Translucency of bulk-fill composite materials: A systematic review

OBJECTIVES

To conduct a systematic review on the translucency of bulk-fill (BF) composite materials, evaluating the factors influencing it and its clinical implications.

MATERIALS AND METHODS

A systematic search was performed on four databases (Embase, Medline/PubMed, Scopus, and Web of Science) for articles published until October 2, 2023. Search terms were: "translucency," "translucency parameter," "contrast," "contrast ratio," "bulk," "bulk-fill," "bulk fill," "composite," "resin," "resin based," "resin-based," "restoration," and "dental." In vitro studies, written in English language, investigating BF resin-based composites translucency were included. The risk of bias was performed with the RoBDEMAT tool.

RESULTS

Of 590 screened articles, 13 were included in this review. They investigated 11 high-viscosity BF and 5 low viscosity ones. The limited number of the identified studies and the heterogeneity of the extracted data did not allow to conduct a meta-analysis.

CONCLUSIONS

BF materials exhibit variability in translucency due to variations in experimental designs and the heterogeneous composition.

CLINICAL SIGNIFICANCE

BFs may behave differently in masking the substrate or in blending capacity.

Zirconia CAD-CAM Crowns Behavior after Intraoral Digital Impression in Normal versus Dysfunctional Patients: 3 Years Retrospective Study

OBJECTIVES

 The aim of this study was to evaluate the clinical performance and possible complications of single zirconia crowns fabricated using an intraoral digital computer-aided design-computer-aided manufacturing (CAD-CAM) protocol in normal and dysfunctional patients after 3 years of follow-up.

MATERIALS AND METHODS

 Seventy patients were included in this study. The teeth were prepared with a knife-edge marginal design, and temporary crowns were placed. Digital impressions were taken using optical scanning, and the frameworks were milled using the same technology. The veneering process was performed by the same dental technician. The occlusal corrections were made before cementation. The outcomes were evaluated in terms of survival, failures, and complications. The marginal adaptation of the crowns was also assessed.

RESULTS

 The digital protocol for single zirconia crowns resulted in satisfactory outcomes, with high rates of survival and minimal complications after 3 years of follow-up. The marginal adaptation of the crowns was excellent, with 93% of the restorations achieving the ideal marginal adaptation, while 7% had minor deviations. Parafunctions were found in 41.9% of the prosthetic rehabilitation, but no significant differences were observed between the normal and dysfunctional groups regarding the survival and complications of the crowns.

CONCLUSION

 The digital protocol for single zirconia crowns is a reliable and predictable treatment option, even for patients with parafunction, when proper occlusal corrections are performed before cementation. The use of intraoral digital CAD-CAM technologies with optical impressions can simplify procedures, reduce the workflow time, and minimize the variables linked to the human factor.

Effect of Different Artificial Staining Procedures on the Color Stability and Translucency of a Nano-Hybrid Resin-Based Composite

BACKGROUND

To evaluate the effect of different experimental staining procedures on color stability and translucency of a nano-hybrid resin-based composite (RBC).

METHODS

Forty-eight cylindrical-shaped specimens (10 × 2 mm) were prepared with a nano-hybrid RBC (Clearfil Majesty ES-2) and randomly divided in four groups according to the experimental staining procedure: G1) static immersion in a staining solution (coffee) (44 ± 1 °C); G2) staining cycling between coffee (44 ± 1°C) and distilled water (37 ± 1°C) with an experimental staining machine based on Arduino, an Open Source hardware development platform; G3) staining cycles as in G2 + brushing with a low abrasive toothpaste (Relative Dentin Abrasion RDA = 30) (Elmex Sensitive Professional); G4) staining cycles as in G3, with brushing performed with a very strong abrasive toothpaste (RDA = 90) (Lacult Active). Color parameters were recorded at the baseline (T0) after staining procedures (T1) and repolishing (T2) using a spectrophotometer. Color change (∆E00) and translucency (TP, CR) were evaluated. Data were statistically analyzed (p < 0.05).

RESULTS

For ∆E00 after staining, Group 1 showed the highest color change and Group 3 the lowest. All groups were significantly different (p < 0.001) except for Group 2 vs. Group 4; after repolishing, Group 1 was significantly higher than Group 3 (p < 0.001), Group 2 (p < 0.001), and Group 4 (p = 0.003); Group 2 was higher than Group 3 (p < 0.001). For TP variable, after staining procedures, Group 2 was significantly higher than all other groups (p < 0.001), and Group 1 was significantly higher than Group 3 (p < 0.001) and Group 4 (p = 0.007). After repolishing, Group 4 was significantly lower than Group 3 (p = 0.008) and Group 2 (p = 0.027). Repolishing procedure significantly reduced color parameters.

CONCLUSIONS

The investigated staining procedure induced significant differences in color stability and translucency. The use of a very strong abrasive toothpaste (RDA = 90) induced higher color change than a low abrasive one (RDA = 30). Repolishing procedures are able to partially reduce color change induced by artificial staining procedures.

Modeling Liquids and Resin-Based Dental Composite Materials—A Scoping Review

Several lubricant materials can be used to model resin-based composites (RBCs) during restorative procedures. Clinically, instruments or brushes are wet with bonding agents (BAs) or modeling liquids (MLs) for sculpturing purposes. However, a knowledge gap exists on their effects on the mechanical properties of RBCs, requiring greater insight. Five databases were searched, including 295 in vitro studies on the use of lubricant materials for modeling RBCs during restorative procedures. Only articles in the English language were included, with no limits on the publication date. The last piece of research was dated 24 March 2022. In total, 16 studies were included in the review process, together with a paper retrieved after screening references. A total of 17 BAs and 7 MLs were investigated. Tensile (n = 5), flexural strength (n = 2), water sorption (n = 2), color stability (n = 8) and translucency (n = 3), micro-hardness (n = 4), roughness (n = 3), degree of conversion (n = 3), and monomer elution (n = 2) tests were carried out. In general, a maximum of 24 h of artificial storage was performed (n = 13), while four papers tested the specimens immediately. The present review identifies the possibilities and limitations of modeling lubricants used during restorative procedures on the mechanical, surface, and optical properties of RBCs. Clinicians should be aware that sculpturing RBCs with modeling resins might influence the composite surface properties in a way that is material-dependent.

1 year impact of COVID-19 pandemic on Italian dental professionals: a cross-sectional survey

BACKGROUND

The Covid-19 pandemic has disrupted the daily work of the dental professionals, assuming unprecedented economic, managerial, and psychological implications. The aim of this cross-sectional survey was to analyze the extent of the impact linked to the imposed working conditions on the Italian dental team.

