Hard and soft tissue analysis of alveolar ridge preservation in esthetic zone using deproteinized bovine bone mineral and a saddle connective tissue graft: A long‐term prospective case series

Multivariable analysis to identify predictors of dental implant failure after alveolar ridge preservation: a non-interventional observational study

PURPOSE

The aim of this study was to determine predictors of implant treatment failure after alveolar ridge preservation (ARP).

METHODS

The study included patients who received implant treatment after ARP between 2014 and 2020. The demographic, clinical, and radiographic data of these patients were collected. Implant success was defined as the absence of pain or tenderness, no mobility, a change of <2 mm in marginal bone level, and no exudation. A Cox proportional hazards model with shared frailty was used to estimate hazard ratios (HRs) for the demographic, clinical, and radiographic factors contributing to implant failure.

RESULTS

The study included 528 implants from 412 patients. The cumulative success rate over 3.5±1.8 years (mean ± standard deviation) was 89.0% (95% confidence interval [CI], 85.4%-92.8%), with 43 failed implants. The multiple Cox proportional hazards model with shared frailty indicated that a pristine bone engagement (PBE) of <1.1 mm was significantly associated with implant failure (HR, 2.50; 95% CI, 1.34-4.67; P=0.004).

CONCLUSIONS

PBE of at least 1.1 mm appears to decrease the probability of implant failure after ARP.

Advancements in alveolar bone grafting and ridge preservation: a narrative review on materials, techniques, and clinical outcomes

This narrative review systematically explores the progression of materials and techniques in alveolar ridge preservation (ARP). We commence by delineating the evolution from traditional ARP methods to cutting-edge alternatives, including platelet-rich fibrin, injectable bone repair materials, and hydrogel systems. Critical examination of various studies reveals these innovative approaches not only accelerate bone healing but also significantly improve patient-reported outcomes, such as satisfaction, pain perception, and overall quality of life. Emphasis is placed on the correlation between advanced ARP techniques and enhanced patient comfort and clinical efficacy, underscoring their transformative potential in dental implantology. Highlighting the effectiveness of ARP, the implant survival rate over a span of 5 to 7 years was high, showcasing the reliability and success of these methods. Further, patients expressed high aesthetic satisfaction with the soft tissue outcome, evidenced by an average visual analog scale (VAS) score of 94. This positive aesthetic appraisal is linked to the clinical health of implants, potentially due to the employment of tooth-supported surgical guides. The economic analysis reveals a varied cost range for bone graft substitutes ($46.2 to $140) and socket sealing materials ($12 to $189), with a noteworthy correlation between the investment in barrier membranes and the diminished horizontal and vertical ridge resorption. This suggests that membrane usage significantly contributes to preserving ridge dimensions, offering a cost-effective strategy for enhancing ARP outcomes. In conclusion, this review illuminates the significant advancements in ARP, highlighting the shift towards innovative materials and techniques that not only promise enhanced bone regeneration and reduced healing times but also improve patient satisfaction and aesthetic outcomes. The documented high implant survival rate and the beneficial economic implications of membrane use further validate the effectiveness of contemporary ARP strategies, paving the way for their broader adoption in dental implantology.

Autogenous bone ring augmentation around single tooth implantation in the esthetic zone: A retrospective case series study with 2-3 years of follow-up

Background

/purpose: Bone ring technique (BRT) is an effective method to reconstruct alveolar bone defects with simultaneous implant placement. This study aimed to evaluate the efficacy of the BRT in single maxillary anterior tooth implantation and its esthetic outcomes over 2-3 years of follow-up.

Materials and methods

Fifteen patients with single maxillary incisor loss received autogenous BRT with simultaneous implant placement. The vertical/horizontal bone gain, remaining vertical bone height (RVBH), remaining buccal bone width (RBBW), and vertical/horizontal bone resorption around implant over 2-3 years of follow-up were measured by using cone-beam computed tomography. Esthetic results including white esthetic score (WES), pink esthetic score (PES), and papilla index (PI) were evaluated by clinical recorded photographs.

Results

All implants showed evidence of osseointegration, and the mean vertical and horizontal bone gain of 14 sites was 5.55 ± 0.87 mm and 4.73 ± 0.70 mm, respectively. During 2-3 years of follow-up, all mean values of RBBW were more than 2 mm. Main vertical bone loss appeared within 4 months after surgery and the RVBH value decreased as the follow-up duration continued. Maximum buccal bone thickness resorption mostly appeared in the middle level of the implant during the primary two follow-up periods (P < 0.05). Esthetic results showed that the mean WES/PES was higher than 17, and more than half cases demonstrated relatively high PI (3 points) throughout the follow-up.

