Search Results (72)

Background/Objectives: Peri-implant mucosa plays a key role in both peri-implant health and aesthetics. Differences in contour and color between implants and natural teeth can negatively affect patient satisfaction, while soft tissue deficiency may lead to complications such as peri-implantitis. Peri-implant plastic surgery aims to improve these conditions. The objective of this study is to describe the trouser-shaped connective tissue graft technique designed to enhance vestibular and interproximal peri-implant tissue volume in a single surgical procedure, and to assess its effectiveness and morbidity. Methods: Ten patients requiring soft tissue augmentation in edentulous areas prior to delayed implant placement were selected. Intraoral scanning was performed before and 6 months after treatment to evaluate tissue thickness gain. Results: Significant soft tissue volume gain was observed at both the coronal (mean: 2.74 mm with a 95% confidence interval of 2.21–3.26 mm) and vestibular (mean: 2.79 mm with a 95% confidence interval of 2.24–3.35 mm) levels in all analyzed positions (p < 0.001). The procedure exhibited low morbidity, with minimal complications and discomfort reported by the patients. Conclusions: The trouser-shaped connective tissue graft technique is effective in increasing peri-implant soft tissue. It allows for vestibular and interproximal tissue augmentation in a single procedure, minimizing tissue contraction and morbidity. This technique could be a predictable and minimally invasive alternative for managing volume deficiencies in peri-implant tissues, particularly in aesthetic areas. Full article

Background/Objectives: Vestibular dysfunction is one of the main complications after cochlear implant (CI) surgery, and there are currently no standardized protocols for vestibular assessment in CI candidates. Our objectives were to investigate the incidence of vestibular impairment after CI surgery, anamnestic (age, known systemic pathologies and cause of deafness) and surgical (intraoperative complications, malposition of the CI) risk factors, and the role of vestibular assessment in the selection of the suitable ear for implantation. Methods: We included 68 adult patients (80 ears) affected by moderate-to-profound SNHL undergoing CI. The dizziness handicap inventory (DHI), the video head impulse test (VHIT), the caloric test, and dynamic posturography (DP) were used to study the vestibular function and balance before and one month after CI. The DHI was also administered 24 h after surgery. Results: Despite significative impairment 24 h after surgery (29.6 ± 30), the mean DHI score returned to preoperative values (17.9 ± 26) after one month. Dizziness persisted in case of age ≥ 65 years old, surgical difficulties, simultaneous bilateral CI, Meniere’s disease and otosclerosis, comorbidities ≥ 3, anxiety/depression, and neurological diseases. The VHIT significantly worsened in 25% of ears, while the caloric test SPV nystagmus significantly decreased in 30% of ears. In cases of preoperative unilateral weakness, the implantation of the better ear was significantly related to higher DHI scores. Only 4/68 patients had a significant persistent reduction in the postural composite score after surgery, with an increased risk of falls. Conclusions: Medical history and vestibular assessment predict the risk of vestibular damage and help to choose the CI’s side and to manage vertigo after surgery. Full article

Background/Objectives: This ex vivo study aimed to evaluate the diagnostic performance of ultra-low-dose (ULD) cone-beam computed tomography (CBCT) protocols in detecting vestibular bone defects for immediate implant planning, using intraoral scan (IOS) data as a reference. Methods: Four CBCT protocols (ENDO, A, B, C) were applied to four dried human skulls using a standardized setup and a single CBCT unit (Planmeca ProMax^® 3D Mid, Planmeca Oy, Helsinki, Finland). All scans were taken at 90 kV, with varying parameters: (1) ENDO (40 × 50 mm, 75 µm, 12 mA, 80–120 µSv, 15 s), (2) A (50 × 50 mm, 75 µm, 9 mA, 20–40 µSv, 5 s), (3) B (100 × 60 mm, 150 µm, 7.1 mA, 22–32 µSv, 5 s), and (4) C (100 × 100 mm, 200 µm, 7.1 mA, 44 µSv, 4 s). Vestibular root surfaces of single-rooted teeth (FDI regions 15–25 and 35–45) were digitized via IOS and exported as STL files. CBCT datasets were superimposed using 3D software (Blender 2.79), and surface defects were measured and compared using one-sample t-tests and Bland–Altman analysis. The level of significance was set at p < 0.05. Results: A total of 330 vestibular surfaces from 66 teeth were analyzed. Compared to the IOS reference, protocols ENDO and A showed minimal differences (p > 0.05). In contrast, protocols B and C exhibited statistically significant deviations (p < 0.05). Protocol B demonstrated a mean difference of −0.477 mm² with limits of agreement (LoA) from −2.04 to 1.09 mm² and significant intra-rater variability (p < 0.05). Protocol C revealed a similar mean deviation (−0.455 mm²) but a wider LoA (−2.72 to 1.81 mm²), indicating greater measurement variability. Overall, larger voxel sizes were associated with increased random error, although deviations remained within clinically acceptable limits. Conclusions: Despite statistical significance, deviations for protocols B and C remained within clinically acceptable limits. ULD CBCT protocols are, thus, suitable for evaluating vestibular bone defects with reduced radiation exposure. Full article

