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Objectives: The purpose of our study is to retrospectively analyze and compare the patterns of maxillofacial-related injuries among rides of electric-powered bikes (E-bikes) and electric-powered scooters (E-scooters), the associated risk factors, and the required treatment. Materials and methods: The medical files of all riders presenting to the emergency department at the Tel Aviv Sourasky Medical Center between 2019 and 2020 with oral- and maxillofacial-related injuries due to E-bike and E-scooter accidents were reviewed. Results: A total of 320 riders sustained oral- and maxillofacial-related injuries due to trauma involving E-bikes and E-scooters during the study period. E-scooter riders were involved in 238 accidents (74.5%) while E-bike riders accounted for the remaining 82 accidents (27.5%). Eighty-four out of 320 riders (26.25%) were hospitalized and required surgical interventions. Most of the 232 riders (72.5%) who reported not wearing a protective helmet during the index accident were E-scooter riders. In addition, 39 riders (18.66%) were riding either of these electric-powered vehicles under the influence of alcohol. Conclusions: E-bike riders are more likely to sustain a maxillofacial fracture than E-scooter riders. Not wearing a protective helmet and riding under the influence of alcohol are major risk factors for maxillofacial injuries.

Background: In more than three decades of work of the Retrieval Bank of the Laboratory for Undemineralized Hard Tissue Histology of the University of Chieti-Pescara in Italy, many types of biomaterials were received and evaluated. The present retrospective review aimed to evaluate the histological and biological aspects of the evaluated bone substitute biomaterials. Methods: In the present study, the authors prepared a retrospective analysis after the screening of some databases (PubMed, Scopus, and EMBASE) to find papers published from the Retrieval Bank of the Laboratory for Undermineralized Hard Tissue Histology of the University of Chieti-Pescara analyzing only the papers dealing with bone substitute biomaterials and scaffolds, in the form of granules and block grafts, for bone regeneration procedures. Results: Fifty-two articles were found, including in vitro, in vivo, and clinical studies of different biomaterials. These articles were evaluated and organized in tables for a better understanding. Conclusions: Over three decades of studies have made it possible to assess the quality of many bone substitute biomaterials, helping to improve the physicochemical and biological properties of the biomaterials used in daily clinical practice.

Numerous types of prosthodontics surgical guides, with and without metallic sleeves, have been found to be useful in clinical studies. The aim of this in vitro research was to compare the time required to complete the surgical procedure with two differently designed surgical prosthetic templates. Ten identical prototype models of mandible based on a CBCT and optical scan of a partially edentulous patient with missing teeth numbers 37, 46, and 47 were prepared and then printed. Five of these models were used for implant site preparation with a surgical guide without metal sleeves and dedicated surgical kit, and the other five models were used for the same procedure performed with a surgical guide with metal sleeves and a dedicated surgical kit. The time of implant site preparation was measured and recorded. Statistical analysis was performed using Student’s t-test for independent samples. Differences between groups were found to be statistically significant (t = −9.94; df = 28; p = 0.0000) with a lower value in favor of the surgical templates without metallic sleeves. Different types of prosthodontics surgical guides, with or without metallic sleeves, seemed to be an important factor which can significantly impact the time of implant site preparation and, therefore, the overall surgical procedure.

Objectives: Repeated abutment disconnection/reconnection may compromise the mucosal barrier and result in crestal bone level changes. The clinical significance of this phenomenon is not yet clear, as most studies on this topic are short-term. Therefore, the aim of the present study was to evaluate the influence of abutment disconnections and reconnections on peri-implant marginal bone loss over a medium-term follow-up period. Material and methods: Twenty-one patients (6 men and 15 women) with a mean age 66.23 ± 9.35 year at the time of implant placement were included. All patients who received two adjacent nonsubmerged implants were randomly assigned into one of the two groups: definitive multiunit abutments (DEFs) connected to the implant that were not removed (test group) or healing abutments (HEAs) placed at surgery, which were disconnected and reconnected 3–5 times during the prosthetic phase (control group). Peri-implant marginal bone levels (MBL) were measured through periapical X-rays images acquired immediately after the surgery (baseline), at 4–7 months immediately after prosthetic delivery, and at 1-year and 3-year follow-up visits. Results: No implant was lost or presented bone loss of more than 1.9 mm during the 3-year follow-up; thus, the survival and success rate was 100%. Peri-implant mucositis was noticed in 38.1% DEFs and 41.9% of HEAs at the 3-year follow-up assessment. At the end of 3 years, the MBL was −0.35 ± 0.69 mm for participants in the DEFs group and −0.57 ± 0.80 mm for the HEAs group, with significant statistical difference between groups. Conclusions: Immediate connection of the multiunit abutments reduced bone loss in comparison with 3–5 disconnections noted in the healing abutments 3 years after prosthetic delivery. However, the difference between the groups was minimal; thus, the clinical relevance of those results is doubtful.

