Department of Oral and Maxillofacial Surgery and Hospital Dentistry
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Item Editorial The insufficient integration of medicine into clinical dental education: a missed opportunity or an ethical dilemma?(Elsevier, 2017) Bennett, Jeffrey; Department of Oral Surgery and Hospital Dentistry, School of DentistryItem Assessing the Medical Emergency Preparedness of Dental Faculty, Residents, and Practicing Periodontists: An Exploratory Study(ADEA, 2018-05) de Bedout, Tatiana; Kramer, Kyle; Blanchard, Steven; Hamada, Yusuke; Eckert, George J.; Maupome, Gerardo; John, Vanchit; Oral and Maxillofacial Surgery and Hospital Dentistry, School of DentistryWith the increased number of elderly and medically compromised individuals receiving dental care and the presence of systemic comorbidities and associated treatment modalities in this patient population, it is imperative that dentists be prepared to manage a variety of medical emergencies. The aim of this study was to assess the knowledge of and preparedness to manage common medical emergencies of cohorts of practicing periodontists, specialty residents, and faculty members, both for comparative purposes and as an aid to refining a dental school’s standardized case scenarios. The study, conducted in 2017, was designed for four groups of randomly selected participants with at least 20 in each group; the actual number of voluntary participants was 28 private practice periodontists, 22 residents in specialty programs, 21 specialist faculty members, and 24 general practice faculty members. Participants were asked to evaluate ten clinical emergency cases and identify the diagnosis and indicated intervention for each. Groups were also evaluated for differences among correct responses for each case. Overall, there were no statistically significant differences for number of correct diagnoses or interventions among the four groups. However, several cases had varying degrees of incorrect diagnoses and management across all groups. Participants who had recently graduated or were still in school were able to treat cases appropriately more often than the other participants. Further refinement of cases to assess provider preparedness to correctly diagnose and manage medical emergencies is needed, specifically establishing case-specific features and addressing areas of potential confusion before the cases are used for educational purposes.Item Number of implants placed for complete‐arch fixed prostheses: A systematic review and meta‐analysis(Wiley, 2018-10) Polido, Waldemar Daudt; Aghaloo, Tara; Emmett, Thomas W.; Taylor, Thomas D.; Morton, Dean; Oral and Maxillofacial Surgery and Hospital Dentistry, School of DentistryObjectives The main purpose of this systematic review was to evaluate outcomes related to the number of implants utilized to support complete‐arch fixed prostheses, both for the maxilla and the mandible. Materials and methods This review followed the reporting guidelines of the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA). A focused question using the PICO format was developed, questioning whether “In patients with an implant supported fixed complete dental prosthesis, do implant and prosthetic survival outcomes differ between five or more compared to fewer than five supporting implants?”. A comprehensive search of the literature was formulated and performed electronically and by hand search. Two independent reviewers selected the papers and tabulated results. Primary outcomes analyzed were implant and prosthesis survival. Implant distribution, loading, and type of retention were observed as secondary outcomes, as they relate to the number of implants. A meta‐analysis was performed to compare results for studies by number of implants. Results The search strategy identified 1,579 abstracts for initial review. Based on evaluation of the abstracts, 359 articles were identified for full‐text evaluation. From these, 93 were selected and included in this review, being nine RCTs, 42 prospective and 42 retrospective. Of the 93 selected studies, 28 reported number of implants for the maxilla, 46 for the mandible, and 19 for both maxilla and mandible. The most reported number of implants for the “fewer than five” group is 4 for the maxilla, and 3 and 4 for the mandible, whereas for the “five or more” implants group, the most reported number of implants was 6 for the maxilla and 5 for the mandible. No significant differences in the primary outcomes analyzed were identified when fewer than five implants per arch were compared with five or more implants per arch (p > 0.05), in a follow‐up time ranging from 1 to 15 years (median of 8 years). Conclusions Evidence from this systematic review and meta‐analysis suggests that the use of fewer than five implants per arch, when compared to five or more implants per arch, to support a fixed prosthesis of the completely edentulous maxilla or mandible, present similar survival rates, with no statistical significant difference at a p < 0.05 and a confidence interval of 95%.Item Bone substitutes in Le Fort I osteotomy to promote bone union and skeletal stability(Elsevier, 2019-05) Zanettini, L.; Polido, W.; Pagnoncelli, R.; Oral and Maxillofacial Surgery and Hospital Dentistry, School of DentistryBackground: Maxillary advancement by Le Fort I osteotomy has become the standard procedure to restore function and facial aesthetics, correct skeletal and occlusal discrepancies and treat obstructive sleep apnea in patients with facial deformities. Incomplete ossification between the bone segments at the jaw osteotomy site has