A Comparative Study on a Novel Fibula Malleolus Cap to Increase the Accuracy of Oncologic Jaw Reconstruction

ObjectivesAlthough computer-assisted surgery using fibula flap has been widely applied for oncologic jaw reconstruction in recent years, the inaccurate positioning of the fibula harvest guide brings sliding and rotational errors, which leads to compromised accuracy in simultaneous implant placement and dental rehabilitation. This study aimed to develop a novel three-dimensional (3D)-printed patient-specific fibula malleolus cap to increase oncologic reconstruction accuracy.MethodsIn this prospective comparative study with a recent historical control cohort, patients in need of oncologic jaw reconstruction with fibula free flaps were recruited. In the study group, the fibula was harvested with the guide of the malleolus cap, whereas in the control group, without the malleolus cap. Deviations of location and angulation of distal fibula osteotomies, jaw reconstruction segments, and simultaneous dental implants were compared.ResultsTwenty patients were recruited, with 10 in each arm. The application of the malleolus cap significantly reduced the deviations in locations and angles of distal fibula osteotomies, from 9.5 to 4.1 mm and 25.3° to 8.7°. For the simultaneous dental implants placed in the fibula flaps, there was a significant increase in the accuracy of implant platform locations (the average deviation from 3.2 to 1.3 mm), apex locations (from 3.8 to 1.5 mm), and angles (from 11.3° to 4.6°). No significant difference was detected in the accuracy of fibula reconstruction segments.ConclusionsWe developed a novel fibula malleolus cap to overcome the sliding and rotational errors during fibula flap harvesting for oncologic jaw reconstruction, with increased accuracy in simultaneous dental implants. This is a step forward to achieve a satisfactory functional outcome of jaw reconstruction with dental rehabilitation.

Nanosuperfície de Titânio como uma nova realidade na implantodontia: Revisão de Literatura / Nano-surface Titanium a new reality in implant dentistry: Literature Review

Resumo: A odontologia vem buscando cada vez mais métodos de reabilitação dentária que sejam menos traumáticos e eficazes estética e visualmente falando. Sob esse aspecto, os implantes dentários têm se desenvolvido cada vez no intuito de garantir a satisfação dos pacientes, através de avanços tecnológicos como o da Nanosuperfície de Titânio. Assim, o presente estudo objetiva abordar a questão das superfícies de implantes de titânio no que se refere à sua capacidade de estímulo na formação óssea, por ser uma técnica que diminui o tempo de osseointegração e, consequentemente, a duração do processo e recuperação do paciente. Para tanto, foi realizada uma revisão bibliográfica em bases de dados eletrônicas acerca do tema, que comprovassem a diminuição de tempo do trabalho do profissional da Odontologia e uma melhor qualidade no que se refere aos implantes dentários, através da análise de três marcas nacionais a fim de comprovar sua eficácia. Palavras-chave: Implante dentário. Nanosuperfície de Titânio. Osseointegração. ---Abstract: Dentistry is increasingly seeking dental rehabilitation methods that are less traumatic and effective aesthetically and visually. In this regard, dental implants have been increasingly developed to ensure patient satisfaction, through technological advances such as the Titanium Nano-surface. Thus, this study aims to address the issue of titanium implant surfaces in terms of their ability to stimulate bone formation, as it is a technique that reduces the time of osseointegration and, consequently, the duration of the process and patient recovery. To this end, a bibliographic review was carried out in electronic databases on the subject, which could prove the reduction of time in the work of the dentistry professional and a better quality regarding dental implants, through the analysis of three national brands to prove its effectiveness. Keywords: Dental implant. Titanium Nano-surface. Osseointegration.

Comprehensive study of dental orthopedic morbidity in elderly people and the ways to eliminate it

Relevance. The social profile of senile people has some differences from other age categories of patients. People of the older age group dream of finding harmony with the outside world, preserving the love of the nearest and dearest and relatives and the opportunity to communicate with the opposite sex. Dental health and the resulting quality of life contributes to this in many ways. A smile, laughter, the ability to talk without feeling embarrassed by splashing saliva, bad breath or visible absence of teeth, taking your favorite food together with the nearest and dearest are the main indicators of their life quality dependent on dental health, without which it is impossible to imagine a modern person High prevalence of dental diseases among senile people cause a high need for making various dental prosthetic structures. Studying dental health of this category of citizens can become a promising area of practical healthcare, a comprehensive study of this issue has determined the relevance and purpose of this publication.Materials and methods. The object of the study was senile people, 75-89 years old, who sought dental orthopedic care in municipal healthcare institutions of Cheboksary, the Chuvash Republic. The sample size was 481 people.Results. It was found that the maximum number of patients in the age group of 75-88 years - 188 persons (39.1%) - had complete absence of teeth, the total number of patients with the first, second, third and fourth classes according to the Kennedy classification of dentition defects was 56 persons (11.6%), 143 persons (29.7%), 79 persons (16.4%), 15 persons (3.2%), respectively. The total number of patients with the first Kennedy subclasses (class 1-3) was 135 persons (33.1%), with the second subclasses – 69 persons (16.9%), with the third subclasses - 53 persons (13.0%). The analysis of dental prosthetic structures mounted in elderly patients showed that the total number of orthopedic structures amounted to 4,615 units, among which there were pin structures - 1,328 units (28.8%); the total number of artificial dental crowns was 1,662 units (36.0%); the total number of prosthetic bridges – 620 units (13.4%); removable laminar dentures in partial loss of teeth – 445 units (9.6%); clasp prostheses – 184 units (4.1%); removable laminar dentures in complete loss of teeth – 376 units (8.1%).Conclusions. All types of dental orthopedic diseases are commonly found in patients of senile age, they had all kinds of dental prosthetic structures made. The choice of the dental prosthetic design used in orthopedic dental rehabilitation was determined by the type of dentition defect and met the principles of rational prosthetics.

