Annals of Oral & Maxillofacial Surgery Annals of Oral & Maxillofacial Surgery Oral and maxillofacial surgery: challenges and changes. No abstract available for this editorial. 07/17/2020 08:57:22 pm Role of mesenchyme stem cells in the chondro-osseous graft reconstruction of temporomandibular joint for continuous growth of the mandible and midface. This studies include 37 children treated by reconstruction of the temporo-mandibular joint (TMJ) by chondro-ossous graft from iliac crest for evaluation  the role of granular mesenchyme stem cells in growth of the graft to simulate normal condyle by continues growth potential andl for repair and remodeling, by experimental studies on young rabbits and by clinical application. This techniques been used in treatment of three diseases, ankylosis of temporo-mandibular joint( TMJ),hemi facial microsomia and in cases with traumatic hypoplasia of the condyle. The total number of the cases were 37 patients reported,26 cases with ankylosis they were ten girls and sixteen boys, ten children including 4 females and six male with hemi facial micro somia or first arch dysplasia syndrome and one female case with traumatic hypoplasia of the condyle.Thier age range between 4-13 years (mean 8.5 years) and follow-up between 3-10 years, all cases were treated in maxillofacial unite, surgical specialty hospital, medical city. Baghdad and in author privet surgery. Animal experiments on 6 Rabbits of 3 months of age, reconstruction of the TMJ done after excision of the condyle,3 months later animal scarified and postmortem studies showed macroscopically the chondro-ossous graft was united remolded and healed with the ramus and the head shape was similar to control one, the graft was fixed by stainless steel wire of 0.5 mm did not show any corrosive property, or infection or resorbtion of the bone surrounding the wire or changes in the color of the wire, microscopically there was 4 distinct zones or layers ,the first layer, fibrocartilage layer was thick due to functional demand of  hard masticatory process and the second proliferative layer showed several layers of active round granular mesenchyme stem cells, the third layer showing hypertrophic chondrocyte converted to osteocyte  and the cartilage arranged in multidirectional fashion due to environmental changes of masticatory function requirements instead of vertical columnar growth pattern as in iliac crest as a weight bearing bone and the fourth layer was osteoid  layer with bone marrow in between This valuable research showed the ability of chondro-ossous graft to be a good substitute of the condyle in both growth and function in children. 07/17/2020 08:57:22 pm Role of environmental factors in onset of non-syndromic orofacial cleft in Italian population. Nonsyndromic cleft lip with or without cleft palate is the most common craniofacial anomaly affecting around 1 in 700 live births worldwide. Clefts of the human face can be classified anatomically as cleft palate only (CPO), cleft lip only (CLO), cleft lip and palate (CLP) or a combined group of cleft lip with or without cleft palate (CL/P), based on different in embryologic development. These malformations have a genetic origin, in fact several association studies have been performed to obtain important information about the candidate genes; but more important are gene-environment interactions that play an increasing role in its etiology. Epidemiological studies have shown how environmental factors (alcohol, smoking, drugs), as well as possible gene-environment interactions,play an important role in the onset of the malformation. On the contrary, folic acid intake seems to have a protective effect. In this review we analyze the role of environmental and genetic factors related to onset of cleft. 07/17/2020 08:57:22 pm A brief history and guidelines of blade implant technique: a retrospective study on 522 implants. Introduction Despite initial enthusiasm, blade implants have received bad press over the years due to fairly high failure rates reported in some publications of non-users. Materials and methods A total of  522 blades were inserted in 20 years (1989-2009). 309  in  females  and  213   in  males.  The  median  age  was  59  ±  11  (min-­max  24-­80  years).   The implants were inserted in deep and atrophic narrow crests. Results Success rate was 93.4 % (488/522) globally, 98.9 % (369/373) at 5 years, 89 % (261/293) at 8 years and 86.2 % (200/232) at ten years. These data show very good results at five years, but slightly more failures at eight and ten years. Conclusion The blade implant is a valid therapeutic device useful for treating cases such as narrow bone crest and scarce spongy bone in the lower distal sector. They have been demonstrated long-term survival. Nonetheless, to prevent failure, practitioners should know that blade implants are not indicated in wide alveolar crests, or in areas where bone density is insufficient and the implant cannot be positioned in the deep cortical layer. 07/17/2020 08:57:22 pm Synthetic materials used for the substitution of bone defects: Critical review.   Introduction The need for bone substitution materials has been increased due to teeth loss, trauma, tumour and bone reconstructive surgery. Various types of bone grafts have been developed to repair craniofacial bone defects over many years. Here, an analysis of Russian and foreign sources of literature, reflecting the characteristics of synthetic bone graft materials used in modern dental practice to fill bone defects, has been done. The importance of developing a new generation of synthetic material to replace bone defects is emphasized. We aim to discuss the synthetic materials that can be used as a substitute for bone defects. Conclusion New materials will allow bone tissue regeneration and bone defect reconstruction. We call on more research into this topic so that we can increase our understanding and improve materials we currently use or even discover a better suited material. 07/17/2020 08:57:22 pm Piezoelectric surgery in oral and maxillofacial surgery. Piezoelectric device or piezosurgery device was originally developed for the atraumatic cutting of bone by way of ultrasonic vibrations and as an alternative to the mechanical and electrical instruments that are used in conventional oral surgery. Over the last two decades, an increasing amount of literature has shown that piezoelectric devices are innovative tools and that there is extensive indication for their use in dental implantology and oral and maxillofacial surgery. Recent publications have also shown the benefits of their use in craniofacial surgery, plastic and reconstructive surgery, head and neck surgery, neurosurgery, ophthalmology, traumatology, and orthopaedics. Key features of piezosurgery include the selective cutting of bone without damaging the adjacent soft tissue (e.g. vessels, nerves or mucosa), providing a clear visibility in the operating field, and cutting with micron sensitivity without the generation of heat. The cutting characteristics of piezosurgery are mainly depending upon the degree of bone mineralisation, the design of the insert being used, the pressure being applied on the handpiece and the speed of movement during usage. Therefore, a novice user must know these factors and adapt their operating technique in order to utilize the advantages of piezosurgery. This critical review summarises the basic operating principles of piezoelectric devices and outlines the application areas in oral and maxillofacial surgery that piezosurgery can be utilized supported by clinic examples. 07/17/2020 08:57:22 pm Prospective multicentre study of immediate occlusal loading of implants in edentulous mandibles.   