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This study evaluates the thermal impact of a one-drill protocol for osteotomy preparation in dental implant surgery. Our findings demonstrate a significant reduction in heat generation compared to traditional sequential drilling, suggesting potential benefits for implant osseointegration and patient comfort. Specifically, the one-drill protocol was associated with lower peak temperatures and a reduced duration of elevated temperatures. These findings suggest that the one-drill protocol may contribute to improved implant stability and reduce the risk of thermal-induced bone damage. While further research is needed to confirm these findings in clinical settings, the results of this study provide promising evidence for the potential advantages of the one-drill protocol in dental implant surgery. Additionally, the one-drill protocol may offer simplified surgical workflows and reduced instrument management, potentially leading to improved efficiency and cost-effectiveness in dental implant procedures. [ABSTRACT FROM AUTHOR]

Introduction: Since its establishment in 1999, the journal of Clinical Implant Dentistry and Related Research (CIDRR) has consistently disseminated notable clinical and translational research within the domain of oral implantology. As the journal approaches its milestone 25th anniversary, this study endeavors to systematically delineate the publication trends, level of evidence, and bibliometric indices characterizing the initial quarter‐century of CIDRR's scholarly activity. Notably, the investigation adopts a contemporary methodology by incorporating Altmetric analysis, thereby enriching the evaluation with an assessment of the broader societal and online impact of the published research. Methods: A comprehensive search was performed in SCOPUS and PubMed to access the bibliographic data of all articles published in the journal from 1999 to 2024. Additionally, Altmetric database was used to obtain social media attention scores (AAS). Journal's overall performance via impact factor and quartile range was assessed. Most cited papers were identified and the most prolific authors, institutions and countries and the collaboration networks among those were assessed. The level of evidence of all articles was determined based on Oxford level of evidence scale. All articles were categorized based on their major topic in the field of implant dentistry. Results: Throughout its first 25 years of activity, CIDRR published 1912 articles with an annual growth rate of 2.67% and consistently being ranked at Q1 quartile in "Dentistry (miscellaneous)" and "Oral Surgery" journal categories. When clinical studies are considered, level I and II evidence constituted 22.82% and 11.82% of all articles, respectively. Sweden, the USA, and Italy as well as Göteborgs Universitet, Sahlgrenska Akademin. and Malmö Högskola were the most prolific countries and institutions respectively. "Implant system/design/characteristics," "Bone Augmentation," and "Implant Prosthesis" were the top most investigated topics. Conclusions: The examination of the journal's initial 25 years highlighted that CIDRR has surpassed similar dental research journals in publishing a greater number of high‐level evidence articles. It also showcased diverse country‐ and author‐collaboration networks. However, the journal's social media presence is still evolving. This article, presenting a comprehensive overview of the journal's scientometric and bibliographic activities, serves as a valuable reference for researchers, clinicians, and stakeholders, offering insights into both traditional and contemporary perspectives. [ABSTRACT FROM AUTHOR]

Sequential drilling is a common practice in dental implant surgery aimed at minimizing thermal damage to bone. This study evaluates the thermal effects of sequential drilling and assesses modifications to drilling protocols to manage heat generation. We utilized a custom drill press and artificial bone models to test five drill bits under various protocols, including sequential drilling with different loads, spindle speeds, and peck drilling. Infrared thermography recorded temperature changes during the drilling process, with temperatures monitored at various depths around the osteotomy. The results reveal sequential drilling does not eliminate the thermal damage zone it creates (well over 70 °C). It creates harmful heat to surrounding bone that can spread up to 10 mm from the osteotomy. The first drill used in sequential drilling produces the highest temperatures (over 100 °C), and subsequent drill bits cannot remove the thermal trauma incurred; rather, they add to it. Modifying drill bit design and employing proper drilling techniques, such as reducing drilling RPM and load, can reduce thermal trauma by reducing friction. Inadequate management of heat can lead to prolonged recovery, increased patient discomfort, and potential long-term complications such as impaired bone-to-implant integration and chronic conditions like peri-implantitis. Ensuring healthy bone conditions is critical for successful implant outcomes. [ABSTRACT FROM AUTHOR]

The maxillary sinuses are anatomically adjacent to the apices of the maxillary posterior teeth through their lower portion known as the maxillary sinus floor. The aim of this study is to integrate the current state of knowledge based on scientific evidence regarding the clinical significance of maxillary sinus damage following endodontic pathology, and endodontic and implant treatments performed in the posterior maxilla. The data were obtained from articles in the specialized literature using Web of Knowledge Core Collection, Google Scholar, and PubMed databases, and from specialized books. In the first part of the study, we analyzed maxillary sinus implications in endodontics, and, in the second part, maxillary sinus implications in implant dentistry. The specialized literature indicates that the spread of the periapical infection to the maxillary sinus is common. It also reveals that maxillary sinuses can often be affected during conservative and radical treatments of the maxillary posterior teeth. According to scientific evidence, the maxillary sinus floor represents a critical area in clinical dental practice, being an anatomical obstacle that requires careful management.

Objectives: Antimicrobial resistance is an alarming global public health concern, threatening the effective treatment of common infections. This phenomenon is driven by the improper prescription of antibiotics. This study aimed to elucidate the patterns of antibiotic prescription in implant dentistry among European dentists and their awareness of antibiotic resistance. Materials and Methods: An anonymous online validated questionnaire was distributed via e‐mail to 6431 recipients through the European Association for Osseointegration. It comprised of 17 structured questions investigating demographic variables, working environment, clinical experience, attitude towards antibiotic prescription in particular in relation to implant dentistry and COVID‐19 pandemic, and awareness of antibiotic resistance. Data were collected from April to May 2023. Results: 281 dentists from 33 European countries completed the survey. Almost 80% affirmed to routinely prescribe antibiotics as prophylaxis as well as after dental implant placement, especially in medically compromised patients or in cases of bone grafting. Amoxicillin, alone (61%) or in combination with clavulanic acid (56%), was the most common antibiotic of choice. Awareness of penicillin resistance among respondents was high. For peri‐implantitis treatment, more than half reported the use of systemic antibiotics. The large majority (95%) did not prescribe more antibiotics since the beginning of COVID‐19 pandemic. Less than 40% declared to follow national guidelines for antibiotic prescription. Conclusion: This survey revealed a high prescription rate of antibiotics in implant dentistry, despite the awareness about antibiotic resistance among the respondents. The development and adherence to European guidelines has been identified as a potential strategy for improving antimicrobial stewardship. [ABSTRACT FROM AUTHOR]

To ensure the prevention of thermal trauma and tissue necrosis during bone drilling in surgical procedures, it is crucial to maintain temperatures below the time- and temperature-dependent threshold of 50 °C for 30 s. However, the absence of a current standard for assessing temperatures attained during bone drilling poses a challenge when comparing findings across different studies. This article aims to address this issue by introducing a standardized testing method for acquiring thermal data during experimental bone drilling. The method requires the use of three controlled variables: infrared thermography, standard bone blocks, and a regulated drilling procedure involving a drill press with irrigation that simulates a surgeon. By utilizing this setup, we can obtain temperature data that can be effectively applied in the evaluation of other variables, such as surgical techniques or drill bit design, and translate the data into bone damage/clinical outcomes. Two surgical drill bits (2.0 mm-diameter twist drill bit and 3.3 mm-diameter multi-step drill bit) are compared using this experimental protocol. The results show the 2.0 mm bit reached significantly higher temperatures compared to the 3.3 mm bit when preparing an osteotomy (p < 0.05). The 2.0 mm drill bit reached temperatures over 100 °C while the 3.3 mm drill bit did not exceed 50 °C. [ABSTRACT FROM AUTHOR]

