Explore the vast range of titles available.

Background This prospective randomized clinical trial aimed to evaluate the immediate and short-term skeletal, dentoalveolar, and periodontal effects of rapid palatal expansion (RPE) and miniscrew-assisted RPE (MARPE) in adolescent and young adult patients. Methods This study followed a two-arm, parallel, randomized clinical trial design that recruited patients with transverse maxillary deficiency in a 1:1 allocation ratio. Forty patients (14 men and 26 women) requiring maxillary expansion were randomly allocated to the RPE (n = 20, age = 14.0 ± 4.5) or MARPE (n = 20, age = 14.1 ± 4.2) groups. The assignment was performed via computer-generated block randomization, with a block size of four. Upon identical (35 turns) amount of expansion, low-dose cone-beam computed tomography images were taken before treatment (T0), immediately after expansion (T1), and after a 3-month consolidation period (T2). The primary outcome of this study comprised the assessment of midpalatal suture separation. Secondary outcomes included, skeletal, dentoalveolar, and periodontal measurements, which were performed at each time point. Results The frequency of midpalatal suture separation was 90% (18/20) and 95% (19/20) for the RPE and MARPE groups, respectively. A greater increase in nasal width in the molar region (M-NW) and greater palatine foramen (GPF) was observed immediately after the expansion (T1-T0) and consolidation periods (T2-T0) in the MARPE group compared to the RPE group ( P  < 0.05). The MARPE and RPE groups showed similar dentoalveolar changes except for the maxillary width (PM-MW, M-MW). The MARPE group presented greater bilateral first premolar (PM-MW) and molar (M-MW) maxillary width in relation to the RPE group ( P  < 0.05). Through the expansion and consolidation periods (T2-T0), lesser buccal displacement of the anchor teeth was observed in the MARPE group (PM-BBPT, PM-PBPT, M-BBPT [mesial and distal roots], and M-PBPT)( P  < 0.05). Conclusions Midpalatal suture separation was observed in 90% and 95% of patients in the RPE and MARPE groups, respectively. Both RPE and MARPE groups exhibited significant triangular basal bone expansion and skeletal relapse during consolidation. Under identical amounts of expansion, the MARPE group showed lower decrease in the skeletal, dentoalveolar and periodontal variables after consolidation. The reinforcement of RPE with miniscrews contributes to the maintenance of the basal bone during consolidation period. Trial registration WHO Institutional Clinical Trials Registry Platform (IRB No. KCT0006871 / Registration date 27/12/2021).

Background In adults, mini-screw-assisted rapid palatal expansion (MARPE) has proven to be an efficient method for overcoming the drawbacks of conventional expansion methods. In treating adult patients with anteroposterior deficient maxilla, the clinician had to decide between an intrusive surgical approach or a camouflage therapy to mask the Class III malocclusion. However, alternate rapid maxillary expansion and constriction (ALT-RAMEC) is the treatment of choice in younger patients. Methods The 7-week ALT-RAMEC protocol was modified and combined with MARPE to evaluate its efficiency and its sutural and dentoskeletal advantages over conventional MARPE in young adults. Twenty-nine patients with transverse and anteroposterior maxillary deficiency (mean age of 21.3) were randomly assigned to two groups. The conventional group received MARPE with its conventional expansion rate (Control group), while the ALT-RAMEC group was treated with a combination of MARPE and the ALT-RAMEC modified protocol. The efficiency of expansion, circummaxillary sutural displacement, and dentoskeletal effects were assessed. Analysis of the change before and after intervention was examined using paired t-tests while analysis of the parameters comparing the two groups was examined using an independent t-test. For variables that were not normally distributed, the p-value was obtained from Bootstrap for pairwise comparison (BCA). Results The two techniques showed 100% efficiency in producing expansion in both groups. Mid-palatal, frontonasal, and intermaxillary sutures were displaced and increased significantly in width after treatment with both protocols ( p  ≤ 0.001), while the zygomaticomaxillary sutures compressed and showed a significant decrease in width with conventional MARPE, though, expanded and increased significantly in width with the ALT-RAMEC group ( p  < 0.001). The dentoskeletal effects revealed that conventional MARPE produced a buccal molar tipping while ALT-RAMEC showed a more bodily movement of the anchor molars. Conclusion The modified ALT-RAMEC technique is a promising protocol sufficient to expand the maxilla transversely without tipping the anchored teeth in young adult patients. The successful subluxation of circummaxillary sutures might be a sign of hope for maxillary anteroposterior deficient patients if proven to aid in non-surgical maxillary protraction. Trial registration The study protocol was registered in ClinicalTrials.gov public website under the name “New Maxillary Expansion Technique in Adults” with identifier number “NCT04908540”, and registration dates: 25-05-2021 (First submitted) and 01-06-2021 (First posted).