Introduction This study reports the results of a prospective clinical study on immediate loading of prostheses in full arches of edentulous mandibles supported by osseointegrated implants from different brands. Materials and methods The study involved 73 patients. A total of 501 implants were inserted, out of which 420 implants were inserted through immediate occlusal loading. Interim prostheses were placed 4 h after surgery. Final prostheses were placed 6 months after. Marginal bone loss was monitored through linear measurement of the mesial/distal surfaces by means of paralleling (long-cone) periapical X-rays. Results Eight implants failed to integrate in 2 months of occlusal loading. The cumulative success rate was 98.06% from 19 July 1999 to 19 October 2012 (the average being 18–84 months). Crest bone loss around immediately loaded implants was found to be similar to that reported in standard protocols for delayed loading. Conclusion The findings of this study suggest that edentulous mandible rehabilitation through fixed, immediately loaded, occlusal, interim prostheses supported by four, five or six implants constitutes a viable alternative to traditional treatment protocols for delayed loading. 07/17/2020 08:57:22 pm Preoperative assessment of the perforators of the anterolateral thigh flap: a critical review.   Introduction The anterolateral thigh flap is gaining widespread popularity as a workhorse in the reconstructive surgery of head and neck defects. The variation of the perforators is still a challenge in preoperative designing. The aim of this critical review is to introduce the current modalities used in perforators’ mapping of the anterolateral thigh flap and evaluate their strengths and weaknesses. Methods The Web of Science database was used in this review. This review examined literatures that assess the accuracy, strengths and weaknesses of new techniques used in the preoperative assessment of anterolateral thigh flap perforators. Search terms included anterolateral thigh flap in combination with computed tomography angiography, handheld Doppler, colour duplex sonography, computed tomography-guided stereotaxy and magnetic resonance angiography. All literatures were found between 2002 and 2012 in English language. Results A total of 20 papers were reviewed according to the refined search. Although the handheld Doppler is non-invasive and portable, it often misidentifies or misses vessels, especially in evaluating small perforators, making this modality unreliable. Colour duplex sonography provides high spatial resolution of superficial perforators. Computed tomography angiography, computerised tomography-guided stereotaxy and magnetic resonance angiography provide the best three-dimensional images and have become the most advanced modalities used to assess the accurate anatomy of the donor site, of the anterolateral thigh flap. Conclusion Given the requirement to improve the outcome of anterolateral thigh flap reconstructive surgery, preoperative assessment of the perforators is essential. The ABC assessment system combined with colour Doppler/computed tomography angiography will facilitate an ideal individual assessment of this perforator flap. 07/17/2020 08:57:22 pm Current trends in the management of maxillofacial gunshot injuries: a critical review.   Introduction Firearm injuries continue to be a major public health problem. Herein, we review and evaluate the current trends in the management of maxillofacial gunshot injuries. Conclusion Ease of reduction and fixation of fractures, easier restoration of occlusion, prevention of contracture and displacement, ability to reduce displaced or avulsed teeth, early mandibular mobilization, less scarring, less anxiety and shorter hospital stay are among the many benefits associated with comprehensive definitive management of maxillofacial gunshot injuries. 07/17/2020 08:57:22 pm Oral leukoplakia: What is achieved by surgical treatment? The surgical management of patients with oral leukoplakia (OL) is discussed herein. Molecular changes in OL or in adjacent “clinically normal mucosa” may influence the persistence/recurrence of OL, affording an opportunity for transformation to squamous cell carcinoma. Clinicians must understand that available treatment options are limited in their capacity to prevent oral cancer. 07/17/2020 08:57:22 pm Membranes for guided tissue and bone regeneration. Since the clinical use of dental membranes in the mid 1980s, guided bone regeneration procedures have become the standard in dental surgeries requiring space provision. A number of advancements have been made over the past 20 years in terms of their fabrication development. This review article discusses original PTEF non-resorbable membranes and more recently the innovative techniques employed to alter resorption periods in resorbable membranes. Furthermore, insight into future developments in membrane fabrication as well as platelet rich fibrin membranes are discussed that will direct the next generation of guided bone regeneration. 07/17/2020 08:57:22 pm Biostimulation and biorevitalization: effects on human skin fibroblasts. Introduction: Aesthetic medicine uses many injective techniques. Among them are Biostimulation (BS) and Bio-revitalization (BR). The term BS indicates a stimulation of the anabolic functions of dermal fibroblasts such as replication, protein synthesis and extracellular matrix components (ECM) production. BR instead uses the same injective technique but different medical devices. It is a direct supplementation of hyaluronic acid (HA) alone or added to other molecules. (i. e. vitamins). Materials and Methods: In order to verify the different metabolic effect of BS and BR fibroblast cell cultures, RNA extraction, cDNA synthesis and PCR were performed. Results: BS and BR produce different metabolic effects in 24 hours fibroblast cell cultures thus showing that are different therapies. For example Neutrophyl Elastine is activated by the BS and less by BR instead Hyaluronan Synthase 1 is more activated by BR using the medical device with the lowest HA content. Neutrophil Elastase (ELANE), responsible of degradation of one of the fibrillar component of ECM, is less activated by BS. Discussion: Additional experiment using more time points (i.e. not only 24 hours of cell cultures but also 12, 48 and 72 hours) are necessary to give additional insights as regard early stages of fibroblast response to BS and BR. A better comprehension of fibroblast biology will give a proper clinical application of BS and BR. 07/17/2020 08:57:22 pm Adipose-derived stem cells secrete neurotrophic factors. Introduction: Structural fat grafting is a widely approved technique in craniomaxillofacial reconstructive surgery used to treat several kinds of diseases including congenital and post traumatic deformities, and to fill out tissue depression due to orbital and periorbital surgery, scars or cancer resections. Adipose tissue is considered a secreting organ which produces special proteins named adipokine and including neurotrophic factors as nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF). Given their role in stimulating repair of peripheral nerves, their expression could influence the good outcome of a structural fat grafting. Materials and methods: In this study we compared the ability of adipose derived stem cells (ADSCs) and adipocytes, obtained from the same patient, to secrete these two neurothophic factors. The expression levels of NGF and BDNF were measured by using Quantitative Real-Time Polymerase Chain Reaction. Results: Stem cells show up-regulation of BDFN and NGF respect to adipocyte. Discussion: These result demonstrated that adipose tissueis an abundant and easily accessible wealth of Mesenchymal Stem Cells and that these cells are the responsible of the production of NGF and BDFN, two neurotrophic factors involved in tissue and nerves repair. 07/17/2020 08:57:22 pm The correction of nasal septal deviations in rhinoplasty. Background: Septoplasty is a commonly performed procedure that provides an effective treatment of nasal septum deformities. It has become an essential issue in nasal surgery for both functional and aesthetic reasons. The traditional septoplasty approach is often unsuitable for severe septal deviations. In such cases, extracorporeal septoplasty has been credited to obtain more reliable outcomes. However, this technique has received some criticisms because of the destabilization of the keystone area. Due to the increasing number of techniques available, an overview of the cosmetic and functional results of such methods is reasonable. In addition, a comparison of the outcomes of the different techniques may shed further light on which is the best method to correct severe septal deviations. Methods: A review of the literature on the evaluation of the main septoplasty techniques has been conducted. The procedures were evaluated and compared for indications, contraindications, advantages and disadvantages. Conclusions: The classic septoplasty approach often appears inadequate in cases of marked septal deformations due to the increased risk of recurrence. From the review the extracorporeal septoplasty technique seems more reliable in such cases. In particular, the modified conservative approach has demonstrated to achieve an adequate septum remodeling with cartilage spare and to avoid post-operative dorsum irregularities compared to the more traditional techniques. 