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   2022| July-August  | Volume 14 | Issue 4  
    Online since August 29, 2022

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Use of nanoparticles in pediatric dentistry: A narrative review
Sonu Acharya, Brinda S Godhi, Sonali Saha, Bismay Singh, Kavita Dinsa, Jitendra Bhagchandani, Ashesh Gautam
July-August 2022, 14(4):357-362
Aims: Nanoparticles are being used a lot in dentistry, and the use of nanoparticles can bring about a change in almost all aspects of pediatric dentistry, from diagnosis to treatment. The aim here was to search scientific databases for the utilization of nanoparticles in pediatric dentistry. Nanotechnology is the science of material world in the scale of less than 100 nm. This has made a revolution in the field of medical and dental sciences by improvement in mechanical and physical traits of substances, helping to reinstate new investigative possibilities and microdelivery options. Materials and Methods: The literature search was done through various databases such as PubMed, Cochrane, Scopus, and Web of Science using MeSh and free terms to collect data on “nanoparticles in pediatric dentistry.” Those articles that are written in English and those that had full text available were considered since its use in dentistry, whereas unpublished data and literature written in other languages and articles with only abstracts were excluded. Following the search results obtained, 31 articles were relevant. The reference list of all the articles thus included was hand-searched; full text evaluation was done; and duplicates were removed. Results: The articles mentioning nanoparticles in pediatric dentistry were very few, so we included articles with some association with pediatric dentistry, and finally 21 articles met the criteria of search. Nanoparticles have tremendous potential for being used in pediatric dentistry, namely the prevention of dental caries, restorative materials, endodontics, and imaging. Although beneficial these materials have to be applied with caution as still no long-term studies are available. Conclusion: Nanotechnology has been exploited in dentistry mostly with beneficial results. Scientists are working very hard to incorporate nanoparticles into every aspect of dentistry, pediatric dentistry in particular. There is a dearth of studies, both in vivo and in vitro, on these materials, and more studies will substantiate the uses in pediatric dentistry. The present scientific review will help us in understanding nanomaterials and the advantages and demerits of nanotechnology by addressing its social and medical implications.
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Application of the health belief model in oral hygiene practice (brushing/flossing): A narrative review
Elwalid F Nasir, Nada M. A. Suliman
July-August 2022, 14(4):342-348
Aim: Application of the health belief model helps explain when people would/would not engage in preventive health behaviors. Several studies were conducted to explore the model’s applicability in oral health; however, review studies on oral hygiene practice are scarce. The present study aimed to review the application of the model concerning oral hygiene practice and to identify the frequently used constructs of the model. Materials and Methods: This review focussed on the studies published during 2010–2020 using the following databases: PubMed, Web of Science, Research Gate, Cochrane Library, and the keywords used are health belief model, oral hygiene practice, brushing, and flossing. Twenty studies that fulfilled the criteria were included in the present review; among them, 12 were cross-sectional. Cluster sampling was the most frequent used by seven studies. Results: Almost all studies reported verifying the validity/reliability of the instruments used except three, and Cronbach α was the most used. The most used analyses were regression (linear/binomial) by 13 studies, besides χ2, t-test, Mann–Whitney, analysis of variance, and Wilcoxon, whereas three studies used statistical models. Nine studies used five constructs, whereas six studies used the extended model with six constructs. Self-efficacy and barriers were the most significant predictors of oral hygiene practice, followed by susceptibility, severity, and benefits. The least significantly related was cues to action, and only one study reported no significant association. Conclusion: This review presented the validity of the psychometric properties of the model in explaining the oral hygiene practice; the review might have a limitation as it is limited by only the last 10 years beside the English language. This review might form a quick reference for the studies during the period of review.