Background: Implant dentistry has become increasingly prevalent, with complications such as peri-implantitis posing challenges. Tumor necrosis factor-alpha (TNF-α) has been implicated in the inflammatory response around dental implants, akin to its role in periodontal diseases. Evaluating TNF-α levels in peri-implant tissues compared to healthy tooth tissues could provide insights into the inflammatory environment and aid in clinical management. Materials and Methods: A cross-sectional study was conducted involving 50 participants with dental implants and healthy adjacent teeth. Peri-implant mucosal samples and gingival tissue around healthy teeth were collected. TNF-α levels were quantified using enzyme-linked immunosorbent assay (ELISA) kits. Statistical analysis was performed to compare TNF-α concentrations between peri-implant tissues and healthy tooth tissues. Results: The mean TNF-α level in peri-implant tissues was found to be 120 pg/mL (standard deviation ± 25 pg/mL), whereas in healthy tooth tissues, it was 60 pg/mL (standard deviation ± 15 pg/mL). Statistical analysis revealed a significant difference (p < 0.05) in TNF-α levels between peri-implant tissues and healthy tooth tissues. Conclusion: Elevated levels of TNF-α in peri-implant tissues suggest a heightened inflammatory response compared to healthy tooth tissues. This underscores the potential role of TNF-α in peri-implantitis pathogenesis and emphasizes the importance of monitoring inflammatory biomarkers for early detection and targeted intervention in implant dentistry. [ABSTRACT FROM AUTHOR]

(1) Introduction: Trust is a cornerstone of the patient–physician relationships. Unforeseen complications in the health care system could jeopardize patients' trust in their physicians. (2) Aim: This article presents a quantitative figure regarding foreseeing the necessity of a three-dimensional quantitative visualization of bone structure and concurrently preparing for an ancillary procedure by a dentist to successfully perform the surgery that could minimize unforeseen complications; (3) Materials and method: This retrospective study has been derived based on an analysis of 1134 patients who had received 4800 dental implants from January 2001 to August 2020, out of which 200 cases were randomly selected for this study. Each procedure during implant treatment was categorized as OPG (Orthopantomography) or OPG with CBCT as per all the procedures which included and were coded as follows, 1: Surgery & Restoration, 2: GBR (Guided Bone Regeneration), 3: GTR (Guided Tissue Regeneration), 4: Block Bone Graft, 5: Spreading, 6: Splitting, 7: Internal Sinus, 8: External Sinus, 9: PRF (Platelet Rich Fibrin). Any of the 200 cases in which implant placement could not have been performed for reasons related to a lack of CBCT were selected for this study. The surgery was aborted halfway through without implant placement in these cases due to a lack of bone quantity and/or lack of primary stability. These cases were registered for re-evaluation and statistical analysis; (4) Results: 7% of the cases that used OPG alone led the surgeon to unexpectedly abort in the middle of the surgery without implant placement. All (100%) of the patients who had CBCT during treatment planning were able to receive implants during the surgery. None of the patients left the surgery without receiving implants if CBCT was used (0%); (5) Discussion: Radiographic image quality is defined as the amount of information within the image that allows the radiologist to make a diagnostic decision with a particular level of certainty (Martin et al., 1999) and hence the importance of CBCT. The unexpected 7% of devastating situations for patients who started surgery but did not have implant placement led to [A] aborting the surgery, [B] procedural difficulties requiring an alternative treatment plan, [C] a negative impact on the patient's behavior, and [D] wanting to change doctor due to a lack of trust; (6) Conclusion: This study indicates that in implant dentistry patients' mistrust could be avoided by 7% if CBCT is obtained. It also shows the significance of cone-beam computed tomography as an adjunct to panoramic radiography during the diagnosis and treatment planning phase. The use of panoramic radiography alone can lead to a 7% likelihood of misdiagnosis. A lack of CBCT during treatment planning negatively affects the outcome of surgical procedures. [ABSTRACT FROM AUTHOR]

The purpose of this review was to summarize the evidence with regard to behavioral and psychosocial assessment of the periodontitis patient, the candidate for implant therapy, and the peri‐implantitis patient. Periodontitis has an adverse effect on quality of life and its treatment can lead to significant improvements experienced by the patient. The latter is true for rehabilitation with dental implants, although patients harbor diverse expectations and perceptions of implant therapy, which can often interfere with satisfaction and/or influence long‐term success. A thorough behavioral assessment of the candidate for implant therapy is essential, which should include, perceptions, expectations, as well as risk for behavioral disorders. Remedial action is essential to correct misperceptions and any identified risks. Finally, patients have limited awareness of limited ability to identify signs of peri‐implantitis. The diagnosis of peri‐implantitis can be a cause of significant distress, resentment, and loss of trust to the treatment and the caregivers. Despite documented value in clinical research, currently available instruments assessing patient‐reported outcomes have little application in day‐to‐day clinical practice. Face‐to‐face patient to doctor open‐ended communication remains the most effective way to comprehensively establish the long‐term "therapeutic alliance" essential for the long journey for the periodontitis patient. [ABSTRACT FROM AUTHOR]

Objective: Provisionalization is an important step to achieve esthetic results in implant cases, and many different techniques for provisional restoration fabrication have been described. However, depending on the clinical scenario, the provisionalization strategy will require different approaches and timing. The clinician should modify the provisional restorations efficiently to reduce the number of disconnections from the implant, as repeated disconnections may have biological consequences. This article aims to schematize different scenarios requiring implant provisionalization and propose strategies to help the clinician condition the peri‐implant tissues, respecting perio‐prosthodontic fundamentals for soft tissue, biological, and esthetic stability. Clinical Considerations: The clinical outcomes of modern implant therapy aim to achieve results that emulate natural dentition. Different scenarios may require adjunct therapy, including hard‐ and soft‐tissue grafting, which complicates treatment. The provisionalization strategy will vary depending on the initial condition of the tissues, the need for reconstructive procedures, and the timing of implant placement. Selecting the right strategy based on the case type is necessary to reduce treatment time and complications associated with inadequate prosthetic handling of the soft tissues. Clinical Significance: Proper emergence profile conditioning through provisional restorations will allow for biologically sound and esthetically pleasing outcomes in implant restorations. [ABSTRACT FROM AUTHOR]

Purpose: The study aimed to investigate the cooling performance of three different surgical methods for bone splitting during implant dentistry procedures. Methods: An in vitro study was conducted on bovine ribs to test the cooling performance of three osteotomy methods: conventional osteotomy with standard cooling irrigation, template-assisted osteotomy with standard cooling irrigation, and modified template-assisted osteotomy with additional cooling fluid through internal irrigation channels in the surgical guide. A negative control group without cooling was also included. Temperature measurements were taken during the procedures using a contactless infrared thermometer. Results: The results showed that the conventional osteotomy without cooling resulted in the highest mean of the peak temperatures (114.7 °C ± 45.4), while the modified template-assisted osteotomy with additional cooling achieved the lowest mean of the peak temperatures (29.4 °C ± 7). Statistically significant differences in temperature were observed among the groups (p < 0.001). Conclusion: The study rejected the null hypothesis and demonstrated that the cooling method used during bone splitting procedures significantly affected the temperature development at the surgical site. The modified template-assisted osteotomy with additional cooling provided the best cooling performance. However, caution should be exercised in interpreting the results due to the limitations of the in vitro study. Further research with stronger external validity is needed to confirm these findings and explore their applicability in clinical settings to benefit patients. [ABSTRACT FROM AUTHOR]

Mentoring has been identified as a key component of training in implant dentistry. However there has been little guidance about how this should take place, the expected outcomes, who should be providing mentoring, and the processes involved. Dentists are required to ensure they are appropriately trained, competent and confident when undertaking clinical tasks. Mentoring will play a key role in giving assurance that these are in place. This article, which is partly based on the College of General Dentistry publication Mentoring in Implant Dentistry: Good Practice Guidelines, provides background and context to the role of mentoring in implant dentistry training programmes. Key components of structured mentoring programmes are described to assist mentors, mentees, and implant education providers. [ABSTRACT FROM AUTHOR]

Abstract Purpose The purpose of this study was to compare the learning in the implant dentistry hands-on course to that of the flipped classroom (FC) and the traditional lecture cohorts (control). Materials and methods In this study,80 students were enrolled for the first time in an implant dentistry program. Subsequently, they were divided into two groups. The first, the FC group, which had free access to a video with a PowerPoint presentation on the Chaoxing-WHU-MOOC platform about the implant placement on first molar sites before class. The second, the control group, which attended a didactic lecture describing implant practice on the first molar site via a bidirectional multimedia interactive teaching demonstration and then operated on a simulation model. Cone beam computed tomography (CBCT) and the deviation gauge were utilized to analyze the accuracy of the implant placement in the students’ models. An online satisfaction questionnaire was distributed to both groups one week after the class. Results The linear deviation of the CBCT examination did not show any statistical difference between the two groups concerning cervical, apex, and angular. A significant buccal deviation was observed in the control group compared with the FC group (mean: 0.7436 mm vs. 0.2875 mm, p = 0.0035), according to the restoration-level deviation gauge. A total of 74.36% of students in the FC group placed implant within 0.5 mm buccal-to-lingual deviations, but only 41.03% of students in the control group reached within 0.5 mm buccal-to-lingual deviation ranges. Additionally, 91.67% of the students in the FC group and 97.5% of the students in the control group were satisfied with the practical implant class. Conclusion FC was more effective than a didactic lecture for implant dentistry practical skill acquisition.