Transalveolar sinus elevation is a minimally invasive technique aimed at augmenting the vertical bone height in the posterior maxilla, facilitating successful implant placement in areas with insufficient bone volume. This study compares the efficacy of osseodensification and piezoelectric internal sinus elevation (PISE) techniques in delayed implant placement. The primary objective was to radiographically assess vertical bone gain and bone density, while secondary objectives included clinical assessment of primary implant stability and post-operative satisfaction of both patients and operators. The study population of a total of 16 patients was randomly divided into two groups. Group 1 underwent osseodensification sinus lift using sticky bone as a graft material, whereas Group 2 received PISE with the same graft material. Results indicated that the osseodensification technique led to greater bone gain, improved bone density, and shorter surgical duration. Additionally, osseodensification was associated with enhanced rapid healing and higher patient satisfaction. Conversely, the PISE technique demonstrated superior primary stability of implants on the day of surgery. These findings suggest that while both techniques are effective, osseodensification may offer advantages in terms of bone gain, density, and patient satisfaction, making it a reliable method for enhancing rapid healing in delayed implant placement. the study was registered on clinicaltrials.gov at 26 th September 2023 and clinical trials ID is NCT06055127 .

IntroductionMaxillary transverse deficiency (MTD) is a common type of malocclusion. For adult MTD patients with highly ossified midpalatal sutures, surgically assisted rapid palatal expansion (SARPE) has been the conventional method of maxillary expansion. However, SARPE has the disadvantages of significant trauma, high cost and a high incidence of adverse events. Therefore, we proposed a novel minimally invasive method for maxillary expansion, which is midpalatal suture osteotomy combined with microimplant-assisted rapid palatal expansion (MSO-MARPE). The results are expected to confirm MSO-MARPE as a novel minimally invasive alternative to SARPE in skeletally mature MTD patients.Methods and analysisA prospective, single-centre, parallel-group randomised controlled trial will be conducted, enrolling 20 adult MTD patients. Participants will be randomised equally to the control and experimental groups. The control group will undergo a Lefort I and median osteotomy and postoperative maxillary expansion with a tooth-borne Hyrax-type expander. The experimental group will undergo a midpalatal suture osteotomy and postoperative maxillary expansion with a microimplant-assisted expander. A series of linear and angular parameters will be measured in the pre- and post-coronal planes before treatment (T0), immediately after expansion (T1) and 6 months after expansion (T2) to evaluate the efficacy of skeletal expansion and dental side effects. The study aims to compare the clinical and cost-effectiveness of SARPE and that of MSO-MARPE. The primary outcome is the contribution of posterior midpalatal expansion immediately after expansion. The secondary outcomes include nasal, sutural, alveolar and dental expansion, pain intensity, operative time and treatment costs. The safety indicator will be the number and incidence of adverse events. The interaction between the control group and the experimental group will be analysed using two independent-sample t-tests or Mann–Whitney U test, and the paired data at different time points will be analysed using paired t-test.Ethics and disseminationThe trial protocol (version 6.0 13 December 2024) has been approved by the Institutional Review Board of the Ninth People’s Hospital of Shanghai Jiao Tong University School of Medicine (approval number: SH9H-2023-T309-3). Results will be disseminated through peer-reviewed publications and presentations at scientific conferences.Trial registration numberChiCTR2400081545.

Background The posterior maxilla presents challenges for implant insertion because of the poor bone quality as well as the loss of vertical bone height. Indirect transcrestal sinus lift techniques are advised when a few millimeters of additional height are needed. This study aimed to evaluate the clinical and radiographic outcomes of antral membrane balloon technique versus Densah burs for transcrestal maxillary sinus lifting with simultaneous implant placement. Materials and methods This randomized clinical trial was conducted on 22 patients received 32 dental implants for replacement of missed maxillary posterior teeth after crestal maxillary sinus lifting. The patients were randomly divided into two groups. Group 1, patients underwent crestal sinus floor elevation with simultaneous implant placement using antral membrane balloon technique. Group 2, patients underwent crestal sinus floor elevation with simultaneous implant placement using Densah burs. Patients were evaluated clinically and radiographically using cone beam computed tomography (CBCT) at regular time intervals immediately, 6 months and 12 months after surgery. All clinical and radiographic parameters were statistically analyzed. Results All dental implants were successful for 12 months of follow up. Regarding implant primary stability, there was a statistical significant difference between the study groups in favor of Densah group ( P  = 0.004), while there was no significant difference after 6 months ( P  = 0.07). Radiographically, balloon group showed a statistically significant immediate postoperative vertical bone height ( P  < 0.0001), and significant reduction in vertical bone height after 6 months ( P  < 0.0001). Densah group showed significant increase in bone density ( P  ≤ 0.05). Conclusion Both techniques demonstrated successful clinical and radiographic outcomes for crestal sinus lift. The antral membrane balloon group demonstrated better immediate postoperative vertical bone gain, while Densah burs had higher implant primary stability and bone density. Trial registration This study was registered in Clinical-Trials.gov PRS ( https://register.clinicaltrials.gov ) under identification number NCT05922592 on 28/06/2023.