METHODS

The survey was administered with a web-based form (Google Forms®) to Italian dentists and hygienists. To be enrolled in the study, participants had to reach the adulthood and agree to sign the privacy policy. The impact of Covid-19 was analyzed through a 27-items questionnaire, which was divided into 4 main domains: personal protective equipment (PPE), operative procedures, secretarial organization, and self-reported quality of life (including elearning appraisal).

RESULTS

A total of 614 between dentists and dental hygienists completed the questionnaire. Compared to the pre-pandemic period, the use of PPE such as face shields, surgical caps and disposable gowns were implemented after the Covid-19 outbreak. Almost the whole interviewed (99.9%) received the Covid-19 vaccine. An increased use of preoperatory mouthwashes and rubber dam was referred during the pandemic, while aerosolization (i.e. ultrasound) was drastically reduced. A certain number of respondents (30% dentists, 27% hygienists) suffered from work-related stresses during the pandemic until they desired to change jobs. E-learning was considered beneficial for the 70% of participants.

CONCLUSIONS

Covid-19 pandemic influenced dental professionals' life, leading to a rearrangement of professional, managerial, and cultural life for both dentists and hygienists even after 1 yr from the outbreak.

Clinical outcomes and biological and mechanical complications of immediate fixed prostheses supported by zygomatic implants: A retrospective analysis from a prospective clinical study with up to 11 years of follow-up

BACKGROUND

Zygomatic implants alone or in combination with conventional implants have been used for severe atrophic maxillary arches. Long-term outcomes of extramaxillary technique need validations.

PURPOSE

To retrospectively assess the clinical outcomes and the prevalence of surgical, biological, and prosthetic complications of implant-fixed complete dental prostheses (IFCDPs) supported by zygomatic implants up to 11 years of follow-up.

MATERIALS AND METHODS

Dental records of 34 subjects treated between October 2008 and June 2019 were reviewed. Patients received an immediate fixed full-arch prosthesis supported solely by zygomatic implants or by a combination of zygomatic and conventional implants.

RESULTS

A total of 90 zygomatic implants and 53 standard implants were placed. Up to 11 years of follow-up, two conventional implants were lost, leading to 96.2% success rate for conventional implants and 100% for zygomatic implants. Marginal bone loss for conventional implants averaged 0.85 ± 0.17 mm after the first year and 1.36 ± 0.12 mm after 10 years, resulting in full implant success. No prosthesis was lost. The main surgical complication was the perforations of the Schneiderian membrane, occurring in five patients and in seven sinus cavities. Considering the biological complications, mucositis for standard and zygomatic implants ranged between 21%-35% and 26%-40%, respectively. No peri-implantitis were reported. Soft tissue hypertrophy ranged between 1.8% and 30% for conventional implants and 1.1%-35% for zygomatic implants. Inflammation under the prosthesis ranged between 33% and 50%. For the mechanical complications, abutment loosening was recorded in 5.8% of cases (two patients), tooth debonding and fracture of the prosthesis happened in five subjects (14.7%), and loosening of the prosthetic screws was reported in one patient (2.9%).

CONCLUSIONS

Immediate rehabilitation of the severely atrophic maxilla with zygomatic implants alone or in combination with standard implants could be considered a viable treatment modality.

Dentistry and Covid-19 pandemic: operative indications post-lockdown

A new Coronavirus, the seventh member of the Coronaviridae family, identified as SARS-CoV-2, spread in late December 2019 in the territory of Wuhan in China. CoV-2019 can be transmitted directly from person to person by respiratory drops, direct contact and contaminated material. Furthermore, 2019-nCov penetrates cells similarly to the SARS coronavirus, i.e., through the ACE2 receptor. This may promote human-to-human transmission. Patients and dental professionals are exposed daily to pathogenic microorganisms, including viruses and bacteria, which infect the oral cavity and respiratory tract. Dental procedures carry the risk of 2019-nCoV infection due to their specificity. Direct transmission regards the distance between operator and patient, exposure to saliva, blood and other body fluids, the use of sharp instruments and "droplet-generating" rotating instruments, contact with the conjunctival mucosa, and finally the contact with droplets produced by coughing and nasal secretion of an infected individual without mask at short distance, increasing the biological risk for the operator. In light of the pandemic linked to COVID-19, although there is no clear scientific evidence in the literature, it is necessary to identify protections with regard to clothing, operating protocols, disinfection of environments and management of waiting rooms and front offices. This paper is a basis for operative indications for dentists and other health care professionals in phase 2 post lockdown for both private and public structures.

Effect of Finishing Systems on Surface Roughness and Gloss of Full-Body Bulk-Fill Resin Composites

Background: In this study, we assess the effect produced on roughness and gloss of full-body bulk-fill materials by different finishing and polishing systems. Methods: Four full-body bulk-fill materials were tested: SonicFill2 (SF), Filtek Bulk Fill Posterior Restorative (FB), Tetric EvoCeram bulk-fill (EC), and Fill-Up! (FU). Sixty discs per material (2 mm in thickness and 7 mm in diameter) were obtained and randomly assigned (n = 15) to four finishing and polishing methods: Sof-Lex Spiral Wheels (SW), HiLusterPLUS (HL), Astropol (AP), and Opti1Step (OS). Surface roughness and gloss were then measured. Results: For roughness, material and surface treatment were significant factors (p < 0.001) with SF = FB = EC < FU and AP < SW < HL = OS. Material and surface treatment had a significant effect also on gloss (p < 0.001), with SF > FB = EC > FU and SW > AP > HL > OS. Conclusions: The tested combinations of bulk-fill and polishing systems provided clinically acceptable results with regard to roughness, while the outcome was poor for gloss. Multistep finishing/polishing systems were able to produce smoother surfaces on full-body bulk-fill materials compared to simplified ones.

