Open Healing: A Minimally Invasive Protocol with Flapless Ridge Preservation in Implant Patients

We aimed to validate the safety and efficacy of the minimally invasive “open healing” flapless technique for post-extraction socket and alveolar ridge preservation, while assessing the alveolar bone changes. The study enrolled (n = 104) patients (0.55 sex ratio), with atraumatic extraction of (N = 135) hopeless teeth, followed by either immediate placement of tissue level implants (N1 = 26), or later stage implant insertion (N2 = 109). No flap was raised in either situation. Post-extraction sockets were filled with deproteinized bovine bone granules and covered by collagen resorbable membrane—left purposely exposed during healing. This yielded an uneventful healing, with sufficient bone formation, while avoiding soft-tissue problems. The need for additional augmentation was assessed clinically and by calibrated CBCT scans at six months, before either loading (N1) or implant insertion (N2). Implant success and survival rate were evaluated at 12-, 24-, and 60-month follow-up control sessions. The inserted implants had a survival rate of 98.5% and a success rate of 94.8% at five-year follow-up. Open healing technique with flapless approach can be favorable for preserving the 3D architecture of the post-extraction socket, as well as the alveolar ridge width and height.

Distraction Osteogenesis of Severely Resorbed Mandible

Edentulous patients require an adequate rehabilitation so that the alveolar ridge in the interforaminal region be restored for subsequent implant-supported overdentures. The ultimate goal of distraction is to reconstruct the alveolar ridge to a suitable height and width compatible with Atwood class 2 in an appropriate direction allowing the sagittal interalveolar relation to be normally restored. Methods. A 65-year-old man presented with a grade 4 Mandibular atrophy as per Atwood classification which resulted in unsatisfactory treatment with full dentures. Endo-Distractor Krenkel® device was used for anterior mandibular vertical distraction osteogenesis. Four mandibular implants (ITI Straumann, Basel, Switzerland) measuring diameter Ø = 4.1 mm and length L = 16 mm were inserted after the required retention period. Standardized prosthetic treatment was completed with titanium bar retained over dentures. Results. A distraction of 11 mm was achieved within 18 days followed by a retention period of 4 months. No signs of infection nor distractor anchorage loosening were detected, and minimal lingual tilting has occurred. Conclusion. Distraction is possible on severely atrophic mandibles. The quality of bone reconstruction is satisfactory for both functional and esthetic results.

Congenital granular cell epulis: a rare paediatric tumour of newborn

Congenital granular cell epulis is a congenital growth rarely found on the gingiva of neonates. These remarkably large tumours present in an infant’s mouth may impede with feeding, respiration or adequate mouth closure. Recognition of this entity and prompt treatment are essential for preventing any difficulties for the neonate. This is a case report of a 35-day-old female neonate who presented with a single exophytic lesion in the maxillary alveolar ridge. The differential diagnosis, management regimens and complications of this condition are reviewed. The lesion was excised under intravenous sedation and subjected to histopathological analysis. Based on the microscopic findings, the diagnosis of congenital granular cell epulis was confirmed. Clinicians including paediatricians, sonographers, dentists and surgical pathologists should be able to timely recognise and intervene such tumours as they may be potentially harmful to the infant.

Clinical application of concentrate growth factors combined with bone substitute in Alveolar ridge preservation of anterior teeth

Objective: To investigate the clinical effect of concentrated growth factors (CGF) combined with Bio-oss bone powder on Alveolar ridge preservation (ARP) during implantology. Methods: A total of 38 patients were selected and randomly divided into 2 groups, with 19 cases in each group. The extraction sockets were filled with Bio-oss bone powder with or without CGF. VAS pain score was recorded within1 week and Landry wound healing index (LWHI) was recorded at 1, 2 and 3 weeks after operation. CBCT was taken 3 and 6 months after operation to measure and compare the changes of vertical height, width and gray value of alveolar bone at extraction site. The changes of alveolar bone contour were observed clinically and compared between the two groups. Results: The VAS score of CGF group was lower than control group on the 1st and 3rd day after operation (P < 0.05). The LWHI of CGF group was higher than control group 1 week after operation (P < 0.05). The absorption of the labial and palatal plates height and the width in the CGF group was significantly less than the control group at 3 months (P<0.05). The gray value of alveolar bone in CGF group was significantly higher than control group at 3 months (P < 0.05). There was no significant difference in new bone contour between the two groups (P > 0.05). 94.7% cases in CGF group did not undergo bone grafting, which was significantly higher than control group (78.9%). Conclusions: The use of CGF combined with Bio-oss bone powder can help to reduce postoperative pain at the early stage of healing, form sufficient keratinized gingival tissue, effectively maintain the height and width of alveolar bone in the three-dimensional direction and provide good conditions for implant repair in the future.

CU-SIL DENTURE AS A TRANSITIONAL PROSTHESIS TO PRESERVE THE REMAINING NATURAL TEETH USING PERMANENT SILICONE LINER

The goal of modern dentistry is to be conservative, preserving teeth but also maintaining the stability of the remaining alveolar ridge and the periodontium's proprioceptive capabilities. Cu-sil denture is the simplest approach in the preservation of teeth and maintaining proprioception. It is a type of transitional denture that provides an alternative treatment plan for the patients willing to replace their missing teeth while retaining their remaining natural teeth. It gives potential psychological benefits to the patients by avoiding extractions. It's a tissue-bearing acrylic appliance with a soft viscoelastic wrap that clasps the neck of each dentition, sealing out food and water simultaneously protecting and splinting each remaining tooth from the rigid acrylic denture base. This case reports series describes chairside techniques to fabricate Cu-sil dentures in the usual dental set-up

Double Layer Socket Preservation Technique Associated with Xenogenous Bone Graft and Polypropylene Membrane: A Case Report

With the demand for tooth/gum aesthetics in implant-supported rehabilitations, the surgeon, whether an implant specialist or not, increasingly needs to be mindful of proper care for socket preservation following extraction. The paper presented here reports the case of a male patient who manifested dental impairment of the Upper Left First Molar (tooth #26) [in FDI notation]; following tomographic analysis and after reaching a consensus with the patient, the decision was made to extract said tooth and preserve the socket for subsequent implant placement. The aim of the case report is to present a clinical case of alveolar ridge preservation through the “Double Layer Socket Preservation” technique, a technique created by Barry Barthee, whereby a xenogenous graft under an xenogenous type III collagen membrane was combined with a polypropylene barrier. Following research and study results on the subject, it was concluded that by applying this technique, the alveolar ridge is greatly preserved and bone volume is maintained, both of which are very important factors for good health of the tissues surrounding the implant and consequent increase in the survival of the implant itself.