Conclusion

BRT could achieve excellent bone augmentation effect and can offer predictable esthetic outcomes for single tooth implant restoration in the esthetic zone.

Three-Dimensional Peri-Implant Tissue Changes in Immediately vs. Early Placed Tapered Implants Restored with Two Different Ceramic Materials-1 Year Results

BACKGROUND

A prospective multi-center randomized controlled clinical trial was performed to digitally analyze tissue volume changes in immediately and early placed implants with simultaneous bone augmentation restored with two different all-ceramic materials.

METHODS

A total of 60 patients received 60 bone-level tapered implants (BLT, Straumann AG) immediately (n = 30) or early placed, 8-10 weeks after tooth extraction, (n = 30). Implants were restored with all-ceramic single crowns fabricated out of zirconia (Lava Plus, 3M), or lithium disilicate (E.max CAD, Ivoclar Vivadent AG) bonded to titanium base abutments (Variobase for Cerec, Straumann AG). Impressions were taken at baseline (BL), 6 and 12 months, and STL data were used to define an area of interest (AOI) to analyze peri-implant volume changes and midfacial recessions.

RESULTS

For immediate placement, a mean volume loss of -5.56 mm3 (±5.83 mm3) was found at 6 months, and of -6.62 mm3 (±6.56 mm3) at 12 months. For early placement, a mean volume loss of -1.99 mm3 (±5.82 mm3) at 6 months, and of -3.7 mm3 (±5.62 mm3) at 12 months was found. The differences in volume loss at 12 months between the two implant placement protocols were significant (p = 0.005). In both groups, mean midfacial recessions of 0.48 mm (±0.52) occurred.

CONCLUSIONS

A more pronounced peri-implant volume loss can be expected 12 months after immediate implant placement compared with early placement.

Silk Fibroin/Collagen/Hydroxyapatite Scaffolds Obtained by 3D Printing Technology and Loaded with Recombinant Human Erythropoietin in the Reconstruction of Alveolar Bone Defects

The fast osteogenesis of the large alveolar fossa and the maintenance of the height of the alveolar ridge after tooth extraction have always been a clinical challenge. Therefore, this work describes the creation of innovative silk fibroin/collagen/hydroxyapatite (SCH) biological scaffolds by 3D printing technology, which are loaded with recombinant human erythropoietin (rh-EPO) for the reconstruction of bone defects. Low-temperature 3D printing can maintain the biological activity of silk fibroin and collagen. The SCH scaffolds showed the ideal water absorption and porosity, being a sustained-release carrier of rh-EPO. The optimized scaffolds had ideal mechanical properties in vitro, and MC3T3-E1 cells could easily adhere and proliferate on it. In vivo experiments in rabbits demonstrated that the composite scaffolds gradually degraded and promoted the accumulation and proliferation of osteoblasts and the formation of collagen fibers, significantly promoting the reconstruction of mandibular defects. In this study, a novel composite biological scaffold was prepared using 3D printing technology, and the scaffold was innovatively combined with the multifunctional growth factor rh-EPO. This provides a new optimized composite material for the reconstruction of irregular mandible defects, and this biomaterial is promising for clinical reconstruction of alveolar bone defects.

Evaluation of the clinical efficacy and safety of modified alveolar cleft bone graft with cone-beam CT digital imaging in children

BACKGROUND

Cone-beam computed tomography (CBCT) is used to observe the bone density and bone height in children with modified alveolar bone graft (ABG) at different times after operation. In this study, the changes of labial-palatal bone mass in the stable period of bone union and in the bone graft area were investigated to provide reference for subsequent treatment.

METHODS

A total of 140 pediatric patients with unilateral complete alveolar cleft were selected and routinely underwent iliac bone grafting. The original data obtained by ProMax 3D (Planmeca) examination were stored in DICOM format at 3 and 6 months postoperatively, and the images were reconstructed by Simplant software (Dentsply Sirona). The bone density of the healthy side was measured at 3 months and 6 months, and the results were expressed as Hounsfield units (HU). The labial and palatal bone height at the bone graft site at 3 and 6 months postoperatively was classified according to the modified Bergland classification method, and was compared with panoramic film classification.

RESULTS

Mean bone density at 3 months after surgery (385.4800±78.39770 HU) was not significantly different from that at 6 months (356.1875±73.67164 HU; P>0.05). There were significant differences between the classification of lip and palatal bone height 3 months after operation and that of the classification of panorama film in the same month (P<0.05); between the classification of lip and palatal bone height 6 months after surgery compared with that of panorama film of the same month (P<0.05); and between the classification of bone height degree in labial, palatal, and panoramic slices at 3 months after operation and that at 6 months after operation (P<0.05).