Stannous Fluoride Preventive Effect on Enamel Erosion: An In Vitro Study

The aim of this in vitro study was to evaluate the effects of a single dose application of two daily toothpastes on enamel exposed to acid attack. The research was conducted on human molars enamel fragments (n = 72). The two different toothpastes active ingredients were sodium fluoride (NaF) and stannous fluoride (SnF₂). They were compared in protecting the surface of the enamel exposed to three acids: citric acid, lactic acid and hydrochloric acid. A spectrophotometer was used to measure the calcium ions and phosphate released in the solutions by the enamel specimens. Afterward, ionic concentrations were analyzed through the t-Student test, in order to estimate the significance level (p < 0.05) of the solubility differences obtained between the treatment and control groups. Finally, sample surfaces were analyzed with scanning electron microscopy and X-ray energy dispersive spectroscopy (SEM/EDX). The two analyzed toothpastes did not reveal any statistically significant variation in the release of calcium and phosphate (p > 0.05). Nevertheless, acid-resistant deposits were detected in samples treated with stannous fluoride and exposed to lactic acid, though the presence of tin ion deposits on samples treated with stannous fluoride was not shown. A single dose of a fluoride-based toothpaste before different acids attack, in simulated oral cavity conditions, did not show a significant preventive effect.

New Application of Osteogenic Differentiation from HiPS Stem Cells for Evaluating the Osteogenic Potential of Nanomaterials in Dentistry

Objective: HiPS stem cells are commonly used for the study of medical disorders. The laboratory in which this study was conducted uses these cells for examining the treatment and cure of neurodegenerative diseases. Bone regeneration poses the greatest challenge for an oral surgeon both in terms of increased implant osseointegration and reducing bone healing times. The aim of this study was to validate the protocol in the literature to produce and then test in vitro osteoblasts with different nanomaterials to simulate bone regeneration. Method: hiPS clones (#2, #4, and #8) were differentiated into an osteoblast cell culture tested for alizarin red staining and for alkaline phosphatase testing at 14, 21 and 28 days, after the cells were plated. Results: The cells showed diffuse positivity under alizarin red staining and the alkaline phosphatase (ALP)-test, showing small formations of calcium clusters. Conclusion: Despite the limitations of our study, it is a starting point for further protocols, laying a solid foundation for research in the field of bone regeneration through the use of stem cells.

Dental Implants with Different Neck Design: A Prospective Clinical Comparative Study with 2-Year Follow-Up

The present study was conducted to investigate whether a different implant neck design could affect survival rate and peri-implant tissue health in a cohort of disease-free partially edentulous patients in the molar–premolar region. The investigation was conducted on 122 dental implants inserted in 97 patients divided into two groups: Group A (rough wide-neck implants) vs. Group B (rough reduced-neck implants). All patients were monitored through clinical and radiological checkups. Survival rate, probing depth, and marginal bone loss were assessed at 12- and 24-month follow-ups. Patients assigned to Group A received 59 implants, while patients assigned to Group B 63. Dental implants were placed by following a delayed loading protocol, and cemented metal–ceramic crowns were delivered to the patients. The survival rates for both Group A and B were acceptable and similar at the two-year follow-up (96.61% vs. 95.82%). Probing depth and marginal bone loss tended to increase over time (follow-up: t₁ = 12 vs. t₂ = 24 months) in both groups of patients. Probing depth (p = 0.015) and bone loss (p = 0.001) were significantly lower in Group A (3.01 vs. 3.23 mm and 0.92 vs. 1.06 mm; Group A vs. Group B). Within the limitations of the present study, patients with rough wide-neck implants showed less marginal bone loss and minor probing depth, as compared to rough reduced-neck implants placed in the molar–premolar region. These results might be further replicated through longer-term trials, as well as comparisons between more collar configurations (e.g., straight vs. reduced vs. wide collars).

Postoperative bleeding in patients taking oral anticoagulation therapy after 'All-on-four' rehabilitation: A case-control study

PURPOSE

The aim of this study was to estimate bleeding prevalence and postoperative peri-oral purpura after full-arch immediate implant rehabilitation according to the 'All-on-four' technique, in patients on different oral anticoagulant therapies (warfarin and rivaroxaban).

MATERIALS AND METHODS

A total of 120 patients (47 women, 73 men, mean age 66.4 years) presented with edentulous or partially edentulous arches. All patients were treated with immediate full-arch fixed prostheses (28 maxillary, 34 mandibular), each supported by four implants (two vertical, two distally tilted). Participants were divided in three groups: 40 patients under treatment with warfarin formed group A, 40 patients under treatment with rivaroxaban composed group B, and 40 healthy subjects composed the control group. As the primary outcome measure, mild, moderate and severe postoperative bleeding was recorded. As the secondary outcome measure, the presence of postoperative petechiae, ecchymoses and haematomas in oral and peri-oral tissues was recorded.

RESULTS

Patients under treatment with warfarin (group A) showed a higher prevalence of postoperative bleeding (P = 0.002) and purpura (P = 0.012) in comparison with other groups. No severe bleeding took place and no haematomas appeared in any patient. Prefabricated metal-reinforced, screw-retained, acrylic resin provisional restorations were delivered in all patients.

CONCLUSIONS

The preliminary results of this prospective case-control study showed how immediate rehabilitation according the 'All-on-four' technique could be a safe and predictable procedure in anticoagulated patients where anticoagulation therapy is not discontinued or modified.

A Preshaped Titanium Mesh for Guided Bone Regeneration with an Equine-Derived Bone Graft in a Posterior Mandibular Bone Defect: A Case Report

One of the most often used bone augmentation techniques is the guided bone regeneration procedure. The authors report the case of a 75-year-old man with an atrophic right posterior mandible who underwent bone augmentation through guided bone regeneration with a preshaped titanium mesh adapted on a stereolithographic model of the patient’s jaw. The graft volume was simulated with a light-curing resin. The actual site was grafted with a mixture of autogenous and equine-derived bone. Five months later, the mesh was retrieved, three cylindrical implants were positioned, and a bone biopsy was collected for histomorphometric analysis. A provisional prosthesis was delivered three and a half months later. Definitive rehabilitation was accomplished after one additional month. The graft allowed for effective bone formation (newly formed bone, residual biomaterial, and medullar spaces were, respectively, 39%, 10%, and 51% of the core volume). The patient has functioned successfully throughout six and a half years of follow-up. Using the preshaped titanium mesh in association with the enzyme-treated equine bone substitute provided effective bone regeneration.

Laser versus LED polymerization: Comparison of in vitro preventive sealing procedures

Introduction:

The technique of sealing is a widely accepted procedure for prevention of caries. The aim of our in vitro study was to compare the effect of two different curing units (traditional LED source and innovative laser diode lamp) on the integrity of fissure sealant material and its interface with tooth enamel.

