Search Results (105)

Background/Objectives: Soft tissues are essential for maintaining the function and long-term success of dental implants. In many cases, implant placement necessitates soft tissue augmentation procedures such as free gingival grafts (FGGs) or connective tissue grafts (CTGs) to restore lost gingival architecture. Nevertheless, a significant challenge associated with FGG and CTG is postoperative pain, largely due to morbidity at the palatal donor site. To address this issue, various approaches have been proposed to reduce patient discomfort and promote improved wound healing at the donor site. This study aimed to compare the effectiveness of four different methods for protecting the palatal donor site following free gingival graft harvesting. Methods: A total of 76 patients undergoing implant therapy with an indication for free gingival grafting were selected and divided into four groups based on the method used to protect the palatal donor site: an absorbable gelatin sponge secured with sutures (GS); an absorbable gelatin sponge with sutures and cyanoacrylate tissue adhesive (GS+CTA); oxidized regenerated cellulose combined with cyanoacrylate tissue adhesive (ORC+CTA); and an absorbable gelatin sponge covered with a flowable resin composite and stabilized with sutures (GS+FRC). The effectiveness of each method was evaluated in terms of postoperative pain, bleeding, and wound healing. Results: Although the differences in pain intensity among the groups were not statistically significant throughout the observation period (p > 0.05), the GS+FRC group consistently exhibited the lowest mean pain scores. No statistically significant differences were observed between the groups regarding the incidence of secondary bleeding. The highest mean wound healing rate was recorded in the GS+FRC group (75.95 ± 18.75%), whereas the ORC+CTA group demonstrated the lowest rate (43.66 ± 25.74%). Conclusions: The use of an absorbable gelatin sponge covered with a flowable resin composite and secured with sutures, despite the presented limitations, appears to be a promising approach for palatal wound protection. While this group consistently demonstrated the lowest mean pain scores, differences in pain intensity among the groups were not statistically significant. Nonetheless, it achieved the most favorable outcomes in terms of wound epithelialization. Full article

Aim: Pacifiers play a critical role in the early stages of craniofacial and palate development during infancy. While they provide comfort and aid in soothing, their use can also have significant impacts on the growth and function of the oral cavity. This study aimed to simulate and predict the behavior of six different types of pacifiers and their functional interaction with the tongue and palate, with the goal of understanding their potential effects on orofacial growth and development. Materials and Methods: Biomechanical analysis using Finite Element Analysis (FEA) mathematical models was employed to evaluate the behavior of six different commercial pacifiers in contact with the palate and tongue. Three-dimensional solid models of the palate and tongue were based on the mathematical framework from a 2007 publication. This allowed for a detailed investigation into how various pacifier designs interact with soft and hard oral tissues, particularly the implications on dental and skeletal development. Results: The findings of this study demonstrate that pacifiers exhibit different interactions with the oral cavity depending on their geometry. Anatomical–functional pacifiers, for instance, tend to exert lateral compressions near the palatine vault, which can influence the hard palate and contribute to changes in craniofacial growth. In contrast, other pacifiers apply compressive forces primarily in the anterior region of the palate, particularly in the premaxilla area. Furthermore, the deformation of the tongue varied significantly across different pacifier types: while some pacifiers caused the tongue to flatten, others allowed it to adapt more favorably by assuming a concave shape. These variations highlight the importance of selecting a pacifier that aligns with the natural development of both soft and hard oral tissues. Conclusions: The results of this study underscore the crucial role of pacifier geometry in shaping both the palate and the tongue. These findings suggest that pacifiers have a significant influence not only on facial bone growth but also on the stimulation of oral functions such as suction and feeding. The geometry of the pacifier affects the soft tissues (tongue and muscles) and hard tissues (palate and jaw) differently, which emphasizes the need for careful selection of pacifiers during infancy. Choosing the right pacifier is essential to avoid potential negative effects on craniofacial development and to ensure that the benefits of proper oral function are maintained. Therefore, healthcare professionals and parents should consider these biomechanical factors when introducing pacifiers to newborns. Full article

