Search Results (45)

Background: Patients with a thin gingival phenotype and a narrow buccal alveolar plate are highly susceptible to periodontal complications during orthodontic expansion. Traditional biomechanics often fail to maintain root control in thin alveolar housing. This report presents two clinical cases illustrating soft- and hard-tissue responses to a novel biomechanical approach, the Bone Protection System (BPS), designed to reduce buccal cortical overload during expansion. Case Presentation: Two adult patients with a thin gingival phenotype assessed by a standardized periodontal probe transparency test and narrow alveolar ridges underwent orthodontic expansion. Patient 1 was treated with the full BPS protocol in both arches. Patient 2 received BPS only in the maxilla, while the mandible was treated conventionally, creating an intra-individual control model under identical systemic conditions. Soft-tissue phenotype and cortical plate response were evaluated clinically and radiographically when applicable. Results: In Patient 1 clinically, the vestibular phenotype showed clear thickening and stabilization. In Patient 2, the maxillary arch treated with BPS exhibited progressive thickening of the vestibular phenotype, whereas the mandible treated conventionally presented thinning and increased translucency—features consistent with buccal compression in thin alveolar bone. No soft- or hard-tissue augmentation procedures were performed in either case. Conclusions: The Bone Protection System may contribute to improved periodontal safety during orthodontic expansion in thin-biotype patients by reducing buccal cortical loading and supporting adaptive soft-tissue and bone responses. Preliminary observations suggests that BPS has potential value for possibly expanding the biological limits of safe tooth movement. Further studies on larger cohorts are warranted. Full article

Background: Ameloblastomas account for roughly 1% of all jaw tumours and cysts, typically manifesting as slow-growing, painless swellings that expand both buccal and lingual cortical plates and may infiltrate adjacent soft tissue, often leading to a delayed diagnosis. These benign tumours, characterized by local invasiveness, originate from epithelial tissues and may develop from dental lamina cell rests, the enamel apparatus, the epithelial lining of odontogenic cysts, or basal epithelial cells of the oral mucosa. Methods: This paper aims to describe the comprehensive and interdisciplinary management of an extensive ameloblastoma in a 16-year-old patient, emphasizing the diagnostic challenges, surgical resection, reconstructive procedures, and subsequent oral rehabilitation. Results: At the eleven-year follow-up, clinical and radiographic examinations showed no signs of tumour recurrence. The patient presented no symptoms, indicating neither pain nor functional impairment. The prosthetic rehabilitation utilizing implant-supported fixed restorations was successfully completed, resulting in satisfactory masticatory function and aesthetics. This case adds to the existing evidence on the management of extensive ameloblastomas by demonstrating successful long-term outcomes following interdisciplinary surgical reconstruction and rehabilitation. Conclusions: The presented case highlights the complexity of restoring the lost tissues and functions, as well as the long-term clinical, functional, and aesthetic outcomes over an eleven-years follow-up period. Full article

Background: Several minimally invasive techniques have been introduced to augment horizontal ridge volume for prosthetically driven implant placement, utilizing different biomaterials to enhance regenerative outcomes. This article presents two clinical cases illustrating a tunneling approach for horizontal alveolar ridge augmentation using a combination of xenogeneic bone graft, hyaluronic acid, and an acellular dermal matrix. Methods: A single vertical incision was made mesial to the bone defect and a dermal matrix was suitably shaped and positioned into the subperiosteal tunnel. Subsequently, the bone graft was inserted between the dermal matrix and the buccal bone plate. Primary wound closure was achieved. After six months, implants were placed. For each patient, an optical scan was performed at baseline (T₀), at six months post-operative ridge augmentation surgery (T₁) and at two months post-implant insertion (T₂). A digital measurement of the horizontal ridge thickness was performed at each inserted implant site. Clinical parameters and patient postoperative morbidity were recorded. Results: The procedure was well tolerated by the patients. No postoperative clinical complications were observed. The mean tissue thickness achieved at T1 was recorded to be 13.3 mm. The same value was recorded at T2. Conclusions: This technique allowed the placement of prosthetically guided implants, with minimal morbidity and no observed complications. Further studies analyzing the histology of newly formed bone and performing three-dimensional radiological examinations to confirm the effectiveness of the surgical technique are warranted to validate these preliminary findings. Clinical Trial Number (NIH): NCT06424223 Full article