Aim: Long-term studies addressing the outcomes of single immediate implantation and provisionalization at the maxillary esthetic zone are needed. The current study aimed to assess such outcomes along a follow-up period of up to 18 years. Materials and methods: The current study is a continuation follow-up of our previously published up to 6-year follow-up study, dated between the years 2002–2008, performed in a private clinical practice in Tel-Aviv, Israel. A total of 15 patients (23 implants) who had been treated for single-tooth replacement at the maxillary esthetic zone since 2002, underwent clinical and radiographic follow-up evaluations. Primary outcomes included mean Marginal Bone Levels (MBL), with Bleeding on Probing (BOP), implant success rate, prosthetic and esthetic complications evaluated as secondary outcomes. Results: The implant success rate was at 100%. Bone remodeling processes were observed over the follow-up period, with 0.9 mm mean marginal bone loss observed during the first 6 years of observation, followed by −0.13 ± 0.06 mm mean loss after 6 to 18 years. The last finding suggests bone deposition, as reported by other studies (Donati et al., 2012). At the final radiographic evaluation, a mean MBL of 1.35 mm ± 0.16 was demonstrated. No differences with respect to implant type or site were found. A generalized absence of BOP and esthetic complications occurred in two cases as a result of continuous adjacent teeth eruption versus obvious implant ankylosis. Conclusions: Adhering to careful clinical protocols and 3D bone to implant considerations while immediately placing an anterior implant, this treatment approach offers both stable and esthetically acceptable results for the replacement of missing teeth at the maxillary esthetic zone.

The aim of the present clinical study was to assess and compare the histomorphometric results and efficacy of freeze-dried bone allograft (FDBA) in combination with platelet-rich fibrin (PRF), and PRF as a sole grafting material for socket preservation. Ninety patients in need of tooth extraction and implant restoration were included in this study. The participants were randomly divided into three groups based on post-extraction clinical protocol: socket preservation procedure with allograft in combination with a PRF membrane (PRFm), PRF as a sole grafting material, and a control group. A total of 90 implants were placed four months post-extraction. During the surgical re-entry a bone biopsy was harvested with a trephine drill. Histological samples were prepared and analyzed for percentage vital bone and connective tissue. One-way ANOVA with Bonferroni post-hoc analysis were used to assess the results. Both test groups revealed a significantly higher percentage of vital bone formation compared to the control group. No statistically significant differences regarding vital bone formation and connective tissue quantity between the tested groups were observed (FDBA + PRFm: 3.29 ± 13.03%, and PRF: 60.79 ± 9.72%). From a clinical and histological point of view, both materials in the test groups are suitable for the filling of post-extraction sockets without bone defects. Both of the tested groups revealed a significantly higher percentage of vital bone formation compared to the control group.

Aim: The current study aims to assess levels of knowledge among Israeli dentists about rare diseases with orofacial manifestations, and whether occupational, regional and social factors influence those levels. Materials and Methods: A total of 309 Israeli dentists participated in an online survey that provided basic demographic information pertaining to their knowledge about rare diseases, their clinical experience with rare diseases, what further information they considered necessary, and which sources of information they most frequently utilize. Results: Young age, country of dental education, practicing in both public and private settings, as well as the number of hours allocated to dental studies and the opportunity to acquire information on rare diseases with orofacial manifestations, all seem to affect the level of knowledge. Conclusions: Developments in the field of rare disease are constantly ongoing, and improvements in post-graduate dental studies about them should keep pace. The results of the current study reveal the areas upon which such curricula should focus with respect to dental practitioners.

In January 2021, Israel started vaccinating healthcare workers (HCWs) and individuals older than 65 years with COVID-19 vaccines. Scientific literature points to vaccine hesitancy as being a major health concern. During time of pandemics, increased consciousness of health behaviors may be encountered. The current study aimed to assess attitudes to general vaccines and to COVID-19 vaccines in particular among adult (&gt, 18) Israeli general public, and among Israeli dentists and dental hygienists. Cross-sectional surveys were filled out by a total of 501 participants (361 Israeli adults &gt, 18 years, 73 dental hygienists, and 67 dentists). Along with basic demographics, participants responded to the Hebrew VAX, COVID-VAX and HCS scales. Group comparisons were analyzed using t tests and ANOVAs with Scheffe’s test used for post hoc comparisons. Dental hygienists demonstrated significantly higher anti-vaccinations approaches than both dentists (p &lt, 0.01) and the general public (p &lt, 0.05). In all groups, attitudes towards the COVID-19 vaccines were more negative compared to attitudes towards general vaccines, with hygienists demonstrating significant negative attitudes compared to dentists (p &lt, 0.05). The general public (p = 0.56) and hygienists demonstrated increased health awareness compared to dentists (p &lt, 0.05). As health awareness has increased during the COVID-19 pandemic primary strategies to combat vaccine hesitancy should be implemented in the general public, and in particular, an dental teams.

