Background: Orthodontic and surgical technical advances in recent years have resulted in treatment opportunities for a whole range of craniofacial skeletal disorders either in the adolescent or adult patient. In the growing child, these can include myofunctional orthodontic appliance therapy or distraction osteogenesis procedures, while in the adult, the mainstay approach revolves around orthognathic surgery. The literature agrees that for a change in craniofacial morphology to remain stable, the muscles acting upon the facial skeleton must be capable of adaptation in their structure and, therefore, their function. Failure of the muscles to adapt to the change in their length or orientation will place undesirable forces on the muscle attachments leading to potential instability of the skeleton. Adaptation can occur through various processes including those within the neuromuscular feedback mechanism, through changes within muscle structure or through altered muscle physiology, and through changes at the muscle/bone interface. It is now accepted that because there is no single method of assessing masticatory function, several measures should be taken, and whenever possible, simultaneously. Methods: This investigation was designed to apply several, newly developed and more sophisticated methods of measuring muscle structure and function to a situation where adaptation of muscle is pivotal to the success of a therapeutic approach. Patients attending the combined orthodontic/orthognathic surgery clinic at the Clitrofa – Centro Médico, Dentário e Cirúrgico, in Trofa, Portugal, were screened. Ten patients scheduled for a bimaxillary osteotomy involving a combination of maxillary Le Fort I impaction procedure coupled with a sagittal split advancement of the mandible were selected to form the study group. The patients have MRI of the masseter muscle to evaluate the masseter muscle volume and fibre orientation changes. This exam was taken before surgery (T0), 6 to 12 months after surgery (T1), and 3 years after surgery (T2), by two independent observers, according to the protocol jointly developed between the Eastman Dental Institute – University of London and the MRI Centre - Department of Radiology at John Radcliffe Hospital – University of Oxford. Results: Significant differences (p < 0.05) have been identified between Time 0 (pre-op) and Time 1 (6–12 months post-op) regarding the masseter area (mm²). The differences against Time 0 (pre-op) seem to disappear at Time 2 (3 years post-op). Conclusions: MRI therefore seems to be a valid tool for measuring differences in the masseter muscle area and volume associated with high-severity occlusal deformities, although showing not to be as efficient in detecting the same differences in cases of low-severity occlusal deformities.

The presence of sufficient bone volumes is one of the most important criteria for the success of oral implant osseointegration. Therefore, the rehabilitation of edentulous atrophic maxillae represents the greatest challenge in terms of oral rehabilitation. Techniques such as bone grafts, angled implants, short implants, tuberosity, and pterygoid implants may not always be a viable alternative in the subsequent rehabilitation of the posterior atrophic maxilla. A breakthrough occurred when Brånemark first introduced longer, custom-designed implants inserted into the zygomatic bone to support craniofacial prosthesis in the 1980s. When used in the treatment of atrophic jaws, zygomatic implants provide a safe and effective alternative, with stable long-term results. Objectives: We aimed to retrospectively evaluate zygomatic bone resorption ten years after the placement of zygomatic implants. Methods: A retrospective observational study was designed to evaluate bone resorption over ten years following the placement of zygomatic implants. In a study group of 50 patients, using Hounsfield scales, the area of the zygoma and its bone density were established and evaluated. The NewTom NNT Analysis software (NewTom^®, Imola, Italy) was employed to trace the bone and implant limits on CBCT scans. Using this software, the three-dimensional information of the postoperative CBCT image was compared with the ten-year postoperative CBCT image, allowing for the assessment of the zygomatic bone resorption and bone density. Results: Highly significant statistical differences to an alpha level of 0.01 were identified between T0 (pre-op), T1 (12 months), and T2 (120 months) concerning zygomatic bone density, both in the first and in the second quadrants. The post hoc Bonferroni test revealed that significant statistical differences were observed between T0 and the remaining timepoints (T1 and T2), with the latter two exhibiting similar values. Conclusions: The evaluation of the resorption at the level of the zygoma, ten years after the placement of zygomatic implants, reveals that there are no significant losses between the initial and final controls. Therefore, it follows that this type of implant rehabilitation represents a viable alternative approach in patients with bone atrophy of the maxilla, offering a predictable therapeutic solution that enables immediate full function and excellent long-term success rates. However, we must not neglect the potential for future innovations in GBR involving the use of barrier membranes, either resorbable or non-resorbable, and even the application of titanium alveolar customized osteogenic scaffold, in conjunction with autologous bone grafts or biomaterials.