Background: The autogenous bone core block (BCB) is a viable, biologically advantageous, and minimally invasive alternative to other augmentation procedures for small bone defects around dental implants. This study focused specifically on horizontal vestibular defects in the mandible, a frequently encountered yet underrepresented clinical situation, to evaluate the effectiveness and predictability of bone core grafting. Methods: Cylindrical autogenous bone cores, harvested from the implant-site osteotomy using trephine drills with a 2.5 internal diameter, were stabilized with osteosynthesis screws, and implants were placed simultaneously. Initial preoperative measurements of the edentulous ridge width were performed based on cone beam computer tomography (CBCT). At 4 months postoperatively, a subsequent CBCT measurement was performed for each implant site. Results: A total of 38 augmentation procedures were analyzed with a mean horizontal bone gain of 1.8 mm (p = 0.000). Improved outcomes were observed in V-shaped defects with remaining vertical bony walls, which contributed to better graft stability and volume preservation. While Khoury et al. previously validated the general applicability of this technique across various defect types, our study refines its indication by offering a clear protocol tailored to a common clinical niche. Conclusions: The proposed BCB method proved to be a safe, efficient, and with reduced morbidity procedure, providing clinicians with a practical and evidence-based tool for predictable horizontal bone augmentation. Full article

Background: Vestibular function implements head position regulation and body spatial navigation. It matures during childhood and adolescence and integrates with the completion of an individual’s motor development. Nevertheless, vestibular impairment is associated with profound paediatric hearing loss and has a negative impact on the child’s motor proficiency. Cochlear implantation (CI) is the treatment of choice for severe hearing loss, where conservative treatment plans are not appropriate or fail. The Teenager and Young Adults Cochlear Implant (TAYACI) study investigates the long-term outcomes of early implantation with respect to the hearing, speech, psychological, and balance development among CI users. Methods: This study focuses on the vestibular function and the appropriate methods for vestibular assessment. The results of two established vestibular test methods are explored: the video head impulse test (vHIT) and cervical/ocular vestibular-evoked myogenic potentials (cVEMP, oVEMP) with air and bone conduction vibration stimulation. The results of vHIT, cVEMP, and oVEMP, per implanted ear and the relation to the aetiology of hearing loss are reported. An additional dynamic visual acuity (DVA) test was included to assess clinical oscillopsia. Results: Overall abnormal lateral canal testing was detected in 35/76 (46.1%) of the implanted ears. Bone-conducted cVEMP (BC cVEMP) was pathological in 33/76 (43.3%) and BC oVEMP in 42/76 (55.3%). Lateral canal impairment was associated with the background diagnosis of the hearing loss. Oscillopsia was related to bilateral canal impairment (sensitivity 73% specificity 100%). Conclusions: Lateral canal testing together with BC VEMPs were the most reproducible modules for vestibular testing The above tests were related to each other and complemented the overall vestibular assessment. DVA is a helpful tool to screen dynamic oscillopsia in patients with bilateral vestibular impairment. Full article