07/17/2020 08:57:22 pm ‘One-piece’ immediate-load post-extraction implants in labial bone-deficient upper jaws. Introduction Contusive trauma or malocclusion-related periodontal disease can severely compromise the upper anterior teeth, leading to labial bone resorption and ultimately loss of function and unsightly root exposure. To resolve these issues, we propose the replacement of compromised teeth using one-piece immediate-load post-extraction implants. These can be implanted and fitted with customized temporary crowns in a single surgical procedure, restoring function and aesthetics and consenting recovery of the bone deficit with reduced healing times and limited patient discomfort. Materials and Methods One-piece wide-diameter titanium screw implants with thread measurements of 3,5 and 4,5 mm with one abutment of 2,5 mm respectively, were positioned and splinted by intraoral welding. Results and Conclusions  These implants yielded satisfactory functional and aesthetic outcome in bone-deficient upper anterior sectors, without invasive regenerative procedures. The low invasiveness of this approach also consents rapid healing, reduced biological burden and greater patient benefit. 07/17/2020 08:57:22 pm Future of surgical oncology in maxillofacial surgery. No abstract available for this type of article. 07/17/2020 08:57:22 pm A retrospective study on needle implants positioned in the posterior inferior sector: surgical procedure and recommendations. Introduction: The titanium needle implants received great enthusiasm at the time of presentation, but have recently received negative publicity due to unusual technique and because it requires a specific instrument to be used, such as the intra-oral welding instrument. Materials and methods: A total of 351 implants were placed during a17 year period (1996-2012) in the posterior inferior sector and welded to a titanium bar using the intra-oral welder. The implants were inserted in atrophic ridges of the D3-D4 bone and were all loaded immediately with a temporary prosthesis. Results: Overall success of the implants investigated during the years 1996-2012 was 97.1% (341/351); five year success rate was 99% (266/299); ten year success rate was 95.8 % (138/144). Progressive thickening of the bone around the implants was observed. Conclusions: Titanium needle implants can be used with immediate loading in the posterior atrophic sector, especially in elderly people, in the zone below the maxillary sinus, in the upper front area. They also give stability to other implants. In all cases, intra-oral welding is necessary and requiresspecific clinical training. Needle implants are not suitable for deep and wide ridges containing dense spongy bone. 07/17/2020 08:57:22 pm Surgically-guided zygomatic and pterygoid implants—a no-grafting rehabilitation approach in severe atrophic maxilla—A case report We present a case report of a successful surgical approach in extreme maxillary atrophy without bone grafting. Six osseointegrated dental implants were positively positioned exploiting the residual atrophic bone: 2 in the canine region, 2 zygomatic implants placed using the sinus slot approach, 2 in the pterygomaxillary region. The procedure used to identify the correct placement of the fixtures is of particular interest. A high-definition computed tomography (CT) scan had been taken purely for diagnostic purposes and this was used to make a stereolithographic model. The surgical approach was simulated and then carried out directly on a solid acrylic resin model. An extremely precise surgical template was then developed and used to transfer the surgical approach for positioning implants to real bone. The Patient was already wearing a complete upper denture, and this was modified to become a temporary denture during the period of osseointegration. No immediate loading was performed. Four months after surgery, the implants were loaded, and an excellent aesthetic and functional result was achieved with no increase in bone volume from bone grafts. The entire residual bone was used as anchorage for the implants. The excellent results achieved demonstrate that zygomatic implants in association with other conservative and guided surgical approaches are a valid alternative to bone grafting in treating severe atrophic and edentulous maxillae. 07/17/2020 08:57:22 pm Hydraulic sinus lift technique: description of a clinical case. In this work the authors describe a new method, indicating in the maxillary sinus lifting through a crestal approach, characterized by the hydraulic detachment of the mucosa and simultaneous filling of the sub-schneiderian space, with a graft material of a pasty consistency. A specific instrument is used, made for this purpose, consisting of a syringe with a micrometrically controlled piston connected with a dispenser used to inject, in a calibrated and precise manner, noted volumes of graft material, of a pasty consistency, into the sub-schneiderian space. 07/17/2020 08:57:22 pm Correct use of artificial gum for implant-assisted prosthesis. Treating the anterior segment of both jaws in complex clinical cases is always difficult, even with clear diagnostic parameters and in spite of following a sensible treatment plan. Completing a bone and soft tissue graft and conditioning them in a second stage surgery does not guarantee the success of the treatment: in some cases, it is necessary to resort to prosthetic devices such as artificial gum. 07/17/2020 08:57:22 pm Periodontal tissue generation using autologous dental ligament micro-grafts: Case report with 6 months follow-up. Introduction In the last years, the stem cell research has found several problem in transferring the scientific models into clinical practice. For this, it has devised a new clinical process of tissue regeneration, through, autologous micro-graft, it named RIGENERA. Using Rigenera, the patient is at the same time, donor and the acceptor of calibrated micro-graft rich of stem cells. This system permit to increase the stem cells number in the surgical site that needed to be regenerated. Thiscase report was performed to analyze the clinical outcomes of an innovative treatment protocol of deep intra-osseous periodontal defects using dental ligament micro-grafts loaded onto collagen sponges as filling biomaterial. Method Selected a healthy female patient with 2 intraosseous defects distal to second lower molars, due to mesio-impact of both vital third molar included.We used the two defect, one as a test site (cell suspension + collagen sponge scaffold) and the other, as a control site (only collagen sponge scaffold).Clinicaland radiographicexamination was performed at baseline and at 1 week, 1,3, 6 months after surgery. Discussion The x-rays performed at  3 and 6 months show a significant differencesbetween the control site and test site: this latter presented a increased of the mineralization rate, and the complete filling  the coronal component of the defect respect the control site. Conclusion This results indicates that the autologous stem cell obtained from connective tissue could be used to provide the basis for bone regenerative surgery, with limited sacrifice of tissue, low morbidity at the collection site, and significant reduction in time needed for clinical recovery. 07/17/2020 08:57:22 pm Treatment of peri-implantitis: Non-surgical therapeutic approaches. The prevalence of peri-implant complications will increase as dental implant-retained prostheses become routine.  Peri-implant diseases present in two forms:  peri-implant mucositis and peri-implantitis. Plaque-induced mucositis is a reversible inflammation of the peri-implant gingiva and responds satisfactorily to nonsurgical treatment.  