Background: In recent years, worldwide dental malpractice claims have dramatically increased. The purpose of the present study is to analyze periodontal therapy related claims in Israel that led to legal decisions. Methods: This retrospective cohort study includes malpractice claims against dental practitioners related to periodontology between 2005 and 2019. Only closed cases where a final decision was made were included. The chi-square test or Fisher exact test for categorical variables were performed and a p value of &lt, 0.05 was considered statistically significant. Results: During the study period there were 508 legal claims related to periodontal disease. Most plaintiffs were women (63.4%), and 71.3% of the patients were &gt, 35 years old. Most claims (82.8%) were settled out of court and ended in compromise. Claims concerning the treatment of periodontal disease by periodontists accounted only for 4.5% (23/508) of the cases while 95.5% (485/508) of the claims were for complications secondary to another treatment. Prosthodontic treatment was involved with the highest number 54.5%, followed by dental implants 17.7%, and endodontics 11.6%. The allegations were related to pain and distress (84.8%), aggravation of existent periodontal disease (83.3%), tooth loss (78.1%), and violation of autonomy (47%). Conclusions: The main cause for lawsuits was related to aggravation of periodontal disease during prosthetic or implant therapy and related to suspected faulty or inexistent preoperative diagnosis and planning. Practical implications: Periodontal consultation before dental treatment may reduce malpractice risks, adverse events, and un-necessary changes of treatment plans.

Both types of surgical guides – with and without metal sleeves are founded beneficial in clinical studies. The aim of this in vitro study was to compare time of surgical procedure in dental implantology depending of used type of the surgical guide. Ten three dimensional (3D) printed models of lower jaws were prepared based on complete virtual model of patient clinical conditions with missing teeth 37, 46 and 47. Five of this models were used for implant sites preparation performed with use of surgical guide without metal sleeves and dedicated surgical kit, and next five were used for the same procedure performed with surgical guide with metal sleeves and dedicated surgical kit. Time of implant site preparation were measured and noted. Statistical analysis was performed using Student’s t test for independent samples. Difference of time in both groups were founded as statistically significant (t=-9.94; df =28; p=0.0000). Type of surgical guide is important factor which can impact on time of implant site preparation and all surgical procedure.

&ldquo, SOS teeth&rdquo, are defined as the first priority teeth for treatment, that have distinct cavitation reaching the pulp chamber or only root fragments are present. These are teeth with severe morbidity, that may require pulp capping, root canal treatment, or extraction, and therefore should be treated first. The study aims to explore whether or not a metabolic syndrome (MetS) is associated with SOS teeth. To that end, we performed across-sectional records-based study of a nationally representative sample of 132,529 military personnel aged 18&ndash, 50 years, who attended the military dental clinics for one year. The mean number of SOS had no statistically significant association with: smoking (p = 0.858), alcohol consumption (p = 0.878), hypertension (p = 0.429), diabetes mellitus (p = 0.866), impaired glucose tolerance (p = 0.909), hyperlipidemia (p = 0.246), ischemic heart disease (p = 0.694), S/P myocardial infarction (p = 0.957), obstructive sleep apnea (p = 0.395), fatty liver (p = 0.074), S/P stroke (p = 0.589), and S/P transient ischemic attack (p = 0.095) and with parental history of: diabetes (p = 0.396)], cardiovascular disease (p = 0.360), stroke (p = 0.368), and sudden death (p = 0.063) as well as with any of the medical auxiliary examinations (p &gt, 0.05). Cariogenic diet was positively associated with SOS teeth (p &lt, 0.001). We conclude that SOS teeth had no statistically significant association with MetS components or with conditions that are consequences or associated with MetS. The only statistically significant parameter was a cariogenic diet, a well-known risk factor for caries and MetS.

This study was conducted to test possibilities of application of 3D printed dental models (DMs) in terms of their accuracy and physical properties. In this work, stone models of mandibles were cast from alginate impressions of 10 patients and scanned in order to obtain 3D printed acrylic replicas. The diagnostic value was tested as matching of model scans on three levels: peak of cusps, occlusal surface, and all teeth surfaces. The mechanical properties of acrylic and stone samples, specifically the impact strength, shore D hardness, and flexural and compressive strength were investigated according to ISO standards. The matching of models&rsquo, surfaces was the highest on the level of peaks of cusps (average lack of deviations, 0.21 mm) and the lowest on the level of all teeth surfaces (average lack of deviations, 0.64 mm). Acrylic samples subjected to mechanical testing, as expected, showed higher mechanical properties as compared to the specimens made of dental stone. In the present study we demonstrated that 3D printed acrylic models could be ideal representatives in the case of use as a diagnostic tool and as a part of medical records. The acrylic samples exhibited not only higher mechanical properties, but also showed better accuracy comparing to dental stone.