Background/Objectives: Periodontal and implant therapies frequently require soft tissue augmentation for optimal outcomes. As the hard palate serves as the primary donor site, this study evaluated palatal masticatory mucosa thickness variations in a Saudi population of the Eastern Province using cone-beam computed tomography (CBCT) at a teaching dental hospital, providing site-specific data for clinical applications. Methods: A retrospective cross-sectional analysis of 215 CBCT scans from systemically healthy, non-smoking adults (>18 years) was conducted at the University Dental Hospital. Measurements were taken at 12 standardized sites (3 mm, 6 mm, and 9 mm from the cementoenamel junction) across maxillary canines, premolars, and first molars. Statistical analysis included Friedman’s test and t-tests. Results: Significant site variations were observed, with the second premolar region showing greatest thickness (3.48 ± 0.80 mm at 9 mm) and the first molar region the lowest (1.88 ± 0.63 mm at 3 mm) (p < 0.001). Mucosal thickness generally increased coronally to apically (p < 0.001). Age >35 years correlated with significantly thicker mucosa (p < 0.05), while no statistically significant gender-based differences were observed for all sites (p > 0.05). Conclusions: CBCT provides reliable, non-invasive assessment of palatal mucosa thickness. These findings offer region-specific data for consideration in periodontal and implant procedures involving soft tissue grafting. Full article

Background/Objectives: Implant placement in cases of severe bone atrophy or compromised alveolar bone requires careful planning, especially in the anterior maxilla. The nasopalatine canal (NPC) and its cortical walls offer potential anchorage sites. This study evaluates the NPC’s anatomical characteristics using cone beam computed tomography (CBCT) to assess its suitability for implant anchorage. Methods: A retrospective analysis of 150 CBCT scans from three dental clinics in Poland was conducted. NPC measurements—including length, width, number of canals, and distances to adjacent anatomical structures—were taken in the sagittal, coronal, and axial planes. Statistical tests included Pearson correlation and Student’s t-test to explore relationships between NPC dimensions and gender. Results: The mean NPC length was 10.27 mm and mean width 3.55 mm. Significant gender differences were observed in the canal length, width, and distances to the labial and palatal plates (p < 0.05). Strong positive correlations were found between the canal width at the palate base and other parameters, such as the midpoint width (r = 0.58) and diameter (r = 0.44). The distance from the palatal opening to the labial plate showed the strongest correlation (r = 0.67), indicating enhanced cortical anchorage potential with increased canal dimensions. Discussion: NPC morphology varied (cylindrical, funnel-like, hourglass), aligning with prior studies. Larger diameters were linked to single-canal configurations. Implant placement strategies—such as direct canal insertion or lateralization—can be effective, especially with polished, single-piece implants that reduce soft tissue ingrowth and improve primary stability. Conclusions: Understanding NPC anatomy is crucial for implant planning in atrophic maxillae. With the proper technique, NPC use for cortical anchorage is a viable treatment option. Full article

Background: Periapical cysts are the most common odontogenic cysts, often resulting in large bone defects. Guided tissue regeneration techniques support tissue healing by means of membranes and bone grafts. The present case report evaluates for the first time clinical application of a resorbable magnesium membrane in guided bone regeneration (GBR) following cystectomy. Case report: A 35-year-old male patient presented with a large periapical cystic lesion in the maxillary anterior region. Treatment involved marsupialization followed by cyst enucleation and GBR using a resorbable magnesium membrane and bovine xenograft. The magnesium membrane served as a structural support to bridge the bony discontinuity in the palatal bone. Cone-beam computed tomography (CBCT) was used for diagnosis, treatment planning, and follow-up assessments. At 16 months post-treatment, CBCT imaging revealed significant bone regeneration, with restoration of the palatal contour and cortication of the palatal wall. Clinical examination showed asymptomatic teeth with normal mobility and optimal soft tissue healing. Conclusions: This case demonstrates the potential of resorbable magnesium membranes in managing large periapical defects, offering a promising alternative to traditional GBR materials by combining mechanical strength with complete resorption, therefore eliminating the need for membrane removal surgery. However, future studies on larger patient samples should focus on confirming the long-term outcomes of this approach and investigating patient-specific factors that are important in choosing effective treatment options. Full article