Purpose: The purpose of this study was to compare the learning in the implant dentistry hands-on course to that of the flipped classroom (FC) and the traditional lecture cohorts (control). Materials and methods: In this study,80 students were enrolled for the first time in an implant dentistry program. Subsequently, they were divided into two groups. The first, the FC group, which had free access to a video with a PowerPoint presentation on the Chaoxing-WHU-MOOC platform about the implant placement on first molar sites before class. The second, the control group, which attended a didactic lecture describing implant practice on the first molar site via a bidirectional multimedia interactive teaching demonstration and then operated on a simulation model. Cone beam computed tomography (CBCT) and the deviation gauge were utilized to analyze the accuracy of the implant placement in the students' models. An online satisfaction questionnaire was distributed to both groups one week after the class. Results: The linear deviation of the CBCT examination did not show any statistical difference between the two groups concerning cervical, apex, and angular. A significant buccal deviation was observed in the control group compared with the FC group (mean: 0.7436 mm vs. 0.2875 mm, p = 0.0035), according to the restoration-level deviation gauge. A total of 74.36% of students in the FC group placed implant within 0.5 mm buccal-to-lingual deviations, but only 41.03% of students in the control group reached within 0.5 mm buccal-to-lingual deviation ranges. Additionally, 91.67% of the students in the FC group and 97.5% of the students in the control group were satisfied with the practical implant class. Conclusion: FC was more effective than a didactic lecture for implant dentistry practical skill acquisition. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to evaluate the effect of sterilization on the retention forces of lithium disilicate (LD) and polymer‐infiltrated ceramic network (PICN) crowns bonded to titanium base (Ti‐base) abutments. Materials and methods: Forty LD and 40 PICN crowns were milled and then bonded to 80 Ti‐bases with two resin composite cements: Multilink Hybrid Abutment (mh) and Panavia V5 (pv) for a total of 8 groups (n = 10). Half of the specimens (test) underwent an autoclaving protocol (pressure 1.1 bar, 121°C, 20.5 min) and the other half not (control). Restorations were screw‐retained to implants, and retention forces (N) were measured with a pull‐off testing machine. The surfaces of the Ti‐bases and the crowns were inspected for the analysis of the integrity of the marginal bonding interface and failure mode. Student's t‐test, chi‐square test, and univariate linear regression model were performed to analyze the data (α = 0.05). Results: The mean pull‐off retention forces ranged from 487.7 ± 73.4 N to 742.2 ± 150.3 N. Sterilized groups showed statistically significant overall higher maximum retention forces (p <.05), except for one combination (LD + mh). Sterilization led to an increased presence of marginal gaps and deformities compared to no‐sterilization (p <.001), while no statistically significant relationship was found between failure mode and sterilization (p >.05). Conclusions: Sterilization may have a beneficial effect on the retention forces of LD and PICN crowns bonded to titanium base abutments, although it may negatively influence the integrity of the marginal bonding interface. [ABSTRACT FROM AUTHOR]

This article discusses the implications of the maxillary sinus in dental procedures, specifically in relation to endodontic treatment and implant dentistry. It highlights common complications such as sinus membrane perforation and implant migration into the sinus, emphasizing the importance of proper planning and surgical techniques to minimize these issues. The article also discusses the impact of tooth loss on alveolar resorption and the need for sinus floor elevation in implant placement. It provides valuable information for clinicians in managing these procedures and their potential complications. Additionally, a list of references to various scientific articles and studies related to the proximity of maxillary posterior teeth to the maxillary sinus is provided, offering valuable insights for researchers and clinicians in the field of oral health. [Extracted from the article]

The implementation of CAD software in the digital production of implant prosthetics stands as a pivotal aspect of clinical dentistry, necessitating high precision in the alignment of implant scanbodies. This study investigates the influence of scanbody geometry and the method of superimposing in CAD software when determining 3D implant position. A standardized titanium model with three bone-level implants was digitized to create reference STL files, and 10 intraoral scans were performed on Medentika and NT-Trading scanbodies. To determine implant position, the generated STL files were imported into the Exocad CAD software and superimposed—automatically and manually—with the scanbody geometries stored within the software's shape library. Position accuracy was determined by a comparison of the 3D-defined scanbody points from the STL matching files with those from the reference STL files. The R statistical software was used for the evaluation of the data. In addition, mixed linear models and a significance level of 0.05 were applied to calculate the p-values. The manual overlay method was significantly more accurate than the automatic overlays for both scanbody types. The Medentika scanbodies showed slightly superior precision compared to the NT-Trading scanbodies. Both scanbody geometry and the type of alignment in the CAD software significantly affect digital workflow accuracy. Manual verification and adjustment of the automatic alignment process are essential for precise implant positioning. [ABSTRACT FROM AUTHOR]

This study evaluates the thermal impact of a one-drill protocol for osteotomy preparation in dental implant surgery. Our findings demonstrate a significant reduction in heat generation compared to traditional sequential drilling, suggesting potential benefits for implant osseointegration and patient comfort. Specifically, the one-drill protocol was associated with lower peak temperatures and a reduced duration of elevated temperatures. These findings suggest that the one-drill protocol may contribute to improved implant stability and reduce the risk of thermal-induced bone damage. While further research is needed to confirm these findings in clinical settings, the results of this study provide promising evidence for the potential advantages of the one-drill protocol in dental implant surgery. Additionally, the one-drill protocol may offer simplified surgical workflows and reduced instrument management, potentially leading to improved efficiency and cost-effectiveness in dental implant procedures.

Sequential drilling is a common practice in dental implant surgery aimed at minimizing thermal damage to bone. This study evaluates the thermal effects of sequential drilling and assesses modifications to drilling protocols to manage heat generation. We utilized a custom drill press and artificial bone models to test five drill bits under various protocols, including sequential drilling with different loads, spindle speeds, and peck drilling. Infrared thermography recorded temperature changes during the drilling process, with temperatures monitored at various depths around the osteotomy. The results reveal sequential drilling does not eliminate the thermal damage zone it creates (well over 70 °C). It creates harmful heat to surrounding bone that can spread up to 10 mm from the osteotomy. The first drill used in sequential drilling produces the highest temperatures (over 100 °C), and subsequent drill bits cannot remove the thermal trauma incurred; rather, they add to it. Modifying drill bit design and employing proper drilling techniques, such as reducing drilling RPM and load, can reduce thermal trauma by reducing friction. Inadequate management of heat can lead to prolonged recovery, increased patient discomfort, and potential long-term complications such as impaired bone-to-implant integration and chronic conditions like peri-implantitis. Ensuring healthy bone conditions is critical for successful implant outcomes.