Repeatability and precision are major factors which have an influence on final implant treatment results. The aim of this study was to evaluate the repeatability of freehand implant procedures assisted with special plastic sleeves which are placed on the drill to guarantee the proper mesiodistal distance from the landmark&rsquo, s surface. Patient data required for implant treatment, including images of mandibles from CBCT scans and virtual models of soft tissues and teeth, were used to prepare complete virtual models of patient clinical conditions. The models were saved as STL files and 3D printed in five copies. Drilling procedures were done at positions 37, 46 and 47. Each model was scanned with pins in the osteotomies and compared using digital aligning of the models&rsquo, surfaces. The average deviation was &minus, 1.38 &plusmn, 1.4 mm. Average deviations on guide pins placed at position 37 were &minus, 0.46 &plusmn, 0.59 mm, at position 46 were &minus, 1.46 &plusmn, 0.88 mm (landmark&rsquo, s surface of both: distal tooth&rsquo, s surface), and at position 47 were the highest: &minus, 2.69 &plusmn, 1.62 mm (landmark&rsquo, s surface: surface of plastic sleeve). The following conclusion was drawn: Using universal plastic sleeves could improve implant procedure precision especially in the case of partially edentulous patients.

The aim of this study was to evaluate the association of COVID-19 factors and psychological factors with psychological distress among dental staff during the COVID-19 pandemic outbreak. A cross-sectional survey was conducted among 338 Israeli dentists and dental hygienists, who provided their demographic data, answered questions about COVID-19-related factors, and were assessed by subjective overload, self-efficacy, and psychological distress scales. Data were analyzed using a multivariate logistic regression. Results revealed that elevated psychological distress was found among those who have background illness, fear of contracting COVID-19 from patient, and a higher subjective overload. Lower psychological distress was associated with being in a committed relationship and having higher scores for self-efficacy. Given these results, gathered during times of an infectious disease outbreak, exploring psychological distress among dental staff is warranted as the effects may be long-term.

Objectives: To assess and compare dietpractices, body mass index (BMI), and oral health-related quality of life (OHRQoL) in adults with and without periodontitis.Methods:Demographics, health-related behaviors, BMI, dental and periodontal parameters, diet practices, and Oral Health Impact Profile-14 (OHIP-14) were collected from 62periodontitis patients and 100 controls without periodontitis.Results:Havingperiodontitis was positively associated with male sex (p=0.004), older age (p&lt, 0.001), smoking pack-years (p = 0.006), weight (p = 0.008), BMI (p = 0.003), number of meals per day (p&lt, 0.001) and had a negative associationwithdecayed teeth (p = 0.013), alcohol (p = 0.006), and sweets (p = 0.007) consumption.Periodontitis patients were more likely to avoid carbonated beverages (p = 0.028), hot (p = 0.003), and cold drinks (p = 0.013), cold (p = 0.028), hardtextured (p = 0.002), and fibrous foods (p = 0.02) thanthe controls, and exhibited higher global OHIP-14 (p&lt, 0.001) andmost domain scores. Age (p&lt, 0.001), BMI (p =0.045), number of meals per day (p = 0.024), and global OHIP-14 score (p&lt, 0.001) remained positivelyassociated with periodontitis in the multivariate analysis. Conclusions:Periodontitis patients exhibitedhigher BMI and altered dietpracticesand OHRQoL as compared to controls. Assessment of diet practices, BMI,and OHRQoLshould bepart of periodontal work-up. Dentists and dietitians shouldcollaborate to design strategies to addressthese challenges.

Background: Immediate implant placement and restoration (IPR), is a reliable treatment modality. Purpose: This historical prospective study evaluated the medium-term outcomes of hard tissue after IPR in the anterior maxilla with simultaneous hard tissue augmentation. Methods: Seventy-three patients treated with single-implant IPR in the anterior maxilla were followed for 1-8 years. Treatment involved, atraumatic extraction, immediate implant placement and abutment adaptation, followed by simultaneous augmentation with mineralized freeze-dried bone allograft (FDBA) particles to fill the gaps and restore the ridge. The surgical site was stabilized with a resorbable collagen membrane, followed by the connection of an acrylic provisional restoration. Results: All implants osseointegrated during the follow-up period (mean, 34 &plusmn, 22 months). Radiographic evaluation of the distance between the implant shoulder (IS) and crestal bone level (CBL) was of 0.86 &plusmn, 0.86 mm and 0.8 &plusmn, 0.84 mm mesially and distally, respectively. Splitting the results into up to 3 years and 3&ndash, 8 years of follow-up data, the corresponding values were 0.90 &plusmn, 0.83 and 0.68 &plusmn, 0.88 for the mesial aspect and 0.99 &plusmn, 0.87and 0.74 &plusmn, 0.83 for the distal aspect, respectively. Mean peri-implant probing depth was 3.63 mm (SD &plusmn, 1.06) and 16 implants (22%) presented at least one bleeding pocket of &ge, 5 mm (peri implant mucositis). Conclusions: The immediate replacement of a single maxillary tooth by implants combined with guided bone regeneration is a predictable treatment modality with favorable peri-implant bony response.

