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Aim To study the time and costs involved with computer-assisted versus non-computer-assisted implant planning and placement. Material and methods Based on the PICO question, "In patients receiving dental implants, is computer-assisted implant planning and surgery (CAIPS) compared to non-computer-assisted implant planning and surgery (non-CAIPS) beneficial in terms of treatment related costs and time involved?", a search path was created to perform an electronic search in the databases PubMed, PubMed Central, EMBASE, and Cochrane. The publication period of eligible publications extended from 01.01.2005 to 04.05.2020. Four independent reviewers reviewed the literature to identify studies that met the eligibility inclusion criteria. A further manual search of articles was performed, and gray literature was excluded. Corresponding authors of potentially eligible manuscripts were contacted for further information. Results Of the 1354 retrieved titles after the search were screened. Thirty-one articles have been identified to read the full text, resulting in four articles to be analyzed for the present review all of which were RCTs. In total, 182 partially and completely edentulous patients were treated with 416 implants following either non-computer-assisted or computer-assisted implant planning and surgery to determine the duration of the single working steps and the financial aspects of the different procedures. Conclusions When evaluating the time and costs involved with the diagnostic and planning procedures in computer-assisted implant planning and surgery workflow protocols, one can summarize that these are higher than in the non-computer-assisted workflow protocols. The time involved with the procedures appears to be the driving factor when it comes to economic considerations. On the basis of the conclusions, also the time for the prosthetic restoration should be taken into account.

To report on the follow-up of two earlier published RCTs on the performance of screw-retained monolithic zirconia restorations on Ti-base abutments based on intraoral optical scanning or conventional impressions.A total of 54 patients receiving 89 restorations (44 single crowns [SC]), 21 splinted crowns [2-FDP], and 24 three-unit fixed partial dentures (3-FDP)] were included in the 1- to 3-year follow-up period. The restoration survival and technical complications were documented.A total of 50 patients with 84 restorations completed the 3-year follow-up. One 3-FDP from the IOS group was lost. This resulted in survival rates of 97.9% for the test and 100% for the control restorations and an overall survival rate of screw-retained monolithic zirconia restorations on implants of 98.8% after 3 years. There was no statistically significant survival difference between the test and control groups (P = .362). When evaluated separately, a 100% survival rate for SCs and 97.7% rate for 2-FDPs was reported. One decementation and three occurrences of screw loosening occurred over the 1- to 3-year follow-up. The multiple-implant restorations showed higher (23.3%) complication rates at the restoration level than the SCs (4.9%) after 3 years of function (P = .026).Screw-retained monolithic zirconia restorations on Ti-base abutments show promising survival rates after 3 years of function. Restorative complications of screw-retained monolithic zirconia restorations on Ti-base abutments are more likely to happen in the first year of function and are more common in multiple-implant restorations than solitary crowns. The impression (IOS or conventional) does not seem to influence these results.

Objectives: To assess the adjunctive effect of systemic amoxicillin (AMX) and metronidazole (MTZ) in patients receiving non-surgical treatment (NST) for peri-implantitis (PI). Materials and methods: Thirty-seven patients were randomized into an experimental group treated with NST plus AMX + MTZ (N = 18) and a control group treated with NST alone (N = 19). Clinical parameters were evaluated at 12 weeks post-treatment. The primary outcome was the change in peri-implant pocket depth (PIPD) from baseline to 12 weeks, while secondary outcomes included bleeding on probing (BoP), suppuration on probing (SoP), and plaque. Data analysis was performed at patient level (one target site per patient). Results: All 37 patients completed the study. Both groups showed a significant PIPD reduction after NST. The antibiotics group showed a higher mean reduction in PIPD at 12 weeks, compared with the control group (2.28 ± 1.49 mm vs. 1.47 ± 1.95 mm), however, this difference did not reach statistical significance. There was no significant effect of various potential confounders on PIPD reduction. Neither treatment resulted in significant improvements in BoP at follow-up; 30 of 37 (81%) target sites still had BoP after treatment. Only two implants, one in each group, exhibited a successful outcome defined as PIPD