Two new species of free-living marine nematodes were collected in the Yellow Sea, China, and they are described herein as Actinonema sinica sp. nov. and Comesoma zhangi sp. nov. Actinonema sinica sp. nov. is characterized by short cephalic setae; lateral differentiation consisting of a row of longitudinal sclerotized bars and beginning at the level of anterior third of the pharyngeal region; horn-shaped telamons; a curved rod-shaped gubernaculum; and an elongate conical tail with a smooth, pointed tip. Comesoma zhangi sp. nov. is characterized by long, thick cephalic setae, reaching up to 28 µm in length; a cup-shaped buccal cavity lacking a tooth and narrowing posteriorly with small projections; an amphidial fovea with two turns; slender, arcuate spicules 2.6 times the cloacal body diameter in length, lacking a proximal capitulum; a plate-like gubernaculum without apophysis; and the absence of precloacal supplements. Updated keys to the valid species of the genus Actinonema and the genus Comesoma are provided. A comparative morphological table of all currently accepted species of Comesoma is also provided. Full article

Although ridge preservation procedures have been shown to prevent post-extraction bone loss, the effectiveness of using a flap or flapless surgical approach remains unclear. The aim of the study was to compare the mentioned above alveolar ridge preservation procedures in the esthetic region of maxilla. Twenty-nine patients were randomly assigned to receive flap (n = 14) or flapless (n = 15) alveolar ridge preservation procedure. Sockets were grafted with alloplastic biomaterial, then covered with a collagen membrane in both groups. Clinical examinations were performed over a 6-month observation period and radiological (CBCT) examination was conducted before and 6 months after treatment. For both after flap and flapless procedures, there was a reduction in interdental papillae height and keratinized tissue width, increase in buccal soft tissues thickness with a decrease in radiological buccal bone plate width, decrease in radiological buccal and lingual plate height (significantly for the flapless group) and radiological alveolar process width reduction (significantly in flapless group at the height of 5 mm and 7 mm from the bottom of the socket). A decrease in the radiological buccal bone plate width was observed, where the further measuring point was from the bottom of the alveolus. In the mucoperiosteal flap preparation, group buccal bone plate width reduction at the height 3 mm, 5 mm and 7 mm was significant and in the flapless group a significant decrease was observed from 5 to 9 mm from the bottom of the socket. Despite ridge preservation, there is soft tissue thickening and a decrease in bone height and width regardless of the flap/flapless method used. Full article

The aim of this study was to evaluate (a) the degree of conversion (DC%), (b) film thickness, and (c) the effect of film thickness on DC% in modern light-cured resin composite restoratives [Filtek Universal (F), Clearfil Majesty ES 2 Universal (M), Tetric EvoCeram (T) and Viscalor (V)] used for luting composite onlays before/after preheating. For (a), the luting composites placed at 150 μm film thickness under the onlays (4 mm thickness, 2.9% transmittance) were light-cured for 120 s (3 × 40 s top, buccal, lingual sites) before and after preheating (54 °C/5 min-F,M,T and 65 °C/30 s-V). The DC% was measured at central, middle and side locations along the median in-length axis by ATR-FTIR spectroscopy. Specimens polymerized without onlays (40 s, top) served as controls. For (b), film thickness was measured employing a modified ISO 4049 standard (37 °C plate temperature, 5 N load) before and after preheating, using a dual-cured resin luting agent as control. For (c), onlays were luted with preheated T at 150 and 350 μm film thickness and light-cured for 2 × (3 × 40) s and 3 × (3 × 40) s, employing directly irradiated specimens (60 s, 120 s) as controls. For (a), significant differences were found in F and T before and after preheating. Before preheating, significant differences were registered between F–T, F–M, F–V and V–T, whereas after they were registered between F–M, F–T and F–V. All these values were significantly lower than the controls. For (b), significantly lower film thickness was recorded after preheating (−16.1–−33.3%, highest in V), with a ranking of F, M > V > T (before) and F, M > T, V (after). All values were significantly higher than the control. For (c), increased exposure improved DC% in the greater spacer group, with the controls providing superior values. It can be concluded that the use of modern highly filled composites as luting agents for low translucency onlays may result in suboptimal polymerization and film thickness, warranting caution. Full article