Objective: The present manuscript describes a technique to virtually switch an implant scan body eliminating the need of obtaining a new intraoral implant digital scan. Clinical Considerations: Implant scan bodies assist on transferring the 3‐dimensional position of the implants into the virtual definitive implant cast. However, if a different implant part is desired during the designing procedures of the implant restoration such as selecting a different implant abutment of varying height, angulation, or manufacturer, a new intraoral implant digital scan with the specific implant scan body is required. Conclusions: This novel protocol aims to reduce possible complications that require capturing a new intraoral implant digital scan, facilitate prostheses design modifications after the obtention of the definitive intraoral implant digital scan, and to ease the manufacturing procedures. Clinical Significance: The novel technique may provide a solution for virtually switch implant scan bodies for fabricating implant‐supported single crowns or short‐span prostheses. Additional studies are needed before its clinical implementation. [ABSTRACT FROM AUTHOR]

Based on the evidence of a significant communication and connection pathway between the bone and immune systems, a new science has emerged: osteoimmunology. Indeed, the immune system has a considerable impact on bone health and diseases, as well as on bone formation during grafts and its stability over time. Chronic inflammation induces the excessive production of oxidants. An imbalance between the levels of oxidants and antioxidants is called oxidative stress. This physio-pathological state causes both molecular and cellular damage, which leads to DNA alterations, genetic mutations and cell apoptosis, and thus, impaired immunity followed by delayed or compromised wound healing. Oxidative stress levels experienced by the body affect bone regeneration and maintenance around teeth and dental implants. As the immune system and bone remodeling are interconnected, bone loss is a consequence of immune dysregulation. Therefore, oral tissue deficiencies such as periodontitis and peri-implantitis should be regarded as immune diseases. Bone management strategies should include both biological and surgical solutions. These protocols tend to improve immunity through antioxidant production to enhance bone formation and prevent bone loss. This narrative review aims to highlight the relationship between inflammation, oxidation, immunity and bone health in the oral cavity. It intends to help clinicians to detect high-risk situations in oral surgery and to propose biological and clinical solutions that will enhance patients' immune responses and surgical treatment outcomes. [ABSTRACT FROM AUTHOR]

The problem of antibiotic resistance is becoming increasingly serious worldwide due to uncontrolled prescription. Dentists are among the groups that prescribe the most antibiotics, often to delay urgent treatment. The purpose of the present study is to investigate the prescribing protocols adopted by dentists for prophylaxis and antibiotic therapy in major clinical surgical indications. Methods: A ten-question survey was administered to a group of Italian dentists. The participants were asked about their preferences for antibiotic administration for the prevention of infective endocarditis, the administration of antibiotics to patients allergic to penicillin, the insertion of implants, and the extraction of third molars. The retrieved data were screened and analyzed. Results: A total of 298 surveys were filled out. The most-prescribed antibiotic was amoxicillin or amoxicillin with clavulanic acid or macrolides for allergic patients. The administration of two grams of amoxicillin one hour before surgery was the most widely used prescriptive protocol for prophylaxis. International guidelines on antibiotic prophylaxis for infective endocarditis were only partially followed. The most heterogeneous results emerged for prophylaxis associated with dental implants or provided prior to surgical third-molar extraction. Conclusions: The present study shows widespread antibiotic prescriptive heterogeneity among the sample of dentists analyzed, especially in conditions where international guidelines are lacking. An evidence-based consensus on prescriptive modalities in dentistry would be desirable in the near future. [ABSTRACT FROM AUTHOR]

Aim: The conventional technique of implant uncovery using a blade and scalpel is associated with various drawbacks, including profuse bleeding, soft-tissue trauma, delayed healing, and patient noncompliance. Therefore, there is a need to explore the alternative approaches that offer improved accuracy and time efficiency during the cover screw location at the second stage of recovery. This study aims to assess the accuracy and time efficiency of a novel technique that utilizes an apex locator in comparison to conventional locating techniques for implant uncovery. Settings and Design: The study employed a simple randomized controlled trial with a sample size of 161. Materials and Methods: The study employed apex locator (Woodpecker Woodpex III Gold 5th generation) in conjunction with a K-file (Mani k-file #10, 21 mm) for detecting the implant location. The accuracy of the novel technique was determined based on the values measured on the apex locator, with positive values indicating soft-tissue response and negative values indicating the cover screw (metal). The accuracy was cross-verified using radiovisiography (RVG). The clinician-based scoring was also done, considering RVG evaluation, amount of incision given, and ease of the procedure. The time required to locate the cover screw was recorded using a timer for both the novel technique and the conventional method. Statistical Analysis Used: All the recorded values were statistically analyzed using the independent t-test (P < 0.005) with the SPSS software (version 23). Results: The results revealed a significant difference in terms of incision given, ease of treatment, and time taken for the procedure (P < 0.05), while the accuracy of the novel technique was not disturbed (P > 0.05). Conclusion: Based on the findings of this in vivo study, the use of an apex locator as an alternative to conventional methods for detecting cover screw location at the second stage of recovery is recommended. The novel technique demonstrated faster uncovering of implants without posing any risks to the surrounding tissues or implants. [ABSTRACT FROM AUTHOR]

Purpose: To establish consensus-driven guidelines that could support the clinical decision-making process for implant-supported rehabilitation of the posterior atrophic maxilla and ultimately improve long-term treatment outcomes and patient satisfaction. Materials and methods: A total of 33 participants were enrolled (18 active members of the Italian Academy of Osseointegration and 15 international experts). Based on the available evidence, the development group discussed and proposed an initial list of 20 statements, which were later evaluated by all participants. After the forms were completed, the responses were sent for blinded analysis. In most cases, when a consensus was not reached, the statements were rephrased and sent to the participants for another round of evaluation. Three rounds were planned. Results: After the first round of voting, participants came close to reaching a consensus on six statements, but no consensus was achieved for the other fourteen. Following this, nineteen statements were rephrased and sent to participants again for the second round of voting, after which a consensus was reached for six statements and almost reached for three statements, but no consensus was achieved for the other ten. All 13 statements upon which no consensus was reached were rephrased and included in the third round. After this round, a consensus was achieved for an additional nine statements and almost achieved for three statements, but no consensus was reached for the remaining statement. Conclusion: This Delphi consensus highlights the importance of accurate preoperative planning, taking into consideration the maxillomandibular relationship to meet the functional and aesthetic requirements of the final restoration. Emphasis is placed on the role played by the sinus bony walls and floor in providing essential elements for bone formation, and on evaluation of buccopalatal sinus width for choosing between lateral and transcrestal sinus floor elevation. Tilted and trans-sinus implants are considered viable options, whereas caution is advised when placing pterygoid implants. Zygomatic implants are seen as a potential option in specific cases, such as for completely edentulous elderly or oncological patients, for whom conventional alternatives are unsuitable. [ABSTRACT FROM AUTHOR]

To ensure the prevention of thermal trauma and tissue necrosis during bone drilling in surgical procedures, it is crucial to maintain temperatures below the time- and temperature-dependent threshold of 50 °C for 30 s. However, the absence of a current standard for assessing temperatures attained during bone drilling poses a challenge when comparing findings across different studies. This article aims to address this issue by introducing a standardized testing method for acquiring thermal data during experimental bone drilling. The method requires the use of three controlled variables: infrared thermography, standard bone blocks, and a regulated drilling procedure involving a drill press with irrigation that simulates a surgeon. By utilizing this setup, we can obtain temperature data that can be effectively applied in the evaluation of other variables, such as surgical techniques or drill bit design, and translate the data into bone damage/clinical outcomes. Two surgical drill bits (2.0 mm-diameter twist drill bit and 3.3 mm-diameter multi-step drill bit) are compared using this experimental protocol. The results show the 2.0 mm bit reached significantly higher temperatures compared to the 3.3 mm bit when preparing an osteotomy (p < 0.05). The 2.0 mm drill bit reached temperatures over 100 °C while the 3.3 mm drill bit did not exceed 50 °C.