Background/Objectives: Vestibulo-ocular reflex (VOR) function, measured by the video head impulse test (vHIT) gains, plays a crucial role in postural stability and quality of life. Cochlear implant recipients often experience vestibular dysfunction, but its relationship with balance and patient-reported outcomes remains underexplored. This study aimed to (1) evaluate the relationship between vHIT gains and postural stability in cochlear implant recipients; (2) assess the impact of vHIT gains on quality-of-life metrics; and (3) identify key predictors of postural stability, including vHIT gains and demographic/clinical characteristics. Methods: This cross-sectional study was conducted between August 2023 and February 2024 and included 46 participants that comprised cochlear implant recipients and age-matched normal hearers who underwent the vHIT for lateral, anterior, and posterior semicircular canal function. Postural stability was assessed using dynamic posturography, and quality of life was measured using the Short Form-36 (SF-36). Multiple linear regression and correlation analyses were performed. Results: The vHIT gains demonstrated significant positive correlations with postural stability, with the lateral canal showing the strongest association (r = 0.742, p = 0.001), followed by the posterior (r = 0.701, p = 0.003) and anterior canals (r = 0.684, p = 0.005). A multiple regression analysis identified the lateral canal as the most significant predictor of postural stability (β = 0.512, p = 0.001, adjusted R² = 0.47). Quality-of-life metrics were inversely correlated with the vHIT gains, particularly in the posterior canal (r = −0.712, p = 0.002), which explained 43–51% of the variance. Conclusions: This study highlighted the lateral semicircular canal as the primary determinant of postural stability in cochlear implant recipients, underscoring the importance of vestibular assessments in optimizing balance and functional outcomes. Full article

Background: One of the parameters of maximum interest regarding the quality of the intraoral hard tissues is represented by the bone density, with direct clinical implications. The evaluation of this extremely important clinical parameter can be achieved by several imaging methods, of which the most known in dentistry is represented by the cone beam computed tomography (CBCT). Objectives: The purpose of the study is to obtain a quantitative analysis of bone mineral density changes in patients who underwent treatments of photobiomodulation (PBM), as complementary to a surgical approach in oral surgery and implantology. Methods: The study included the retrospective analysis of maxillary cone beam computed tomography of 28 patients without pathology or medication known to affect bone metabolism or its qualitative and quantitative properties. All patients from the study group followed the same laser PBM treatment protocol after placing dental implants; the PBM protocol implied the intraoral use of a gallium aluminum arsenide laser (GaAlAs) of 808 nm, 450 mW, in pulsed mode, administering an energy of 6 J in 3 points corresponding to each inserted dental implant—mesial, distal, and apical—totaling 18 J/implant. Treatment sessions were performed immediately postoperatively and at a subsequent distance of 48 h for 2 weeks (a total of eight sessions). For every patient, bone density was analyzed before and after PBM treatment, in the same areas of interest, within the same anatomical landmarks. A comparison was also made between the results obtained for the anterior maxilla and the posterior maxilla. All the measurements made were analyzed statistically, the results being presented in the dedicated section. Results: Based on the data analysis, the comparison between the lasered and non-lasered groups reveals that patients who underwent PBM showed a statistically significant improvement in bone mineral density, with the mean increasing from 530.91 HU before treatment to 842.55 HU after treatment (t-test: p < 0.001). In contrast, the non-lasered group showed no significant improvement, with a slight decrease in bone mineral density, as the mean dropped from 495.19 HU before treatment to 462.16 HU after treatment (t-test: p = 0.47). Conclusions: The study demonstrated results with statistical significance regarding the mineral bone density improvement of patients who underwent laser PBM treatment. This positive effect of laser therapy has been shown, both at the level of the vestibular cortical bone and at level of the trabecular bone, independent of the patient’s sex, for the anterior maxilla and at the lateral areas also. Full article