Background and Clinical significance: Apical fenestration is a rarely reported clinical finding that may be associated with apical periodontitis. However, its diagnosis can often be complicated by overlapping clinical and radiographic features. While management traditionally involves a combination of endodontic and surgical interventions, there is limited documentation regarding successful outcomes achieved through non-surgical treatment alone. Therefore, further reporting and investigation of such cases are warranted to enhance clinical understanding and inform decision-making. Case Presentation: This case report describes the non-surgical management of a 20-year-old patient presenting with symptomatic apical periodontitis and a labial apical fenestration in a previously treated maxillary left central incisor (tooth #21) exhibiting an open apex. Diagnosis was confirmed using cone-beam computed tomography (CBCT), which revealed a bone defect in the facial cortical plate. The treatment protocol involved conservative canal debridement, intracanal placement of calcium hydroxide, and final obturation using an apical plug of calcium silicate-based hydraulic cement (CSBHC) and the monoblock technique. Over a follow-up period of two years and eight months, clinical and radiographic assessments demonstrated resolution of symptoms, healing of the sinus tract, and complete regeneration of the buccal cortical bone. Conclusions: This case highlights the potential for complete healing of apical fenestration associated with apical periodontitis in an open apex tooth through non-surgical endodontic treatment alone. Full article

Objective: A peri-implant gap or a “jumping gap” between an implant surface and the buccal bone can often complicate the successful integration of dental implants, impairing osseointegration and long-term implant stability. Although various techniques and materials are available for managing this gap, there is no consensus on the most effective approach. The current literature lacks standardized, evidence-based guidelines for selecting the optimal technique or material for managing peri-implant gaps, especially following immediate implant placement. This systematic review aims to evaluate the efficacy of various techniques and materials to manage the peri-implant gap to improve the implant stability, bone preservation, and esthetic outcomes using the PROSPERO registration number CRD42024508852. Methods: A comprehensive search of the MEDLINE, Embase, and Cochrane databases was conducted, and various studies were selected, including 11 randomized clinical trials that investigated different grafting materials and techniques for managing the gap between the implant and the buccal plate. The selected studies were assessed for the risk of bias, and the data were extracted based on primary outcomes such as implant stability, bone density, and esthetic parameters. Results: The findings indicate that xenografts and alloplastic grafts were superior in preserving bone volume compared to platelet-rich fibrin. Techniques like the socket shield and immediate provisional prothesis methods showed promise in maintaining soft tissue and bone integrity. However, heterogeneity across the studies limits definitive conclusions. Conclusions: Further high-quality research is needed to establish standardized guidelines for peri-implant gap management. The selection of techniques and materials should be tailored to individual patient needs. Full article

Background/Objectives: The socket-shield technique (SST) was developed to preserve the facial/buccal portion of a tooth root to prevent post-extraction ridge resorption. It has gained attention for use in anterior implant sites, but its application in posterior sites remains unexplored. The aim of this case report was to report a proof-of-principle case using SST in a lower molar site and evaluate its effectiveness in preserving tissues. Methods: A 34-year-old non-smoking patient with a non-restorable mandibular first molar (tooth #36) underwent immediate implant placement with the SST. The tooth’s crown was removed, and the buccal segments of the roots were retained as “shields” while the implant was placed in the center of the socket. Preoperative and postoperative cone-beam CT (CBCT) scans and clinical exams were used to assess outcomes up to 12 months. Results: The SST procedure was completed uneventfully. CBCT after 4 months and 12 months showed minimal horizontal bone loss: ~0.2 mm at 4 months; ~0.1 mm additional loss by 12 months. The peri-implant soft tissue profile remained stable, and the implant achieved osseointegration with high primary and secondary stability. Conclusions: In this clinical case, the socket-shield technique effectively preserved alveolar bone and soft tissue contours in a molar extraction site, avoiding the ridge collapse often seen post-extraction. This suggests SST may be a viable tissue preservation approach in posterior sites; however, long-term follow-up and further studies are needed to confirm sustained outcomes and validate the technique’s predictability. Full article