Materials and methods:

Sixty healthy third molars were randomly assigned to two groups. In group A were teeth intended for polymerization by LED B lamp, and group B comprised teeth to be polymerized by an innovative laser diode. Both groups were treated with the traditional sealing technique, subjected to a metallization process, and analyzed by scanning electron microscope.

Results:

Micro-gaps between the sealant and the enamel were found in specimens in both A (43%) and B (40%) groups ( p=0.793), and sealant shrinkage was seen. Significant differences between the groups emerged in the percentage of perimetric micro-erosion sites (80% vs. 100%, p=0.010) and the presence of holes and micro-bubbles on the sealant surface (21% vs. 63%, p=0.001).

Conclusions:

Although macroscopic clinical polymerization occurred with both instruments, the microscopic evaluation showed significant differences between the studied groups in terms of perimetric micro-erosion sites and micro-bubbles, which were higher in laser-cured samples.

Relationship Between Crestal Bone Levels and Crown-to-Implant Ratio of Ultra-Short Implants With a Microrough Surface: A Prospective Study With 48 Months of Follow-Up

The aim of this cohort study was to investigate the relationship between crestal bone levels and crown-to-implant ratio of ultra-short implants, after functional loading. Sixty patients with single or partial edentulism and alveolar bone atrophy were enrolled and treated between December 2009 and January 2016. Without using bone-grafting procedures, patients were rehabilitated with ultra-short implants characterized by a microrough surface and a 6-mm length. Clinical and anatomical crown-to-implant (C/I) ratios and crestal bone levels (CBL) were measured after a follow-up period ranging from 12 to 72 months; all peri-implant and prosthetic parameters were recorded. The data collected were statistically analyzed ( P = .05). A total of 47 patients with 66 ultra-short implants were completely followed up according to described protocol. The mean follow-up was 48.5 ± 19.1 months. The mean anatomical C/I ratio was 2.2, while the mean clinical C/I ratio was 2.6 ± 0.6 at baseline and 2.8 ± 0.6 at the last follow-up appointment. Mean CBL as calculated at the baseline was 0.7 ± 0.5 mm, while at the last appointment it measured 1.0 ± 0.5 mm. The overall implant-based success rate was 96.9%, and the mean peri-implant bone loss (PBL) was 0.3 ± 0.3 mm. No statistically significant relationship was found between anatomical or clinical C/I ratio and PBL. Ultra-short implants appear to offer a predictable solution for implant-prosthetic rehabilitation in patients with edentulism and bone atrophy. A high percentage of implants were successful, with minimal crestal bone loss. The high C/I ratio did not appear to influence either peri-implant bone loss or prosthetic complication rates.

Midfacial Tissue Assessment of the Effect of Amount of Keratinized Mucosa on Immediate Temporarization of Fresh Socket Implants: 8-Year Follow-up

The aim of the present study was to consider the long-term midfacial mucosal outcome around final prosthetic restorations on dental implants placed and loaded immediately after tooth extractions. A total of 42 patients requiring tooth extractions were recruited, and 142 teeth were extracted. Based on the amount of keratinized mucosa (KM), implants were categorized into group A (KM ≥ 2 mm; n = 61) or group B (KM < 2 mm; n = 62). In both groups, all patients received temporary prosthetic restorations immediately after the surgical procedure. Baseline levels were measured at placement of the final prosthetic restoration and patients were followed for 8 years. After the 8-year follow-up, a survival rate of 98.37% was reported. Two implants were lost due to peri-implantitis after 6 and 7 years of function, respectively. Peri-implantitis occurred at 9 implants (3 from group A and 6 from group B) in 8 patients (7.32%). At the 8-year follow-up for group A, an increase in midfacial tissue level of 0.14 ± 0.13 mm (screwed restorations) and 0.16 ± 0.09 mm (cemented restorations) was measured. For group B, a decrease in midfacial tissue level of 0.15 ± 0.09 mm (screwed restorations) and 0.17 ± 0.12 mm (cemented restorations) was reported. Statistically significant differences between groups were measured at 2, 5, and 8 years of follow-up (P < .01). The results demonstrated that the presence of KM is significantly associated with less mucosal inflammation and less gingival recession, regardless of the type of prosthetic restoration (screwed vs cemented).

Tissue Remodeling in Immediate Versus Delayed Prosthetic Restoration in Fresh Socket Implants in the Esthetic Zone: Four-Year Follow-up

The aim of this study was to compare midfacial soft tissue assessment and horizontal width changes of fresh socket implants in immediate and delayed prosthetic restorations. Patients requiring extractions in the maxillary esthetic zone were recruited. In one group, 30 implants were placed using an immediate loading approach; in the second group, 30 implants were loaded after a period of 3 months. At the 4-year follow-up, statistically significant differences (P < .001) were found. Immediate implants restored on the day of surgery demonstrated more stable midfacial soft tissue levels and bone volume maintenance than delayed implants.

Etiological periodontal treatment with and without low-level laser therapy on IL-1β level in gingival crevicular fluid: an in vivo multicentric pilot study

Cytokine proteins may have important roles during different human physiological and pathological processes. In the oral cavity, the bone loss and periodontal tissue pathology was related to inflammatory process activation. The aim of the present study was to assess the effects of etiological periodontal therapy with and without the use of Low Level Laser Therapy (LLLT) on clinical periodontal parameters and interleukin (IL)-1β level in gingival crevicular fluid (GCF) from chronic periodontitis (CP) patients. Thirty non-smoker CP patients were selected from the Foggia University Dental Clinic and other 2 private dental clinics. All patients were divided into two homogeneous randomized groups: 15 patients were treated with only scaling and root planing (group 1) and 15 patients with scaling and root planing etiological treatment and LLLT (group 2). In all sites, at baseline before treatment, the periodontal pocket depth (PPD) and bleeding on probing (BOP) were measured. In the PPD sites, the GCF samples were collected from 30 deep (≥5 mm) and shallow (≤3 mm) sites and IL-1β were evaluated at baseline, after 10 days and 1 month. In all the samples at baseline, the IL-1β concentration in GCF and BOP rate were significantly higher at deep PPD sites than at the shallow ones. After 10 days in all samples no PPD improvement was observed in the BOP rate but the IL-1 β level was statistically significantly improved (p<0.005) in group 2 compared to group 1. At 10 days and 1 month, in all deep PPD sites, PPD and BOP improvements were observed. At same time, IL-1β levels were lower and statistically significantly (p<0.005) improved in group 2 compared to group 1. The results confirmed that the periodontal etiology treatment of deep PPD sites with or with-out associated LLLT promotes periodontal health. Etiological treatment associated with LLLT, improves BOP and inflammation in periodontal disease. Moreover, the IL-1β concentration changes in GCF suggest these cytokines as a predictable marker of gingival inflammation in chronic periodontitis patients.