It is generally accepted that mucositis will eventually give rise to peri-implantitis, with inflammation encroaching on the alveolar support.  Depending on the severity of peri-implantitis lesion, surgical or non surgical procedures should be implemented . Based on the diagnosis, continuously made during recall visits, a maintenance system termed Cumulative Interceptive Supportive Therapy (CIST) has been followed in this manuscript, further expanding the nonsurgical protocols, including the adjunctive use of the diode laser.  Long-term maintenance care for high-risk groups is essential to reduce the risk of peri-implantitis. Informed consents for patients receiving implant treatment must include the need for such maintenance therapy. When surgical treatment is contraindicated or not accepted by the patient, it is essential to implement nonsurgical therapy, well aware, however, of unpredictable results. 07/17/2020 08:57:22 pm Solitary fibrous tumour of the buccal mucosa: Morphological and histopathological differences and similarities in relation to other spindle cell neoplasms. This case report describes an unusual tumour of the oral and head neck region – the Solitary Fibrous Tumour (SFT). This patient presented with a relatively fast growing lump in the right bucca. It was initially diagnosed as a dermofibrosarcoma and a secondary operation was performed with extended excision. The  final diagnosis was later changed to SFT by the pathologist. The histopathological features of the SFT and resemblance with other spindle cell tumours are discussed. 07/17/2020 08:57:22 pm Maxillary sinus grafting: A proposal for avoidance of postoperative complications. According to the literature, it is well known the occurrence of post operative sinusitis, in conjunction with maxillary sinus graft, appears to be limited to patients with a predisposition for this. In order to prevent post and also intra operative complications it is essential to be able to precise anatomical particularities and to diagnose the health status of maxillary sinus prior the grafting procedure. A team approach gathering the implant surgeon and the ENT specialist to identify those parameters is crucial for the patient selection and the prevention of complications. 07/17/2020 08:57:22 pm Reconstruction of composite oromandibular defects with a rib-major pectoralis myocutaneous flap carrying costal parietal pleura: a forgotten option? Reconstruction of composite oromandibular defects of oral malignancy is a challenging problem for oromaxillafacial and plastic surgeons. Revolutionary microvascular surgical techniques permit surgeons to use two free flaps in one stage, one for the bone and inner lining and one for the skin or soft tissue. But in some case with poor quality of recipient vessel site and heavily irradiated neck condition, these flaps also have some problems, especially in ablative surgical cases with large soft tissue loss. In this paper, a rib-major pectoralis myocutaneous flap was used to reconstruct a composite oromandibular defect with excellent cosmetic and functional outcome. It provided a suitable and cost-effective reconstruction with low microsurgical risk, relatively short operative time, sufficient soft tissue replacement, and minimum donor site morbidity. This reconstructive method of this compound osteomyocutaneous flap should not be forgotten when two free flaps in one reconstructive stage are gaining in popularity recently. 07/17/2020 08:57:22 pm Is platelet-rich fibrin really useful in oral and maxillofacial surgery? Lights and shadows of this new technique The healing of hard and soft tissues is mediated by a wide range of intra and extra-cellular events that are regulated by protein signals. It is known that platelets are involved in the process of wound healing through blood clot formation and release of growth factors that promote and maintain the wound healing. Platelet Rich Fibrin (PRF) is a second generation of platelet concentrates which allows to get fibrin membranes enriched with platelets and growth factors, starting from an anticoagulant free blood harvest. PRF is similar to a fibrin network that allows cell migration and proliferation and consequently a more efficient cicatrisation. Many growth factors such as platelet-derived growth factor (PDGF) and transforming growth factor (TGF) are released from PRF. Recent studies have demonstrated that PRF has a very significant slow sustained release of key growth factors, which means that PRF could stimulate the surrounding environment to a more rapid wound healing. This review aims to analyze the clinical results of PRF in periodontology, oral surgery and head plastic surgery. 07/17/2020 08:57:22 pm Oral rehabilitation with implant-supported overdenture in a child with hypohidrotic ecto-dermal dysplasia. Ectodermal Dysplasia syndromes (EDs) are a heterogeneous group of inherited diseases characterized by abnormal development of tissues of ectodermal origin. The most common form of EDs is X-linked Hypohidrotic Ectodermal Dysplasia (XL-HED) characterized by abnormalities of the skin, teeth, hair and sweat glands. The intraoral abnormalities include hypodontia, malformed teeth (conically shaped) and reduced alveolar ridge height. It causes severe impairment of chewing, swallowing, speech, esthetics and affects social relation. Early dental treatment at 2-3 years is essential to improve oral function and reduce the social impairment. This may include resin bonded restorations to conventional prosthetic treatment. In some cases suffering from severe hypodontia, however, conventional prostheses are inadequate due to lack of retention and instability. The replacement of teeth by implants is usually restricted to patients with completed craniofacial growth; however implants can be used as abutments for overdentures. The present study reports a 9-year follow up case in a child affected with XL-HED accompanied by anodontia. At 2 yrs of age, conventional upper and lower removable prostheses were fabricated. Subsequently, at age 11 years and 11 months; the patient was treated with a lower implant supported overdenture placed on two tapered implants (3.8 x 10 mm) in the anterior mandible. CBCT (Cone Beam Computer Tomography) of the mandible was done and dicom data used to obtain a rapid stereolithographic model. 07/17/2020 08:57:22 pm Reconstruction of the lip commissure with upper and lower lip full-thickness defects using submental and nasolabial flaps: a case report. Lip carcinoma is considered the most common oral cavity malignancy, representing about 30% of all oral cavity malignancies. The treatment of lip carcinomas is mainly by surgical removal, and less frequently by radiotherapy or a combination of these two methods. Surgical excision of larger lesions of the lips and/or oral cavity usually creates a two dimensional or three dimensional defects. The reconstruction of such defects is technically challenging. Local flaps are often not sufficient and also regional flaps have the disadvantages of being too bulky, have a limited reach and may require a second session for refashioning and division of the pedicle. The only satisfactory method of reconstruction of such extensive defects is the use of free vascular flaps. In this case, we describe the results of reconstructing a commissure defect extending to adjoining parts of both lips and inner buccal mucosa using extended superiorly based nasolabial flap and submental flap. 07/17/2020 08:57:22 pm Comparative outcome assessment between secondary and tertiary alveolar cleft grafting. A retrospective comparison between secondary and tertiary cleft patients. Twelve patients with unilateral alveolar clefts were included divided according age at the time of ACG between two groups. Group I included secondary ACG patients while group II included tertiary ACG counterparts.  All patients received a mandibular symphyseal graft augmented with allogeneic demineralized freeze dried graft. Review of the clinical and CBCT volumetric radiographic assessment at six months and then at one year interval was performed.  Statistical analysis of the volumetric data was performed. The total mean graft volume for group I during follow up period was 162.60 mm3 while that of group II during follow up period was 178.79 mm3 . However, the mean of resorption throughout the study in the group II exceeded that of the group I . There was no statistical significant difference regarding the mean of graft resorption.  