(1) Introduction: Trust is a cornerstone of the patient–physician relationships. Unforeseen complications in the health care system could jeopardize patients’ trust in their physicians. (2) Aim: This article presents a quantitative figure regarding foreseeing the necessity of a three-dimensional quantitative visualization of bone structure and concurrently preparing for an ancillary procedure by a dentist to successfully perform the surgery that could minimize unforeseen complications; (3) Materials and method: This retrospective study has been derived based on an analysis of 1134 patients who had received 4800 dental implants from January 2001 to August 2020, out of which 200 cases were randomly selected for this study. Each procedure during implant treatment was categorized as OPG (Orthopantomography) or OPG with CBCT as per all the procedures which included and were coded as follows, 1: Surgery & Restoration, 2: GBR (Guided Bone Regeneration), 3: GTR (Guided Tissue Regeneration), 4: Block Bone Graft, 5: Spreading, 6: Splitting, 7: Internal Sinus, 8: External Sinus, 9: PRF (Platelet Rich Fibrin). Any of the 200 cases in which implant placement could not have been performed for reasons related to a lack of CBCT were selected for this study. The surgery was aborted halfway through without implant placement in these cases due to a lack of bone quantity and/or lack of primary stability. These cases were registered for re-evaluation and statistical analysis; (4) Results: 7% of the cases that used OPG alone led the surgeon to unexpectedly abort in the middle of the surgery without implant placement. All (100%) of the patients who had CBCT during treatment planning were able to receive implants during the surgery. None of the patients left the surgery without receiving implants if CBCT was used (0%); (5) Discussion: Radiographic image quality is defined as the amount of information within the image that allows the radiologist to make a diagnostic decision with a particular level of certainty (Martin et al., 1999) and hence the importance of CBCT. The unexpected 7% of devastating situations for patients who started surgery but did not have implant placement led to [A] aborting the surgery, [B] procedural difficulties requiring an alternative treatment plan, [C] a negative impact on the patient’s behavior, and [D] wanting to change doctor due to a lack of trust; (6) Conclusion: This study indicates that in implant dentistry patients’ mistrust could be avoided by 7% if CBCT is obtained. It also shows the significance of cone-beam computed tomography as an adjunct to panoramic radiography during the diagnosis and treatment planning phase. The use of panoramic radiography alone can lead to a 7% likelihood of misdiagnosis. A lack of CBCT during treatment planning negatively affects the outcome of surgical procedures.

Objectives: Nano-modified surfaces for dental implants may improve gingival fibroblast adhesion and antibacterial characteristics through cell-surface interactions. The present study investigated how a nanocavity titanium surface impacts the viability and adhesion of human gingival fibroblasts (HGF-1) and compared its response to Porphyromonas gingivalis with those of marketed implant surfaces. Material and methods: Commercial titanium and zirconia disks, namely, sandblasted and acid-etched titanium (SLA), sandblasted and acid-etched zirconia (ZLA), polished titanium (PT) and polished zirconia (ZrP), and nanostructured disks (NTDs) were tested. Polished titanium disks were etched with a 1:1 combination of 98% H2SO4 and 30% H2O2 (piranha etching) for 5 h at room temperature to produce the NTDs. Atomic force microscopy was used to measure the surface topography, roughness, adhesion force, and work of adhesion. MTT assays and immunofluorescence staining were used to examine cell viability and adhesion after incubation of HGF-1 cells on the disk surfaces. After incubation with P. gingivalis, conventional culture, live/dead staining, and SEM were used to determine the antibacterial properties of NTD, SLA, ZLA, PT, and ZrP. Results: Etching created nanocavities with 10–20-nm edge-to-edge diameters. Chemical etching increased the average surface roughness and decreased the surface adherence, while polishing and flattening of ZrP increased adhesion. However, only the NTDs inhibited biofilm formation and bacterial adherence. The NTDs showed antibacterial effects and P. gingivalis vitality reductions. The HGF-1 cells demonstrated greater viability on the NTDs compared to the controls. Conclusion: Nanocavities with 10–20-nm edge-to-edge diameters on titanium disks hindered P. gingivalis adhesion and supported the adhesion of gingival fibroblasts when compared to the surfaces of currently marketed titanium or zirconia dental implants. Clinical relevance: This study prepared an effective antibacterial nanoporous surface, assessed its effects against oral pathogens, and demonstrated that surface characteristics on a nanoscale level influenced oral pathogens and gingival fibroblasts. Clinical trial registration: not applicable [ABSTRACT FROM AUTHOR]

Featured Application: This study aims to validate a new diagnostic test that predicts the risk of peri-implantitis, thereby enabling early intervention and improved implant survival rates. The aim of this parallel group study was to determine the clinical applicability of a newly developed bacterial test. We evaluated the ability of the test to detect five bacteria associated with peri-implantitis: Porphyromonas gingivalis, Tannerella forsythia, Aggregatibacter actinomycetemcomitans, Prevotella intermedia, and Treponema denticola. Sensitivity, specificity, and positive and negative predictive values were established. Furthermore, by analyzing the pre-test and post-test probabilities, likelihood ratios were established, and a Fagan nomogram was constructed. As the standard, the clinical criteria of peri-implantitis adopted in the latest classification of peri-implant diseases of 2018 were used. The sample consisted of 13 patients clinically diagnosed with peri-implantitis (various implant brands) with at least 1 year of loading, of whom 11 were included in the study. The healthy group comprised 10 patients who received implants (Ticare inhex hybrid) at the university dental clinic and were monitored and exhibited no signs or symptoms of peri-implantitis during 1 year of loading. The results indicated that this test has high sensitivity and low specificity; therefore, positive results will be of great importance for a confirmatory diagnosis of peri-implantitis. However, the test is not suitable as a screening tool. [ABSTRACT FROM AUTHOR]

The implementation of CAD software in the digital production of implant prosthetics stands as a pivotal aspect of clinical dentistry, necessitating high precision in the alignment of implant scanbodies. This study investigates the influence of scanbody geometry and the method of superimposing in CAD software when determining 3D implant position. A standardized titanium model with three bone-level implants was digitized to create reference STL files, and 10 intraoral scans were performed on Medentika and NT-Trading scanbodies. To determine implant position, the generated STL files were imported into the Exocad CAD software and superimposed—automatically and manually—with the scanbody geometries stored within the software’s shape library. Position accuracy was determined by a comparison of the 3D-defined scanbody points from the STL matching files with those from the reference STL files. The R statistical software was used for the evaluation of the data. In addition, mixed linear models and a significance level of 0.05 were applied to calculate the p-values. The manual overlay method was significantly more accurate than the automatic overlays for both scanbody types. The Medentika scanbodies showed slightly superior precision compared to the NT-Trading scanbodies. Both scanbody geometry and the type of alignment in the CAD software significantly affect digital workflow accuracy. Manual verification and adjustment of the automatic alignment process are essential for precise implant positioning.