The micronization of low-salinity Baltic Sea blue mussels (Mytilus edulis/trossulus) was investigated as a novel valorisation pathway to eliminate the need for labor-intensive meat–shell separation. The small size of Baltic mussels poses a challenge for traditional meat–shell separation. This study investigates micronization as an alternative processing approach to enhance biomass utilization while preserving functional and nutritional properties. This study assessed the feasibility of whole-mussel micronization, focusing on its impact on particle size distribution, grittiness, and the potential separation of meat and shell fractions post-processing. The results demonstrated that micronization at 4000 rpm resulted in a fine powder (<63 µm), significantly reducing grittiness. However, mild chalkiness was observed at higher concentrations (4% solution), highlighting the need for formulation adjustments. While it was expected to facilitate the separation of soft tissue from shell material, the results indicated that this remained impractical due to structural or compositional similarities at finer scales. A sensory evaluation of the whole-mussel powder assessed its texture and palatability, revealing its potential suitability for functional food applications. The findings highlight the potential of micronization as a resource-efficient and scalable processing method, enhancing the economic and environmental value of Baltic mussels in the food industry. Full article

Background: This cephalometric study aimed to evaluate the effects of clear aligner therapy in growing individuals with Class II malocclusion, comparing two functional approaches: the use of Class II elastics or the Mandibular Advancement (MA). Methods: Cephalometric data from 39 patients with Class II malocclusion treated using clear aligners either combined with Class II elastics (EL group; n = 18) or Mandibular Advancement (MA group; n = 21) were analyzed and compared with an untreated control group (UC2; n = 15). Results: Both treatment groups (EL and MA) showed a significant reduction in the ANB angle compared to the control (MA: −1.5°; EL: −2.2°; UC2: +0.2°). An increase in mandibular length, as measured by Co–Gn, was observed in both the EL and MA groups (+5.5 mm and +8.3 mm, respectively) relative to the control group. Soft tissue analysis of the Pg–TVL distance from T1 to T2 revealed the most substantial forward displacement of the chin in the MA group (MA: +2.0 ± 3.7 mm; EL: +0.5 ± 0.7 mm; UC2: −1.6 ± 3.3 mm). Vertically, the MA group exhibited a more marked decrease in the palatal-mandibular plane angle than the other groups. Both treatment modalities significantly reduced overjet and overbite from T1 to T2. Conclusions: The EL and MA appliances effectively advanced the mandible, leading to significant improvements in the sagittal relationship, overjet, and overbite while maintaining stable vertical control. Additionally, the MA group exhibited a more pronounced forward movement of the soft tissue chin. Full article

Background and Clinical Significance: Lipomas, benign tumors composed of adipose tissue, are recognized as one of the two most common fat-containing soft tissue tumors, underscoring their relative prevalence among benign tumors in children. Despite their prominence, lipomas rarely occur before 20 years of age, highlighting a discrepancy between their commonality and the age at which they typically manifest. This case report focuses on a 11-year-old patient who noticed the presence of an intraoral mass, which prompted further investigation, ultimately leading to the diagnosis of a lipoma located on the palate. Following our diagnosis, we searched for similar cases; however, the relevant literature was rather limited. There was a case report of a 4-year-old patient who presented with a lipoma on her tongue and a case report of a 6-year-old patient who presented with a lipoma on the buccal mucosa. Case Presentation: The young patient came with his parents to the Department of Oral Medicine and Pathology, School of Dentistry, Aristotle University of Thessaloniki, Greece, and reported the presence of a growth in the middle of the upper jaw. A tumor, of approximately 1 cm diameter, was observed in the middle of the palate, on the border between the hard and soft palate. The surrounding mucosa appeared normal, which is critical in differentiating the tumor from more aggressive pathological entities. It was characterized by a soft and slippery consistency. The patient was referred to a cone beam computed tomography (CBCT) examination to investigate if there was any bone involvement. Based on clinical and radiographical findings, a biopsy was carried out. The tumor was initially excised in its entirety and the base was electrocauterized to avoid placing sutures. The histopathological examination that followed suggested the presence of an intraoral lipoma since lobules of mature adipose tissue in lamina propria and fatty tissue in close proximity to mucinous salivary glands were noticed. Conclusions: The development of lipomas in young patients can be attributed to a multitude of factors that interplay with one another, emphasizing the need for a comprehensive understanding of these growths. Additionally, underlying conditions such as diabetes mellitus, hypercholesterolemia, and obesity also play a crucial role, highlighting the interconnected nature of metabolic disorders and lipoma formation. The surgical approaches for the removal of oral lipomas primarily revolve around complete surgical excision, which is considered the mainstay treatment for these benign tumors. Full article

