Surgical guide plays a crucial role to facilitate optimal positioning and angulation of implants. Nonlimiting designs guide only the position but not the angulation of implant placement. This article describes a simplified technique of fabricating a surgical guide to limit the freedom of implant placement. In addition, it also has an advantage of holding the flap away from the operating site by means of a flange extended onto the buccal slope, allowing adequate visibility during the osteotomy preparation.

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Background and Objective: Immediate implant placement may preserve the alveolar anatomy and helps to maintain the bony crestal height. There are not enough studies addressing other outcome measures that determine the quality of survival such as the peri-implant hard and soft tissue integrity. The objective of this study was to evaluate and compare the peri-implant soft tissues, crestal bone resorption, and peri-implant bone healing in immediate and delayed implants in the esthetic zone of maxilla. Materials and Methods: Selective sampling done among the patients who reported to our center for implant placement. A total sample size of 100 implant sites in the esthetic zone of maxilla were selected from 77 patients (52 females and 25 males) with fifty sites in immediate implant group and fifty in delayed implant group. Samples from both groups were evaluated on follow-ups at 1^st week, 1^st month, 3^rd month, and 6^th month postoperatively. Evaluation was based on (1) assessment of peri-implant soft tissue by means of implant esthetic score, (2) radiographic assessment of peri-implant crestal bone loss, (3) peri-implant bone densitometry by grayscale assessment of radiograph. Results: Unpaired t-test was performed for each parameter, which showed a very high level of significance for implant esthetic score, high significance for gray scale assessment, and no significance for peri-implant crestal bone loss. Interpretation and Conclusion: The present study showed that immediate implants had better esthetic and functional outcome in terms of peri-implant soft tissue and peri-implant bone healing. However, there were no statistically significant data suggesting a lesser alveolar crestal bone loss in immediate implants.

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Odontomas are the most common odontogenic tumors. These tumors are asymptomatic and are generally diagnosed on radiographic examination. The sole management depends on the early diagnosis, histopathological examination, and excision of the pathological tissue. This article presents surgical management of excision complex odontoma in 22-year-old female patient followed with prosthetic rehabilitation with dental implants for replacement of missing teeth. After excision, bone grafts may be necessary depending on the need for further treatment. The present case emphasizes that new bone formation can take place without using any graft materials for the placement of dental implants in a cases of benign pathology.

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Background and Aim: The incisive canal (or nasopalatine duct) is located palatal to the maxillary central incisors and connects the palate to the floor of the nasal cavity. A branch of the greater palatine artery, the nasopalatine artery, and the nasopalatine nerve passes through this canal. A proper three-dimensional image of the incisive canal and foramen before any surgical intervention in the anterior maxilla is highly important since it can help determine the morphology and position of the canal in relation to the surrounding structures. The aim of this article is to analyze the influence of gender and age on the morphology and length of nasopalatine canal (NPC) using cone-beam computed tomography (CBCT). Study Design: This retrospective study analyzed 100 CBCT scans of patients between 15 and 75 years enrolled at a CBCT center in Bhopal, India. The images were acquired using Sirona's Orthophos SL. Two oral and maxillofacial radiologists examined all images to analyze the morphology and length of NPC with respect to gender and age. Results: Morphologically, there were four different shapes of NPC in sagittal CBCT section, and most common was cylindrical both in males and females. Least common shape seen was spindle shape in both genders. The NPC length decreased with increase in age. The length of the canal was found to be longer in men. Conclusion: This study highlights the importance of morphology of NPC during surgical procedures such as implant planning.

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Aims: The purpose of this study was to evaluate the effect of bilateral balanced occlusion (BBO) and canine guidance occlusion (CGO) on the masseter muscle activity using implant-retained mandibular overdentures. Subjects and Methods: Cone beam computed tomography evaluation of twelve edentulous patients was completed. Mucoperiosteal flaps were reflected and two implants were placed in the interforaminal region for each of the twelve patients. After a healing period of 3 months, acrylic resin maxillary complete dentures and mandibular overdentures were fabricated with BBO for six patients and CGO for the other six patients. Positioner attachments were used. Electromyographic evaluation of the masseter muscles, during clenching on a silicon index and chewing peanuts and cake, was conducted on the patients after using their dentures for 4 weeks. Each occlusion concept was then converted into the other concept using the same dentures and the procedure of evaluation was repeated after 4 weeks. The recordings were analyzed statistically using Wilcoxon signed ranks test. The value of P < 0.05 was considered statistically significant. Statistical Analysis Used: Kruskal–Wallis test and Mann–Whitney U-test were applied. Significance of the obtained results was judged at the 5% level. A P < 0.05 was considered statistically significant. Results: The highest electromyographic activity of the masseter muscles was recorded during clenching on a preformed silicon index followed by chewing peanut then cake for both occlusal concepts. The recordings of the masseter muscle associated with CGO were higher than BBO but with no statistically significant difference. Conclusions: The results show that by applying CGO, muscle activities similar to bilaterally balanced occlusion were obtained.

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This article discusses how the microvascularized fibula flap with or without cutaneous component has become the reconstructive option of choice for mandibular defects due to its length,the ability to be molded, its acceptable and consistent vascular pedicle, and the relative ease to obtain. Since this bone has shown, due to its vascularization, to maintain the bone mass in time, which gives a potential advantage over other free bone flaps, and therefore, the possibility of rehabilitation with dental implants. However, this can be a challenge because most of these patients have large oncologic resections, frequent medical comorbidity, and often require associated radiotherapy. Initially we review some published works about changes over time in height and bone mass of fibula bone in patients treated for osteoradionecrosis (ORN), and therefore, about the success or failure of the implant rehabilitation in these patients was performed. After, the case of a male patient aged 40 is presented who underwent mandibular reconstruction with fibula free flap after an oncological resection which showed a picture of ORN managed with previous surgical therapy and hyperbaric oxygen as adjuvant therapy and on whom rehabilitation was then performed with implant-supported prostheses with favorable development during 7 years follow-up. Therefore we conclude that the microvascularized fibula bone can receive a functional dental rehabilitation with osseointegrated implants even if there has been a previous history of properly treated ORN.

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