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Physical effects of cleaning agents on orthodontic thermoplastic retainer polymer: A narrative review
Iman Azmuddin, Nik M. N. Mustapha, Hasnah B S G Khan, Saraswathy D Sinniah
July-August 2022, 14(4):349-356
Aim: Orthodontic thermoplastic retainers are fabricated from polymers such as polyurethane, copolyester, polypropylene, and modified polyethylene terephthalate glycol (PET-G). This review outlines the cleaning methods employed by clinicians and patients and discusses the evidence related to the effect on the physical properties, including translucency, surface roughness, flexibility, and color of the thermoplastic polymer material. Materials and Methods: An electronic search through Web of Science, Scopus, Google Scholar, and PubMed was performed, seeking original studies published between January 2010 and July 2021 on cleaning agents’ effect on thermoplastic retainers’ physical properties. There were only six in-vitro studies found and they investigated 14 cleaning agents on the 4 most used polymer materials. There were no clinical studies carried out in this area of research. Results: PET-G was the polymer least impacted by cleaners. Its structural integrity was not altered much by Invisalign Cleaning Crystals, Retainer Brite, Cetron Powder, Corega tablets, or brushing with toothpaste. Polyurethane and copolyester retainer polymer experienced the least notable changes when cleaned with Invisalign crystals or Retainer Brite. Dawn dish soap was the only cleaning agent that caused little changes in the polypropylene polymer. Generally, it may be best to avoid cleaning retainers made of polyurethane, polypropylene, and copolyester with vinegar or hydrogen peroxide. Conclusion: This narrative review has summarized the commonly used cleaning agents’ effects on the physical properties of thermoplastic polymer. Further trials are needed to offer the best retainer cleaning agent with least adverse effects on the physical properties of the retainer polymer.
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Validity and reliability of Impact on Family Scale for Indonesian cleft lip and palate parents: A questionnaire-based study
Reza Al Fessi, Andra Rizqiawan, David Buntoro Kamadjaja
July-August 2022, 14(4):394-402
Aim: Cleft lip and palate (CLP) in children might impact their parents’ mental health. The pathology may cause burden in the parents’ life, primarily in the financial and social aspects. The IOFS (Impact on Family Scale) questionnaire, with 33 items and 4 aspects, measures the quality of life by quantifying the impact on families of chronic childhood conditions. This cross-sectional study was conducted to assess the validity and reliability of the IOFS. Materials and Methods: The translation of the IOFS questionnaire to Indonesian language was conducted by two translators. Thirty respondents based in three regions in East Nusa Tenggara (Kupang, Bima, and Selong) were selected for data collection. The scoring was measured using a Likert scale, and then the data were tested by Pearson’s bivariate test and Cronbach’s alpha test to assess the questionnaire’s validity and reliability, respectively. Results: A total of 31 statements showed validity scaling using the coefficient Pearson’s correlation >0.361 (P < 0.05) and 29 statements showed reliable scaling (Cronbach’s alpha) >0.60 (P < 0.05). The overall validity and reliability test revealed 27 valid and reliable IOFS instrument statements. Conclusion: The majority of the statements were valid and reliable. Thus, the IOFS instrument can be considered a reliable, valid, and straightforward tool to assess the burden on the cleft and lip palate family in Indonesia.
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Preservation of biological width to avoid marginal bone loss and implant failure - A retrospective study
Terry Zaniol, Alex Zaniol, Anna Tedesco, Stefania Palumbo
July-August 2022, 14(4):386-393
Aim: To evaluate the medium-term survival and the progression of marginal bone loss by determining the statistical relationship between the explanatory variables for dental implants with internal hexagonal connection in native bone and with guided bone regeneration. Materials and Methods: The present retrospective study was carried out on a total of 218 implants (143 implants in native bone and 75 implants with guided bone regeneration) placed in 53 patients selected without restrictive inclusion criteria. Clinical and radiographic variables, including marginal bone loss, were recorded up to 46 months of follow-up. Mann-Whitney U test was used to compare annual bone loss and total marginal bone loss. The cumulative survival rate was calculated according to the lifetable method and illustrated with Kaplan–Meier survival curves. Univariate and multivariate analysis was performed to investigate the association between study variables and the time to implant failure. Additional factors influencing marginal bone loss were also evaluated. Results: The cumulative survival rates for implants placed in native bone and with guided bone regeneration at 46 months were 97.9% and 97.3%, respectively. In our cohort, the univariate analysis identified marginal bone loss, gingival thickness, and bleeding on probing as risk indicators of implant failure. Moreover, bone loss was correlated with gingival thickness and implant depth. Conclusion: No statistically significant differences in survival rates were reported between two types of implants. On the other hand, the correlation of marginal bone to implant insertion depth and gingival thickness, suggests that the biological width measurement should be respected.