Infected bone defect healing is hindered by infection and compromised bone regenerative capacity. In this study, we designed a dual functional bone‐defect‐filling material with a sequential release system, that is, a burst release of a potent antibacterial agent, hydroxypropyltrimethyl ammonium chloride chitosan (HACC), followed by a controlled release of osteoinductive bone morphogenic protein (BMP2) to repair the infected bone defect. Minimum bactericidal concentration (MBC) of HACC against methicillin‐resistant Staphylococcus aureus was 40 μg/mL. HACC at 40 μg/mL did not affect preosteoblast proliferation and did not influence the BMP2‐induced alkaline phosphatase activity, osteocalcin expression, and matrix mineralization. in vitro release profile revealed burst release of HACC followed by a slow release of BMP2. in vivo bone formation was observed only in the BMP2‐containing groups. HACC did not influence of biomimetic calcium phosphate (BioCaP) resorption and BMP2‐induced bone formation. In conclusion, the optimized HACC/BMP2‐incorporated BioCaP complex showed strong antibacterial effect and robustly enhanced osteoinduction both in vitro and in vivo.

Background The aim of this systematic review was to provide an update on the contemporary knowledge and scientific development of augmented reality (AR) and virtual reality (VR) in dental medicine, and to identify future research needs to accomplish its clinical translation. Method A modified PICO-strategy was performed using an electronic (MEDLINE, EMBASE, CENTRAL) plus manual search up to 12/2018 exploring AR/VR in dentistry in the last 5 years. Inclusion criteria were limited to human studies focusing on the clinical application of AR/VR and associated field of interest in dental medicine. Results The systematic search identified 315 titles, whereas 87 abstracts and successively 32 full-texts were selected for review, resulting in 16 studies for final inclusion. AR/VR-technologies were predominantly used for educational motor skill training (n = 9 studies), clinical testing of maxillofacial surgical protocols (n = 5), investigation of human anatomy (n = 1), and the treatment of patients with dental phobia (n = 1). Due to the heterogeneity of the included studies, meta-analyses could not be performed. Conclusions The overall number of includable studies was low; and scientifically proven recommendations for clinical protocols could not be given at this time. However, AR/VR-applications are of increasing interest and importance in dental under- and postgraduate education offering interactive learning concepts with 24/7-access and objective evaluation. In maxillofacial surgery, AR/VR-technology is a promising tool for complex procedures and can help to deliver predictable and safe therapy outcomes. Future research should focus on establishing technological standards with high data quality and developing approved applications for dental AR/VR-devices for clinical routine.

Pathological stimuli, such as bacterial activity, dental bleaching, and nonpolymerized resin monomers, can cause death of dental pulp cells (DPCs) through oxidative stress- (OS-) induced mitochondrial dysfunction. However, the crucial molecular mechanisms that mediate such a phenomenon remain largely unknown. OS is characterized by the overproduction of reactive oxygen species (ROS), e.g., H2O2, O2−, and ⋅OH. Mitochondria are a major source of ROS and the principal attack target of ROS. Cyclophilin D (CypD), as the only crucial protein for mitochondrial permeability transition pore (mPTP) induction, facilitates the opening of mPTP and causes mitochondrial dysfunction, leading to cell death. In the present study, we hypothesized that CypD-mediated mitochondrial molecular pathways were closely involved in the process of OS-induced death of human DPCs (HDPCs). We tested the phenotypic and molecular changes of HDPCs in a well-established OS model—H2O2 treatment. We showed that H2O2 dramatically reduced the viability and increased the death of HDPCs in a time- and dose-dependent manner by performing MTT, flow cytometry, and TUNEL assays and quantifying the expression changes of Bax and Bcl-2 proteins. H2O2 also induced mitochondrial dysfunction, as reflected by the increased mitochondrial ROS, reduced ATP production, and activation of mPTP (decreased mitochondrial membrane potential and enhanced intracellular Ca2+ level). An antioxidant (N-acetyl-L-cysteine) effectively preserved mitochondrial function and significantly attenuated H2O2-induced cytotoxicity and death. Moreover, H2O2 treatment markedly upregulated the CypD protein level in HDPCs. Notably, genetic or pharmacological blockade of CypD significantly attenuated H2O2-induced mitochondrial dysfunction and cell death. These findings provided novel insights into the role of a CypD-dependent mitochondrial pathway in the H2O2-induced death in HDPCs, indicating that CypD may be a potential therapeutic target to prevent OS-mediated injury in dental pulp.

