Paulina Pruszyńska

Background/Objectives: Dental implants are a predictable treatment modality for missing teeth, and the crown emergence angle may affect peri-implant tissue health. This study evaluated the influence of crown emergence angle on marginal bone loss (MBL) and the corticalization index (CI) at 3-month and 5-year follow-ups, considering restoration type and implant location. Methods: Records from 155 patients treated with MIS implants were analyzed retrospectively. The primary outcome was marginal bone loss (MBL) at 60 months after loading; secondary/exploratory outcomes included MBL at 3 months and the Corticalization Index (CI) at 3 and 60 months. Three prosthodontic restorations were included: single crowns, splinted crowns, and bridges. Intraoral radiographs were used to measure crown emergence angle, MBL, and CI. Results: Recorded emergence profile was 32° ± 10°. Marginal bone loss increased over time but did not differ significantly among restoration groups. No significant relationship was found between emergence angle and MBL for single crowns (p = 0.369) or splinted crowns (p = 0.176). For bridges, a weak but statistically significant relationship was observed (p = 0.042). CI increased over time in all groups, without significant differences by restoration type. Restoration type was significantly associated with anterior/posterior implant location (p = 0.0004): single crowns predominated anteriorly, whereas splinted crowns and bridges were more frequent posteriorly. No significant association was found for maxilla versus mandible (p = 0.077). Conclusions: Within the limitations of this retrospective radiographic analysis, no clinically meaningful association was observed between emergence angle and MBL for single or splinted crowns. For bridges, the observed association was statistically significant but weak and should be interpreted cautiously. Other biological, biomechanical, and systemic factors may play a greater role in peri-implant tissue stability than emergence angle alone.

Background. Since there is no ideal classification of mandibular condyle fractures, there have been several attempts to make this issue clearer for clinicians as well as facilitating communication. In 2018, new classification including improved arrangement of the reference lines was introduced. The aim of the study is to present a two-center evaluation of the effect of different classification types on the reported incidence of mandibular condyle fractures in a five times larger research sample than previously. Materials and methods. Two classification types were validated using a series of 431 cases from Ukrainian and Polish databases. Information was obtained from clinical notes and computed tomography scans of each patient using a standardized data collection form, then statistical analysis was performed. Results. It was noted that the difference between classifications result varied more in Ukraine than in Poland (p < 0.01); thus, Ukrainian data may be more susceptible to AO & SORG & IBRA classification complexities. In Poland, 2018 Kozakiewicz scheme is probably better recognizable, whilst in Ukraine it may significantly improve the representation of mandibular neck fractures in epidemiological descriptions. Conclusions. At the moment, both the AO & SORG & IBRA and Kozakiewicz classifications are equally effective, but the meaning of an established diagnosis is slightly different in each of them due to localization of reference lines.

Background: Marginal bone loss (MBL) is a condition leading to implant loss and treatment failure. MBL is one of the main complications in dental implantology. The aim of this research is to show the method that can predict bone loss around implants and protect patients from implant loss. Methods: A total of 1026 intraoral standardized radiographs of dental implants were included in this study. A total of 2052 peri-implant jawbone image samples were analyzed in MaZda 4.6 software. A new scale was calculated and described. MBL was measured, and groups of patients were compared. Results: After 3 months of functional loading, the Corticalization Index (CI) was calculated to be 210.70 ± 149.78 and increased after 60 months to 277.88 ± 198.78. In the 60-month observation, MBL was 0.85 mm ± 1.29 mm, and it has been noted that low MBL is associated with CI lower than 300, high MBL with CI higher than 500, and critical high MBL appeared when CI was higher than 1200. Conclusions: Authors created a new scale, and research showed that the specified CI in our scale may predict MBL around dental implants with a five-year forecast horizon. It allows us to implement specific treatment and protect implants from loss.

Despite the significant ongoing development of fixation materials, plate breakages still occur after osteosynthesis of the mandibular condyles. The aim of this study is to demonstrate the complications caused by fixation material breakages in the hope of inspiring the development of new, more durable plates; we analyzed a total of 238 plates used for osteosynthesis in this anatomical region. Cases where compression screws were used as the sole fixation material were excluded. Plate breakage was found in six cases, which accounted for 2.52% of treated individuals. It seems that most plate breakages can be avoided by maintaining effective patient supervision for up to 6 months after surgery. Risk factors for breakage are identified and guidelines for improving the design of future plates are provided. By analyzing some plate design features, we provide some indications for improving their strength and improving their designs for use in this field.

Despite continuous and significant development of fixation materials, plate breakage is still observed after osteosynthesis of the mandibular condyles. The aim of this study is to present the complication of fixation material breakage, hoping that it will trigger the development of new, more durable plates. 238 cases of plate use for osteosynthesis in this anatomical region were analyzed. Cases of compression screw use as the sole fixation material were excluded from the study. Plate breakage was found in 6 cases, which accounts for 2.52% of treated individuals. It seems that most plate breakages could be avoided by maintaining effective control over patients after surgery for up to 6 months. Risk factors for breakage were identified and guidelines for improving the design of future plates were provided. It appears that by analyzing some features of the plate design, it is possible to indicate the direction in which the design of stronger plates for osteosynthesis of mandibular condylar fractures should develop.

Background: Treatment methods for mandibular head fractures are controversial, although effective techniques for open reduction and rigid fixation (ORIF) have been known since the late 1990s. Notably, some forms of posttraumatic comminution of the mandibular head can be reduced or fixed. Methods: This study presents a personalized treatment to cure patients with nonreduced comminuted fractures of the mandibular head: total temporomandibular joint alloplastic replacement (18 patients). The reference group included patients who underwent ORIF (11 patients). Results: Personalized alloplastic joint replacements resulted in a more stable mandibular ramus after three months compared with ORIF. Conclusions: The authors recommend not performing osteosynthesis when the height of the mandibular ramus cannot be stably restored or when periosteal elevation from most of the mandibular head is necessary for ORIF. Personalized TMJ replacement should be considered in such patients. Personalized medicine allows patients to maintain a normal mandibular ramus height for a long period of time.

The goal of surgical treatment of mandibular head fracture is to restore anatomical relations; however, it also carries other implications. The purpose of this study is to present the alteration in the size of lateral pterygoid muscles after surgical treatment of unilateral mandibular head fractures and the impact of this change on the range of motion of the mandible. Another issue addressed is the persistence of changes in the appearance of the lateral pterygoid muscles after surgical treatment. In this study, 66 patients with unilateral mandibular head fracture were included. An additional 15 patients from this group who were treated only conservatively were separated as an extra reference group to exclude completely the effect of surgery on the appearance of the pterygoid lateral muscle (even on the opposite side to the surgically treated side). The range of mandibular movements was measured at specific time intervals up to 24 months post-operationally. Then, the lengths and widths of the lateral pterygoid muscles on the operated and healthy site were measured in CT images. The results were compared with a control group which consisted of muscles of the intact site (opposite site to the fracture). A significant reduction in the length-to-width ratio of the lateral pterygoid muscle on the operated side by approx. 20% is observed. This suggests that the muscle becomes more spherical, and thus the range of lateral movement to the contralateral side is permanently reduced.