Introduction: In patients refractory to vestibular rehabilitation in the management of bilateral vestibulopathy, the cochleo-vestibular implant has emerged as a viable alternative to enhance both audiovestibular function and quality of life. The main objective of this study is to pioneer the use of PET to assess cortical modifications in patients with cochleo-vestibular implants, aiming to evaluate the safety and functional improvements in individuals with bilateral vestibulopathy and severe to profound hearing loss. Methods: A phase I pilot clinical trial was conducted with participants who received a BIONIC-VEST CI24RE cochleo-vestibular implant, with pre- and post-implantation assessments conducted for twelve months. Audiovestibular testing and two PET studies with 18F-FDG under baseline conditions and with active stimulus to observe cortical-level differences were performed. Results: Five patients were included in the study, all of them treated with a cochleo-vestibular implant, none of whom presented postoperative adverse effects. Audiologically, the mean post-implant gain was 56.63 ± 14.53 dB and 50.40 ± 35.54% in terms of speech intelligibility. From a vestibular perspective, the most remarkable findings were observed at the graviceptive pathway level, where a mean posturographic improvement was observed, with a sensory organization test score of 24.20 ± 13.74 and a subjective visual vertical of 1.57° ± 0.79°, achieving, in most cases, results within the normal range (<2.3°) by the end of the follow-up. PET images confirmed that with the electrical stimulus active (implant ON), there was a supratentorial activation pattern, particularly in areas related to somatosensory integration, emotional regulation, and autonomic control. Conclusions: The BIONIC-VEST implant significantly improved the vestibular system, particularly the graviceptive pathway, enhancing balance and SVV and reducing fall risk. PET revealed distinct uptake patterns in baseline and activated conditions, highlighting a cortical-level response with the use of the cochleo-vestibular implant. Full article

Background: Immediate post-extraction dental implants are increasingly popular, but ensuring primary stability and managing peri-implant tissues remain challenging. Implant macro-design significantly impacts stability and osseointegration. This study used Cone-beam Computed Tomography (CBCT) to evaluate changes in alveolar bone following immediate placement of two implant designs, System 2P and Dura-Vit 3P, which feature semi-conical microgeometry and apical self-tapping portions for improved stability and bone regeneration. Methods: With a 1:1 allocation ratio, the current investigation was a two-arm parallel group randomized clinical trial. Patients qualified if they required immediate dental replacements with adequate buccal bone support. Two types of implants were placed: System 2P (cylindrical shape) and Dura-Vit 3P (more conical shape, with a particular architecture of threads). Following the intervention, CBCT was performed both immediately (T1) and six months later (T2). Measurements of CBCT horizontal bone level at apical, medial, and bevel height on the palatal/lingual and vestibular sides as well as the buccal vertical gap were the primary results. Complications, implant stability quotient (ISQ), and torque insertion were evaluated. The Mann–Whitney test was used to determine time-based differences within each group, while the Wilcoxon test was used to estimate differences between groups. The impact of baseline marginal gap dimension and gingival biotype was estimated using multiple regressions. Results: Thirty patients were recruited and randomized to treatments, with two lost to follow-up. One System 2P implant failed and two patients of the Dura-Vit 3P group dropped out. At T1, the Dura-Vit 3P group exhibited a lower mean insertion torque and a higher ISQ than the System 2P group. Furthermore, the Dura-Vit 3P group showed lower bone reduction compared to System 2P at horizontal and vertical measurements with significant differences for the vestibular and palatal base and medial level (p-values < 0.05). Regression models indicated a positive effect of thick biotypes on gap filling and dimensional bone reduction. No complications were observed in both groups. Conclusions: The Dura-Vit 3P implant exhibits high primary stability when inserted in post-extraction sites. Furthermore, this kind of implant stimulates higher bone stability on both the palatal and buccal side when compared to the System 2P implant. The present findings support the evidence that the macro-design of the Dura-Vit 3P implant promotes increased primary stability and reduces bone loss. Full article

Objectives: Congenital hearing loss is a significant health concern, with diverse etiologies encompassing cochlear and cochleovestibular pathologies. Preoperative radiological evaluation in cochlear implant candidates is pivotal for treatment planning. We aim to elucidate the spectrum of radiological findings in patients with congenital hearing loss undergoing cochlear implant assessment. Methods: An analysis included 389 sensorineural hearing loss (SNHL) patients who underwent cochlear implantation at a tertiary university hospital, of which 177 were congenital SNHL. Computed tomography (CT) and magnetic resonance imaging (MRI) data were meticulously assessed for diverse congenital pathologies, focusing on congenital malformations. Results: In the congenital SNHL group, comprising 177 patients (80 females and 97 males), congenital cochleovestibular malformations were evident in 56 ears of 29 cases. Different congenital cochleovestibular malformations, ranging from labyrinthine aplasia to isolated large vestibular aqueducts, were detected. Among the various anomalies, incomplete partitions and cochlear hypoplasia emerged as more frequent patterns. Conclusions: This study offers a comprehensive radiological analysis of congenital SNHL patients undergoing cochlear implantation, revealing a spectrum of anomalies. It demonstrates the diverse nature of anomalies affecting the external auditory canal, middle ear structures, and cochleovestibular system. These insights provide a deeper understanding of congenital SNHL and contribute to developing informed treatment strategies. Full article

