Subcutaneous oral emphysema is defined as penetration of pressurized air into the tissue spaces. One possible means of air entry is through the bone window made during a direct sinus lift. There are only 3 cases published in the literature of subcutaneous emphysema with this etiology. It is important that the dentist carefully instruct the patient about the post-surgical protocol that must be carried out to reduce the risk of this complication. A 52-year-old patient underwent a maxillary direct sinus lift for the future placement of implants in the posterior area. A few hours after the surgery, the patient repeatedly sneezed with his mouth closed 3 times, immediately causing a large swelling in the left periorbital area that prevented him from opening the eye. After clinical and radiographic examination, it was determined that it was a subcutaneous emphysema. The prescribed treatment was antibiotics. Subcutaneous emphysema is a benign and usually self-limited entity, which usually resolves spontaneously. Most authors agree on the use of turbines as the most frequent etiology. Other reasons, however, have also been reported in the literature, such as endodontic treatment and the use of dental lasers. The main clinical manifestations that aided us in establishing a correct differential diagnosis were swelling without redness, edema and crepitating palpation of the soft tissue. In general, patients do not report pain, but at worst a slight discomfort due to swelling.
KeywordsSubcutaneous emphysema; periorbital edema; orbital emphysema; complications; sinus floor elevation.
The objective was to analyze bone resorption patterns in posterior mandibles and the dimensions of their corresponding digital bone grafts. This could allow the fabrication of bone grafts with standardized dimensions that can be applied in the majority of clinical cases. Cone beam computed tomography scans (n = 120) were analyzed to evaluate the frequency of Cawood and Howell (C&H) classes. The most frequent class needing bone augmentation was virtually regenerated using specific software. Dimensions of the grafts were calculated. Class V was the most frequent atrophic class needing augmentation in posterior mandibles (20.4%). Severe atrophic stages were more frequent in females (adjusted P value = 0.001), in older people (adjusted P value = 0.31) and in the right mandible (adjusted P value = 0.03). After virtual regeneration of Class V cases (n = 36), 3 clusters based on the number of missing teeth were evident. The mean length of the grafts was 20 mm when 2 teeth were missing (reference), 23.9 mm in the case of 3 missing teeth (P < 0.001) and 29.6 mm for 4 missing teeth (P < 0.001). Height and width were comparable across the 3 clusters (P-values = 0.39–0.93). The mean graft volume was 1,469 mm3 in the case of 2 missing teeth (reference), 1,814 mm3 for 3 missing teeth (P = 0.001) and 2,177 mm3 for 4 missing teeth (P < 0.001). These volumes corresponded to those of soft-tissue expanders, suggesting the possibility of a 2-step augmentation protocol: soft-tissue expansion, followed by regeneration with prefabricated grafts of the corresponding volume. Class V was the most frequent resorption pattern requiring augmentation in posterior mandibles. Virtual regeneration revealed 3 clusters of grafts, differing only in length based on the number of missing teeth. A 2-step augmentation protocol is proposed using soft-tissue expanders and prefabricated grafts with corresponding volumes. This protocol might be more applicable in the right mandible, females and older patients.
KeywordsMandible; alveolar bone grafting; bone graft; cone beam computed tomography; soft-tissue expansion.
The following article describes 2 original techniques that use CAD/CAM technology to generate a pre-surgical healing abutment or provisional restoration. Two clinical cases are described using different techniques to create a guided soft-tissue emergence profile using a pre-surgical custom healing abutment or provisional restoration and their benefits. The first case describes the use of digital libraries with pontic emergence profiles. The 3-D object (tooth) is manipulated to replicate or to establish a natural contour that will determine the shape of the soft tissue during the healing process. The second technique describes the use of segmentation and mirroring of a natural tooth to generate an exact replica and emergence profile of the patient’s dentition. These techniques constitute a very simple and efficient way of generating a pre-surgical customized healing abutment or provisional restoration that allows the clinician to guide the soft-tissue healing process and emergence profile immediately after the surgery. The techniques are developed not to be software-specific, but rather to be used with any free or paid open architecture software.
KeywordsCAD/CAM; guided surgery; 3-D printing; segmentation; digital wax-up.