Secondary alveolar grafting procedures appear to have enhanced clinical and volumetric results than tertiary grafting on long term in spite of the lack of statistical significant difference. 07/17/2020 08:57:22 pm Pedicled latissimus dorsi myocutaneous flap for large neck defect reconstruction. In the last decade, pectoralis major myocutaneous flap has became the most frequently-used flap to reconstruction of large complex defects in head and neck. Recently, a new method called pedicled latissimus dorsi myocutaneous flap has became a new option. In this paper we report a case of a 23-year-old woman with a recurrence of malignant schwannoma in her right neck, used this kind of flap to reconstruct the large defect, and proved the pedicled latissimus dorsi myocutaneous flap is a good choice. In this review, the advantage of pedicled latissimus dorsi myocutaneous flap is summarized. 07/17/2020 08:57:22 pm Hemifacial reimplantation in surgical treatment of maxillary sinus cancer: A case report. Introduction. Tendency of cancer of the mucous membrane of the maxillary sinus to persistent recurrence, relatively high resistance of the most of them to radio- and drug therapy define complexity of treatment of this oncological pathology. At the present time expanded surgery in combination with chemo- and radiotherapy allows achieving high oncological und functional outcomes. Case report.  Here we describe the case of 28-year-old patient T. with locally advanced low differentiated squamous cell carcinoma of the mucous membrane of the maxillary sinus. During the first stage of complex treatment 4 courses of chemotherapy were held. Further preoperative radiotherapy ROD-10 was conducted. Then bloc-resection of the left upper jaw with left orbital exenteration, plastic with displaced muscle graft, reimplantation of facial tissue with microsurgical grafting of the facial nerve on the left was performed. No complications were observed. Follow-up was 6 months long. Cosmetic and functional results are satisfactory. Discussion. Using this approach during surgery on maxilla for locally advanced tumors provides more detailed visualization of facial skull structures which facilitates radical operation. Excellent visualization and skin preserving technique promotes good cosmetic and functional results. The functional rehabilitation in such patients significantly increases their life quality. 07/17/2020 08:57:22 pm Role of preemptive use of mannitol in reducing airway edema following maxillofacial and radical neck surgeries. Background: Major head and neck surgeries especially in difficult airway patients have a great hazard for postoperative laryngo-pharyngeal edema and airway obstruction. In this prospective study, mannitol was administrated intraoperatively in an attempt to reduce airway edema and hence post-extubation airway collapse and obstruction. Patients and methods: 200 patients undergoing maxillofacial and radical neck surgeries were randomly allocated into 2 equal groups .1-Group M : in which 0.25 gm /Kg mannitol was given after intubation and 30 minutes before end of surgery . 2- Group C: in which similar volume of the infused mannitol but of lactated Ringer was given in the same time points . Cuff-air leak test, Flexible Fiberoptic laryngoscopic assessment of the upper airway before extubation , post-extubation clinical evaluation of upper airway obstruction and incidence of post-extubation stridor(PES) have been conducted to evaluate airway edema. Results: The total mean cuff –leak volume was significantly higher in Group M than in the Group C. The incidence of moderate upper airway lesion was statistically significant lower in mannitol group than in control group .The incidence of PES (after failed cuff-leak test was 4/17 (24%) in mannitol group and 6/26(23%) in control group after passed cuff-leak test was 2/83 (0.02%) in mannitol group and 4/74(.05%) in control group). Conclusion: preemptive use of mannitol in maxillo-facial and radical neck sergeries is effective and nearly side effects free maneuver to reduce airway edema and postextubation airway obstruction. 07/17/2020 08:57:22 pm New concept and technologies in mandibular reconstruction: A case report. Mandibular reconstruction with fibula free flap is today the gold standard for functional and aesthetic rehabilitation after oncological surgery. There has been rising interest in virtual surgical planning and computer assisted mandibular reconstruction (CAMR) for preoperative planning and execution of osseous free flap. CAMR fosters multidisciplinary communication and provides accurate pre-surgical planning; this allows seamless reconstruction in patients requiring mandibular reconstruction via fibula free tissue transfer.In this paper we present a case report of a mandibular reconstruction programmed with these new technologies. We posit that using CAMR and virtual surgical planning for mandible reconstruction after ablative surgery will significantly improve the functional results, allowing for accurate recovery of function and facial contour and decreasing surgical time. 07/17/2020 08:57:22 pm Blade implants in the rehabilitation of severely atrophic ridges. Introduction: The conception of the endosseous blade implant arose from the intuitions of LI. Linkow and R. Roberts. Given the thinness of the blade, this implant can be used in any alveolar crest, but it is particularly useful in the thinnest, where the use of root-form implants is difficult and needs bone regeneration procedures. Methodology: This report involved five centers located throughout the Italian country from year 1972 to 2013. The clinicians used a specific surgical protocol; in some cases was used a variation of the original technique like “Endosseous Distal Extension” (EDE) for the treatment of lower posterior sectors in the presence of low-density bone. In presence of satisfactory primary stability, the blade implants were loaded immediately. Discussion: The blade implant allow simple surgical technique performed with standard instruments, valorization of existing tissue and  can be used without bone expansion and regeneration procedures. Also, it is possible  the mechanical correction of parallelism issues during implant surgery and the blade implant can be immediately loaded if adequate stability has been achieved. Conclusion: The blade implant is an effective therapeutic device that is useful in the implant and prosthetic rehabilitation of severely atrophic ridges with a reduced trabecular component, especially, in the lower posterior sectors. The distally extended type can be employed in the posterior sectors, both upper and lower, while in the front aesthetic area and in the lateral sectors the blade can be used when an alternative device would entail less predictable and more invasive procedures. The response of the soft tissues surrounding this type of implant is excellent. 07/17/2020 08:57:22 pm Surgical correction of trigonocephaly in Jacobsen syndrome. Jacobsen syndrome is a condition caused by a loss of genetic material from chromosome 11. Because this deletion occurs at the end (terminus) of the long (q) arm of chromosome 11, Jacobsen syndrome is also known as 11q terminal deletion disorder. Patients have a spectrum of malformations of the heart, kidney, gastrointestinal tract, genitalia, central nervous system and skeleton. Trigonocephaly is a typical feature of skull deformity. Due to the complex pattern of the malformations and the wide spectrum of clinical features the surgical correction of trigonocephaly is challenging. The surgical correction technique of trigonocephaly in an 8-month-old infant with Jacobsen syndrome is reported. 