Digital dentistry and guided treatments: a concise systematic review

Introduction: In the landscape of new digital technologies, many dental treatments have benefited from this digital advance. The development of computed tomography (CT) dental scanners has enabled powerful imaging capabilities and software applications. The prosthetic plane and implanted drill guides with the placement of trajectories based on a drill according to the position of the CT 3-D Space markers. Objective: To present, through a systematic review, the main considerations of guided surgery in implant dentistry and its respective advantages, disadvantages, and limitations. Methods: Clinical studies with qualitative and/or quantitative analysis were included, following the rules of the systematic review-PRISMA. Results: Out of a total of 102 articles found, 82 articles were evaluated and 57 were rejected for not meeting the GRADE classification, and only 25 articles were used in this study to compose the textual part. Advances in technology have contributed to the improvement of implant models. 3D reconstructions make it possible to determine the quantity and quality of available bone and also enable the simulation of implant installation in a virtual environment, reducing time and the possibility of errors, allowing for an overall reduction in the costs of oral rehabilitation. Conclusion: Guided preoperative planning or project-guided dental surgery provides high implant and dental rehabilitation success rates, also benefiting prosthetic restorations supported by fixed implants. Furthermore, the concept of using personalized implants with the help of 3D virtual treatment planning improves mandibular restoration with a good facial profile, esthetics, and dental rehabilitation.

A New Strategy for Patient-Specific Implant-Borne Dental Rehabilitation in Patients With Extended Maxillary Defects

Purpose of the StudyPatients undergoing ablative tumor surgery of the midface are faced with functional and esthetic issues. Various reconstructive strategies, such as implant-borne obturator prostheses or microvascular tissue transfer, are currently available for dental rehabilitation. The present study shows the first follow-up of patients treated with patient-specific implants (IPS Implants® Preprosthetic) for the rehabilitation of extended maxillary defects following ablative surgery.Patients and MethodsAll patients treated with patient specific implants due to postablative maxillary defects were included. 20 implants were placed in the 19 patients (bilateral implants were placed in one of the cases). In 65.75% of the cases, resection was performed due to squamous cell carcinoma. In addition to the primary stability, the clinical implant stability, soft tissue management, successful prosthodontic restoration, and complications were evaluated at a mean follow-up period of 26 months.ResultsAll patient-specific implants showed primary stability and were clinically stable throughout the observation period. Definitive prosthodontic restorations were performed in all patients. No implant loosening was observed. Major complications occurred only in previously irradiated patients with insufficient soft tissue conditions (p = 0.058). Minor complications such as exposure of the underlying framework or mucositis were observed, but they never led to failure of restorations or implant loss.ConclusionsTreatment of postablative maxillary defects with patient-specific implants offers a safe alternative with predictable results for full and rapid dental rehabilitation, avoiding time-consuming augmentation procedures and additional donor-site morbidity.

COMPREHENSIVE STUDY OF DENTAL ORTHOPEDIC MORBIDITY IN ELDERLY PEOPLE AND THE WAYS TO ELIMINATE IT

Social longevity of elderly people is largely determined by their dental health. The ability to talk freely without feeling socially awkward due to bad breath or visible absence of teeth greatly facilitates the lives of elderly people engaged in work. Unfortunately, the majority of elderly people have compromised dentitions, restored by dental prosthetic structures that meet social and functional requirements to varying degrees. The high need of elderly people in stomatological orthopedic treatment and the demand for comprehensive dental rehabilitation determined the relevance and purpose of this publication. Research methods. The object of the study was elderly people aged 60-74 years who sought dental orthopedic care in dental medical organizations, the sample size was 408 persons. Results. The maximum number of patients in the 60-74 age group was found to have complete absence of teeth – 26.5%, the total number of patients with the first, second, third and fourth classes according to Kennedy classification was 13,3%, 24,7%, 24,9%, 10,6% accordingly. The total number of patients with the first Kennedy subclasses (class 1-3) was 135 persons (33.1%), with the second subclasses – 69 persons (16.9%), with the third subclasses – 53 persons (13.0%). Conclusions. All types of orthopedic dental structures were manufactured for elderly patients. The choice of the dental prosthetic design used in orthopedic dental rehabilitation was determined by the type of dentition defect and met the principles of rational prosthetics.

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.