Background/Objectives: Autogenous palatal free gingival graft (FGG) harvesting presents challenges for patients due to the increased risk of postoperative morbidity related to a second intraoral surgical wound that heals with secondary intention. This parallel-group, randomized, controlled, open-label trial aimed to evaluate the efficacy of the application of leukocyte- and platelet-rich fibrin (L-PRF) membrane to the palatal donor site on wound healing, hemostasis, and pain control after FGG harvesting. Methods: Twenty-eight adult patients with insufficient attached gingiva underwent soft tissue augmentation using FGG harvested from the palate at the Department of Oral and Maxillofacial Surgery, Baskent University, Turkey. Patients were randomized to either an L-PRF group or a control group. In the L-PRF group, the L-PRF membrane was sutured to the donor sites, whereas in the control group, donor sites healed by secondary intention. Postoperative evaluations were conducted on days 1, 3, 5, and 7 and at weeks 2, 3, 4, 5, and 6. Donor sites were evaluated clinically for pain, burning sensation, bleeding, wound healing, and color match to adjacent tissues. Donor site wound areas were analyzed using digital images. Results: Two patients were excluded from the analysis due to loss of contact, leaving 26 (n = 13, n = 13) patients for analysis. Donor site pain and burning sensation were significantly lower in the L-PRF group compared to the control group during the first two postoperative weeks (p < 0.001). Bleeding was significantly lower in the L-PRF group on postoperative days 1 and 3 (p < 0.001). Clinical healing index scores were significantly higher in the L-PRF group at weeks 3 and 4 (p < 0.001). Additionally, palatal wound area reductions from baseline were significantly greater in the L-PRF group at all follow-up intervals (p < 0.001). Conclusions: The application of an L-PRF membrane to palatal donor wounds after FGG harvesting significantly reduces postoperative pain, decreases bleeding, and accelerates healing, providing a valuable autologous biomaterial for enhanced wound healing and improved patient comfort. Full article

Background/Objectives: Tooth extraction induces significant alveolar ridge dimensional changes and soft tissue modifications, often leading to challenges in implant placement or conventional prosthetic rehabilitation. Alveolar Ridge Preservation (ARP) strategies aim to mitigate post-extraction resorption of the alveolar ridge, enhancing both the quality and quantity of bone and soft tissue during healing. Hyaluronic acid (HYA) has emerged as a promising biological agent for ARP due to its osteoinductive, antimicrobial, and anti-inflammatory properties. However, the effects of HYA in ARP remain inconsistently reported. This study aims to assess current clinical and preclinical evidence regarding the biological effects of HYA and its application in ARP. Additionally, it evaluates HYA’s impact—alone or in combination with other products—on hard and soft tissue dimensional changes, early wound healing, and implant success rates. Methods: A comprehensive electronic literature search was conducted, and studies meeting the inclusion criteria were critically evaluated. Relevant data were extracted from the final selection of articles. Results: Thirteen publications were evaluated. Some studies reported a significantly improved newly formed bone following ARP with intra-socket HYA application as a single approach (p = 0.004). Combining HYA with a bone graft and a free palatal graft resulted in significantly greater amounts of newly formed and mature bone, reduced clinical bone width changes, lower radiographic crestal bone loss (p < 0.01), and diminished radiological volumetric and linear bone resorption (p = 0.018). Short-term follow-up data indicated improved soft tissue healing associated with HYA-based ARP. While HYA appears to have a protective effect on ridge dimensional changes in ARP, other studies reported no significant differences in radiographic bone dimensional changes or soft tissue improvement. Conclusions: The addition of HYA to bone grafts may enhance some ARP outcomes. However, the variability in outcomes and methodologies across the evaluated studies precludes drawing definitive clinical conclusions. Further robust research is needed to clarify HYA’s role in ARP. With respect to clinical significance enhancing the understanding of ARP management strategies and their effects on post-extraction sockets empowers clinicians to make more informed decisions. The knowledge of HYA effects facilitates the selection of personalized ARP approaches tailored to optimize outcomes for subsequent interventions. Full article