Background/Objectives: The purpose of this study was to measure the bone thickness and angulation of the maxillary and mandibular anterior teeth on the buccal and palatal/lingual sides and also to analyze the sagittal root position (SRP) in the alveolar bone in relation to age and gender using cone-beam computed tomography (CBCT) in an Iraqi subpopulation. Methods: CBCT images of 1200 maxillary and mandibular central and lateral incisors and canines from 100 patients (48 males and 52 females) were retrospectively analyzed. These patients were categorized by age into group I ≤ 25, group II 26–40, and group III ≥ 41 years old. The SRP in the alveolar bone was classified as class I, class II, class III, and class IV, and the buccal type was further classified into subtypes I, II, and III. In addition, the buccolingual inclination of the tooth and buccal/palatal/lingual bone thickness at the coronal, middle, and apical thirds were evaluated and then compared based on age and gender. The data were analyzed using the Pearson chi-square test. Descriptive statistics, Kruskal–Wallis and Mann–Whitney U test were used to compare the thickness and angulation according to the SRP classes. Results: The mean frequency distribution of SRP of maxillary anterior teeth indicated that most of them were located buccally and were classified as (Class I) and subtype (III). Moreover, for mandibular anterior teeth, the majority were classified as (Class IV) and subtype (II). The mean sagittal angulation of maxillary anterior teeth approximately ranged from 5.9 for tooth 12# to 8.2 for teeth 13# and 23#, while for mandibular anterior teeth it ranged from 7.4 for tooth 33# to 10.3 for tooth 41#. The thickness of bone in the apical third of the buccal side of all maxillary and mandibular teeth was significantly related to age (p < 0.05). In the middle third, the thickness of bone in the buccal and palatal side of all maxillary anterior teeth and in the apical third of most mandibular teeth in the lingual side was significantly higher in males (p < 0.05). Conclusions: A majority of the maxillary anterior tooth roots were positioned close to the buccal cortical plate, while most of the mandibular anterior teeth were engaging both the buccal and lingual cortical plates. Males had more alveolar bone thickness for both maxillary and mandibular anterior teeth, and only the apical portion significantly changed with age. CBCT of the buccal and palatal/lingual bone and SRP is recommended for the selection of the appropriate treatment approach and implant placement. Full article

To compare preadolescents’ smile outcomes after two different orthodontic treatments: RME/Schwarz plate (RS) and clear aligners (CAs). A sample of 31 patients (13 M, 18 F, mean age 8.3 ± 1.2 y.m) treated with RS and a sample of 28 patients (12 M, 16 F, mean age 7.9 ± 1.1 y.m) treated with CAS were included. Pre-treatment and post-treatment records were taken before the treatment (T1) and at the end of treatment (T2). Seventeen variables were evaluated. Both therapies were effective in smile width increase (RS = p < 0.02; CAs = p < 0.04) and buccal corridor reduction (RS = p < 0.02; CAs = p < 0.04). The intragroup analysis showed in the RS group an increase of incisor gingival display (p < 0.02), overbite (OVB) (p < 0.04) alongside a reduction of overjet (OVJ) (p < 0.01). Conversely, the CAs group evidenced a reduction in incisor gingival display (p < 0.04) and OVB (p < 0.01) with an increase in C angulation (p < 0.02) and maxillary incisor inclination (p < 0.04). An intergroup comparison evidenced a greater improvement in smile width, smile index and buccal corridor in the RS group with respect to the CAs group (p < 0.02; p < 0.02; p < 0.03). CAs were more effective in the management of gingival display, incisor position, midline correction (incisor gingival display p < 0.01; maxillary incisor position p < 0.04; maxillary dental midline p < 0.02), with a better control of OVJ (p < 0.01) and OVB (p < 0.02). The RS approach resulted in a greater smile width and a reduction in buccal corridor with respect to the CAs. The CAs provided a better management of both gingival display and smile aesthetics. Full article

Background/Objectives: Various bone substitutes have been recommended to augment the horizontal gap following immediate implantation. The purpose of this study was to compare the effectiveness of an autogenous mineralized dentin graft or a deproteinized bovine bone in horizontal gap augmentation following immediate implant placement in the maxillary anterior region. Methods: A total of 110 patients underwent tooth extraction followed by immediate implant placement. The patients were divided into two groups. The first group received an autogenous mineralized dentin graft (the test group) while the second group received a deproteinized bovine bone (the control group) to augment the horizontal gap. Preoperative (T0), immediate postoperative (T1), and 1-year postoperative (T2) cone beam computed tomography scans were taken from all the patients. Linear measurements were recorded 1 mm (R1) and 5 mm (R2) points apical to the implant platform at both T1 and T2 time intervals. Pink Esthetic Scores and prosthetic complications were evaluated as well. Results: There were 57 patients with a mean age of 45.42 ± 9.86 (range 24–63 years) selected as the test group and 53 patients with a mean age of 40.28 ± 11.69 (range 20–63 years) as the control group. The mean reduction in the buccal bone plate at R1 was 6.39 ± 3.78% in the test group and 6.99 ± 5.01% in the control group (p > 0.05). The mean reduction in the buccal bone plate at R2 was 5.46 ± 4.98% in the test group and 6.77 ± 7.60% in the control group (p < 0.05). The PES and prosthetic-related complications were shown to be negligible between the groups (p > 0.05). Conclusions: The efficiency of using an autogenous mineralized dentin graft for horizontal gap augmentation showed similar results in comparison to using a deproteinized bovine bone in relation to buccolingual socket reduction following immediate implantation. Full article