Purpose: Citation-based metrics, such as the H-classics method, have been used as an indicator to assess academic performance in the scientific community. However, information addressing issues regarding self-citation, citation halflife, and subject area of origin in implant dentistry is lacking. The purpose of this study was to investigate the citation characteristics of H-classics articles in implant dentistry throughout different time periods. Materials and Methods: H-classics implant dentistry articles were searched and selected by applying the H-classics method from the Scopus database. Bibliometric analysis was conducted to evaluate the citation characteristics, including institutional and journal self-citation, citation half-life, and subject area of origin of identified H-classics articles. Results: The International Journal of Oral & Maxillofacial Implants and Clinical Oral Implants Research are the leading journals contributing the majority of citations to the retrieved H-classics articles. Articles published in the United States cited the most H-classics articles. Journal self-citation was 12.41% on average, while institutional self-citation was approximately 7.81%. Citation half-life decreased significantly across time periods, with an average decreasing ratio of 43.95%. Research on Scope III, bioengineering interventions, had the most prominent distribution citation frequency in the subject area “Others.” Conclusion: This study provides insightful views regarding citation characteristics of H-classics articles in implant dentistry (eg, interdisciplinary publications on bioengineering interventions) during the investigation periods, which may foster the translation of preclinical research into clinical applications in the future. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to analyze the projects submitted to the ITI International Team for Implantology for funding and the scientific publications ensuing from these projects, over a period of 30 years. Materials and Methods: This analysis was performed based on information available in the database of the ITI. For each project, data related to institution, country of origin, and grant status (financed or rejected) were extracted. For the financed projects, the grant amount and number of publications were recorded. Publications were searched independently by two investigators. For all publications, the study topic, study design, and citation number were recorded. Results: From a total of 1,372 submitted projects from 51 different countries and 308 different institutions, 514 (37.46%) were financed by the ITI. This amounts to more than CHF 52 million invested in favor of implant dentistry and related fields. A total of 552 publications (including original research and reviews) were identified related to these projects, with the majority being in vitro studies (n = 198), and the most common topic researched was implant surface modification (n = 134). The United States was the country and the University of Bern was the institution with the largest number of financed projects and published papers. Conclusion: This analysis revealed that the ITI has been actively supporting research in the field of implant dentistry and related areas globally. Several concepts in present-day implantology are based on literature from ITI-funded projects. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the sequential osseointegration of a novel titanium implant system based on a 3D printing technology in comparison with conventional titanium implants. Material and methods: Two novel titanium implants based on 3D printing were tested in the mandible of eight Beagle dogs. As a control, two different commercially available titanium implants were used. The implants were staged to accommodate healing periods of 2 and 6 weeks. The primary outcome variable was bone‐to‐implant contact (BIC) in non‐decalcified tissue sections and micro‐CT analysis. Results: Histomorphometrically, the proportions of tissues adjacent to the implant surfaces were similar for all implants, whereas the BIC percentage of new mineralized bone was greater for the control implants after both 2 and 6 weeks (p <.05). Micro‐CT analysis revealed increasing osseous volume and BIC from 2 to 6 weeks. In contrast to the histomorphometry, the BIC evaluation with the micro‐CT data revealed a significantly higher BIC for the two test implants compared with controls (p <.001). The analysis of the total implant surface area disclosed a value that was approximately double as high for the test compared to the control implants. Conclusions: The novel titanium implant system based on 3D printing yielded values for osseointegration that were adequate and satisfactory. The higher percentage of new mineralized bone in the control implants is explained by the fact of a completely different three‐dimensional surface area. [ABSTRACT FROM AUTHOR]

The occurrence of errors, complications, and adverse effects may occur as a consequence of single or multiple events related to the clinician and/or patient. Apparently, the amount of dental literature on these undesirable outcomes has not been as prolific as that obtained for conventional primary periodontal outcome measures. This review explores the potential reasons for the lack of studies reporting on errors and complications in periodontal and implant therapy, as well as other noteworthy methodological aspects, to enlighten their impact on the selection of the best (or most appropriate) "gold standard" periodontal/implant‐related treatment options, and on the overall decision‐making process. The following points were addressed: (a) the importance of reporting errors and complications in clinical research; (b) the adequate reporting of errors and complications in periodontology and dental implantology; and (c) efficacy trials vs effectiveness studies and their impact on the assessment and report of periodontal and implant treatment‐related risks and complications. [ABSTRACT FROM AUTHOR]

Computer-guided software and kits have significantly improved the clinical applications of implant surgery. Nonetheless, some technical problems are still in evidence during clinical procedures because of cumbersome surgical tools that can limit access to implant sites, mainly in posterior areas of the mouth in the presence of bulky anatomical structures and in patients with reduced mouth-opening capacity. The present paper aimed to present a novel approach to guided implant surgery, describing the technical characteristics of an innovative guided surgical kit made up of modified sleeves and modular surgical drills. The proposed guided surgical kit is based on a novel patented system of sleeves and modular burs, with an increased length of the metal sleeves and a reduced height of the drills. The innovative design of the proposed system would allow the clinician to position guided fixtures in all clinical situations; the reduced encumbrance would be particularly helpful to gain access to the posterior areas of both maxilla and mandible, which have limited inter-arch space, with an easy and user-friendly approach. The modular system could overcome anatomical limitations, such as reduced mouth-opening capacity, and permit clinicians to maintain the stability and integrity of the surgical templates, even in cases where there is very limited intermaxillary space.

Aim: To obtain input from multiple stakeholders and generate agreement on essential outcomes in implant dentistry using the Delphi methodology and incorporate them into an international consensus defining a core outcome set. Materials and Methods: Candidate outcomes in implant dentistry were generated from scientific evidence through five commissioned systematic reviews and from people with lived experience in dental implants (PWLE) through four international focus groups. A steering committee identified stakeholders among representatives from dental professionals, industry‐related experts and PWLE. Participants underwent a three‐round Delphi survey using a multi‐stakeholder approach; they assessed candidate outcomes and additional outcomes identified in the first Delphi round. The process followed the COMET methodology. Results: From the 665 potential outcomes identified in the systematic reviews and 89 in the PWLE focus group, the steering committee selected 100 and organized them into 13 categories, to be included in the first‐round questionnaire as candidate outcomes. A total of 99 dental experts, 7 dental‐industry‐related experts and 17 PWLE participated in the first round, and 11 additional outcomes were added to the second round. There was no attrition between the first and second rounds, where 61 (54.9%) outcomes exceeded the pre‐established threshold of agreement. PWLE and experts participated in the third round that applied "a priori" standard filters to distil a list of candidate essential outcomes. Conclusion: This Delphi study utilized a standardized, transparent and inclusive methodology and preliminarily validated 13 essential outcomes organized into four core areas. These results informed the final stage of the ID‐COSM consensus. [ABSTRACT FROM AUTHOR]

Aim: Lack of consistently reported outcomes limits progress in evidence‐based implant dentistry and quality of care. The objective of this initiative was to develop a core outcome set (COS) and measurements for implant dentistry clinical trials (ID‐COSM). Materials and Methods: This Core Outcome Measures in Effectiveness Trials (COMET)‐registered international initiative comprised six steps over 24 months: (i) systematic reviews of outcomes reported in the last 10 years; (ii) international patient focus groups; (iii) a Delphi project with a broad range of stakeholders (care providers, clinical researchers, methodologists, patients and industry representatives); (iv) expert group discussions organizing the outcomes in domains using a theoretical framework and identifying the COSs; (v) identification of valid measurement systems to capture the different domains and (vi) final consensus and formal approval involving experts and patients. The methods were modified from the best practice approach following the Outcome Measures in Rheumatoid Arthritis Clinical Trial and COMET manuals. Results: The systematic reviews and patient focus groups identified 754 (665 + 89, respectively) relevant outcome measures. After elimination of redundancies and duplicates, 111 were formally assessed in the Delphi project. By applying pre‐specified filters, the Delphi process identified 22 essential outcomes. These were reduced to 13 after aggregating alternative assessments of the same features. The expert committee organized them into four core outcome areas: (i) pathophysiology, (ii) implant/prosthesis lifespan, (iii) life impact and (iv) access to care. In each area, core outcomes were identified to capture both the benefits and harms of therapy. Mandatory outcome domains included assessment of surgical morbidity and complications, peri‐implant tissue health status, intervention‐related adverse events, complication‐free survival and overall patient satisfaction and comfort. Outcomes deemed mandatory in specific circumstances comprised function (mastication, speech, aesthetics and denture retention), quality of life, effort for treatment and maintenance and cost effectiveness. Specialized COSs were identified for bone and soft‐tissue augmentation procedures. The validity of measurement instruments ranged from international consensus (peri‐implant tissue health status) to early identification of important outcomes (patient‐reported outcomes identified by the focus groups). Conclusions: The ID‐COSM initiative reached a consensus on a core set of mandatory outcomes for clinical trials in implant dentistry and/or soft tissue/bone augmentation. Adoption in future protocols and reporting on the respective domain areas by currently ongoing trials will contribute to improving evidence‐informed implant dentistry and quality of care. [ABSTRACT FROM AUTHOR]