Stainless steel crowns are the most popular restoration technique for young permanent first molars treated endodontically. However, these restorations are not aesthetically appealing and need to be replaced. Endocrowns constitute a reliable approach for restoring severely damaged molars and premolars. Intraoral scanners (IOSs) are well tolerated by children and are easily and quickly implemented. We present an innovative treatment approach for endodontically treated teeth in children, using a digital workflow with IOS and computer-aided design/computer-assisted manufacturing (CAD/CAM) fabrication of the restoration. The protocol involves a thorough diagnostic phase and comprehensive treatment planning. Among the factors to be considered are the child’s behavior, the parents’ cooperation and compliance, and initial preparation including inhalation sedation, effective local anaesthesia and the use of a rubber dam. Full attention should be given to 1−2 mm of ferruling by the endocrown, which should be appropriately prepared to accommodate endocrowns for molars. IOSs include scanning of the prepared tooth and its antagonist, and scanning of the bite. CAD-CAM preparation of the restoration is followed by restoration bonding and follow up. Digital workflow should be considered in the treatment of endodontically treated molars since the high accuracy of the scanning enables definitive restoration in young patients.

Bone regeneration around newly implanted biomaterials is a complex process, which in its early phases involves the interactions between Mesenchymal Stem Cells (MSCs) and immune cells. The response of these cells to the biomaterial depends both on the local microenvironment and on the characteristics of the inserted bone substitute. In this work, bone allografts impregnated with albumin are loaded with a co-culture of human MSCs and monocytes; bone granules without albumin are used for comparison. Co-cultures are contextually treated with pro-inflammatory cytokines to simulate the inflammatory milieu naturally present during the bone regeneration process. As revealed by microscopic images, albumin-impregnated bone granules promote adhesion and interactions between cells populations. Compared to control granules, albumin coating diminishes reactive species production by cells. This reduced oxidative stress may be attributable to antioxidant properties of albumin, and it is also reflected in the mitigated gene expression of mitochondrial electron transport chain complexes, where most intracellular reactive molecules are generated. MSCs-monocytes co-cultured onto albumin-impregnated bone granules additionally release higher amounts of immunomodulatory cytokines and growth factors. In summary, this work demonstrates that impregnation of bone granules with albumin positively modulates the interactions between MSCs and immune cells, consequently influencing their mutual activities and immunomodulatory functions.

The purpose of our study was to compare micromorphometric data obtained by cone-beam computed-tomography (CBCT) and microcomputed-tomography (micro-CT) of the augmented sinus and to evaluate the long-term stability of the bone gain achieved using BoneAlbumin. Sinus lifts, and after 6-months, healing bone-biopsy and implant placement were carried out. Specimens were analyzed by micro-CT. A total of 16 samples were collected from nine patients (mean age 54.7 &plusmn, 6.5 years). Pre-, postoperative, and 3-year control CBCT-data were registered to determine from where the biopsy samples were harvested. Micromorphometric variables were calculated from the micro-CT- and CBCT-data, and their correlation was determined by Spearman's test. The volume of augmented bone was calculated at the time of implant placement and after 3 years. A positive correlation was found between bone-volume fraction, trabecular-separation, open-, and total-porosity, while a negative correlation was found between trabecular-thickness obtained from CBCT- and micro-CT-data (p &lt, 0.05). Mean volumetric reduction of 39.28% (11.88&ndash, 60.02%) was observed. Correlation of CBCT- and micro-CT-data suggested that micromorphometric analysis of CBCT reconstructions of the augmented sinuses provided reliable information on the microarchitecture of augmented bone. CBCT as a modality might be adequate in the analysis of bone quality in the augmented sinus. At the 3-year, control sinus grafts showed volumetric stability.

Analyses of composition, distribution of cellular and extracellular matrix components, and molecular analysis of mitochondria related genes of bone loss in the presence of inflammatory environment in humans was the aim of the present project. As a human model we chose peri-implantitis. Morphological analyses were performed by means classical histological, immunohistochemical, and SEM (scanning electron miscroscopy) test. Gene expression analysis was performed to evaluate epithelium maturation, collagen fiber production, and genes related to mitochondrial activity. It was found that a well-defined keratinocyte epithelium was present on the top of all specimens, a distinct basal lamina was present, as well as desmosomes and autophagic processes related to the maturation of keratinocytes. Under this epithelium, a full inflammatory cell infiltrate was present for about 60% of the represented by plasma cells. Collagen type I fibers were present mainly in the form of fragmented cord tissue without cells. A different distribution of blood vessels was also present from the apical to the most coronal portion of the specimens. High levels of genes related to oxidative stress were present, as well as the activation of genes related to the loss of ability of osteogenic commitment of Mesenchymal stem cells into osteoblasts. Our study suggests that peri-implantitis lesions exhibit a well defined biological organization not only in terms of inflammatory cells but also on vessel and extracellular matrix components even if no difference in the epithelium is evident, and that the presence of reactive oxygen species (ROS) related to the inflammatory environment influences the correct commitment of Mesenchymal stem cells.