Artificial Intelligence (AI) is a concept whose goal is to imitate human intellectual activity in computers. It emerged in the 1950s and has gone through three booms. We are in the third boom, and it will continue. Medical applications of AI include diagnosing otitis media from images of the eardrum, often outperforming human doctors. Temporal bone CT and MRI analyses also benefit from AI, with segmentation accuracy improved in anatomically significant structures or diagnostic accuracy improved in conditions such as otosclerosis and vestibular schwannoma. In treatment, AI predicts hearing outcomes for sudden sensorineural hearing loss and post-operative hearing outcomes for patients who have undergone tympanoplasty. AI helps patients with hearing aids hear in challenging situations, such as in noisy environments or when multiple people are speaking. It also provides fitting information to help improve hearing with hearing aids. AI also improves cochlear implant mapping and outcome prediction, even in cases of cochlear malformation. Future trends include generative AI, such as ChatGPT, which can provide medical advice and information, although its reliability and application in clinical settings requires further investigation. Full article

Background and Objectives: The purpose of this case report is to examine the management of vestibular bone fenestration during alveolar socket preservation using the Periosteal Inhibition (PI) approach. Here, for the first time, the PI technique, which has been shown to be successful in maintaining intact cortical bone, is examined in the context of a bone defect. Materials and Methods: After an atraumatic extraction of a damaged tooth, a vestibular bone fenestration was discovered in the 62-year-old male patient. To shield the defect, a non-resorbable PTFE membrane (OSSEO GUARD by Zimmer Biomet) was positioned between the mucosa and the fenestration site. A resorbable porcine gelatin sponge (SPONGOSTAN^TM) was used to achieve hemostasis, and a 5/0 PGCL absorbable suture was used to close the wound. A CBCT scan was performed, and a dental implant was inserted after 4 months. Results: After 4 months, the case demonstrated positive results, with full cortical remodeling and preservation of the original bone proportions. The fenestration completely healed, proving that the PI approach works even in the presence of bone flaws in cortical bone that is still intact. Conclusions: This is the first case report that shows that vestibular bone fenestration can be successfully treated with the PI approach. It has now been demonstrated that the procedure, which hitherto needed an undamaged cortical bone to work, can help bone abnormalities to repair completely. These results imply that the PI technique is a flexible and useful approach that provides predictable results in dental surgery for treating different types of alveolar bone abnormalities. Its use might be expanded with more study to include bone dehiscence treatment. Full article

Background/Objectives: Cochlear implantation (CI) is an effective intervention for individuals with severe to profound hearing loss; however, it may impact vestibular function due to its proximity to related anatomical structures. Vestibular evoked myogenic potentials (VEMPs) assess the function of the saccule and utricle, critical components of the vestibular system. This review examines CI’s impact on air conduction (AC) and bone conduction (BC) VEMP responses. Methods: A scoping review was conducted following PRISMA guidelines, using databases such as Medline, Embase, Cochrane Library, Scopus, and ProQuest Dissertations. Studies reporting on AC and/or BC-VEMP in CI recipients were included. Data extraction focused on VEMP response rates, amplitudes, and latencies pre- and post-CI. Risk of bias/quality assessment was performed using the Newcastle–Ottawa Scale. Results: Out of 961 studies identified, 4 met the inclusion criteria, encompassing a total of 245 CI-implanted ears. Results indicated that AC-VEMP responses were often reduced or absent post-CI, reflecting the influence of surgical changes in the middle ear mechanics rather than otolith dysfunction. In contrast, BC-VEMP responses were more consistently preserved, suggesting that BC stimuli bypass the middle ear and more accurately delineate otolith function. Variations in VEMP outcomes were noted depending on the surgical approach and individual patient factors. Conclusions: CI impacts vestibular function as measured by VEMP, with AC-VEMP showing greater susceptibility to postoperative changes compared to BC-VEMP. The presence of preserved BC-VEMP alongside absent AC-VEMP underscores the need to differentiate between these measures in assessing vestibular function. Full article

