Tilted Implants and Sinus Floor Elevation Techniques Compared in Posterior Edentulous Maxilla: A Retrospective Clinical Study over Four Years of Follow-Up

Innovative Alveolar Ridge Preservation Surgical Technique with Immediate Dental Implant Placement: A Retrospective Case Report of 1-Year Follow-Up

Following tooth extraction, the alveolar ridge undergoes morphological and dimensional changes, including a clot formation that is gradually replaced by granulation tissue. Studies indicate that both horizontal and vertical ridge dimensions decrease after extraction; however, these changes can be mitigated through grafting with biomaterials and barrier membranes. Alveolar ridge preservation (ARP) techniques are employed to counteract bone resorption postextraction, encompassing periosteal inhibition and modified periosteal inhibition (MPI) techniques. The Degidi clot chamber technique offers a means to achieve biomaterial-free extraction sockets, promoting healing and osteointegration. This study aims to present the first rehabilitation of a postextraction dental implant in the maxilla using an innovative ARP procedure via a MPI technique. The technique does not involve autologous or heterologous grafting materials; instead, a cortical lamina and a customized screw are used in conjunction with the blood clot. The primary objective is to protect the vestibular cortical bone from preosteoclastic aggression, which can trigger bone resorption. The technique employs a 0.5-mm cortical lamina to mechanically shield the vestibular cortical bone, preventing vestibular cortical bone resorption and increasing its thickness without the need for biomaterial insertion, relying on the blood clot. The effectiveness of the technique was assessed through a 12-month postimplantation cone-beam computed tomography scan, revealing a 0.5-mm increase. Although based on a single case, the 1-year follow-up results are promising, and further studies are warranted to validate the technique's efficacy.

Immediate loading full-arch rehabilitation using transmucosal tissue-level implants with different variables associated: a one-year observational study

BACKGROUND

The aim of the present observational study was to investigate the application of transmucosal tissue-level implants in immediate loading full-arch rehabilitation with different variables associated.

METHODS

Patients needing a full-arch implant rehabilitation were recruited and rehabilitated with four transmucosal tissue level implants. Data related to implants' diameters and lengths, jaw distributions, and presence of angulated abutments were collected. The following outcomes were evaluated: survival rate, marginal bone loss (MBL), Plaque Index (PI), bleeding on probing (BoP), probing depth (PD). Descriptive statistical analysis was reported and univariate linear regression models were built to assess a significant correlation between MBL and the different implant related factors.

RESULTS

Twenty patients were rehabilitated for a total implant number of 80; 11 rehabilitations were performed on the maxilla, while 9 were performed on the mandible; 48 implants presented a 3.8 mm diameter and 32 implants presented a 4.25 mm diameter. Implants length varied between 10 to 15 mm; 40 tilted implants were connected to angulated abutment, while 40 straight implants were connected directly to the prostheses (no abutments). At the one year follow-up visit no implants failed resulting in an implant survival rate of 100%. The overall MBL was 1.19±0.30 mm. No statistically significant difference (P>0.05) was highlighted among any of the subgroups analyzed.

CONCLUSIONS

Despite different variables associated, tissue level implants seem to represent a valid option when applied in immediate loading full-arch rehabilitation. Further research and longer observational periods are encouraged to confirm the result.

Fiber-reinforced composite full-arch prosthetic reconstructions supported by three standard, short or extra-short implants: a two-center retrospective study

OBJECTIVES

To evaluate the survival of implants and prostheses, and marginal bone level of fiber-reinforced composite implant supported fixed complete prostheses supported by 3 implants.

MATERIALS AND METHODS

Patients with fiber-reinforced composite fixed prostheses supported by 3 standard-length, short or extra-short implants were included in this retrospective cohort study. Kaplan-Meier survival was computed for implants and prostheses. Univariate and multivariate Cox proportional hazard regressions, clustered by patient, were used to analyze bone level differences as a function of different study covariates. Linear regressions were used to investigate the relationship between distal extension lengths and bone levels.

RESULTS

Forty-five patients with 138 implants were followed for up to 10 years after prosthesis insertion (mean 52.8; SD 20.5 months). Kaplan-Meier survival analysis showed overall survival rates of 96.5% for implants and of 97.8% for prostheses. The 10-year success rate for prostheses was 90.8%. Extra-short implants survived at similar rates to short and standard implants. Marginal bone levels surrounding implants remained stable over time, even showing slight bone gain on average (mean + 0.1 mm/year; SD ± 0.5 mm/year) Acrylic denture teeth, overdentures on the opposing arch, and implant placement in the posterior maxilla were correlated with bone gain. Screw retention, opposed to telescopic retention, was correlated with bone loss. Longer distal extensions were correlated with bone gain on the implants closest to the distal extensions.