After tooth extraction, the alveolar bone tends to shrink in volume, especially on the vestibular side. The role of myofibroblasts in bone remodeling has not been sufficiently investigated. The aim of the present study was to explore the gene expression related to myofibroblasts presence and activity during a 90-day healing period after tooth extraction. The study included 36 rabbits, and a single tooth extraction was performed on each rabbit. The extractive sockets were randomly distributed to natural healing or to scarification of the wound. The sacrifices were staggered in such a manner that animals contributed with sockets representing 2, 7, 15, 30, 60, and 90 days of healing. Nanostring technology was used to evaluate the expression of a wide panel consisting in 148 genes related to the activation, induction, and suppression of myofibroblasts, socket microenvironment, and autophagy. We found that the expression profile of this custom panel was time-related. The post-extractive socket was subjected to significant gene expression changes after 15 days: the genes involved in the induction of myofibroblasts were up-regulated in the first 15-day period and down-regulated during the rest of the follow-up. The study suggested that myofibroblasts play a major role in the immediate 15-day period following tooth extraction.

Background: Early peri-implant bone loss has been associated to long-term implant-prosthetic failure. Different technical, surgical, and prosthetic techniques have been introduced to enhance the clinical outcome of dental implants in terms of crestal bone preservation. The aim of the present cohort study was to observe the mean marginal bone level around two-part implants with gingivally tapered abutments one year after loading. Methods: Mean marginal bone levels and change were computed following radiological calibration and linear measurement on standardized radiographs. Results: Twenty patients who met the inclusion criterion of having at least one implant with the tapered prosthetic connection were included in the study. The cumulative implant success rate was 100%, the average bone loss was &minus, 0.18 &plusmn, 0.72 mm, with the final bone level sitting above the implant platform most of the time (+1.16 &plusmn, 0.91 mm). Conclusion: The results of this cohort study suggested that implants with tapered abutments perform successfully one year after loading and that they are associated with excellent marginal bone preservation, thus suggesting that implant-connection macro-geometry might have a crucial role in dictating peri-implant bone levels.

Peri-implantitis is an inflammatory disease affecting tissues surrounding dental implants. Although it represents a common complication of dental implant treatments, the underlying mechanisms have not yet been fully described. The aim of this study is to identify the role of titanium nanoparticles released form the implants on the chronic inflammation and bone lysis in the surrounding tissue. We analyzed the in vitro effect of titanium (Ti) particle exposure on mesenchymal stem cells (MSCs) and fibroblasts (FU), evaluating cell proliferation by MTT test and the generation of reactive oxygen species (ROS). Subsequently, in vivo analysis of peri-implant Ti particle distribution, histological, and molecular analyses were performed. Ti particles led to a time-dependent decrease in cell viability and increase in ROS production in both MSCs and FU. Tissue analyses revealed presence of oxidative stress, high extracellular and intracellular Ti levels and imbalanced bone turnover. High expression of ZFP467 and the presence of adipose-like tissue suggested dysregulation of the MSC population, alterations in vessel morphology were identified. The results suggest that Ti particles may induce the production of high ROS levels, recruiting abnormal quantity of neutrophils able to produce high level of metalloproteinase. This induces the degradation of collagen fibers. These events may influence MSC commitment, with an imbalance of bone regeneration.

Nowadays it is possible to perform an optimal implant placement and to achieve a good long-term prognosis for an implant-borne prosthesis in the grafted posterior maxilla. This study evaluates the efficiency of one-stage piezosurgery by using as graft material a combination of particulate bovine bone substitutes with platelet-rich fibrin to achieve sinus lift. We included in this study 14 cases of one-stage sinus lift surgeries during which we placed 30 standard implants. The mean vertical bone height gain was 10.12 mm six months after surgery, and the mean postoperative follow-up time was 43.79 months. There were no major complications during or after surgery, and all implants are in use. Therefore, it can be concluded that one-stage sinus piezosurgery using particulate bovine bone substitutes and platelet-rich fibrin can be applied as a predictable and effective technique in the treatment of the posterior edentulous maxilla ensuring 4-5 mm vertical bone height.

