine model, the present study proves the regenerative potential of adipose- derived stem cells (ADSCs) to repair peri-implant bone defects occurring in immediate dental implant placement. In six labradors, all mandibular premolars and the first molars were extracted bilaterally and three months later dental implants were installed with a marginal gap. The marginal defects were filled with hydroxyapatite (HA)-based scaffolds previously seeded with ADSCs. After one month of healing, specimens were prepared for histological and histomorphometric evaluations. Histological analyses of ground sections show that ADSCs significantly increase bone regeneration. Several new vessels, osteoblasts and new bone matrix were detected. By contrast, no inflammatory cells have been revealed. ADSCs could be used to accelerate bone healing in peri- implant defects in case of immediate dental implant placement.