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Predictability of short dental implants for rehabilitation of the complete edentulous: A systematic review
Setyawan Bonifacius, Rasmi Rikmasari, Tatacipta Dirgantara, Cortino Sukotjo
July-August 2022, 14(4):331-341
Aim: The use of short implants is emerging as a promising option in the implant-based rehabilitation of edentulous patients; yet their clinical performance is not fully documented. The purpose of this systematic review was to assess the clinical performance of the use of short implants on complete-arch implant-supported fixed dental prostheses and to compare their design with the in-vitro study. Materials and Methods: The PubMed database of the United States National Library of Medicine and EBSCOhost Research Databases were used as electronic databases, and a literature search was accomplished with a personal computer on articles published in English from January 2010 up to and including August 2020. Articles available online in electronic form before their publication in material form were considered eligible for inclusion in the present article. Results: The electronic search in both databases (PubMed and EBSCOhost) provided a total of 6779 titles and abstracts that were deemed potentially relevant to the influence of the short implant on a fixed complete denture. During the manual search of dental journals, 57 titles and abstracts were examined. In the second phase of study selection, the complete text of 1028 articles was retrieved and subjected to scrutiny. Throughout this procedure, 70 articles were obtained and the rest were excluded. Finally, the remaining 15 articles met the study inclusion criteria and were approved by all reviewers. Short implants offer benefits in terms of less invasive surgery, ease of handling, and reduced risk of damaging anatomical structures. Short implants can also be used in the rehabilitation of edentulous jaws. Avoiding or minimizing the length of the cantilever in dental implants is an important rule for the long-term success of implant treatment, including the rehabilitation of an edentulous jaw using an implant-supported fixed denture. The location of placement and the number of short implants are very influential in reducing the risk of excessive stress on the peri-implant bone. Conclusion: Short implants are potential alternatives to rehabilitating edentulous jaws, whether combined with standard size or longer implants or “All-on-short” as a whole. Further studies are still needed to obtain a guideline for the use of short implants to rehabilitate edentulous patients.
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Effect of cement-space thickness on the marginal fitness of all zirconium oxide crowns—An in vitro study
Farah A Taha, Zainab M Jasim, Hala A Husseien
July-August 2022, 14(4):382-385
Aim: To estimate the influence of cement-space thickness on the vertical marginal fitness of full zirconia crowns. Materials and Methods: A total of 24 newly extracted sound human maxillary first premolars were mounted and thereafter prepared to receive fully contoured zirconia crowns. Teeth were scanned via Chairside Economical Restoration of Esthetic Ceramic (CEREC) digital intraoral scanner (Omnicam, Sirona, Germany). Afterward, teeth were randomly assorted into three groups (depending on the cement-space thickness parameter of their corresponding designed crowns): group A = 80 μm, group B = 100 μm, and group C = 120 μm. Zirconia crowns were assembled using In-Lab MCX5 milling machine (Sirona). The cementation procedure was undergone using RelyX Unicem self-adhesive luting cement (3M, ESPE, Germany). The marginal discrepancy was measured at 16 points/tooth utilizing a digital microscope (85× magnification). Data were statistically analyzed utilizing one-way analysis of variance (ANOVA) and Tukey honestly significant difference (HSD) test (P = 0.05). Results: The analysis revealed that the cement-space thickness parameter had a highly significant effect on the marginal gap values in all groups. The lowest mean of marginal gap values was noted for group C (120 μm). Conclusion: Increasing cement-space thickness from 80 μm to 100 and 120 μm might be favorable for a better adaptation of monolithic zirconia crowns.