Background Nowadays implant placement protocols are widespread among clinicians all over the world. However, available literature, only partially analyses what can be potential benefits for the clinicians and patients, often focusing just on specific aspects, such as accuracy. The purpose of this review is to compare computer guided implant placement with conventional treatment protocols. Methods A search strategy according to the P-I-C-O format was developed and executed using an electronic MEDLINE plus manual search from 2000 up to December 2016. This review included only randomized controlled trials (RCTs) focusing on subjects treated with digital workflow for oral implant placement compared to conventional procedures. Data were extracted from eligible papers and analysed. All kinds of outcomes were considered, even patient-related and economical outcomes. Results The search strategy revealed 16 articles; additional manual searches selected further 21 publications. Afterwards the evaluation of articles, only two studies could be selected for subsequent data extraction. The two identified RCTs analysed primary outcomes as prosthesis failure, implant failure, biological or prosthetic complications, and secondary outcomes as periimplant marginal bone loss. One RCT evaluated also the duration of treatment, post-surgical progress, additional treatment costs and patient satisfaction. The other RCT focused instead on evaluating eventual improvement of patient’s quality of life. In both selected studies, were not observed by the authors statistically significant differences between clinical cases treated with digital protocols and those treated with conventional ones. In one RCT, however post-surgical progress evaluation showed more patients’ self-reported pain and swelling in conventional group. Conclusions Within the limitation of this review, based on only two RCTs, the only evidence was that implant survival rate and effectiveness are similar for conventional and digital implant placement procedures. This is also confirmed by many other studies with however minor scientific evidence levels. Reduction of post-operative pain, surgical time and overall costs are discussed. Authors believe that scientific research should focus more in identifying which clinical situations can get greatest benefits from implant guided surgery. This should be done with research protocols such as RCT that assess comprehensively the advantages and disadvantages of fully digital surgical protocols.

An ideal tissue-engineered bone graft should have both excellent pro-osteogenesis and pro-angiogenesis properties to rapidly realize the bone regeneration in vivo. To meet this goal, in this work a porcine bone scaffold was successfully used as a Trojan horse to store growth factors produced by mesenchymal stem cells (MSCs). This new scaffold showed a time-dependent release of bioactive growth factors, such as vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF), in vitro. The biological effect of the growth factors-adsorbed scaffold on the in vitro commitment of MSCs into osteogenic and endothelial cell phenotypes has been evaluated. In addition, we have investigated the activity of growth factor-impregnated granules in the repair of critical-size defects in rat calvaria by means of histological, immunohistochemical, and molecular biology analyses. Based on the results of our work bone tissue formation and markers for bone and vascularization were significantly increased by the growth factor-enriched bone granules after implantation. This suggests that the controlled release of active growth factors from porcine bone granules can enhance and promote bone regeneration.

Purpose. To compare marginal bone loss between subgingivally placed short-collar implants with machined collars and those with machined and laser-microtextured collars.Materials and Methods. The investigators used a retrospective study design and included patients who needed missing posterior teeth replaced with implants. Short-collar implants with identical geometries were divided into two groups: an M group, machined collar; and an L group, machined and laser-microtextured collar. Implants were evaluated according to marginal bone loss, implant success, and probing depth (PD) at 3 years of follow-up.Results. Sixty-two patients received 103 implants (56 in the M group and 47 in the L group). The cumulative survival rate was 100%. All implants showed clinically acceptable marginal bone loss, although bone resorption was lower in the L group (0.49 mm) than in the M group (1.38 mm) at 3 years (p<0.01). A significantly shallower PD was found for the implants in the L group during follow-up (p<0.01).Conclusions. Our results suggest predictable outcomes with regard to bone loss for both groups; however, bone resorption was less in the L group than in the M group before and after loading. The laser-microtextured collar implant may provide a shallower PD than the machined collar implant.

Introduction. The bone volume of the posterior maxilla may not be appropriate for implant placement, due to factors such as pneumatized maxillary sinus. The purpose of this study was to evaluate the percentage of graft volume reduction following sinus floor elevation (SFE), with either slow resorbable bone substitute only or a composite of slow and fast resorbable bone substitutes, using cone beam computed tomography (CBCT).Materials and Methods. In this retrospective study, CBCT scans of SFE procedures were evaluated to determine the volume of grafted sinus with either deproteinized bovine bone (DBB) or a 2 : 1 mixture of biphasic calcium sulfate (CS) and DBB, as a composite. The volumetric changes of sinus augmentations were measured 2 weeks (V-I) and 6 months (V-II) after operation.Results. Thirty-three patients were included in this study. The average percentage volume reduction was9.39±3.01% and17.65±4.15% for DBB and composite grafts, respectively. A significant graft volume reduction was observed between V-I and V-II for both groups (p<0.01). The DBB group exhibited significantly less volume reduction than the composite group (p<0.01).Conclusions. Augmented sinus volume may change before implant placement. DBB offers greater volume stability during healing than composite grafts.