Background and Objectives: The palate’s morphological characteristics are of great importance, especially in periodontology, where the palatine tissue represents a source of tissue graft for multiple mucogingival surgeries. This study aimed to estimate the amount of donor tissue available through the average palatal height and average location of the greater palatine artery in the Saudi population according to age and gender. Materials and Methods: Digital casts for adult Saudi patients at the age of 18–60 years old with a mean age of 37.76 ± 12.68 years were collected and analyzed using EXOCAD software. The digital casts were evaluated, and measurements of arch width at molars and canines, palatal vault height (PVH), palatal height index (PHI), and extension of the palatal rugae were registered. Finally, the amount available for soft tissue graft harvesting was calculated. Results: Overall, 109 maxillary casts for Saudi patients, 52 (47.7%) males and 57 (52.3%) females, were analyzed. The maxillary inter-molar arch width, inter-canine width, and palatal vault height significantly differed between males and females (p < 0.05). The mean PHI was 45.51% ± 8.12%, and 27.5% were classified as orthostaphyline, while 72.5% were categorized as hypsistaphyline, with no significant difference between the genders. The mean maximum graft width was 11.45 mm, and the graft width was significantly different between males and females (p < 0.005), while the mean maximum graft length was 17.78 mm, and the graft length showed no significant difference. Conclusions: The results of this study provide specific clinical guidelines for periodontal procedures by emphasizing the importance of gender-specific anatomical considerations. Data on graft dimensions and palatal measurements will enable the exact planning of soft tissue harvesting to minimize surgical risks and optimize mucogingival surgery outcomes in the Saudi population. Full article

Background: Post-extraction ridge resorption is an inevitable phenomenon that cannot be eliminated but is significantly reduced using additional surgical techniques known as socket preservation. They aim to create favorable conditions for implant placement and prosthetic restoration. This study aims to assess the effect of socket sealing (SS) with free gingival grafts on the vertical resorption of socket walls at the premolar and molar regions over 3 months. Methods: This randomized two-arm controlled trial with parallel groups (1:1 allocation) was conducted at the Department of Oral Surgery, Medical University-Varna, Bulgaria, from 27 June 2022 to 20 April 2023. Forty patients aged 30–65 were equally and randomly allocated to the SS or the control groups. Atraumatic tooth extraction was performed. In the control group, the socket was left on secondary wound healing. In the SS group, the socket orifice was “sealed” with an FGG harvested from the hard palate or maxillary tuberosity. Results: Data analysis demonstrated that SS with an FGG is a successful method for reducing the post-extraction resorption of the socket walls. In addition, this study confirms that the thickness of the buccal wall is a significant factor in its vertical resorption. Conclusions: Socket sealing with an FGG is a valuable method that eliminates the need for flap reflection and compensates for the soft tissue deficit when immediate implant placement or bone augmentation is required. Further research is necessary to determine the role of different factors influencing bone resorption and compare the effect of different socket preservation methods. Full article

Background/Objectives: Dental malocclusions are highly prevalent worldwide, negatively impacting patients’ quality of life and leading to complex, often costly, orthodontic treatments. In Romania, the economic status of patients and the limited public funding for orthodontic care significantly influence treatment accessibility and choices. Advanced technologies, such as mini-implants (MIs), offer improved anchorage and treatment efficiency but are often underutilized due to financial constraints and variability in clinical training. In this context, there are limited data regarding the use and preferences of MI among orthodontists in Romania. This study aims to explore the characteristics, preferences, and challenges of Romanian orthodontists in their use of MI systems. Methods: A survey was conducted between June and September 2024, targeting orthodontists across Romania. The questionnaire, distributed via social media platforms, consisted of 24 items addressing professional experience, MI system preferences, insertion methods, and complications. Statistical analyses were conducted using IBM SPSS Statistics 25. Fisher’s Exact Test and Pearson’s Chi-Square Test were employed to evaluate relationships between categorical variables. When appropriate, logistic binomial univariable regression models were applied to predict key dependent variables (e.g., MI placement zones, MI experience, and MI complications) based on independent variables such as specific MI system usage and frequency of MI usage. A significance threshold of α = 0.05 was used for all tests. Results: Out of 105 participants, 85.7% reported using mini-implants (MIs) in their orthodontic practice, with the Dual Top and Benefit systems being the most frequently used (60% and 43.3%, respectively). The interradicular area was the most common placement site (60%), while the palatal and retromolar regions showed significant correlations with the Benefit system (p = 0.008). Practitioners with more than 10 years of experience reported a significantly higher frequency of MI use (p = 0.001), with frequent use being observed in 60.9% of these practitioners. Complications were common, with MI mobility reported by 92.2% and soft tissue damage by 57.8%. The midpalatal area was significantly associated with higher complication rates compared to other sites (p < 0.001). The success rates of MI usage ranged from 76% to 100% in 57.8% of respondents, with higher success rates being associated with infrazygomatic placements (p < 0.05). Conclusions: MI usage is prevalent among Romanian orthodontists, with experienced practitioners utilizing them more frequently. Despite high success rates, common complications highlight the need for improved insertion techniques and post-operative care. Further research and training are recommended to optimize MI application and reduce complication rates. Full article