CONCLUSIONS

The labial and palatal classification is different, and the bone height classification 6 months after surgery is lower than that 3 months after surgery, indicating the persistence of bone resorption. CBCT can objectively evaluate the bone quality in the bone graft area, which has clinical application value for surgical evaluation value and posttreatment guidance.

Horizontal ridge augmentation in the anterior maxilla with in situ onlay bone grafting: a retrospective cohort study

OBJECTIVES

This study aimed to introduce a digitally guided in situ autogenous onlay grafting technique and compare its effectiveness with the conventional (ex situ) onlay technique in augmenting horizontal bone defects of the anterior maxilla.

MATERIALS AND METHODS

This retrospective cohort study included 24 patients who had received autogenous onlay bone grafts combined with guided bone regeneration (GBR) in the anterior maxilla. Fourteen patients were recruited into the in situ onlay grafting group (EG), and 10 were recruited into the ex situ onlay group (CG), defined by the donor sites. The clinical parameters, radiographic changes, micro-CT, and histological processes were evaluated after a mean follow-up period of 1.7 years.

RESULTS

The horizontal bone width reflected significant bone modeling over time (p < 0.001) in the first 6 months. Multivariable analysis showed that the treatment modality (grouping) was a critical factor positively associated with vertical bone height alteration. However, neither the alteration rate of horizontal bone width nor the bone volume was associated with the treatment modality. The number of periosteal screws per graft positively affected horizontal contour maintenance (p < 0.05). No significant differences were observed between the groups in the clinical parameters (complications, success rate, and peri-implant parameters). The micro-CT and histological outcomes were similar between the groups.

CONCLUSION

Despite the limitations of this study, in situ onlay grafting combined with GBR was an effective and reliable approach for horizontal bone augmentation in the anterior maxilla and appeared to demonstrate better stability in vertical bone remodeling.

CLINICAL RELEVANCE

This study introduces a modified and minimally invasive technique of onlay grafting for horizontal bone augmentation. This in situ onlay grafting demonstrates superior stability in vertical bone remodeling. The trial registration number is ChiCTR2100054683.

Hard and Soft Tissue Augmentation with Single-Implant Restoration in the Esthetic Zone

The removal of the central incisor of the upper jaw is a challenging process, since the restoration of a single implant in the esthetic zone is of great responsibility. When tooth extraction with immediate implant placement is not possible, modern protocols imply the use of the socket preservation technique. This method of preserving socket properties significantly reduces changes that occur during the healing process of the postextracted area and along with soft tissue augmentation allows to achieve a satisfying aesthetic result. The aim of present case report is to assess capabilities of socket preservation concept and application of soft tissue augmentation in the anterior maxillary region. The treatment steps of a 35-year-old woman who needed to remove tooth 11 with further dental implant placement are described. The clinical case is of interest because after socket preservation and soft tissue augmentation, an acceptable aesthetic result was not reached. However, additional soft tissue augmentation made it possible to achieve the desired result, which was stable for 7 years.

Immediate implant placement combining socket seal abutment and peri-implant socket filling: A prospective case series

OBJECTIVES

The aim of this prospective case series was to assess the implant outcomes as well as hard and soft tissue dimensional changes of immediate implant placement in posterior sites using a custom-made sealing socket abutment (SSA) combined to peri-implant socket filling (PISF).

MATERIAL AND METHODS

Twenty patients were considered for single extraction and immediate implant in upper or lower posterior regions. The remaining peri-implant sockets were filled with Deproteinized Bovine Bone Mineral. Based on intra-oral scans (IOS), custom-made SSAs were placed the same day. Implant survival rate, peri-implant bone changes, peri-implant health and pink esthetic score (PES) were recorded up to 1 year post-implant placement. Moreover, CBCT and IOS were performed to monitor hard and soft tissue dimensional changes.

RESULTS

One implant failed to osseointegrate leading to an implant survival rate of 95% after 1 year. Peri-implant bone changes yielded 0.19 ± 0.31 mm and 84.2% of the implants displayed no or mild bleeding on probing. Horizontal bone remodeling was not significant from baseline to 1 year at any levels. Finally, soft tissue profile was stable in the most cervical area while minor changes occurred during the first 6 months below the gingival margin. The absence of mid-buccal recession (0.07 mm) and good PES were found after 1 year.