07/17/2020 08:57:22 pm Incidence of long-lasting neurosensory disturbances after bilateral sagittal split osteotomy: A questionnaire study. Introduction - The aim of the present study was to highlight the incidence and patients’ subjective perception of neurosensory disturbance (NSD) and the degree of satisfaction after bilateral sagittal split osteotomies (BSSO), at least three years after surgery. Material & Methods – The sample population was consistedof all 52 consecutively operated subjects whom had undergone BSSO between the years 2003–2008 at the Department of Maxillofacial Surgery at Örebro University Hospital. Patients were contacted by a letter and asked to complete a questionnaire about perceived sensory changes after the operation and their satisfaction with the result of the operation. Discussion - The lack of standard methods for evaluating NSD is evident. Thus, the evaluation methods in the literature vary from strictly subjective to strictly objective. However, the most important factor, from the patient’s point of view, must be the patient’s own perception of the nerve impairment, not what the objective results indicate. Conclusion - Half of the operated subjects had long-lasting NSD. However, the majority of the patients  (89%) were satisfied with the result of the operation despite sensory disturbances of some degree. It appears that NSD is not the main determining factor of patient satisfaction and seems outbalanced by pre-operative information and results of function and esthetics. 07/17/2020 08:57:22 pm Simplified protocol using a translucent transference guide in immediate implant loading in the edentulous mandible. Immediate implant loading in edentolous mandible is supported by numerous studies demonstrating predictability and a success rate similar or even greater than the conventional load. The purpose of this article is to report a protocolized technique that places 4 to 6 rough-surface implants in the mandible by means of a Translucent Transference Guide (T.T.G.).  The use of this device simplifies the location of implants, their transference and the taking of aesthetic and intermaxillary records. Screwed prosthesis is done by the dental technician and the implants were loaded within 72 hours. This article describes the pre-surgical, surgical and prosthetic stages, elaboration of the prosthesis, installation and subsequent tests. A total of 20 patients (111 implants) were placed with this protocol and were  controlled for 18 months (+-3). The survival rate of the implants was 100% and the prosthetic success was 95%. 07/17/2020 08:57:22 pm The effect of regional nerve blockade on the incidence of trigemino cardiac reflex in TMJ surgeries due to use of bi-block prosthesis. Background:Ankylosis is a serious and handicapping problem and has been associated with a lot of hazards from chewing problems and malnutrition up to frank sleep apnea syndrome (OSA) and life threatening upper air way complications during anesthesia. On the other hand, trigeminocardiac reflex (TCR) consists of dysrhythmias, hypotension, apnea and gastric hypermotility. Clinically, it is encountered in cranio-maxillo facial and occular surgeries. In this study we try to study the incidence of TCR due to forcible mouth opening by bi-block prosthesis following TMJ procedures after regional nerve blocks of maxillary and mandibular nerves. Methods:100 patients enrolled for TMJ surgeries are grouped into 2 groups each contains 50 patients, control group (C-group) and nerve block group (NB-group) in which maxillary and mandibular nerves are blocked. Acrylic – bi-block prosthesis is inserted. The incidence of TCR (which is defined by a drop in both HR and MABP > 20% of the base line values), also lowest H.R, occurrence of asystole, dysrhythmias and lanyngospasm, all are reported intraoperatively. Results: There is significant drop of incidence of TCR in NB group (0%) compared to the C-group (2/50 – 4%). The lowest H.R. is insignificantly higher in the NB-group (49+3) Than the C-group (44+2). There were no hemodynamically significant  hypotension, arrhythmias or laryngospasm. Conclusion: Prophylactic nerve blockade at end of TMJ procedures and before bi-block prosthesis  application  is efficient to recduce the incidence of TCR. 07/17/2020 08:57:22 pm Ultrastructural changes in the parotid gland of rats after intraglandular injection of botulinum toxin A. Background and purpose: Intraglandular injection of BoNT-A into the salivary glands are effective for sialorrhea in children with cerebral palsy or other neurological disease without any severe side effects. It leads to a transient denervation of the gland and this is associated with reduced salivary secretion. The aim of this study was to evaluate the histological changes of the rats’ parotid glands after accidental or intended intraglandular  injection of BoNT-A in patients with bruxism or sialorrhea. Experimental approach: After 20 days of the experiment, tissue specimens of the right parotid gland taken from 15 albino rats after intraglandular injection of BoNT-A while the left parotid gland was used as a control. Ordinary light microscopy and electron microscopy were used to detect the morphological changes of the injected parotid glands. Key results: Morphological and ultrastructural analyses of the cell organelles and secretory granules showed a clear atrophy of the acini in glands injected with the BoNT-A. Acinar cells revealed highly morphologic variations of rER and degenerated mitochondria. The secretory vacuoles appeared highly variable in size, in shape and in electron density. The nucleus had an irregular shape and finely dispersed chromatin. Conclusions: Intraglandular application of BoNT-A induces structural and functional changes of the salivary glands indicated by glandular atrophy. Thus, injection of Botox-A into the salivary glands at a relatively low dose can be used to treat sialorrhoea. This is an easily performed procedure with low morbidity and can be recommended as a first-line intervention in the treatment of adult sialorrhoea. 07/17/2020 08:57:22 pm Oral squamous cell carcinoma after allogeneic hematopoietic stem cell transplantation: A report of 2 cases. Hematopoietic stem cell transplantation (HSCT) has improved the survival rate of patients with different malignancies and other haematopoiesis disorders. However, late complications such as oral squamous carcinoma (OSCC) have been described. Chronic graft-versus-host disease (cGVHD) and long-term immunosuppression are important risk factors for the development of OSCC. This report describes two cases of secondary OSCC diagnosed early in patients with cGVHD. The clinical and histopathological findings, risk factors, and treatment are discussed. 07/17/2020 08:57:22 pm Retroseptal structural fat grafting to correct paediatric post-traumatic enophthalmos. INTRODUCTION Orbital volume deficiency is caused by various diseases and it can be present in different clinical scenarios. Orbital volume replacement in the post-traumatic enophtalmos is currently addressed by different surgical methods. Several autologous tissues and alloplastic materialshave been used. The purpose of this article is to introduce our experience in the management of 8 complex cases of post traumatic enophthalmos treated successfully by retroseptal autologous fat grafting. Methodology:To address the research purpose, we designed a retrospective case series. Our study was based on 8 patients (mean age 10,5 years: range, 5-16 years; 6 males and 2 females)  who underwent fat grafting for postoperative orbital defect. All patients had monolateral amaurosis and post-traumatic enophthalmos. Postoperative follow-up was recorded at 1 week and at 1, 3, and 6 months and 12 monthswith an accurate physical examination and clinical photography. We evaluated the outcome of these surgical procedures by measuring the morphological change of the face with a software package (Adobe Photoshop, Microsoft Corporation, CA). The preoperative photograph of the healthy side of the face has been reflected with the software to obtain the virtual ideal face (VIF). Postoperatively, we compared the VIF with the postoperative photograph. We obtained a similar facial morphology in 6 patients. DISCUSSION Fat grafting in the intraconal space has been described in the treatment of enophthalmic orbit using a sharp needle. Hunter investigated the effects of intraconal fat grafting in patients with post-traumatic enophthalmos; it was used either in patients with healthy eyeball or in those with anophthalmic socketshe stated that enophthalmos is stabilized within the first 3 months with this technique. He obtained overall good results, but in 64% of cases, multiple injections were necessary. Maletdescribed a consistent number of patients with anophthalmic sockets treated by injection into the deep upper eyelid sulci. Hardydescribed a retrospective study on 12 patients with anophthalmic and enophthalmic orbital cavity. Fat grafting can be safely carried out in the treatment of the enophthalmic orbit. It has long-lasting effect and can be a valid alternative to other autologous tissues or alloplastic materials. 