Role of platelet-rich plasma in maxillofacial surgery

Platelet-rich plasma (PRP) has been reported as an efficacious modality that can enhance the process of wound healing and tissue regeneration and has been validated in different medical settings, including cardiovascular surgery, otolaryngology, head and neck surgery, and maxillofacial surgery. In dental and oral surgery settings, PRP has been reported as an efficacious approach with favorable outcomes in different settings. Some of these procedures include surgical repair of the alveolar cleft, mandibular reconstruction, ablative surgical procedures, placement of osseointegrated implants, periodontal plastic surgery, and management of infrabony periodontal defects. In the present study, we aim to discuss the role and mechanisms that PRP plays in the settings of maxillofacial surgery based on evidence from the relevant studies in the literature. Evidence indicates the wide acceptance of the modality, which has been proven to increase the rate of wound healing and reduce the frequency of pain and swelling. The administration of PRP has been reported to dispense with the need for invasive approaches that might be furtherly associated with complications and different morbidities. However, in most of the favorable events where the PRP administration of was associated with enhanced outcomes, the modality was used in combination with another therapeutic approach. Therefore, further research is needed to validate the efficacy of the modality in the different settings.

Oral Cancer around Dental Implants: Are the Clinical Manifestations and the Oncogenic Mechanisms Unique?

Osseointegrated implants have been an optimal treatment option for dental rehabilitation of fully or partially edentulous patients. Although peri-implantitis remains as the most common local risk factor for dental implant failure, the development of oral cancer involving the soft tissue around the titanium may lead to early implants loss and impact the quality of life of the patient negatively. Oral squamous cell carcinoma (OSCC) is the most common malignancy among head and neck tumors. It has higher prevalence in men over 50 years old, and in tobacco and/or alcohol users. Unfortunately, oral cancer is often detected in advanced stages, when the treatment options are limited. Thus, OSCC typically has poor prognosis. Despite the recent advances in oral carcinogenesis understanding, the relationship between dental implants and the development of malignant lesions around them is not completely understood. It has been suggested that the titanium corrosion occurring at the top of dental implants causes the release of metal ions. These ions might lead to oral epithelial genetic damage and higher susceptibility of normal mucosa to malignant transformation. The aim of this chapter was to review the clinical characteristics, diagnosis, and the possible carcinogenic mechanisms involved in oral cancer around dental implants.

An immediate implant placement technique to rehabilitate multi-rooted teeth by pre-extraction interradicular implant bed preparation using remaining roots as a guide: A case presentation

The introduction of osseointegrated implants have revolutionized the art and science of modern dentistry giving a new lease of life to the restorative aspects in day-to-day practice. Immediate loading (IL) of dental implants can significantly decrease treatment time and thus increase patient acceptance. IL of dental implants has recently gained popularity due to several factors including reduced trauma as well as aesthetic and psychological benefits to the patient. The present case report describes the immediate replacement of partially edentulous maxilla using Nobel Active™ implant. It describes about the diagnosis, treatment planning and procedures involving the placement of single tooth immediate implant followed by uneventful healing.

Evaluating the Prospects of Ti-Base Lattice Infiltrated with Biodegradable Zn–2%Fe Alloy as a Structural Material for Osseointegrated Implants—In Vitro Study

The term “osseointegrated implants” mainly relates to structural systems that contain open spaces, which enable osteoblasts and connecting tissue to migrate during natural bone growth. Consequently, the coherency and bonding strength between the implant and natural bone can be significantly increased, for example in operations related to dental and orthopedic applications. The present study aims to evaluate the prospects of a Ti–6Al–4V lattice, produced by selective laser melting (SLM) and infiltrated with biodegradable Zn2%Fe alloy, as an OI–TiZn system implant in in vitro conditions. This combined material structure is designated by this study as an osseointegrated implant (OI–TiZn) system. The microstructure of the tested alloys was examined both optically and using scanning electron microscopy (SEM) and X-ray diffraction (XRD) analysis. The mechanical properties were assessed in terms of compression strength, as is commonly acceptable in cases of lattice-based structures. The corrosion performance was evaluated by immersion tests and electrochemical analysis in terms of potentiodynamic polarization and electrochemical impedance spectroscopy (EIS), all in simulated physiological environments in the form of phosphate buffered saline (PBS) solution. The cytotoxicity was evaluated in terms of indirect cell viability. The results obtained demonstrate the adequate performance of the OI–TiZn system as a non-cytotoxic structural material that can maintain its mechanical integrity under compression, while presenting acceptable corrosion rate degradation.