proven to be a major problem in these cases. There are several studies in the literature that address orthognathic surgery, but only a limited number that discuss the use of graft materials in maxillary osteotomy. Bone grafts were introduced in recent decades in order to promote and improve bone union and prevent the formation of gaps.Item Digital planning and guided surgery in dental implants: a case report(Elsevier, 2019-05) Zanettini, L.; Zanettini, P.; Polido, W.; Pagnoncelli, R.; Oral and Maxillofacial Surgery and Hospital Dentistry, School of DentistryBackground: Dental implants are constantly evolving, with several new technologies. Nowadays, it is the most sought after treatment option for individuals who are candidates for oral rehabilitation, improving esthetics and recovering masticatory capacity. Always in search of minimally invasive procedures, dentistry has sought ways to decrease surgical time, decrease morbidity and greater safety of the surgical procedure. Based on these searches digital planning and guided surgery are being widely used, with the possibility of greater predictability and precision in the planning of dental implants, giving greater chances of successful surgery along with the technique performed correctly.Item Short implants: an alternative to bone grafts in the posterior mandible(Dental Press, 2015-10) Zanettini, Leonardo Matos Santolim; Fortuna, Carlos Roberto; Polido, Waldemar Daudt; Oral and Maxillofacial Surgery and Hospital Dentistry, School of DentistryIntrodução: a Implantodontia sofreu grande aprimoramento de técnicas e alternativas de tratamento, visando melhorar a previsibilidade e reduzir a invasividade dos procedimentos. Existem diversos fatores que limitam a colocação de implantes, entre eles um volume insuficiente de osso, que é frequentemente encontrado em pacientes com reabsorção severa de mandíbula. Técnicas de aumento ósseo, tais como enxertos ósseos do tipo onlay ou inlay, regeneração óssea guiada e distração osteogênica, estão entre as mais utilizadas para reabilitar muitos desses casos com implantes. No entanto, essas técnicas aumentam o tempo de tratamento, a morbidade, complicações e o custo. Na última década, o uso de implantes curtos tornou-se de grande interesse para a reabilitação dentária em áreas de volume vertical reduzido. Diversos estudos mostram que os implantes curtos (< 8mm) têm os mesmos índices de perda óssea marginal que os implantes longos, desde que alguns fatores sejam observados, tais como a superfície do implante e o tipo de conexão protética. Recentemente implantes extracurtos foram lançados no mercado odontológico, buscando uma alternativa de tratamento menos invasiva para as atro as mais severas. Objetivo: o objetivo desse artigo é repor- tar a viabilidade e previsibilidade da reabilitação bucal com implantes curtos de 4mm, em região posterior de mandíbula. Conclusões: os estudos revisados e o relato de caso confirmam que os implantes curtos de 4mm oferecem uma alternativa viável para reabilitações em região posterior de mandíbula atrófica. Implantes curtos podem ser usados com segurança e previsibilidade, desde que associados a um planejamento prévio e a uma técnica cirúrgica adequada.Item The Zygoma Anatomy-Guided Approach for Placement of Zygomatic Implants(Elsevier, 2021) Aparicio, Carlos; Polido, Waldemar D.; Zarrinkelk, Hooman M.; Oral and Maxillofacial Surgery and Hospital Dentistry, School of DentistryItem Round and flat zygomatic implants: effectiveness after a 1-year follow-up non-interventional study(Springer, 2022-04-01) Aparicio, Carlos; Polido, Waldemar D.; Chow, James; Davó, Rubén; Al‑Nawas, Bilal; Oral and Maxillofacial Surgery and Hospital Dentistry, School of DentistryIntroduction: There are few zygomatic implants (ZI) designs available. The objective of this non-interventional study was to report the effectiveness of two new site-specific ZI, selected and placed following the zygoma anatomy-guided approach (ZAGA). Materials and methods: Consecutive patients presenting indications for rehabilitation using ZI were treated according to ZAGA Concept recommendations. Implants were immediately loaded following the manufacturer's instructions. Success criteria regarding prosthetic offset, rhino-sinus status, soft tissue condition, and implant stability were additionally used as outcome parameters. Results: Twenty patients were followed for a period of 12 to 28 months (average 18.8 months). Ten received 2 ZI plus regular anterior implants; One received 3 ZI plus regular implants and nine received 4 ZI. In total, 59 ZI were placed, 34 (58%) Straumann ZAGA-Flat design, and 25 (42%) ZAGA-Round. Forty-nine percent of the sites were classified as ZAGA-4 type and 27% as ZAGA-2. Four patients (20%) presented discontinuities of the sinus-nose floor before surgery and 15 patients (75%) presented previous sinus opacities. All implants bar one reached more than 45 N.cm of insertion torque. No surgical complications were observed. After 1 year, the modified Lund-Mackay score was negative in 17 patients. Seventeen sites in 11 patients exhibited decreased opacity when pre-surgical imaging was compared to 1-year post-surgical CBCT. All implants and prostheses remained stable and in function. Conclusions: The study concluded 100% implant/prosthesis survival rates and low complication levels. Within the limitations of the sample and observation period, results suggest that even in cases of extremely resorbed maxillae (as per cases in this study), ZAGA-Flat and ZAGA-Round ZI are viable treatment options when restoring atrophic maxillae following the ZAGA protocol.