07/17/2020 08:57:22 pm Composite polymer-coated mineral grafts for bone regeneration: material characterisation and model study. Bone xenografts were coated with degradable synthetic (poly(L-lactide-co--caprolactone), PLCL) and natural (polysaccharides) polymers in order to increase their mechanical properties, on one side, and to improve cell adhesion, on the other, with the final purpose to develop a novel composite material for bone tissue engineering. In vitro assays examined the microstructure of the scaffold by FT-IR and ESEM analyses and the porosity of the material by micro-computed tomography. The good adhesion of polymer coated onto the mineral scaffold was deeply analyzed and proved. The in vitro polymer degradation, in terms of time evolution of polymer coating thickness, was rationalized with a mathematical model: the purpose of such modeling activity is to provide a simple but powerful tool to understand the influence of design parameters on coating behavior. The fabricated bone graft exhibited regular microstructure similar to healthy iliac bones with an average 27% open porosity and an adequately rigid structure, which ensures a better osteointegration once implanted. 07/17/2020 08:57:22 pm Efficacy of platelet rich plasma in oral surgery and medicine: An overview. Advancements in medicine demand less invasive therapies and faster recovery times for large-area skin damage caused by burns, large ulcers, and tumors. To cover the wound and aid in the recovery process Platelet Rich Plasma (PRP) is often used as adjuvant for skin grafting. Platelet Rich Plasma (PRP) is a growth factor-enriched platelet concentrate and is obtained from whole autologous blood by utilizing density-gradient centrifugation. The platelet concentration of PRP is 4 times higher than that of whole blood and upon activation, platelet can induce the production of a variety of GFs such as platelet-derived growth factor (PDGF-AB), transforming growth factor β (TGF-β), epidermal growth factor (EGF), and vascular endothelial growth factor (VEGF). As such, PRP contains not only a high level of platelets, but also the full complement of clotting factors. Preparation of PRP is quick, simple, and relatively inexpensive. Moreover, because PRP is prepared from the patient’s own blood, the risk of experiencing complications is minimal. 07/17/2020 08:57:22 pm Intraoraly welded titanium bar for immediate restoration in maxilla: Case report and review of the literature. Oral rehabilitation of edentulous maxilla is particularly difficult because of the lack of bone in correspondence of maxillary sinuses. Therefore, surgeon is forced to place implants in sites where bone is more prevalent. In addition, patients require more frequently oral immediate rehabilitation in order to reduce the discomfort related to wearing a total denture. A viable solution to provide stability and retention of the prosthesis in a short time, is represented by the technique of intraoral welding systems supporting total denture or fixed prosthesis.This goal may be achived thank to the technique ofwelding titanium bars on implant abutments.  In fact, the procedure can be performed directly in the mouth eliminating possibility of errors or distortions due to prosthetic procedures. This paper describes a case report and the most recent data about long-term success and high predictability of intraoraly welded titanium bar in immediate loading implants. 07/17/2020 08:57:22 pm Bundle bone preservation with Root-T-Belt: Case study. This paper reports the results of a prospective case study on a new surgical technique, known as Root-T-Belt and aimed at preserving peri-implant bone crest in humans. Methodology and Materials Seven patients with an average age of 50 (70 ± 35) were selected. Ten implants were inserted (Seven-M.I.S. Technologies, Israel), using the Root-T-Belt surgical technique. The implants were loaded in 90 days. Marginal bone loss 6 months after x-ray analysis: mesial area, 0.8; distal area, 0.7. Findings Accumulative implant integration success rate of 100% during the first six months of use. Crest bone loss around the implants was between 1.3 ±0.2 mm, i.e. 0.7 mm on average 6 months into the study. Conclusion:  The results of the study suggest that this is a very simple technique which reduces treatment time, stabilizes the bundle bone around the implants and creates a biological surface offering long-term predictability. 07/17/2020 08:57:22 pm Crestal sinus lift using a turbine fitted with spherical diamond-faced burs with stops: Non-traumatic technique. One of the most frequent reasons for failures during the operation of maxillary sinus floor lift is connected with the possibility of a rupture to the Schneiderian membrane which, if lacerated, cannot perform its function of graft contaiment. In order to reduce the incidence of complications the turbine is frequently used in association with spherical diamond-faced burs to cut the hard tissue with extreme accuracy and minor trauma, while saving the soft tissue. In this study a new technique of maxillary crestal sinus lift performed with the aid of a turbine with spherical diamond-faced burs is proposed. Calibrated stops have been created to perfectly control the procedure. The cortical of the maxillary sinus is reduced through the use of these burs so as to obtain a hole which can enable both access to the maxillary sinus and, subsequently, the lifting of the Schneiderian membrane. Working time is reduced to less than 3 minutes in the cortical thinning operation and percussive trauma is avoided. Due to the reduction in trauma and invasivness of the process, this technique could be a valid alternative to the techniques known and applied to date. 07/17/2020 08:57:22 pm Prevalence, location and orientation of maxillary sinus septa. Background:The most common complication of sinus floor elevation procedures is the perforation of the Schneiderian membrane. This often occurs during the membrane elevation, and it is associated with the presence of antral septa. The prevalence of the sinus septa differs between populations. So far, no information concerning Middle East population has been published. The aim of this retrospective study was to evaluate the prevalence, location and orientation of the sinus septa in the Department of Dentomaxillofacial Radiology of a Lebanese hospital. Methods:The CBCT scans of 348 consecutive patients were analyzed to identify the presence of septa within the sinus cavities. Axial, coronal and sagittal slices were used to explore the location and orientation of the sinus septa. Axial and coronal slices were divided into 3 thirds to evaluate and compare the anatomical position of the septa. Sagittal slices were used to evaluate the height and the angulations of the septa. Results:37.07% of the patients presented at least one septa. No difference was detected between dentate and edentulous patients. Coronal slices showed that the majority of the septa (76.04 %) were localized in the lower third of the sinus cavity. Axial slices of the sinus indicated no difference in the antero-posterior location of the septa. The analysis of the sagittal slices showed a mean septal height ranging from 1.6 mm to 24.52 mm. The angle between the septa and the medial palatal suture ranged from 31° to 120°; whereas, the angle with the sinus floor ranged from 61° to 150°. Conclusion: In the present study, the prevalence of septa is in the top third values published so far in the literature. This high prevalence indicates that medical imaging of the sinus is mandatory prior to sinus floor augmentation procedures, and may impact the sinus membrane elevation procedures. 07/17/2020 08:57:22 pm Differential diagnosis of antral pseudocyst, surgical ciliated cyst, and mucocele of the maxillary sinus. The article has been forwarded to the production team. The processing may take few weeks. Then the proof will be forwarded to the corresponding author. The final PDF HTML file will be uploaded when the corrections to the proof are returned by the corresponding author. 