Comparison between fiber-reinforced polymers and stainless steel orthodontic retainers

Objective

The aim of this study was to examine the properties of fiber-reinforced composite and stainless steel twisted retainers for orthodontic retention.

Methods

Three different span lengths (5.0, 8.0, and 14.0 mm) of fiber-reinforced composite were investigated. The three fiber-reinforced composite retainer groups were subdivided according to the storage condition (dry and wet), resulting in a total of six groups. Each stainless steel and fiber-reinforced composite group was comprised of six specimens. The three-point bending flexural test was conducted using a universal testing machine. ANOVA was used to assess differences in the maximum load and maximum stress according to the span length, material, and storage condition. Post-hoc comparisons were performed if necessary.

Results

The maximum stress and maximum load were significantly (p < 0.001) associated with the span length, material, and storage condition. The significant interaction between the material and span length (p < 0.001) indicated the differential effects of the material for each span length on the maximum stress and maximum load, with the difference between materials being the highest for the maximum span length.

Conclusions

Our findings suggest that fiber-reinforced composite retainers may be an effective alternative for orthodontic retention in patients with esthetic concerns or allergy to conventional stainless steel wires.

Combined Regenerative and Mucogingival Treatment of Deep Intrabony Defects Associated with Buccal Gingival Recession: Two Case Reports

The case reports presented in this article describe a surgical approach for improving root coverage and regenerative parameters in deep intrabony defects associated with buccal gingival recession. A mandibular canine and a maxillary premolar were treated. The surgical technique consisted of a connective tissue graft (CTG) that was placed and sutured at the inner surface of a coronally advanced envelope flap (CAF), thickening the buccal soft tissue wall of the most coronal extension of the intrabony defect and treated with biomaterials as scaffold. No palatal/lingual flap was elevated. Two years after the surgery, clinically significant root coverage, increased buccal keratinized tissue height and thickness, some minor improvement in the position of the interdental papilla, and clinical attachment level gain were achieved. The radiographs showed bone fill of the intrabony components of the defects. This report encourages a novel application of CAF + CTG + biomaterials to improve both esthetic and regenerative parameters in deep intrabony defects associated with gingival recessions.

Point-of-care testing for hepatitis C virus infection at alternative and high-risk sites: an Italian pilot study in a dental clinic

The Infectious Diseases Department and the Department of Dentistry of San Raffaele Scientific Institute in Milan conducted a screening and prevention program, the "EASY HCV-test Program," at a dental clinic to increase the identification of unrecognized infections. Using a cross-sectional community-based study design, hygienists in the dental clinic offered patients a hepatitis C virus (HCV) rapid salivary test (OraQuick ADVANCE® Rapid HCV Antibody Test) with pre- and post-test counseling prior to initiation of their oral hygiene routine. From April 2015 to November 2015, the EASY HCV test was offered to 2650 patients visiting the Center of Oral Health and Prevention at the Department of Dentistry at San Raffaele Hospital in Milan. Among them, 2077 eligible volunteers were tested. The test showed positive reactivity in 22 cases; of these, 21 subjects were known to suffer from HCV, and the test confirmed their status. One subject was newly diagnosed with HCV infection. The results of this study suggest EASY HCV test screening conducted in dental clinics may constitute an effective strategy for increasing HCV testing among people at risk for infection.

Improvement of a Digital Impression with Conventional Materials: Overcoming Intraoral Scanner Limitations

Intraoral digital impression is a viable alternative to conventional impression techniques and has been proven to be even more accurate than conventional materials. Nevertheless, there are cases in which the rheologic properties of conventional materials can be helpful. This article describes a method to overcome an insufficient sulcus-depth reading of intraoral scanners in challenging cases.

The insertion torque-depth curve integral as a measure of implant primary stability: An in vitro study on polyurethane foam blocks

STATEMENT OF PROBLEM

Recent research has shown that dynamic parameters correlate with insertion energy-that is, the total work needed to place an implant into its site-might convey more reliable information concerning immediate implant primary stability at insertion than the commonly used insertion torque (IT), the reverse torque (RT), or the implant stability quotient (ISQ). Yet knowledge on these dynamic parameters is still limited.

PURPOSE

The purpose of this in vitro study was to evaluate whether an energy-related parameter, the torque-depth curve integral (I), could be a reliable measure of primary stability. This was done by assessing if (I) measurement was operator-independent, by investigating its correlation with other known primary stability parameters (IT, RT, or ISQ) by quantifying the (I) average error and correlating (I), IT, RT, and ISQ variations with bone density.

MATERIAL AND METHODS

Five operators placed 200 implants in polyurethane foam blocks of different densities using a micromotor that calculated the (I) during implant placement. Primary implant stability was assessed by measuring the ISQ, IT, and RT. ANOVA tests were used to evaluate whether measurements were operator independent (P>.05 in all cases). A correlation analysis was performed between (I) and IT, ISQ, and RT. The (I) average error was calculated and compared with that of the other parameters by ANOVA. (I)-density, IT-density, ISQ-density, and RT-density plots were drawn, and their slopes were compared by ANCOVA.

RESULTS

The (I) measurements were operator independent and correlated with IT, ISQ, and RT. The average error of these parameters was not significantly different (P>.05 in all cases). The (I)-density, IT-density, ISQ-density, and RT-density curves were linear in the 0.16 to 0.49 g/cm³ range, with the (I)-density curves having a significantly greater slope than those regarding the other parameters (P≤.001 in all cases).

CONCLUSIONS

The torque-depth curve integral (I) provides a reliable assessment of primary stability and shows a greater sensitivity to density variations than other known primary stability parameters.

Radiographic Evaluation of Crestal Bone Level in Split-Crest and Immediate Implant Placement: Minimum 5-Year Follow-up

PURPOSE

This study aimed to evaluate the radiographic bone level changes of implants positioned via the split-crest procedure both in the maxilla and mandible at a long-term follow-up.

MATERIALS AND METHODS

Seventy-one patients were retrospectively enrolled in the study. The placement of 137 dental implants was performed in the edentulous premolar or molar region after a split-crest ridge expansion procedure. Implants followed a delayed loading protocol. Intraoral digital radiographs were performed at baseline, upon implant placement, at 70 days (following placement of the provisional prosthesis), and on a yearly basis during followup. Crestal bone levels were evaluated at the baseline, upon provisional prosthesis placement, at 12, 36, and 60 months, and at the long-term follow-up of healing from implant placement.

