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Objective: The objective of this study was designed to evaluate bone augmentation of posterior alveolar mandibular ridge using 3D computer guided ceramic sheets as a membrane in GBR. Subjects and Methods: Seven patients were included in the present study. Preoperative clinical evaluation, and CBCT scan for ridge evaluation and planning, all patient clinically suffering from severed resorbed posterior alveolar ridge of the mandible. Measuring height and width of right and left residual alveolar ridge was performed in CBCT software viewer base on this digital model 3D zirconia sheet was designed and plan on patient CBCT then milled on CAD/ CAM 5 axis machine to the desired macroscopic shape. After surgery, clinical evaluations were done at intervals of 2 weeks, first month, 3 rd and 6 th month and directed toward the observation of the healing process, signs of inflammation, infection soft tissue dehiscence, Zirconia exposure or any complications of wound. Second surgical intervention was to remove the screws and Zirconia sheet with CBCT evaluation to measure alveolar ridge on both sides. Results: Results of the current showing that customized Zr sheet can use successfully to obtain vertical and horizontal bone augmentation well compatible with soft tissue without exposure. Conclusion: Customized Zirconia sheet act as a perfect barrier and space maintaining in GBR procedures with precise fit, and good soft tissue acceptance to Zirconia. Customized Zirconia sheet reduce chairing time and amount of graft. More predictable results can obtained by using xenograft under Zirconia sheet.

Objective: The aim of this study was to evaluate the outcome of mandibular fractures fixation in order to compare lag screw technique with standard miniplates. Methods: This prospective randomized comparative study was conducted on 20 patients with mandibular anterior fractures treated with open reduction and internal fixation. The patients were then randomly allocated into two groups. Group 1: two lag screws were used for fracture osteosynthesis in 10 patients. Group 2: two miniplates were used for fracture osteosynthesis in 10 patients. The surgery was done by the same surgical team who did not involve within the research work. The time for hardware fixation was recorded intraoperatively. Patients were assessed clinically and radiographically for fracture stability, malocclusion, masticatory efficiency, mouth opening, paresthesia, pain, edema, infection, wound dehiscence, malunion/ununion and hardware loosening. A repeated measure ANOVA were used to evaluate the different between lag screw and miniplates. Results: Hardware fixation time showed a highly significant (p<0.001*) difference between group-1 Lag screw with an average of 15.80±0.80 minutes and group-2 miniplates with an average of 20.01±0.823 minutes. The difference in interfragmentary distance between lag screw and miniplates treatments were nonsignificant (p>0.05). regarding occlusion, fracture stability, mastication biting efficiency and postoperative complications a non-significant (p<0.05) difference between both groups as revealed. Conclusions: According to the result of this prospective study it is concluded that, the internal fixation of anterior mandibular fractures with lag screws osteosynthesis is simple, successful, achieving rapid fixation with minimal complications.

Objective: The present study was designed to evaluate the effect of flap and flapless procedures in dental implant installation on initial crestal bone loss. Subjects & Methods: Twelve patients were enrolled in the present study. These patients were divided into two groups. In group I (flapless group), implants were inserted without elevation of a mucoperiosteal flap. In group II (flap group), implants were inserted through elevation of a mucoperiosteal flap. Patients were followed up at the 2 nd and 7 th days after surgery for severity of pain, swelling, infection, dehiscence of the tissue. The periodontal probing depth, post-operative implant stability, crestal bone level, and postoperative bone density were measured 6 months after surgery. Results: The flapless technique group showed statistically significant reduction in pain intensity and swelling than the flap technique. Patients operated with flap technique showed higher pocket depth than patients operated with flapless technique. The implant stability was greater in patients of flapless group than in patients of flap group. The amount of crestal bone loss was less in the flapless group than the flap group. Bone density was increased in the flapless group as well as in the flap group. Conclusion: Both techniques achieved good success rates, and the flapless technique showed no advantage over flap technique regarding probing depth, implant stability and bone density. Moreover, the use of flapless technique might produce less postoperative soft tissue inflammation, pain and significant reduction in the amount of crestal bone loss compared to flap technique.

Purpose: The aim of this research was to assess the clinical effectiveness of buccal infiltration of 4% Articaine hydrochloride in comparison to routine buccal and palatal infiltration during the extraction of maxillary molars. Patients and Methods: Current research were carried out on 200 patients where study group included 100 patients, and 100 were controls. Unilateral extractions were made to patients in the research group. All patients were injected with 1.8 ml of 4% Articaine hydrochloride with 1:100.000 epinephrine in the buccal vestibule of chosen tooth for removal without performing palatal injection. The maxillary tooth was removed after 8 minutes. One hundred participants in the control group were subject to the same procedure with palatal injection. Upon extracting, every patient completed a face pain scale (FPS) and visual analog scale (VAS). Results: According to the FPS and VAS scores, the difference in pain rates was statistically non-significant (p>0.05) when compared with permanent maxillary dental removal with or without palatal injection. Conclusion: Permanent maxillary tooth extraction is possible when 1.8 mL of 4% Articaine is deposited in the buccal vestibule of the tooth without palatal anesthesia.