Functional Outcomes with Facial Artery Musculo-Mucosal (FAMM) Flap and Dental Implants for Reconstruction of Floor of the Mouth and Tongue Defects in Oncologic Patients

Optimal functional outcomes in oncologic patients with squamous cell carcinoma (SCCA) of the tongue and floor of the mouth require good lingual mobility, adequate facial competence, the cheek suction effect and dental rehabilitation with osseointegrated implants. In this study, twenty-two oncologic patients who had been diagnosed with intraoral SCCA affecting the tongue and the floor of the mouth and who had undergone wide resection of the tumor and immediate reconstruction with an inferiorly pedicled FAMM flap and immediate osseointegrated implants were assessed. Lingual mobility, speech articulation, deglutition, implant success rate, mouth opening, and aesthetic results were evaluated. All patients were staged as T2 and the defect size ranged from 3.7 × 2.1 cm to 6.3 × 4.2 cm. A selective neck dissection was performed in all patients as part of their oncologic treatment, either electively or for node positive disease. Thirteen patients (59%) were diagnosed with node positive disease and underwent adjuvant radiotherapy. A total of 101 osseointegrated implants were placed for prosthetic rehabilitation and 8 implants were lost (7.9%), of which 7 received radiotherapy (87.5%). The implant success rate was 92.1%. Mouth opening was reported as normal in 19 patients (86.3%). Tongue tip elevation was reported as excellent in 19 patients (86.3%) and good in 3 patients (13.6%). Lingual protrusion was referred to as excellent in 15 patients (68.2%) and good in 6 patients (27.2%). Lateral excursion was reported as excellent in 14 patients (63.6%) and good in 7 patients (31.8%). In terms of speech articulation, 20 patients reported normal speech (90.9%). Regarding deglutition, 19 patients (86.3%) reported a regular diet while a soft diet was reported by 3 patients (13.7%). Aesthetic results were referred to as excellent in 17 patients (77.3%). FAMM flaps, immediate implants and fixed prostheses enable the functional rehabilitation of oncologic patients, optimizing aesthetics and functional outcomes even in patients undergoing irradiation, thus returning oncologic patients to an excellent quality of life.

General Factors of Anatomical Variation on the Size and Number of Dental Roots Influencing the Choice of Immediate Implants

Bone metabolism is gaining more prominence due to osseointegrated implants. Even after a minimally traumatic tooth extraction, there are natural reductions and losses in the proportions of the alveolar bone and other periodontal tissues. Maintaining these dimensions has become a challenge for researchers. Immediate implants are set in the same surgical act as tooth extraction. Implants are recommended aiming at reducing the waiting time for bone repair and thus offering the necessary stimuli to the bone for its dimensional, functional, and esthetic maintenance. Planning prior to immediate setting should take into account anatomical variations and even anomalies mainly related to the dimensions and number of tooth roots. Among the general factors of anatomical variation, those related to Gender, Age, Biotype, and Ethnicity stand out. These data were provided in studies carried out by several authors in several countries, correlating them with the dimensions and number of tooth roots. A selection of works using measurement methods as Cone Beam Computed Tomography or direct measurements in extracted teeth was carried out. Studies confirm that Panoramic Radiography presents greater distortions and does not provide sharpness for dimensional boundary markings. Significant data were obtained and confirm the correlation of these general factors of anatomical variation with the length and number of tooth roots. Further studies need to be carried out, in order to provide clinicians with details of these variants, important in the planning and prior choice of the best shape and size of the dental implant to be installed.

Short Dental Implants (≤8.5 mm) versus Standard Dental Implants (≥10 mm): A One-Year Post-Loading Prospective Observational Study

Background: Recent data have shown that short dental implants can be the preferred treatment in most of cases of posterior atrophic alveolar ridges, offering higher survival and lower complication rates than long implants. The survival rates, stability, and marginal bone level changes were compared between short implants (7 and 8.5 mm) and standard-length implants (≥10 mm). Methods: Prospective observational study in which adult patients requiring ≥1 osseointegrated implants to replace missing teeth were recruited consecutively. A clinical examination was performed on the day the definitive prosthesis was placed and after 6 and 12 months. Implant stability quotient (ISQ), marginal bone level (MBL) changes, and the correlation between these parameters and the characteristics of the implants were evaluated. Results: A total of 99 implants were inserted (47 short, 52 standard) in 74 patients. The 12-month survival rate was 100%. ISQ values showed a similar pattern for both types of implants. No correlation was found between ISQ changes after one year and MBL values, nor between the latter and the characteristics of the implants. Conclusions: With clinical treatment criteria, shorter implants (7 and 8.5 mm in length) can be just as useful as standard-length implants in atrophic alveolar ridges, demonstrating similar rates of survival, stability, and crestal bone loss.