RESULTS

The patients underwent a mean follow-up of 6.54 ± 1.32 years, from which the implant survival rate was reported at 98.54%. Within the first year from implant placement, a bone loss resulted at a mean value of -1.11 ± 0.44 mm. After almost 3 years from implant placement, a mean bone gain of +0.89 ± 0.39 mm was reported, which was statistically significant compared with 12-month values (P < .05). From this point, bone levels remained stable, reporting similar values over time, with no significant differences (P > .05).

CONCLUSION

A mean vertical bone gain of +0.89 ± 0.39 mm was observed after almost 36 months after implant positioning.

Bone-Level Changes Around Delayed Dental Implants in Previous Large Bone Defects Filled with Reactive Soft Tissue After Extraction: A Cone Beam Computed Tomography Study

PURPOSE

The objective of this study was to evaluate new bone regeneration around delayed implants positioned in large bone defects, filled with reactive soft tissue, using cone beam computed tomography (CBCT) at a follow-up of 3 years.

MATERIALS AND METHODS

Patients presented large bone defects after tooth extraction. Reactive soft tissue was left in the defects, and no grafts were used. CBCT scans were performed before tooth extraction and upon implant placement (at 3 months after extraction), and bone volume measurements were then evaluated 3 years after implant placement.

RESULTS

Three months after extraction, CBCT revealed a bone volume gain both for single-rooted and multirooted sites: an overall mean bone level of 8.34 ± 3.18 mm was calculated, and implants were placed. At the 3-year follow-up, CBCT revealed bone maintenance, with mean levels of 10.47 ± 3.68 mm. Statistically significant differences were not observed between 3-month and 3-year bone levels, both for maxillary or mandibular defects and for sites (single-rooted or multirooted teeth).

CONCLUSION

CT scans presented a successful outcome of delayed implants placed in large bone defects at the 3-year follow-up.

Bone Inflammation, Bone Infection and Dental Implants Failure: Histological and Cytological Aspects Related to Cement Excess

Background: Dental implant failure can recognize several causes and many of them are quite preventable with the right knowledge of some clinical critical factors. Aim of this paper is to investigate about the histological aspects related to dental implants failure in such cases related to cement excess, how such histological picture can increase the risk of bacterial infections and how the different type of cement can interact with osteoblasts in-vitro. Methods: We randomly selected 5 patients with a diagnosis of dental implant failure requiring to be surgically removed: in all patients was observed an excess of dental cement around the failed implants. Histological investigations were performed of the perimplant bone. Cell culture of purchased human Osteoblasts was performed in order to evaluate cell proliferation and cell morphology at 3 time points among 3 cement types and a control surface. Results: Dental cement has been related to a pathognomonic histological picture with a foreign body reaction and many areas with black particles inside macrophage cells. Finally, cell culture on different dental cements resulted in a lower osteoblasts survival rate. Conclusions: It is appropriate that the dentist puts a small amount of dental cement in the prosthetic crown, so to avoid the clinical alterations related to the excess of cement.

Two or three machined vs roughened surface dental implants loaded immediately supporting total fixed prostheses: 1-year results from a randomised controlled trial

PURPOSE

To compare implants with machined vs roughened surfaces placed flapless in totally edentulous jaws and immediately restored with metal-resin screw-retained cross-arch prostheses. Mandibles were rehabilitated with two implants (Fixed-on-2 or Fo2) and maxillae with three implants (Fixed-on-3 or Fo3).

MATERIALS AND METHODS

Forty edentulous or to be rendered edentulous patients (20 in the mandible and 20 in the maxilla) were randomised to the machined group (20 patients: 10 mandibles and 10 maxillae) and to the roughened group (20 patients: 10 mandibles and 10 maxillae) according to a parallel group design. To be immediately loaded implants had to be inserted with a minimum torque of 60 Ncm. Outcome measures were prosthesis and implant failures, complications and peri-implant marginal bone level changes evaluated up to 1 year post-loading.

RESULTS

Flaps were raised in four patients from the machined group. Four prostheses on machined implants and three on roughened implants were delayed for loading because a sufficient insertion torque was not obtained. There were no dropouts 1 year after loading. Two maxillary machined implants were lost in two patients (difference in proportions = 0.10; 95% CI = -0.03 to 0.23; P (Fisher's exact test) = 0.487); one maxillary Fo3 prosthesis on machined implants and one mandibular Fo2 prosthesis on roughened implants had to be remade (difference in proportions = 0; 95% CI = -0.14 to 0.14; P (Fisher's exact test) = 1.000). Five patients with machined implants had six complications vs seven patients who had eight complications at roughened implants (difference in proportions = -0.10; 95% CI = -0.38 to 0.18; P (Fisher's exact test) = 0.731). There were no statistically significant differences for implant failures, prosthetic failures or complications between groups. There were no statistically significant differences for marginal peri-implant bone levels between the two groups (estimate of the difference = -0.06 mm; 95% CI = -0.23 to 0.10; P (ANCOVA) = 0.445), with both groups losing marginal bone in a statistically significant way (0.35 ± 0.23 mm for machined and 0.42 ± 0.27 mm for roughened surface).

CONCLUSIONS

These preliminary results suggest that immediately loaded cross-arch prostheses can be supported by only two mandibular or three maxillary dental implants at least up to 1 year post-loading, independently of the type of implant surface used. Longer follow-ups are needed to understand whether one of the two-implant surfaces is preferable.

Immediate loading of two (fixed-on-2) vs four (fixed-on-4) implants placed with a flapless technique supporting mandibular cross-arch fixed prostheses: 3-year results from a pilot randomised controlled trial

PURPOSE

To evaluate the outcome of two vs four implants placed flapless in fully edentulous mandibles and immediately restored with metal-resin screw-retained cross-arch prostheses.

MATERIALS AND METHODS

A total of 60 patients from two different centres were randomised: 30 to the fixed-on-2 group and 30 to the fixed-on-4 group according to a parallel group design. To be immediately loaded implants had to be inserted with a minimum torque of 40 Newton/cm (Ncm). Outcome measures were prosthesis and implant failures, complications, and marginal bone level changes.