(1) Background: A free gingival graft (FGG) is a common technique used to reconstruct or enhance the area of keratinized mucosa, while a connective tissue graft (CTG) is utilized to boost soft tissue thickness, thereby promoting stability in interproximal marginal bone levels. Most reported complications following FGG procedure are associated with the donor site. In addition to a painful, open wound in the palate, the most frequent complications linked to FGG harvesting include excessive bleeding, postoperative bone exposure, and recurrent herpes lesions. Numerous methods for securing the donor site after a free gingival graft surgery have been documented in research publications. The main objective of this systematic review was to assess various techniques for protecting the palate after graft harvesting and their impact on patient experience, with a focus on pain management. The secondary objective was to evaluate these techniques in relation to donor site wound healing. (2) Methods: The search was performed across four databases: Medline (PubMed Central), Scopus, Web of Science, and Embase, in accordance with PRISMA guidelines and the recommendations set forth in the Cochrane Handbook for Systematic Reviews of Interventions. The initial search took place on 9 October 2023, followed by an update on 28 June 2024. The search utilized the following keywords: (“wound” OR “injury”) AND (“graft” OR “free gingival graft” OR “graft harvesting”) AND (“healing” OR “recovery”) AND “palate”. (3) Results: After conducting the follow-up search, a total of 958 papers were identified: 193 from PubMed, 314 from Scopus, 101 from Web of Science, and 350 from Embase. Ultimately, of the 49 papers that remained, 11 were excluded due to not fulfilling the inclusion criteria, leaving 38 full-text papers on free gingival grafts (FGG) for qualitative analysis. (4) Conclusions: Various methods for palatal protection after free gingival grafts (FGG) are described in the literature, stemming from biological, physical, or chemical sources. Most studies in this review examined platelet-rich fibrin and suggested that it provides no benefits for patients’ subjective experiences or wound healing outcomes. While photobiomodulation appears to support wound epithelialization, it does not influence pain perception. Alternatives such as propolis, hyaluronic acid, and medicinal plant extracts show potential for palatal protection; however, further research is needed to thoroughly evaluate their effectiveness. Full article

This study aimed to describe a case of simultaneous guided bone regeneration (GBR) and implant placement in a patient with prior aesthetic implant failure, focusing on achieving optimal aesthetic and functional outcomes, and to perform a literature review of the current evidence. A 38-year-old male presented with an improperly positioned implant at the level of the right upper central (tooth 2.1), leading to aesthetic and functional issues. The initial assessment included a panoramic radiograph revealing marginal bone loss and an enlarged peri-implant space, necessitating implant removal. Following implant removal and provisional restoration, the patient was re-evaluated for subsequent therapeutic treatments. The patient underwent orthodontic treatment to improve mesio-distal spacing, followed by surgical intervention involving GBR and simultaneous implant placement. The GBR procedure utilised bone substitutes and resorbable membranes, with soft tissue augmentation conducted subsequently. The surgical intervention involved local anaesthesia, flap design, defect assessment, and palatally oriented implant placement. GBR was then performed. After six months, implant uncovering and soft tissue augmentation were conducted. The implant was loaded with a screwed restoration following complete hard and soft tissue healing. The patient was monitored every six months for two years, then annually. At the 10-year follow-up, no signs of bone resorption or soft tissue inflammation were observed. This case demonstrated that GBR and simultaneous implant placement, with the application of advanced biomaterials, effectively promoted osseointegration and maintained aesthetic and functional stability over a decade. Full article