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The management of Miller’s class I gingival recession: Vestibular incision subperiosteal tunnel access (VISTA) in combination with acellular dermal matrix: A case report
I Komang Evan Wijaksana, Novia Wiyono, Noer Ulfah, Muhammad Rubianto
July-August 2022, 14(4):427-431
The vestibular incision subperiosteal tunnel access (VISTA) has many advantages for successfully treating multiple recession defects. Soft-tissue regeneration is generally achieved by either free gingival or connective tissue grafts. In recent years, various investigations have evaluated the outcome of acellular dermal matrix (ADM) for mucogingival surgery with encouraging outcomes. A 26-year-old male presented with a chief complaint of unattractive appearance in the upper left teeth. Miller’s class I gingival recession presented in 23, 24, and 25 teeth. The VISTA approach combined with ADM affords a number of unique advantages to the successful treatment of multiple recession defects on this case report. The VISTA method was selected to manage this condition. During coronal advancement, subperiosteal dissection reduces gingival margin tension while maintaining blood flow to the interdental papillae. The increase of keratinized gingiva is notable, and after 1 year, soft tissue stability is apparent. The management of Miller class I gingival recession with the VISTA could achieve a commendatory result. ADM (Mucoderm) is a suitable alternative for connective tissue graft to augment gingival thickness.
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Impact of COVID-19 pandemic on orthodontic patient’s inflow in daily orthodontic practice: A cross-sectional study
Talat H Al-Gunaid, Mohammad M Hammad, Maher O Shahada, Hamzah S Allam, Abdulqader Z Abuanq, Ghaidaa S Zakour, Hazim H Zubaidi, Ghofran A Karbouji
July-August 2022, 14(4):409-415
Aim: To evaluate the effects of the COVID-19 pandemic and lockdown on orthodontic patients’ apprehension and inflow and to investigate the treatment-related problems encountered during the pandemic. Materials and Methods: A cross-sectional study was carried out in Saudi Arabia, and patients with active orthodontic treatment were reached via an online questionnaire. A total of 260 orthodontic patients agreed to participate in the study. The sample size calculation was performed using the Raosoft sample size calculator based on the estimation of 75% of the population need orthodontic treatment. The questionnaire included three sections: demographic data, patient fear, and troubles encountered during the lockdown. A link was sent to the participants via different social media platforms and applications. The chi-square goodness-of-fit test was used to assess differences between the variables. Pearson correlation, binomial logistic regression, and multiple logistic regression tests were used to assess the extent of the relationship between patient apprehension and safety measures of COVID-19, as well as between patient orthodontic-related problems. Results: About half of the participants (52.3%) were not afraid of COVID-19 or panicked; however, 54% of them felt depressed during the lockdown. More than 80% were not afraid of visiting the orthodontists or thinking of changing their orthodontists for safety measures and did not want to postpone their treatment. The participants felt that excellent disinfection was the most important measure of infection control followed by wearing masks, face shields, and protective clothing. Conclusion: COVID-19 and the lockdown have a noticeable impact on the patients’ apprehension and dejection. A very high percentage of patients in this study showed no hesitation to visit their orthodontists, and they did not want to stop their treatment during the pandemic. The most common treatment-related problem reported was cheek injury, followed by bracket breakage.
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Effectiveness of oral exercise programs on oral function among independent elderly people: A cluster randomized controlled trial
Suphak Wongworasun, Jaranya Hunsrisakhun, Achara Watanapa
July-August 2022, 14(4):363-369
Aims: To compare the effectiveness of two oral exercise programs on oral function among independent elderly people. Materials and Methods: This was a cluster randomized controlled trial study conducted among 60–74 years old in Chonburi Province, Thailand. Participants in six senior schools were randomly allocated to one of two groups: the intervention group (n = 123) received a simple oral exercise program of 2 min/session (SOE) and the control group (n = 121) received a traditional oral exercise program of 15 min/session (TOE). They were required to practice twice daily. The baseline and 3-month follow-up oral function assessments included chewing ability, dry mouth status, Unstimulated Whole Saliva (UWS), dysphagia, and the Repetitive Saliva Swallowing Test (RSST). Paired t test and independent t test were used to compare the outcome variables within and across the two groups, respectively. Results: At the 3-month follow-up, the SOE group significantly improved in chewing ability and UWS, whereas in the TOE group, there was a significant improvement in UWS and RSST. Comparing oral function mean differences between groups, RSST in the TOE group was significantly greater than in the SOE group (P < 0.05) but there were no differences in chewing ability, dry mouth status, UWS, or dysphagia. Conclusion: Both oral exercise programs were similarly beneficial in enhancing elderly oral function in terms of UWS. TOE outperformed SOE in terms of improving swallowing function. The other oral function had a chance to improve in both programs.