RESULTS

Flaps were raised in 18 patients. Two implants in two patients did not reach the planned insertion torque and were replaced immediately by larger diameter ones. Three years after loading, two patients dropped out from the fixed-on-2 group and one from the fixed-on-4 group. No implant failure or prosthetic failure occurred. A total of 12 fixed-on-2 patients were affected by one complication each vs 13 fixed-on-4 patients. There were no statistically significant differences for complications between groups (difference in proportion = -0.03; 95% CI -29 to 0.22; P [Fisher's exact test] =1.000). There were no statistically significant differences for marginal peri-implant bone loss between the two groups (mean difference = 0.14; CI 95% -0.17 to 0.45; P [ANCOVA] = 0.356), with both groups losing marginal bone in a statistically significant way (1.70 mm for fixed-on-2 implants and 1.56 mm for fixed-on-4 implants). There were statistically significant differences between the two centres, with more bone being lost for the Bologna centre (2.18 vs 1.13 mm; P (ANCOVA) < 0.001).

CONCLUSIONS

Up to 3 years after loading, these preliminary results suggest that immediately loaded mandibular cross-arch fixed prostheses can be supported by only two dental implants. Longer follow-ups (about 10 years) are needed to properly evaluate this therapeutic option. Conflict of interest statement: This study was completely self-financed and no funding from the implant manufacturers has been sought or obtained, not even in the form of free materials.

Orthodontic management of missing lateral incisor by miniscrew-anchored device

Congenitally missing teeth are one of the most common tooth anomalies associated to therapeutic sets of problems. Orthodontists should consider these clinical cases because management often requires an integrated orthodontic and restorative approach. In the present study authors reported a therapy note referred to a 14-year-old male patient affected by missing maxillary lateral incisors, bilateral dental Class II and deep bite, treated in 2009 at the Department of Orthodontics of the University of Messina. An orthodontic treatment has been planned with the aim of distalize maxillary molar and the following opening of the spaces necessary for the prosthetic restoration of missing lateral incisor. For the distalization of maxillary molars has been decided to use a Distal Jet supported by miniscrew (Distal-Screw, American Orthodontics, Sheboygan, WI, USA). After seven months of treatment with distal screw, maxillary molar distalization was completed, obtaining a bilateral molar Class I. A multi-bracket orthodontic appliance was bonded in the upper and lower arch using Empower Brackets (American Orthodontics). Class II molar relationship has been over-corrected to Class I in about seven months. The orientation of the force vector resulted in a tipping and rotation of the first molars, without significant vertical changes. Distal Jet reinforced with screws seems to be effective in molar distalization without any type of side effects. The advantages of this device were the absence of patient compliance, relatively predictable outcomes, favorable esthetics, possibility of different activations in each side.

Bone Formation Following Sinus Augmentation with an Equine-Derived Bone Graft: A Retrospective Histologic and Histomorphometric Study with 36-Month Follow-up

PURPOSE

The aim of this study was to investigate bone formation over time following maxillary sinus augmentation with an enzyme-deantigenic, bone collagen-preserving equine bone graft by retrospective assessment of histomorphometric data.

MATERIALS AND METHODS

Records of patients with atrophic ridges who underwent maxillary sinus augmentation with the enzyme-deantigenic equine bone graft and two-step implant placement between 3 and 12 months after the sinus-augmentation surgery were assessed retrospectively. The histomorphometric data were clustered in three classes according to time of collection from the augmentation surgery and analyzed to assess newly formed bone deposition and residual biomaterial degradation rates. Data concerning the 36-month clinical follow-up were also assessed.

RESULTS

Records of 77 patients and 115 biopsy specimens were retrieved, and histomorphometric data were clustered (3 to 5 months, n = 33; 6 to 8 months, n = 57; 9 to 12 months, n = 25). Mean minimum atrophic ridge thickness was 4.9 ± 0.5 mm (range, 4.0 to 7.1 mm). The amount of newly formed bone and residual biomaterial did not significantly differ among the three clusters. Qualitative analysis showed a denser trabecular structure in late (> 8 months) samples. At the 36-month clinical follow-up, no differences were found among the implant success rates in the three groups, according to the Albrektsson and Zarb criteria for success. The overall implant success rate was 98.3%.

CONCLUSION

Based upon this retrospective human study of 77 patients with 4 to 7 mm of residual bone, when enzyme-deantigenic equine bone is used for sinus augmentation, new bone formation occurs at an early time (< 3 months) after the grafting, and implant placement can be safely carried out as soon as 3 to 5 months after the augmentation surgery.

Conventional Versus Digital Impressions for "All-on-Four" Restorations

PURPOSE

This study aimed to evaluate the most accurate impression technique for "All on Four" restoration, comparing conventional (CIG) and digital impressions (DIG).

MATERIALS AND METHODS

Patients randomly selected for this study were required to be edentulous in at least one arch, presenting with severe posterior mandibular or maxillary atrophy. All patients underwent full-arch immediate-load rehabilitations, which were fixed to a total of four implants (two axial and two tilted). Following implant placement, patients were stratified into two groups. Conventional pick-up was carried out in the control group, and digital impressions were performed in the test group. Following prosthetic rehabilitation, patients underwent intraoral digital radiographs to check for the presence of voids at the bar-implant connection and to evaluate accuracy. Three-, 6-, and 12-month follow-up examinations were performed.

RESULTS

A total of 25 patients received immediately loaded "All-on-Four" prostheses (17 maxillary, 13 mandibular) supported by four implants (total 120 implants), of which five received both maxillary and mandibular prosthetic rehabilitation (three patients in CIG, two patients in DIG). No implant dropouts occurred, showing a survival rate of 100%. The digital impression procedure required significantly less time than the conventional procedure (P < .001).

CONCLUSION

Results demonstrate that it is possible to develop computer-aided design/computer-assisted manufacturing (CAD/CAM) cobalt-chromium full-arch rehabilitations with satisfactory accuracy using digital impression techniques.

Biologic and clinical aspects of integration of different bone substitutes in oral surgery: a literature review

Many bone substitutes have been proposed for bone regeneration, and researchers have focused on the interactions occurring between grafts and host tissue, as the biologic response of host tissue is related to the origin of the biomaterial. Bone substitutes used in oral and maxillofacial surgery could be categorized according to their biologic origin and source as autologous bone graft when obtained from the same individual receiving the graft; homologous bone graft, or allograft, when harvested from an individual other than the one receiving the graft; animal-derived heterologous bone graft, or xenograft, when derived from a species other than human; and alloplastic graft, made of bone substitute of synthetic origin. The aim of this review is to describe the most commonly used bone substitutes, according to their origin, and to focus on the biologic events that ultimately lead to the integration of a biomaterial with the host tissue.