Background/Objectives: The primary aim of this retrospective clinical study was to assess the success and bone gain achieved by using the Fibrinogen-Induced Regeneration Sealing Technique (F.I.R.S.T.) in different indications. Methods: In this single-center retrospective clinical study, F.I.R.S.T. was performed in the following indications: alveolar ridge preservation (ARP), immediate implant placement, and horizontal and vertical guided bone regeneration (GBR) with simultaneous dental implant placement. F.I.R.S.T. is a modified approach to GBR characterized by the application of a porcine cortical lamina, as a long-term resorbable bone barrier to cover the bone defect, and a fibrin sealant for easy adaptation of the xenogenic bone graft material and the fixation of the collagenic bone barrier. Patients with uncontrolled systemic diseases, medications, or diseases that may alter bone metabolism; local inflammation; poor oral hygiene; and heavy smoking were excluded from this study. Horizontal and vertical bone gain (HBG and VBG) were measured by comparing postoperative and preoperative cone beam computed tomography (CBCT) reconstructions. Patients were recalled for controls and oral hygiene treatment every 6 months. Results: Altogether, 62 patients (27 male, 35 female, age 63.73 ± 12.95 years) were included in this study, and 105 implants were placed. Six implants failed during the 50.67 ± 22.18-month-long follow-up. Cumulative implant survival throughout the groups was 94.29 %. In the immediate implant group, HBG was 0.86 mm (range: −0.75–8.19 mm) at the 2 mm subcrestal level, while VBG was 0.87 ± 1.21 mm. In the ARP group, HBG was 0.51 mm (range: −0.29–3.90 mm) at the 2 mm subcrestal level, while VBG was −0.16 mm (range: −0.52–0.92 mm). In the horizontal GBR group, HBG was 2.91 mm (range: 1.24–8.10 mm) at the 2 mm subcrestal level. In the vertical GBR group, VBG was 4.15 mm (range: 3.00–10.41 mm). Conclusions: F.I.R.S.T. can be utilized successfully for bone augmentation. The vertical and horizontal bone gains achieved through F.I.R.S.T. allow for implant placement with adequate bone width on both the vestibular and oral aspects of the implant. Full article

Clinical indications for the Ti-Zr alloy (Roxolid^®) mini-implants (MDIs) in subjects with narrow ridges are still under review. The aim was to analyze peri-implant and posterior edentulous area strains dependent on the MDI number, splinting status, loading force, and loading position. Six models were digitally designed and printed. Two, three, or four Ti-Zr MDIs, splinted with a bar or unsplinted (single units), supported mandibular overdentures (ODs), loaded with 50–300 N forces unilaterally, bilaterally, and anteriorly. The artificial mucosa thickness was 2 mm. Strain gauges were bonded on the vestibular and oral peri-implant sides of each MDI, and on the posterior edentulous area under the ODs. Loadings were performed through the metal plate placed on ODs’ artificial teeth (15 times repeated). Arithmetic means with standard deviations and the significance of the differences (MANOVA, Sheffe post hoc) were calculated. Different MDI numbers, loading positions, forces, and splinting elicited different peri-implant microstrains. In the two-MDI models, 300 N force during unilateral loading elicited the highest microstrains (almost 3000 εμ on the loaded side), which can jeopardize bone reparation. On the opposite side, >2500 εμ was registered, which represents high strains. During bilateral loadings, microstrains hardly exceeded 2000 εμ, indicating that bilateral chewers or subjects having lower forces can benefit from the two Ti-Zr MDIs, irrespective of splinting. However, in subjects chewing unilaterally, and inducing higher forces (natural teeth antagonists), or bruxers, only two MDIs may not be sufficient to support the OD. By increasing implant numbers, peri-implant strains decrease in both splinted and single-unit MDI models, far beyond values that can interfere with bone reparation, indicating that splinting is not necessary. When the positions of the loading forces are closer to the implant, higher peri-implant strains are induced. Regarding the distal edentulous area, microstrains reached 2000 εμ only during unilateral loadings in the two-MDI models, and all other strains were lower, below 1500 εμ, confirming that implant-supported overdentures do not lead to edentulous ridge atrophy. Full article