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The effect of alpha-mangostin on interleukin-10 and collagen 1A1 gene in the inflammation process: An experimental in-vitro study
Menik Sayekti, Andra Rizqiawan, Pratiwi Soesilawati, Ni P Mira, David B Kamadjaja, Mohammad Z Rahman
July-August 2022, 14(4):403-408
Aims: Bone resorption after tooth extraction can cause serious problems on subsequent denture implants and restorative dentistry procedures that rely on the bone healing process. The peel of the mangostin fruit is one of the natural components that can help with wound healing. Its constituents, particularly alpha-mangostin, have antifungal, antioxidant, antiviral, antibacterial, and anti-inflammatory properties. The research was carried out because there was an effort to speed up the healing process following tooth extraction and because of the high potential of alpha-mangostin. The aim of this study is to see whether taking alpha-mangostin decreases interleukin-10 (IL-10) and increases collagen 1A1 expression in the inflammation process. Materials and Methods: This study was a post-test-only control group design. An in-vitro experiment was conducted on the following four groups. Then lipopolysaccharide (LPS) and alpha-mangostin were inducted into cell culture. In osteoblast cell culture 7F2, real-time polymerase chain reaction was performed to see markers collagen 1A1 and IL-10. The research was statistically analyzed, using a variance test and one-way analysis of variance. Results: The highest IL-10 gene expression was found in group induction with LPS, but there was no significant difference in IL-10 expression between the groups. The highest collagen 1A1 gene expression was found in a group that received induction with LPS and alpha-mangostin, but there was not a significant difference in collagen 1A1 expression between the groups. Conclusion: Alpha-mangostin induction effectively reduces inflammation and IL-10 expression, while increasing collagen 1A1 expression.
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Fabrication of a detachable cheek plumper on a removable partial denture using a custom-made assembly
Ankita Srivastava, Pradeep Sherigar, Nayana Prabhu
July-August 2022, 14(4):416-421
Esthetics remain an inseparable aspect affecting the mental health of a person. On losing teeth, patients suffer from a lack of confidence, and in the majority of cases, it affects their mental well-being. Mental health and social interaction are integral entities for evaluating the quality of life. A prosthodontist should aim to provide the best possible version of rehabilitation to the patient. However, constraints such as affordability, willingness, and acceptance of the patient always affect the suggested treatment plan. Many modifications have been done previously using attachments on the complete denture but not on a removable partial denture. This case report demonstrates a patient who was partially edentulous, had sunken cheeks, and was concerned about her facial appearance. In the presented case, an alternative method of the fabrication of cheek plumper on a removable partial denture was done to provide an esthetic restoration. For the construction of the prosthesis, a lumbar puncture needle was used, which was soldered to Adams clasps, to support the cheek plumper on the removable partial denture. The prosthesis improved the facial shape of the patient and provided a youthful appearance. The patient was happy and contented with the treatment outcome.