07/17/2020 08:57:22 pm Osteochondroma of mandibular condyle: A case report. The article has been forwarded to the production team. The processing may take few weeks. Then the proof will be forwarded to the corresponding author. The final PDF HTML file will be uploaded when the corrections to the proof are returned by the corresponding author. 07/17/2020 08:57:22 pm Micro computed tomography as a new method of investigation: Biointegration performance of a bone substitute. The article has been forwarded to the production team. The processing may take few weeks. Then the proof will be forwarded to the corresponding author. The final PDF HTML file will be uploaded when the corrections to the proof are returned by the corresponding author. 07/17/2020 08:57:22 pm Lateral window for major sinus lift bone grafting: Technical note. The article has been forwarded to the production team. The processing may take few weeks. Then the proof will be forwarded to the corresponding author. The final PDF and HTML files will be uploaded when the corrections to the proof are returned by the corresponding author. 07/17/2020 08:57:22 pm Immunohistochemical assessment of Bcl-2 and Ki-67 in gingival tissues of normal and immunosuppressed patients as predictors of neoplasia. Gingival overgrowth is one of several oral side effects of cyclosporine A, a potent immunosuppressant drug, which is commonly used to prevent organ transplant rejection. Disturbances of proliferation and apoptosis are fundamental events in early carcinogenesis, and may be useful in characterizing tissue that is histologically normal but at high-risk for neoplastic growth. Thus, it would be valuable to investigate the immunohistochemical expressions of Ki-67 (a proliferation associated antigen) and Bcl-2 (antiapoptotic protein) and their potential role in the pathogenesis ofcyclosporine A induced gingival hyperplasia (CIGH) and assessment of their levels of expression in keratinocytes and underlying connective tissue. This study involves gingival biopsies collected from renal transplanted patients receiving cyclosporine-A with moderate to severe gingival overgrowth during gingivectomy procedures. Normal healthy tissue samples without clinical signs of periodontal inflammation were also included as control samples.  Tissue samples were fixed in 10% formalin, embedded in paraffin and stained with hematoxylin and eosin to evaluate the histopathologic presentation of gingival enlargement. Sections were incubated separately with Bcl-2 and Ki-67 monoclonal antibodies. Computerized image analysis software was used to count the number of immunopositive cells regardless of intensity as well as the number of the remaining unstained ones. Ki-67 and Bcl-2 labeling indices were statistically analyzed. The expression patterns of Ki-67 and Bcl2 were significantly higher (p ˂ 0.000) in both epithelium and connective tissues of cyclosporine-A treated groups as compared to normal healthy tissues.  Statistically significant positive correlations were found between the number of Ki-67 positive cells and Bcl-2 positive cells in each group. In conclusion increased expression of Bcl-2 and Ki-67 may have a role in the pathogenesis of gingival overgrowth induced by cyclosporine-A and patients with CIGH are at high risk of development of neoplasms. 07/17/2020 08:57:22 pm Guided bone regeneration by means of a preformed titanium foil: A case of severe atrophy of edentulous posterior mandible. The aim of this case report was to evaluate the potential of PTF as membrane, used together with a mouldable allograft paste, for the Guided Bone Regeneration in a case of severe mandibular posterior atrophy involving the alveolar nerve. In order to create a rigid barrier to the competitive growth of soft tissues and a stable volume for the colonization of the osteoprogenitor cells, a foil of pure titanium was pre-shaped by means of a stereolithographic model, obtained from CT-scan of the patient. This procedure showed promising results, allowing to maximize the outcome and simplifying the surgical phase. 07/17/2020 08:57:22 pm Bone marrow mononuclear cell fraction for bone reconstruction in sinus augmentation: A pilot study. The demand for bone reconstruction in oral rehabilitation has been growing substantially.  However, patients willing to undergo reconstructive surgery want less invasive procedures with less postoperative morbidity. Less invasive bone reconstruction techniques have used bone substitutes to achieve these objectives. However, recent studies about tissue engineering have demonstrated that cell therapy, in combination with bone grafts, may potentially improve the biological characteristics of graft materials. The aim of this study was to histomorphometrically analyse sinus elevation using autologous bone marrow aspirate resulting from the isolation of the bone marrow mononuclear cell fraction, associated with xenogenous graft. Four patients requiring sinus lift procedures before implant placement, with less than 3 mm of residual bone height, where selected for this pilot study. The two patients of Control Group received a xenogenous graft covered by a barrier membrane. The two patients of the Test Group received a xenogenous graft associated with bone marrow mononuclear cell fraction covered by a barrier membrane. Six months after the grafting procedures, bone biopsies were harvested during implant placement and analysed by histomorphometry. Histomorphometric analysis revealed a large amount of vital mineralized tissue (VMT) in Test Group compared to Control Group sites (70+25.46% vs 34+14.14%). For both non vital mineralized tissue (NVMT) and non mineralized tissue (NMT) Test Group showed lower values than Control Group sites (9+12.73% vs 20+26.87% and 21+12.73% vs 46+12.73%, respectively).This pilot study indicated that the clinical use of bone marrow mononuclear cell fraction associated with xenogenous graft in maxillary sinus elevation seems to result in a more adequate bone repair. 07/17/2020 08:57:22 pm Mandibular condyle fractures: Literature review. Face is a frequently injured area of the body, and the mandible is the most fractured bone among the facial bones. Bones fracture at site of tensile strain, since their resistance compressive force is greater.Condylar fractures represent between 29% and 52% of all mandibular fractures. The present review provides an overview on  condylar fractures diagnosis, treatment methods, and the way to select an appropriate treatment modality. The treatment for mandibular condyle fractures remains controversial. Conservative management (CM) and open reduction/internal fixation (ORIF) are both used, but the evidence to support superiority of one method has not been clearly assessed. 07/17/2020 08:57:22 pm Vertical ridge augmentation of posterior atrophic sites with bone block allografts: A systematic review. Background: Insufficient data exist to describe vertical bone augmentation with allograft blocks. It is of interest for the clinician to anticipate mean vertical ridge augmentation in posterior sites grafted with bone block allografts. Purpose:To evaluate the efficacy of allogeneic bone block-grafting in vertical ridge augmentation (VRA) procedures. Materials and Methods:A systematic review of the literature was performed targeting the height of vertical bone augmentation, implant survival rates, and vertical bone resorption after graftingwhen using allogeneic bone blocks in VRA procedures. The literature was surveyed (MEDLINE by PubMed and Embase) from January 1975 up to and including December 2013. Results: The combined searches resulted in 268 potentially eligible studies. Only two articles met all inclusion criteria. The data indicate thata mean vertical height gain of 4.03 mm to 4.30 mm can be achieved. Conclusion:Within the limits of the available data, allogeneic blocks tend to promote bone height when used in posterior vertical resorption indications. There is insufficient evidence to recommend bone block allografts for VRA of posterior atrophic sites. Well-designed and implemented randomized-control trials are further required to evaluate the clinical outcomes associated with VRA procedures. 07/17/2020 08:57:22 pm