This prospective 3-year follow-up clinical study evaluated the survival and success rates of 3DP/AM titanium dental implants to support single implant-supported restorations. After 3 years of loading, clinical, radiographic, and prosthetic parameters were assessed; the implant survival and the implant-crown success were evaluated. Eighty-two patients (44 males, 38 females; age range 26–67 years) were enrolled in the present study. A total of 110 3DP/AM titanium dental implants (65 maxilla, 45 mandible) were installed: 75 in healed alveolar ridges and 35 in postextraction sockets. The prosthetic restorations included 110 single crowns (SCs). After 3 years of loading, six implants failed, for an overall implant survival rate of 94.5%; among the 104 surviving implant-supported restorations, 6 showed complications and were therefore considered unsuccessful, for an implant-crown success of 94.3%. The mean distance between the implant shoulder and the first visible bone-implant contact was 0.75 mm (±0.32) and 0.89 (±0.45) after 1 and 3 years of loading, respectively. 3DP/AM titanium dental implants seem to represent a successful clinical option for the rehabilitation of single-tooth gaps in both jaws, at least until 3-year period. Further, long-term clinical studies are needed to confirm the present results.

Surface topography of Titanium (Ti) dental implants strongly influences osseointegration. In the present work, we have analyzed the influence of two Ti implant surfaces characterized by similar microtopography but different nanotopography and chemistry on the osteoblastic phenotype of Dental Pulp Stem Cells (DPSCs). The effect on osteogenic differentiation, extracellular matrix (ECM) and cell adhesion molecules production have been evaluated by means of molecular biology analyses. The morphology of the cells grown onto these surfaces has been analyzed with SEM and immunofluorescence (IF), and the safety of the surfaces has been tested by using karyotype analysis, Ames test and hemocompatibility assay. Results showed that starting from 15 days of DPSCs culture, a substantial expression of osteoblast specific markers and a strong increase of cell adhesion molecules can be detected. In particular, when DPSCs are seeded on the Ti implants expression of microRNA (miRNA)-196a, which is involved in osteoblastic commitment of stem cells, and of Vascular Cell Adhesion Molecule 1 (VCAM1), a factor involved in angiogenesis, is strongly enhanced.

Purpose The aim of this study was to compare the trueness and precision of four intraoral scanners used in oral implantology. Methods Two stone models were prepared, representing a partially and a totally edentulous maxilla, with three and six implant analogues, respectively, and polyether-ether-ketone (PEEK) cylinders screwed on. The models were digitized with an industrial scanner (IScan D104I®) used as a reference, and with four intraoral scanners (Trios®; CS 3500®; Zfx Intrascan®; Planscan®). Five scans were taken for each model, using each different intraoral scanner. All datasets were loaded into reverse-engineering software (Geomagics 2012®), where intraoral scans were superimposed on the reference model, to evaluate general trueness, and superimposed on each other within groups, to evaluate general precision. General trueness and precision of any scanner were compared by model type, through an ANOVA model including scanner, model and their interaction. Finally, the distance and angles between simulated implants were measured in each group, and compared to those of the reference model, to evaluate local trueness. Results In the partially edentulous maxilla, CS 3500® had the best general trueness (47.8 μm) and precision (40.8 μm), followed by Trios® (trueness 71.2 μm, precision 51.0 μm), Zfx Intrascan® (trueness 117.0 μm, precision 126.2 μm), and Planscan® (trueness 233.4 μm, precision 219.8 μm). With regard to general trueness, Trios® was significantly better than Planscan®, CS 3500® was significantly better than Zfx Intrascan® and Planscan®, and Zfx Intrascan® was significantly better than Planscan®; with regard to general precision, Trios® was significantly better than Zfx Intrascan® and Planscan®, CS 3500® was significantly better than Zfx Intrascan® and Planscan®, and Zfx Intrascan® was significantly better than Planscan®. In the totally edentulous maxilla, CS 3500® had the best performance in terms of general trueness (63.2 μm) and precision (55.2 μm), followed by Trios® (trueness 71.6 μm, precision 67.0 μm), Zfx Intrascan® (trueness 103.0 μm, precision 112.4 μm), and Planscan® (trueness 253.4 μm, precision 204.2 μm). With regard to general trueness, Trios® was significantly better than Planscan®, CS 3500® was significantly better than Zfx Intrascan® and Planscan®, and Zfx Intrascan® was significantly better than Planscan®; with regard to general precision, Trios® was significantly better than Zfx Intrascan® and Planscan®, CS 3500® was significantly better than Zfx Intrascan® and Planscan®, and Zfx Intrascan® was significantly better than Planscan®. Local trueness values confirmed these results. Conclusions Although no differences in trueness and precision were found between partially and totally edentulous models, statistically significant differences were found between the different scanners. Further studies are required to confirm these results.