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Comparative evaluation of patient satisfaction following the use of two different orthodontic removable retainers: A prospective randomized controlled trial
Sowmithra Devi, Ravindra K Jain, Arthi Balasubramaniam
July-August 2022, 14(4):370-376
Aim: To evaluate and compare the patient level of satisfaction with vacuum-formed retainer (VFR) and Clear Bow Hawley’s retainer (CBR). Materials and Methods: This prospective randomized controlled trial included 46 subjects treated with fixed orthodontics who required retainers. The study subjects were randomly segregated into two groups using a table of random numbers. Twenty-three patients received CBRs (group 1) and 23 patients received VFRs (group 2). Following 3 months of usage of retainer, patients were given a pre-validated self-assessment questionnaire consisting of nine items and responses were recorded. Using SPSS software version 23, the data were statistically evaluated. The Shapiro–Wilk normality test followed by non-parametric χ2 test and Mann–Whitney U-test were done. Subject response between gender and age groups was correlated with Pearson’s correlation test. Results: A non-parametric data distribution was obtained (P = 0.05). The Mann–Whitney U-test showed significant differences in median values for difficulty in swallowing fluids (P = 0.039), speech (P = 0.047), appearance of the retainers (P = 0.024), and comfort (P = 0.000), and other parameters such as overall satisfaction (P = 0.544), retainer fit (P = 0.103), and oral hygiene (P = 0.162) did not show any significant differences. In terms of retainer adjustments (P = 0.06) and retainer breakage (P = 0.97), no intergroup difference was noted. Pearson’s correlation test revealed a statistically significant correlation between age and gender for domains of comfort, speech, swallowing, oral hygiene, and overall satisfaction (P < 0.05). Conclusion: This trial concludes a greater comfort and better aesthetics among subjects who used CBRs, and subjects using VFRs had better speech articulation and swallowing of fluids. Between the two retainers, there was no discernible difference in overall satisfaction.
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Efficacy of domestically manufactured remineralizing agent on artificially created surface lesions: A comparative ex-vivo study
Sowmiya Tamil, Chakravarthy S Vineetha, Ram Prasad, Srilekha Jayakumar, Bindu M John, Remya Varghese
July-August 2022, 14(4):377-381
Aim: To compare and evaluate the efficacy of domestically manufactured remineralizing agents on artificially created carious lesions. Materials and Methods: Freshly extracted 60 human maxillary first premolars were used for our in-vitro comparative study. The samples were embedded in acrylic resin such that the surface of enamel is visible for study. These samples were stored in deionized water for 1 month. The surfaces were demineralized to create a subsurface lesion. Samples were then divided using random sampling method into four groups. Each group had a sample size of 15, according to the remineralizing agent used. Group 1—tri-calcium phosphate (β-TCP), Group 2—domestically manufactured nano hydroxyapatite (NHA), Group 3—bioactive glass (BAG), and Group 4—artificial saliva (control). These remineralizing agents were applied on the samples of respective groups for 4 min, at every 24th hour for a duration of 7 days. After which, incubation of the samples was carried out by placing them in artificial saliva. This was done at a temperature of 37°C between every cycle. After completion of seven cycles, Vickers microhardness test was used to measure the surface microhardness. Data were collected and HV values among the groups were compared using one-way analysis of variance. Multiple pairwise comparisons were analyzed using Tukey’s honestly significant difference post hoc tests. Results: Improved surface remineralization was observed in all the three groups. Nano-hydroxyapatite showed highest remineralization. TCP showed better remineralization compared to BAG. Conclusion: Remineralizing efficacy of NHA toothpaste was higher when compared with BAG and β-TCP.
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Modified approach for alveolar ridge augmentation in narrow maxillary anterior region by using screw-shaped bone expanders: A case report
Monika Bansal, Rakhshinda Nahid, Samidha Pandey
July-August 2022, 14(4):422-426
The objective of the present case report is to discuss the ridge expansion by using screw-shaped bone expanders in the narrow maxillary anterior region. A 24-year-old male subject was subjected to rehabilitate the #12 edentulous site with an implant-retained fixed prosthesis. Initially, a point drill of 1.5 mm diameter was used to initiate the osteotomy preparation to the depth of the implant length. After that, sequential screw-shaped bone expanders were used to expand the osteotomy progressively rather than cutting to the desired width of the implant. Finally, an implant was placed with an insertion torque of 35–40 N-cm. At the third month, a final prosthesis was placed and excellent esthetic was achieved. Conclusively, ridge split and expansion technique is a simple, less-invasive, and viable alternative to modify the ridge to make the prosthetic-driven implant placement rather than bone-driven and screw-shaped bone expanders to avoid the bone augmentation procedure and to reduce the overall treatment time.
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