Histomorphometric Comparison of Enzyme-Deantigenic Equine Bone and Anorganic Bovine Bone in Sinus Augmentation: A Randomized Clinical Trial with 3-Year Follow-Up

PURPOSE

To conduct a histomorphometric investigation comparing the use of enzyme-deantigenic equine bone (EDEB) and anorganic bovine bone (ABB) for maxillary sinus augmentation.

MATERIALS AND METHODS

Forty patients with Cawood Class V atrophic ridges who required maxillary sinus augmentation randomly received EDEB (n = 20) or ABB (n = 20) granules. Six months later, biopsy specimens were obtained, and implants were placed. Bone specimens were subjected to histomorphometric analysis, and newly formed bone (NFB) and residual biomaterial (RB) percentages were calculated. Patients were followed up for 3 years after definitive prosthetic rehabilitation, and implant success and survival rates were determined according to the criteria of Albrektsson and Zarb.

RESULTS

All patients healed uneventfully. Histomorphometric results for the EDEB were as follows: NFB = 46.86% ± 12.81% and RB = 11.05% ± 9.27%. For ABB, they were: NFB = 25.12% ± 7.25% and RB = 28.65% ± 9.70%. The difference was significant at a .05 level of confidence both for NFB and RB. At the 3-year follow-up, the implant survival rate was identical in the two groups (100%).

CONCLUSION

Grafting with EDEB resulted in a greater quantity of NFB at implant insertion. No significant clinical differences were observed between the two patient groups at the 3-year follow-up. EDEB was as effective as ABB for sinus augmentation.

Vascular endothelial growth factor and nitric oxide synthase expression in human tooth germ development

Vascular Endothelia Growth Factor (VEGF) and Nitric Oxide Synthase (NOS) expression, were evaluated in human tooth germs at two different stages of embryogenesis, to clarify the role of angiogenesis during tooth tissue differentiation and growth. Seventy-two third molar germ specimens were selected during oral surgery. Thirty-six were in the early stage and 36 in the later stage of tooth development. The samples were evaluated with Semi-quantitative Reverse Transcription-Polymerase chain Reaction analyses (RT-PcR), Western blot analysis (WB) and immunohistochemical analysis. Western blot and immunohistochemical analysis showed a VEGF and NOS 1-2-3 positive reaction in all samples analysed. VEGF high positive decrease reaction was observed in stellate reticulum cells, ameloblast and odontoblast clusters in early stage compared to later stage of tooth germ development. Comparable VEGF expression was observed in endothelial cells of early and advanced stage growth. NOS1 and NOS3 expressions showed a high increased value in stellate reticulum cells, and ameloblast and odontoblast clusters in advanced stage compared to early stage of development. The absence or only moderate positive reaction of NOS2 was detected in all the different tissues. Positive NOS2 expression showed in advanced stage of tissue development compared to early stage. The action of VEGF and NOS molecules are important mediators of angiogenesis during dental tissue development. VEGF high positive expression in stellate reticulum cells in the early stage of tooth development compared to the later stage and the other cell types, suggests a critical role of the stellate reticulum during dental embryo-morphogenesis.

Reliability and efficacy of palifermin in prevention and management of oral mucositis in patients with acute lymphoblastic leukemia: a randomized, double-blind controlled clinical trial

BACKGROUND

Myeloablative and hematopoietic stem cells transplantation therapy (HSCT) often acts as side-effect to oral mucositis (OM) with no effective treatment. This randomized-controlled trial analyzed the efficacy of palifermin, administered as a dose during HSCT therapy, as primary prophylaxis on pediatric patients with acute lymphoblastic leukemia (ALL).

METHODS

In this study forty-six patients (9-15 years) with B-cell acute lymphoblastic leukemia (B-ALL) were analyzed. The patients underwent allogenic HSCT conditioned by myeloablative regimen. Subsequently to randomization, patients in the palifermin group were assigned to receive palifermin, 60 mg/kg, intravenously as a single dose 3 days before and after transplant conditioning regimen cycle. The patients in the Control group received only a placebo treatment. Maximum severity of OM, incidence and duration of ulcerative OM, incidence and duration of severe OM limitations were evaluated.

RESULTS

A statistically significant reduction in the incidence of OM up to grade 3 in the palifermin group compared to the control group was discovered. There was also a reduction, confirmed at 60 days, in the degree of severity of mucositis in the palifermin group, with an average of 1.54 grade in the palifermin group, and of 2.16 in the Control group and in the use of opioid analgesics.

CONCLUSIONS

This study indicates that a single dose of palifermin used as primary prophylaxis during HSTC therapy can prevent severe OM in pediatric patients with ALL and used as secondary prophylaxis can prevent the recurrence of severe OM in high-risk patients with previous mucosal injury and improves the quality of life in pediatric patients with ALL.

Effect of roughened micro-threaded implant neck and platform switching on marginal bone loss: a multicenter retrospective study with 6-year follow-up

OBJECTIVE

The aim of this retrospective study was to evaluate medium-term marginal peri-implant bone loss following placement of root-form implants featuring a micro-threaded rough-surfaced neck and a platform-switched implant-abutment connection.

METHOD AND MATERIALS

Records were identified of patients treated with such implants over a 3-year period at three Italian dental centers. Patient radiographs were digitized and subjected to computerized analysis of peri-implant bone resorption.

RESULTS

Records of 112 patients who received 257 implants were analyzed. Although implant diameters and lengths varied, all had a 0.3-mm platform-switching width and a 2.5-mm high micro-threaded neck. All patients healed uneventfully, and no peri-implant infection, implant mobility, or radiolucency around the implant were detected at any follow-up control. At the 72-month control (average 71 ± 5 months) all implants were successful according to Albrektsson and Zarb's criteria. At implant level, average peri-implant bone resorption was 0.18 ± 0.12 mm at 6 months, 0.22 ± 0.15 mm at 12 months, 0.23 ± 0.16 mm at 24 months, 0.25 ± 0.17 mm at 36 months, 0.26 ± 0.15 mm at 48 months, and stable at subsequent controls, regardless of the implant diameter and length. At patient level, a similar trend was observed, with crestal bone loss stabilizing from 48 months onward.

CONCLUSION

The surface, geometry, and platform-switching features of the implant under investigation allowed effective bone preservation on a medium-term basis.