Background: Anorganic bovine bone has been deeply studied for bone regeneration in the oral cavity. Different manufacturing processes can modify the final composition of the biomaterial and the responses that induce. Aim: To evaluate the physico‐chemical characteristics of a bovine bone mineral matrix and the clinical, radiographical, histological, and mRNA results after using it for maxillary sinus floor augmentation in humans. Materials and Methods: First, the physical–chemical characteristics of the biomaterial were evaluated by X‐ray powder diffraction, X‐ray fluorescence, and electron microscopy. A frequently used biomaterial with the same animal origin was used as comparator. Then, a clinical study was designed for evaluating clinical, radiographical, histological, and mRNA outcomes. Patients in need of two‐stage maxillary sinus floor augmentation were included in the study. Six months after the grafting procedure, a bone biopsy was collected for evaluation. Results: In terms of physico‐chemical characteristics, no differences were found between both biomaterials. Clinically, 10 patients were included in the study. After 6 months, clinical and radiographical data showed adequate outcomes for allowing implant placement. Histological, immunohistochemical and mRNA analyses showed that the biomaterial in use provides biological support to induce responses similar to those of other commonly used biomaterials. Conclusion: Bovine bone mineral matrix (Creos™ Xenogain) used as a single material for maxillary sinus floor augmentation shows adequate biological, clinical, and radiological outcomes. In fact, the results from this study are similar to those reported in the literature for another bovine bone‐derived biomaterial with whom it shares composition and micro‐ and nanoscale characteristics. [ABSTRACT FROM AUTHOR]

Innovation in the healthcare profession to solve complex human problems has always been emulated and based on solutions proven by nature. The conception of different biomimetic materials has allowed for extensive research that spans several fields, including biomechanics, material sciences, and microbiology. Due to the atypical characteristics of these biomaterials, dentistry can benefit from these applications in tissue engineering, regeneration, and replacement. This review highlights an overview of the application of different biomimetic biomaterials in dentistry and discusses the key biomaterials (hydroxyapatite, collagen, polymers) and biomimetic approaches (3D scaffolds, guided bone and tissue regeneration, bioadhesive gels) that have been researched to treat periodontal and peri-implant diseases in both natural dentition and dental implants. Following this, we focus on the recent novel application of mussel adhesive proteins (MAPs) and their appealing adhesive properties, in addition to their key chemical and structural properties that relate to the engineering, regeneration, and replacement of important anatomical structures in the periodontium, such as the periodontal ligament (PDL). We also outline the potential challenges in employing MAPs as a biomimetic biomaterial in dentistry based on the current evidence in the literature. This provides insight into the possible increased functional longevity of natural dentition that can be translated to implant dentistry in the near future. These strategies, paired with 3D printing and its clinical application in natural dentition and implant dentistry, develop the potential of a biomimetic approach to overcoming clinical problems in dentistry. [ABSTRACT FROM AUTHOR]

The problem of antibiotic resistance is becoming increasingly serious worldwide due to uncontrolled prescription. Dentists are among the groups that prescribe the most antibiotics, often to delay urgent treatment. The purpose of the present study is to investigate the prescribing protocols adopted by dentists for prophylaxis and antibiotic therapy in major clinical surgical indications. Methods: A ten-question survey was administered to a group of Italian dentists. The participants were asked about their preferences for antibiotic administration for the prevention of infective endocarditis, the administration of antibiotics to patients allergic to penicillin, the insertion of implants, and the extraction of third molars. The retrieved data were screened and analyzed. Results: A total of 298 surveys were filled out. The most-prescribed antibiotic was amoxicillin or amoxicillin with clavulanic acid or macrolides for allergic patients. The administration of two grams of amoxicillin one hour before surgery was the most widely used prescriptive protocol for prophylaxis. International guidelines on antibiotic prophylaxis for infective endocarditis were only partially followed. The most heterogeneous results emerged for prophylaxis associated with dental implants or provided prior to surgical third-molar extraction. Conclusions: The present study shows widespread antibiotic prescriptive heterogeneity among the sample of dentists analyzed, especially in conditions where international guidelines are lacking. An evidence-based consensus on prescriptive modalities in dentistry would be desirable in the near future.

Based on the evidence of a significant communication and connection pathway between the bone and immune systems, a new science has emerged: osteoimmunology. Indeed, the immune system has a considerable impact on bone health and diseases, as well as on bone formation during grafts and its stability over time. Chronic inflammation induces the excessive production of oxidants. An imbalance between the levels of oxidants and antioxidants is called oxidative stress. This physio-pathological state causes both molecular and cellular damage, which leads to DNA alterations, genetic mutations and cell apoptosis, and thus, impaired immunity followed by delayed or compromised wound healing. Oxidative stress levels experienced by the body affect bone regeneration and maintenance around teeth and dental implants. As the immune system and bone remodeling are interconnected, bone loss is a consequence of immune dysregulation. Therefore, oral tissue deficiencies such as periodontitis and peri-implantitis should be regarded as immune diseases. Bone management strategies should include both biological and surgical solutions. These protocols tend to improve immunity through antioxidant production to enhance bone formation and prevent bone loss. This narrative review aims to highlight the relationship between inflammation, oxidation, immunity and bone health in the oral cavity. It intends to help clinicians to detect high-risk situations in oral surgery and to propose biological and clinical solutions that will enhance patients’ immune responses and surgical treatment outcomes.

Purpose: This case series illustrates a simplified soft tissue management, namely, the subperiosteal periimplant augmented layer (SPAL), to increase hard and soft tissue dimensions at the most coronal portion of an implant. Materials and Methods: Twenty-seven implants in 16 patients presenting either a buccal bone dehiscence or a thin (< 1 mm) buccal cortical bone plate (BCBP) were consecutively treated. Briefly, a split-thickness flap (namely, the mucosal layer) was raised on the buccal aspect. Then, the periosteal layer was elevated from the bone crest. A full-thickness flap was elevated on the oral aspect. After implant site preparation, a xenograft was used to fill the space between the periosteal layer and the BCBP and/or exposed implant surface and, if present, to completely correct the bone dehiscence. The periosteal layer was sutured to the oral flap. The mucosal layer was coronally advanced and sutured to submerge both the graft and the implants. At 3 to 6 months, a re-entry procedure for implant exposure was performed. Results: Healing was uneventful, with no signs of infection in all cases. A wound dehiscence was observed in three implants in two patients at 2 weeks postsurgery. Out of 15 implants showing an initial bone dehiscence, 12 implants (80%) showed a complete resolution, with a subperiosteal tissue thickness (SPTT) at the time of re-entry of 3.1 ± 1.0 mm. Three implants presented a residual dehiscence of 1 mm (two implants) or 2 mm (one implant), with a SPTT of at least 2 mm. Out of 12 implants showing a thin BCBP at implant placement, 10 implants (90%) revealed a SPTT ≥ 2 at the time of re-entry. Two implants revealed a SPTT of 1 mm. Conclusion: The SPAL technique represents a valuable simplified surgical approach associated with a low rate of complications in the treatment of peri-implant bone dehiscence and in the horizontal augmentation of peri-implant tissue thickness. [ABSTRACT FROM AUTHOR]

Different collagen barrier membranes come in various sources and crosslinking that may affect barrier function and tissue integration. This study investigated barrier function and tissue integration of the three different collagen membranes (Jason®: porcine pericardium, GENOSS: bovine tendon, and BioMend® Extend: cross-linked bovine tendon) with human gingival fibroblasts. The barrier function and tissue integration properties were determined under confocal microscopy. Morphological characteristics were observed using scanning electron microscopy. Our results showed that all collagen membranes allowed a small number of cells to migrate, and the difference in barrier function ability was not significant. The cross-linked characteristics did not improve barrier ability. The native collagen membrane surfaces allowed evenly scattered proliferation of HGF, while the cross-linked collagen membrane induced patchy proliferation. Statistically significant differences in cell proliferation were found between Jason and BioMend Extend membranes (p = 0.04). Scanning electron microscope showed a compact membrane surface at the top, while the bottom surfaces displayed interwoven collagen fibers, which were denser in the crosslinked collagen membranes. Within the limitations of this study, collagen membranes of different origins and physical properties can adequately prevent the invasion of unwanted cells. Native collagen membranes may provide a better surface for gingival cell attachment and proliferation. [ABSTRACT FROM AUTHOR]