Tooth extraction is one of the oldest and most well-known surgical procedures in dental medicine. It is still routinely performed by general practitioners and dental undergraduates. The Benex extraction system allows for the extraction of teeth in a vertical direction, which avoids most trauma against surrounding alveolar bone and soft tissues. The study included 56 patients who were recruited from the Department of Oral Surgery, Medical University—Plovdiv. The patients were split into two groups of 28 patients—Group I (control group) and Group II (study group). For each group, the success of the extraction, buccal cortical plate preservation, pain experience and early wound healing were assessed. There was no statistical significance between the success of the extractions in both groups. The Benex extractions preserved the buccal cortical plate in 95% of the cases, whereas the forceps extractions preserved it in only 71.8%, which is statistically significant. On the seventh day, patients in Group II reported less pain, without a significant difference. There was a significantly bigger number of completely healed extraction wounds on the 10th day. Atraumatic extractions allow for more hard and soft tissues to be preserved in the extraction site. This is essential for a successful outcome and the aesthetically pleasing results of the following dental restoration. Full article

Study Design: This is a retrospective observational study. Objective: To evaluate the clinical outcomes after an open reduction and internal fixation (ORIF) of condylar neck and base fractures (CNBFs) with a trapezoidal shape plate in patients using a less invasive transparotid approach. Methods: Fifteen patients with condylar fractures were classified according to the Arbeitsgemeinschaft für Osteosynthesefragen Craniomaxillofacial (AOCMF) classification system, treated by ORIF with a trapezoidal plate. All patients were evaluated by clinical examination (pain, occlusion, and mandibular dynamics) and imaging through computed axial tomography. Postoperative evaluations considered a favourable clinical outcome of fragment stability, stable occlusion, absence of pain, and regular mouth opening ranges. In addition, any signs of local infection, malocclusion, facial nerve damage, or failure of the fixation system were recorded. Results: According to the AOCMF classification for condylar fractures, eight fractures affected the condylar base and seven involved the condylar neck. No patients presented pain or joint sounds in the TMJ. All patients obtained a buccal opening greater than or equal to 35 mm. Two patients showed postoperative malocclusion which was corrected by intermaxillary elastics therapy. In addition, two patients had transient paresis during the postoperative period. One of them had paresis of the frontal and buccal branches of the facial nerve while the second patient had paresis of the zygomatic and buccal branches. Conclusions: Using trapezoidal miniplates provides functionally stable fixation for neck and base condylar fractures and allows for a less invasive surgical transparotid approach (2 cm extension). They also reduce the amount of osteosynthesis material and are easier to adapt and fix in the author’s opinion. Full article

(1) Background: Cleft lip and palate is the most common congenital malformation of the head and neck. After surgical closure, velopharyngeal dysfunction can arise, which has implications for phonation, sucking, swallowing, middle ear function, and interpersonal well-being. This case series aimed to present an adaptation of the conventional pharyngeal obturator design in order to allow its use with fixed orthodontic appliances. (2) Methods: A new custom-made pharyngeal obturator device was built in order to enable a correct function of the velopharyngeal valve. The fabrication of the plate was made by altering the conventional Hawley retainer, replacing the Adams hooks with 0.9 mm spherical hooks and removing the buccal arch. (3) Results: The new pharyngeal obturator design was used in six cleft patients with fixed orthodontic appliances. The appliance was well tolerated and there was a slight improvement in auditory-perceptive evaluations. (4) Conclusions: The new pharyngeal bulb design proved to have good retention during fixed orthodontic treatment. Moreover, despite the short-term follow-up, it also showed a reduction in the severity of the hypernasality sentences. Full article