CONCLUSION

Despite its limitations, this study showed that immediate implants in the posterior region using the SSA + PISF protocol resulted in promising implant outcomes with limited hard and soft tissue dimensional changes while decreasing the overall treatment time.

Implants Survival Rate in Regenerated Sites with Innovative Graft Biomaterials: 1 Year Follow-Up

In thirteen different dental clinics in Singapore, Spain, Czech Republic and Italy, 504 patients were selected, and 483 dental implants were placed in maxillary sites after alveolar socket preservation (ASP) procedures with an autologous demineralized tooth extracted as graft material from an innovative Tooth Transformer device was obtained. All procedures used were reported in n°638 Ethical Committee surgical protocol of University of Chieti and approved. After 4 months, at dental implant placing, bone biopsies were performed to evaluate the histologic outcomes, and 12 months after implant loading, global implant survival rate, failure percentage and peri-implant bone loss were detected. After ASP, only 27 post-operative complications were observed and after 4 months, bone biopsy histomorphometric analysis showed a high percentage of bone volume (BV) 43.58 (±12.09), and vital new bone (NB) 32.38 (±17.15) with an absence of inflammation or necrosis areas. Twelve months after loading, only 10 dental implants failed (2.3%), with a 98.2% overall implant survival rate, nine cases showed mucositis (1.8%) and eight showed peri-implantitis (1.6%). At mesial sites, 0.43 mm (±0.83) of bone loss around the implants was detected and 0.23 mm (±0.38) at the distal sites with an average value of 0.37 mm (±0.68) (p > 0.568). Several studies with a longer follow-up will be necessary to confirm the preliminary data observed. However, clinical results seem to suggest that the post-extraction socket preservation procedure using innovative demineralized autologous tooth-derived biomaterial may be a predictable procedure to produce new vital bone able to support dental implant rehabilitation of maxilla edentulous sites.

Early implant placement in ridge preserved extraction sockets: A pre-clinical in vivo study

OBJECTIVES

The aim was to analyse the outcomes of early implant placement after 6 and 12 weeks of healing in ridge preserved sites in a canine model.

MATERIALS AND METHODS

Implants were placed in second maxillary incisors sites in 9 dogs 6 weeks after grafting of the sockets with 90% deproteinized bovine bone mineral in 10% collagen matrix (DBBMC) and closure with resorbable type I/III porcine collagen matrix (PCM). The implants were randomly assigned to 6 (T6) and 12 (T12) weeks of healing.

RESULTS

The percentage of bone-to-implant contact (%BIC), old bone, new bone and residual DBBMC was similar between T6 and T12. In relation to the implant shoulder (IS), the original bone crest (IS-ROB) was more apical on the buccal than the palatal side. The regenerated bone crest (IS-C) and IS-ROB were similar between groups. However, the distance from IS to first bone-to implant contact (IS-fBIC) was significantly less in T12 compared with T6 (p = .022; Wilcoxon signed-rank test). The bucco-palatal ridge dimensions between T6 and T12 were similar.

CONCLUSIONS

This study confirms that implants can successfully be placed early in ridge preserved maxillary second incisor sites and are osseointegrated by 6 weeks. There were significantly lower IS-fBIC values at 12 weeks than at 6 weeks on the buccal aspect. The original buccal bone crest underwent greater corono-apical resorption than the palatal crest. The %BIC, relative proportions of mineralized tissues and dimensions of the alveolar ridge demonstrated stability between 6 and 12 weeks of healing.

Immediate implant in the posterior region combined with alveolar ridge preservation and sealing socket abutment: A retrospective 3D radiographic analysis

BACKGROUND

Customized sealing socket abutment (SSA) has been claimed to optimize the peri-implant hard and soft tissues in type 1 implant placement. However, the evidence to claim the benefits of this technique over the use a conventional healing abutment remains weak.

PURPOSE

The aim of this retrospective study was to provide a 3D-radiographic evaluation of hard tissues changes following immediate implant placement in molar sites combined to ARP technique and installation of SSA.

MATERIALS AND METHODS

Baseline and follow-up (FU) CBCTs (from 1 to 5 years) of 26 patients were collected and included in the study. Baseline and FU CBCTs were superimposed and horizontal and vertical bone changes were assessed.

RESULTS

A total of 26 patients and 27 implants were included. Horizontal bone remodeling was not significant in any of the measured areas except in the most cervical level, where a mean bone remodeling of 0.73 mm was found. Proximal and buccal vertical bone changes were not significant.

CONCLUSIONS

Within the limits of a retrospective study, dimensional alveolar ridge changes 1 to 5 years after immediate implant placement in molar sites with simultaneous ARP technique and installation of SSA seem to be very limited.