Introduction: Osteoradionecrosis (ORN) is a secondary complication from radiotherapy, which is difficult to manage and significantly reduces the life quality of the affected patients. Case Report: A 59-year-old female patient, diagnosed with infiltration by squamous cell carcinoma in the left cervical region, underwent adjuvant cervical-facial radiotherapy with a total dose of 66.6 Gy of radiation. Eight years after the diagnosis, the patient underwent multiple extractions and, subsequently, the installation of osseointegrated implants, evolving to extensive intraoral bone exposure associated with oral cutaneous fistula. The patient was initially exposed to photobiomodulation therapy (PBMT), with a low-power laser at wavelengths of 660 nm and 808 nm, and thereafter to antimicrobial photodynamic therapy (aPDT). After an improvement in the clinical condition and resolution of the oral cutaneous fistula, a surgical procedure with the Er: YAG laser was performed to remove the remaining necrotic bone. Once the ORN condition was completely treated, the patient's oral rehabilitation was implemented by the installation of an upper mucous-supported total prosthesis and a lower implant-supported prosthesis. Conclusion: The patient is in a clinical follow-up and has no signs of bone necrosis recurrence, suggesting that low and high-power laser treatment can be an effective therapeutic alternative to resolve this condition. [ABSTRACT FROM AUTHOR]

Background: Dental implants are a popular solution for replacing missing teeth, but one potential complication is marginal bone loss around the implant site. Researchers have turned to artificial intelligence models for predictive analysis to address this concern. The objective of this systematic review was to evaluate how well artificial intelligence models perform in predicting the occurrence of marginal bone loss around dental implants. Methods: This systematic review conformed to Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020 guidelines. PubMed, Scopus, ScienceDirect, and Cochrane were searched from inception till June 7, 2023. Studies were selected based on the following predefined criteria: 1) studies investigating periimplant bone loss through artificial intelligence models; 2) no date restriction; and 3) studies available in English language. Keywords such as "artificial intelligence", "machine learning", "neural network", "deep learning", "dental implant", "implant dentistry", "peri-implant", "marginal bone loss", and "bone loss" were used. Two review authors assessed the methodological quality using the Joanna Briggs Institute Critical Appraisal Checklist for Quasi-Experimental Studies (non-randomized experimental studies). Results: Three relevant studies were included in this systematic review. Support vector machine, artificial neural network, logistic regression, random forest, and convolutional neural network artificial intelligence models were used. Cone-beam computed tomography and periapical radiographs were used to develop artificial intelligence models. All three research studies confirmed the effectiveness of artificial intelligence models in feasibly predicting peri-implant bone loss at par with dental physicians and clinicians. The overall risk of bias assessment of studies demonstrated a consistently low risk of bias across all included articles. Conclusion: The artificial intelligence models have the potential to predict marginal bone loss around dental implants and, therefore, can be considered for utilization and deployment in clinical practice. [ABSTRACT FROM AUTHOR]

Computer-guided software and kits have significantly improved the clinical applications of implant surgery. Nonetheless, some technical problems are still in evidence during clinical procedures because of cumbersome surgical tools that can limit access to implant sites, mainly in posterior areas of the mouth in the presence of bulky anatomical structures and in patients with reduced mouth-opening capacity. The present paper aimed to present a novel approach to guided implant surgery, describing the technical characteristics of an innovative guided surgical kit made up of modified sleeves and modular surgical drills. The proposed guided surgical kit is based on a novel patented system of sleeves and modular burs, with an increased length of the metal sleeves and a reduced height of the drills. The innovative design of the proposed system would allow the clinician to position guided fixtures in all clinical situations; the reduced encumbrance would be particularly helpful to gain access to the posterior areas of both maxilla and mandible, which have limited inter-arch space, with an easy and user-friendly approach. The modular system could overcome anatomical limitations, such as reduced mouth-opening capacity, and permit clinicians to maintain the stability and integrity of the surgical templates, even in cases where there is very limited intermaxillary space. [ABSTRACT FROM AUTHOR]

This report describes the predoctoral comprehensive digital implant dentistry program at the University of Kentucky, College of Dentistry (UKCD). UKCD has implemented a digital dentistry workflow in the dental curriculum for predoctoral and graduate programs since 2018. Digital implant dentistry education involves using cone beam computed tomography (CBCT) for diagnosis and treatment planning, intraoral scanner for digital impression, and treatment planning software to plan for single implant-supported restorations and implant-retained mandibular overdenture cases. The laboratory components include virtual designing of a surgical guide and using three-dimensional printing to fabricate a fully guided surgical template for implant placement procedures for the patient. In the last 3 years, including the COVID year, a total of 294 implants have been placed by dental students. Unfortunately, 6 implants failed in the early healing time due to infection, with an overall success rate of 98%. These treatment outcomes are very favorable compared with published literature. [ABSTRACT FROM AUTHOR]

Different techniques can be used to design and manufacture a full-arch, implant-supported prosthesis, and different materials can be chosen for its production, each with its advantages and limitations. One of the possibilities provided by digital tools is their ability to maintain low costs to give more patients the chance to choose this commonly expensive treatment. The present work aims to present a protocol for the realization of full-arch, implant-fixed complete dentures (IFCDs) in monolithic zirconia and titanium. When the analogic master model is obtained, it is scanned to perform the digital wax-up, and the two parts of the prosthesis—a bar in titanium and an aesthetic component in monolithic zirconia—are milled. The dental team must then verify the precision of the milled components on the master model, so that they can be cemented together and delivered to the patient. This technique offers different advantages, in terms of cost sustainability, minimal wear risk for the prosthesis and its antagonists, and ease of re-intervening in the case of complications. The main limitations of the technique may lie in the aesthetic needs of the patient, because of the relatively poor aesthetic performance of monolithic zirconia and the absence of a pink orthopedic component.

In 2019, Wuhan city of China announced the epidemic of COVID-19 as a public health disaster which has been recognized as an uncommon type of single stranded RNA virus belonging to Coronaviridae family and then quickly spread all over the world. Clinically symptomatic patients are identified as the primary source of COVID-19 transmission. Most of dental procedures require the use of high-speed handpieces which leads to aerosol generation. Implant dentistry is the field of dentistry which deals with prosthetic rehabilitation with minimal aerosol generation ensuring an aseptic surgical environment. There are several decisive recommendations regarding COVID-19 precautions that should be appreciated in implant dentistry. Sharp drills in slow speed drilling machines are preferred during surgery. Regular irrigation with high volume suction is greatly encouraged. Osteotomes are encouraged over ultrasonic devices to minimize the generation of aerosols during surgical procedures. Immediate implants placement is more preferred as the number of visits to the dentists is reduced. Impression techniques should be shifted to the digital approach instead of conventional methods. Full mouth rehabilitation cases requiring complex procedures should be accomplished restrictedly.

Objectives: The aim of this retrospective study is to assess whether axial and tilted implants supporting All-on-4 prosthesis show any differences in terms of survival rate, success rate and marginal bone loss (MBL) after a long-term follow-up (mean 9 years). Material and Methods: One hundred and fifty-six implants were included in this study, 78 of which were tilted (Group A) and 78 were axial (Group B). MBL was measured after a mean time of 9 years on periapical radiographs. Success and survival rate were assessed with the Misch criteria. The prevalence of peri-implantitis was calculated. Statistical analysis was conducted to assess comparisons between groups. A Kaplan–Meyer analysis was carried out for the survival rate. Results: A total of 156 implants were analyzed. After a 9-year mean time follow-up, the survival rate was 96.2% in group A and 98.7% in group B; and the success rate was 80.8% in group A and 74.4% in group B. The mean MBL was 1.2 mm (IQR 0.6–1.8) in group A and 1.4 mm (IQR 0.9–2.1) in group B. No statistically significant differences were shown between the two groups (p < 0.05). Peri-implantitis occurred in 15 implants and was equally distributed between the two groups. Conclusions: This study shows that axial and tilted implants have similar success rates, survival rates and MBL values after a long-time follow-up, assessing the biological reliability of the prosthesis they supported. Peri-implantitis occurred equally between the two groups.