CONCLUSIONS

Fiber-reinforced composite fixed prostheses supported by only 3 implants, most of which were extra-short, presented high survival rates with stable bone levels.

CLINICAL RELEVANCE

An encouraging prognosis can be expected for restoration of atrophic maxillary and mandibular arches, when restored with fixed fiber-reinforced composite frameworks with long distal extensions and supported on only 3 short implants.

Peri-implant cell differentiation in delayed and immediately-loaded dental implant: A mechanobiological simulation

OBJECTIVE

This study aimed to investigate the effect of immediate versus delayed dental implant placement strategies on cell differentiation in a dental callus.

DESIGN

The implant was placed in the mandible with two nearby teeth using an idealized two-dimensional finite element model. Eight weeks after surgery, the mechanobiological modeling of healing was used to estimate cell differentiation. It was assumed that the callus was initially filled by mesenchymal cells. The model then transformed mechanical stimuli received by the callus from loadings in terms of distortional and dilatational strains into predictions of the cellular phenotypes, including fibroblasts, chondrocytes, and osteoblasts, or whether they would remain unchanged or die.

RESULTS

The results demonstrated that delayed loading led to greater bone formation than immediate loading. Osteoblast colonies were observed in the base of threads in the immediately-loaded implant, whereas the delayed loading caused distant bone formation from the surrounding bone side towards the implant. The osteoblasts were differentiated from both intramembranous and endochondral mechanisms of ossification. After eight weeks, approximately 61 % of the callus was ossified in the delayed placement model compared to 35 % in the immediate placement model, resulting in a greater amount of fibrocartilaginous tissue on the bone side of the callus.

CONCLUSIONS

Immediate and delayed loading models generated different results. In the delayed strategy, bone cells were supplied appropriately during the first few weeks following surgery, whereas the immediate loading caused fibrocartilaginous tissue differentiation. In the form of distant osseointegration, the secondary stability of the dental implant was higher and faster due to the delayed placement.

Marginal Bone Loss Compared in Internal and External Implant Connections: Retrospective Clinical Study at 6-Years Follow-Up

The aim of this study was to assess and compare the marginal bone loss between two different categories of implants (Winsix, Biosafin, Ancona, Italy) having the same diameter and belonging to the Torque Type^® (TT^®) line, in the internal hexagon version (TTi, Group A) and in the external hexagon configuration (TTx, Group B). Patients with one or more straight implants (insertion parallel to the occlusal plane) in the molar and premolar regions in association with tooth extraction at least 4 months prior to implant insertion, who have a fixture diameter of 3.8 mm, who followed up for at least 6 years, and whose radiographic records were available were enrolled in this study. Depending on implant connections (externally or internally), the sample was divided into groups A and B. For externally connected implants (66), the marginal resorption was 1.1 ± 0.17 mm. The subgroup of single and bridge implants showed no statistically significant differences with a marginal bone resorption of 1.07 ± 0.15 mm and 1.1 ± 0.17 mm, respectively. Internally connected implants (69) showed an overall marginal resorption of 0.91 ± 0.17 mm, while the subgroup of single and bridge implants showed resorption of 0.90 ± 0.19 mm and 0.90 ± 0.17 mm, respectively, with no statistically significant differences. According to the obtained results, internally connected implants showed less marginal bone resorption than externally connected implants.

Alveolar ridge augmentation with 3D-printed synthetic bone blocks: A clinical case series

This report documents the clinical and histological outcome of 3D-printed calcium phosphate blocks placed in two-stage procedures to successfully rehabilitate atrophic alveolar ridges. This approach yielded a functionally favorable result. Histological evaluations were performed after healing periods of 6 months and showed ongoing bone regeneration and sprouting capillaries.

Efficacy Ozone Therapy in Reducing Periodontal Disease

The aim of this study is to highlight the properties of ozone as an aid to non-surgical therapy compared to non-surgical therapy alone. This study included thirty Caucasian patients (eighteen women and twelve men) aged between 35 and 65, recruited at the Oral Hygiene and Prevention Center of the Dental Clinic of the Vita-Salute San Raffaele University, at the San Raffaele hospital in Milan. The periodontal probing was recorded with a PC-PUNC 15 manual probe (Hu Friedy) at time 0; the scaling and root planing session was performed at T1 with or without the aid of ozone therapy, and then, the patients were re-evaluated at one month (T2), three months (T3), and six months (T4). The results obtained show that there are not statistically significant differences in terms of reduction in clinical periodontal indices such as plaque, bleeding, and pocket depth between the two groups. Therefore, treatment with ozoral gel would not seem to improve non-surgical periodontal therapy alone. However, clinical periodontal indices significantly improved in patients treated with non-surgical therapy and ozone gel. From this point of view, ozone gel can be used as an aid to non-surgical therapy due to its excellent characteristics, in particular, its powerful virucidal action.