ObjectivesTo compare the accuracy of implant placement performed with either a surgical motor or a torque wrench as part of a half-guided surgical protocol.Materials and methodsImplant insertion with half-guided surgical protocol was utilized by surgical motor (machine-driven group) or torque wrench (manual group) in the posterior maxilla. After the healing period, accuracy comparison between planned and actual implant positions was performed based on preoperative cone beam computed tomography and postoperative digital intraoral scans. Coronal, apical, and angular deviations, insertion time, and insertion torque were evaluated.ResultsForty patients were treated with 1 implant each; 20 implants were inserted with a surgical motor and 20 implants with a torque wrench. Global coronal and apical deviations were 1.20 ± 0.46 mm and 1.45 ± 0.79 mm in the machine-driven group, and 1.13 ± 0.38 mm and 1.18 ± 0.28 mm in the manual group (respectively). The mean angular deviation was 4.82 ± 2.07° in the machine-driven group and 4.11 ± 1.63° in the manual group. Mean insertion torque was 21.75 ± 9.75 Ncm in the machine-driven group, compared to 18.75 ± 7.05 Ncm in the manual group. Implant placement duration was 9.25 ± 1.86 s in the machine-driven group at a speed of 50 rpm, and 36.40 ± 8.15 s in the manual group.ConclusionNo significant difference was found between the two groups in terms of accuracy and mean insertion torque, while machine-driven implant placement was significantly less time-consuming.Clinical relevanceOptimal implant placement accuracy utilized by half-guided surgical protocol can be achieved with both machine-driven and torque wrench insertion.Trial registrationID: NCT04854239

Background Rehabilitation of the atrophic maxilla is challenging due to bone resorption and anatomical limitations. Although the All-on-Four concept offers a predictable treatment strategy, posterior cantilevers may increase biomechanical risk. Pterygoid implants have been proposed as an alternative to enhance posterior support without the need for bone grafting. This study aimed to compare stress distributions in bone and prosthetic components using three different implant-supported treatment strategies for the atrophic maxilla. Methods Three three-dimensional finite element models were developed based on cone-beam computed tomography scans of an edentulous maxilla. Model 1 included four implants following the All-on-Four protocol. Model 2 consisted of five implants, including two pterygoid implants for posterior support. Model 3 comprised six implants, also including two pterygoid implants. Stress distributions in cortical and trabecular bone, implants, abutments, and prosthetic frameworks were analyzed under oblique occlusal loading conditions. Results Model 3 demonstrated the most favorable biomechanical profile, with reduced maximum and minimum principal stresses and strain values in both cortical and trabecular bone. Model 1 exhibited the highest stress concentrations, particularly around posterior implants (up to 110 MPa) and prosthetic components (28–45 MPa), likely due to the cantilever effect. In contrast, Model 3 showed lower maximum principal stress in the cortical bone (0.4 MPa) compared to Model 1 (1.54 MPa). Additionally, the von Mises stress in the first and second implants decreased in Model 3 (28 MPa and 63.6 MPa, respectively) compared to Model 1 (39 MPa and 110.5 MPa) and Model 2 (20 MPa and 80.0 MPa).  In terms of strain distribution, all models remained within physiological thresholds but Model 3 exhibited a more balanced and uniform strain pattern, particularly around posterior implant sites. This suggests improved load transfer and reduced risk of biomechanical overload. Conclusions Increasing the number of implants and incorporating pterygoid implants enhances biomechanical stability in the atrophic maxilla. These strategies reduce stress and strain concentrations in both bone and prosthetic components and offer a less invasive alternative to bone grafting procedures. Optimizing implant number and posterior support is critical for improving long-term success in full-arch implant rehabilitation.