Purpose: The aim of this study was to test a prototype device called occlusal force diagnostic system in relation to occlusal force adaptation following orthognathic surgery. Methods: Retrospective study of 10 patients scheduled for a bimaxillary osteotomy involving a combination of maxillary Le Fort I impaction procedure coupled with a sagittal split advancement of the mandible; in a 3 years follow-up period. Results: The selection of examiner is not a variable that affects the occlusal force (N) measured by FSS sensors in any of the experimental conditions tested. The sensor position and the surgery recovery time affect the occlusal force irrespective of the examiner selection and/or the surgery recovery time. Conclusion: The piezoelectric sensors used in the present study have shown high reliability and validity of measurement. The surgery recovery time impacts the occlusal force (N), with a 50% increase in occlusal force (N) measured after 6 months post-surgery, with the value keeping stable at 36 months. This suggests that the patient is only fully recovered from the functional point-of-view at 6 months, having from that point on an improved and stable masticatory function.

Fracture of a zygomatic implant is an uncommon but clinically challenging complication. Conventional management generally involves implant removal or alternative anchorage strategies, both of which may require extensive surgery, increase patient morbidity, and compromise an existing implant-supported rehabilitation. This technical report describes the development, biomechanical validation, and first clinical application of a novel prosthetic rescue device for the conservative management of cervical fractures of zygomatic implants while preserving the osseointegrated apical segment. A customized Grade V titanium device incorporating an internal threaded connection and supplementary self-tapping fixation screws was specifically designed to restore the fractured implant. Biomechanical performance was assessed by dynamic fatigue testing according to ISO 14801. The device was subsequently used in a 60-year-old woman presenting with a cervical fracture of a zygomatic implant. Placement was performed using a surgical guide, and the device was secured with an insertion torque of approximately 20 Ncm. Fatigue testing demonstrated mechanical resistance exceeding five million loading cycles under a maximum load of 129 N. At the 24-month follow-up, the patient remained free of mechanical or biological complications, with stable clinical and radiographic findings and successful maintenance of the implant-supported prosthetic rehabilitation. This case suggests that the proposed prosthetic rescue device may represent a minimally invasive alternative to implant removal in carefully selected cases of cervical fracture of zygomatic implants with a stable osseointegrated apical segment. Further clinical studies are required to confirm the reproducibility, long-term mechanical performance, and clinical predictability of this approach.

Introduction: Peri-implant diseases are defined as pathological inflammatory reactions in the tissue surrounding osseointegrated implants. They are classified into two categories: mucositis—defined as peri-implant soft tissue inflammation and peri-implantitis—bone loss in the peri-implant region. Case Report: A clinical case of a 61-year-old woman with an implant in the 46 anatomical position presented with peri-implantitis after a 5-year follow-up. A probe depth of 5 mm and a bone defect length of 35% was observed. The Implacure Protocol was applied, with the main objective of eliminating the biofilm present on the exposed implant surface. There are multiple approaches to treat peri-implant diseases. While non-surgical treatment is essentially sufficient for mucositis control, the treatment in most cases of peri-implantitis should be surgery. Regenerative bone reconstruction promotes bone repair in the defect area and reduces bleeding during probing. To achieve that, autologous fibrin combined with Cerasorb M was used. Conclusion: The proposed approach in the presented clinical case involves the application of Implacure Protocol, whose combination of the physical decontamination technique, together with the use of chlorhexidine and orthophosphoric acid, added with the combination Piperacillin + Tazobactam together with hyaluronic acid, provided a base that allows to regenerate bone using platelet-rich fibrin with Cerasorb M and increase the implant survival time.

(1) Background: Irrigation activation techniques may improve the success of endodontic treatment by removing the smear layer and enhancing the sealing ability of bioceramic sealers. The aim of this work was to compare the efficacy of different irrigation activation protocols and assess their subsequent influence on the sealing ability of teeth obturated with a bioceramic sealer. (2) Methods: Fifty-three extracted human single-rooted teeth were mechanically prepared with HyFlex EDM rotary system. The samples were randomly assigned to three experimental groups based on the final irrigation activation protocol using PIPS, EndoActivator and Conventional Needle Irrigation and two control groups (positive and negative). Root canals were then obturated using a single-cone technique with a bioceramic sealer (CanalPro Calciseal). Apical microleakage was analyzed through nuclear medicine, incubating the specimens for 3 h in a sodium pertechnetate (^99mTcNaO₄) solution and quantifying radioisotope infiltration with a gamma well counter. (3) Results: The laser activation group demonstrated the lowest mean microleakage values (37.86 [35.77–42.82]), followed by the conventional irrigation group (50.96 [37.06–103.70]) and the EndoActivator group (52.34 [40.11–64.57]). (4) Conclusions: No statistically significant differences were found among the three experimental irrigation activation protocols. Laser-activated irrigation (PIPS) showed a numerically lower mean microleakage value, representing a trend toward minimal leakage.