Dynamic and static computer-assisted implant surgery for completely edentulous patients. A proof of a concept

OBJECTIVES

To assess the accuracy and patient reported outcome measures (PROMs) of the computer-guided "double factor" technique for treating fully edentulous patients.

METHODS

A proof of concept prospective study was designed. Ten consecutive patients requiring full arch dental implant supported rehabilitation in a private practice were enrolled between October 2021 and March 2022. All patients were treated by means of an All-on-four®, and implants were planned and placed according to the "double factor" technique. This technique merges the static and dynamic computer-guided surgical approach in the same surgery. The primary outcome was the accuracy of implant placement, measured by overlapping post- and pre-operative cone-beam computerized tomography with the implant planning. Additionally, PROMs and patient quality of life after surgery were evaluated using different questionnaires. Descriptive and bivariate data analyses were performed. Statistical significance was considered for p < 0.05.

RESULTS

A total of 48 implants were placed using the "double factor" technique, and 12 full-arch immediate loading prostheses were delivered. The mean angular deviation was 3.74° (standard deviation [SD]: 2). The total linear deviation at the apex and platform of the implant was 1.25 mm (SD: 0.55) and 1.42 mm (SD: 0.64), respectively. No statistically significant differences were found between tilted and axial implants, the upper and lower jaw, or the right and left side. High self-reported satisfaction was registered, and the Oral Health Impact Profile-14 (OHIP-14) score improved postoperatively (p = 0.002).

CONCLUSIONS

The "double factor" technique is a valid and accurate treatment approach for fully edentulous patients.

CLINICAL SIGNIFICANCE

The double factor technique merges the advantages of both the dynamic and static computer assisted surgery approaches, affording accurate and predictable results when treating fully edentulous patients in a minimally invasive manner.

Mapping Evidence on the Epidemiology and Cost Associated with Maxillofacial Injury among Adults in Sub-Saharan Africa: A Scoping Review Protocol

(1) Background: Maxillofacial injury (MI) occurs universally, for it disregards preference for age, gender, and geographical region. The global incidence and prevalence of facial fractures rose by 39.45% and 54.39%, respectively, between the years 1990 to 2017. Projections indicate that the burden of injuries will persist in sub-Saharan Africa (SSA) in the next twenty years. This scoping review aims to map the literature on MI epidemiology and the economic burden on society in SSA. (2) Methods: The methodology presented by Arksey and O'Malley and extended by Levac and colleagues will be employed in the scoping review. The researcher will report the proposed review through the Preferred Reporting Items for Systematic Review, and Meta-Analysis extension for scoping reviews (PRISMA-ScR). The review will include studies encompassing MI in sub-Saharan African adults 18 years and above. (3) Results: This will be presented as a thematic analysis of the data extracted from the included studies, and the Nvivo version 12 will be employed. (4) Discussion: We anticipate searching for related literature on the prevalence, incidence, risk factors, mortality, and cost associated with MI in the adult population of SSA. The conclusion from the review will assist in ascertaining research gaps, informing policy, planning, authorizing upcoming research, and prioritizing funding for injury prevention and management.

Reliability and Validity of a Lithuanian Version of the Oral Health Impact Profile-A Study in Patients with Stage III-IV Periodontitis

Background and Objectives: The study aimed to translate the original English version of Oral Health Impact Profile (OHIP) into Lithuanian and to assess reliability and validity of the translated instrument (OHIP-Lt) in patients with advanced stages of periodontitis. Materials and Methods: Subjects (N = 67) with stage III-IV periodontitis aged 30-63 years were surveyed by questionnaire and examined clinically. Psychometric analysis included explanatory (EFA) and confirmatory (CFA) factor analyses and psychometric tests. Results: Cronbach's alpha of the translated OHIP was 0.96. EFA revealed four dimensions which Cronbach's alpha ranged from 0.75 to 0.96. Construct validity of the four-factor model derived from the OHIP-Lt was supported by findings of CFA (RMSEA = 0.077). The total OHIP-Lt and its subscale scores increased as the patients' self-rated oral health status changed from healthy to unhealthy. Discriminative validity of the OHIP-Lt was confirmed by its higher scores among patients who had an increased spacing between the maxillary anterior teeth and increased clinical attachment level (CAL ≥ 5 mm) compared to those who did not. Conclusions: The translated Lithuanian version of OHIP-Lt was identified as four-dimension inventory. Good reliability and validity of the OHIP-Lt provide the evidence for its further use in study on advanced periodontal disease burden among Lithuanian patients.

Dental Pain in Care Homes: Is It a Phenomenon? A Systematic Review of the Literature

Background: Evidence suggests that 80% of residents living in nursing homes have moderate to severe pain, could dental causes be an under reported contributory factor. The evidence suggests that this is an under-researched area. Our project aims were to explore and consolidate the current literature and conduct some stakeholder groups with care home managers and dentists. Our stakeholder group will be reported elsewhere. Methods: We used the SPIDER framework to set out key search terms. Which included “dementia” OR “cognitively-impaired” OR “carehome residents” AND “dental pain” OR “oralfacial pain” OR “mouth pain” AND “pain assessment” OR “pain identification”. A literature search was carried out on 8 and 9 March 2022 in the electronic databases: Cochrane, PubMed, Medline, Dental & Oral Sciences Source, CINAHL, Global Health, SocINDEX, Ovid (Medline) and Scopus. Restrictions were placed on dates and language (2012–2022 and English only). Results: The search yielded 775 papers up to the year 2020. After screening and exclusion, we were left with five papers: four quantitative and one qualitative. Conclusions: This review demonstrates that there has been very little research into oral health and/or dental pain in adults with dementia. Furthermore, the recommendations have yet to be taken forward. Identifying pain in older adults with dementia remains challenging. There is a need to develop an algorithm in conjunction with care home staff and dental practitioners in order to identify and address the pain associated with dental disease in adults with dementia.

Full Arch Implant-Prosthetic Rehabilitation in Patients with Type I Diabetes Mellitus: Retrospective Clinical Study with 10 Year Follow-Up

The aim of this retrospective clinical study was to evaluate and compare implant survival, marginal bone loss, and clinical and prosthetic complications in healthy patients and patients with type I diabetes undergoing full arch implant-prosthetic rehabilitation. A total of 47 patients needing total fixed rehabilitation of one or both arches were enrolled for this study. Based on the absence of any systemic diseases (Group A) or the presence of type I diabetes (Group B), the sample was divided into two groups. According to the grade of bone atrophy in the posterior region, patients received full arch rehabilitation (of one or both jaws) with 6 axial implants or, if the residual posterior bone height was insufficient, All-on-Four rehabilitation and a total 236 dental implants were placed. Follow-up visits were performed 1 week after surgery, at 3 and 6 months and then once a year for the next 10 years. No statistically significant differences between groups were recorded about implant survival rates, marginal bone loss, or clinical and prosthetic complications. However, concerning complications, post-surgical bleeding and wound infection were recorded in Group A more than in Group B. In cases of compensated diabetes compensation, implant placement could be considered a safe procedure.

Plasma of Argon Treatment of the Implant Surface, Systematic Review of In Vitro Studies

This paper aims to review the evidence of the cellular activity on titanium samples exposed to Plasma of Argon (PoA) treatment. A systematic review was carried out based on the PRISMA statement by searching the Cochrane Library, PubMed, Web of Science, EMBASE and Scopus, up to October 2020. Papers were selected according to PICOS format that is: Population (P): osteoblasts, fibroblasts, gingival cells; Intervention (I): PoA disinfection treatment; Comparison (C): untreated controls; Outcome (O): cell culture; Setting (S): in vitro assays. The quality assessment was performed according to the CRIS Guidelines (Checklist for Reporting In vitro Studies). A total of 661 articles were found, of which 16 were included. The quality assessment revealed an overall poor quality of the studies analyzed. In vitro studies on the potential of PoA showed a potential effect in promoting higher cell adhesion and protein adsorption in the earliest times (hours). This outcome was not so evident when later stages of cell growth on the surfaces were tested and compared to the control groups. Only one study was conducted in vivo on a human sample regarding abutment cleaning. No meta-analysis was conducted because of the variety of experimental settings, mixed methods and different cell lines studied. PoA seems to be effective in promoting cell adhesion and protein adsorption. The duration of this effect remains unclear. Further evidence is required to demonstrate the long-term efficacy of the treatment and to support the use of PoA treatment in clinical practice.