To compare the fit and clinical performance of screw-retained monolithic zirconia implant fixed dental prostheses (FDPs) based on either intraoral optical scanning (IOS) or conventional impressions.Patients with two posterior tissue-level implants (Straumann Regular Neck) replacing two or three adjacent teeth were recruited. Impressions were taken with both IOS (True Definition Scanner, 3M ESPE) and a conventional (polyether) pick-up impression. Double-blind randomization was performed after impression-taking, and patients were to receive an FDP based on either the digital or the conventional impression. The fit was evaluated, and the time required for adjustments was recorded. Additionally, survival and technical complication rates with a follow-up of 1 year were documented.A total of 38 patients requiring 45 FDPs were included: 24 FDPs in the test (IOS) and 21 in the control (conventional) group. The average adjustment time was 6.92 minutes (SD: ± 10.84, range: 0 to 49 minutes) for digital vs 12.38 minutes (SD: ± 14.52, range: 0 to 54 minutes) for conventional impressions (P = .090). A proper fit (no adjustments) was achieved in 33.3% of the digital and 28.6% of the conventional group. Forty-two FDPs could be placed within the two planned appointments, and 3 FDPs exhibited an unacceptable fit and required an extra appointment. Eight technical complications occurred during the first year of function. The overall restoration survival rate was 100%.The clinical fit of CAD/CAM FDPs based on digital impressions is comparable to conventional impressions. Screw-retained monolithic zirconia FDPs on Ti-base abutments show low major complication and survival rates in the short term.

Objectives: To investigate whether xenograft EB (EndoBon) is non-inferior to xenograft BO (Bio-Oss) when used in reconstructive surgery of peri-implant osseous defects. Materials and methods: Dental patients with one implant each demonstrating peri-implantitis were randomized to receive surgical debridement and defect fill with either BO or EB. Changes in bone level (BL) and intrabony defect depth (IDD) evaluated radiographically were the primary outcomes. The secondary outcomes included changes in probing pocket depth (PPD), bleeding on probing (BoP), and suppuration on probing (SoP). All outcomes were recorded before treatment and at 6 and 12 months post-treatment. Results: Twenty-four patients (n = 11 BO, n = 13 EB) completed the study. Both groups demonstrated significant within-group improvements in all clinical and radiographic parameters at 6 and 12 months (p ≤.001). At 12 months, both groups presented with IDD reductions of 2.5–3.0 mm on average. The inter-group differences were not statistically significant at all time points and for all the examined parameters (p >.05). While the radiographic defect fill in both groups exceeded > 1 mm and can be considered treatment success, successful treatment outcomes as defined by Consensus Reporting (no further bone loss, PPD ≤ 5 mm, no BOP, and no SoP) were identified in 2/11 (18%) BO and 0/13 (0%) EB individuals (Fisher's exact test, p =.199). Conclusions: Within the limitations of this pilot study, the application of xenograft EB showed to be non-inferior to xenograft BO when used in reconstructive surgery of peri-implant osseous defects.

Objectives: To investigate the osseo-integrative behavior of untreated (UCFP) and sandblasted ceramic filled PEEK (SCFP) implants in comparison with titanium implants through measurement of bone implant contact (BIC) and bone density (BD). Materials and methods: Nine implants from each type were inserted into 9 dogs in which every experimental dog received the three different implants in the lower border of the mandible. The animals were euthanized after 3 months and extracting bone blocks containing implants followed by blocks preparation for histological examinations. Results: BIC and BD were significantly higher in titanium and SCFP compared with UCFP group (p =.007) and (p =.012), respectively. Aluminum blasting increased the bone ingrowth and bone implant contact when compared to machined surfaces of untreated PEEK implants. Conclusion: In conclusion, sandblasting with 110 µm aluminum oxide particles can be proposed as a suitable surface treatment that enhances hydrophilicity of CFP. Further in vivo animal studies are still needed to confirm the findings of this study.

Objective To explore how bruxism is dealt with by accredited oral implantologists within daily clinical practice. Materials and methods Nine semi-structured interviews of oral implantologists practicing in non-academic clinical practices in the Netherlands were performed, and thematic analysis was conducted using a framework-based approach. Results Oral implant treatments in bruxing patients were a generally well-accepted practice. Complications were often expected, with most being of minor impact. Contradictive attitudes emerged on the topic of bruxism being an etiologic factor for peri-implant bone loss and loss of osseointegration. Views on the ideal treatment plan varied, though the importance of the superstructure’s occlusion and articulation features was repeatedly pointed at. Similarly, views on protective splints varied, regarding their necessity and material choice. Bruxism was diagnosed mainly by clinical examination, alongside with patient anamnesis and clinician’s intuition. There was little attention for awake bruxism. Discussion Bruxism was generally not considered a contraindication for implantological treatments by accredited oral implantologists. Views on the interaction between bruxism and bone loss/loss of osseointegration varied, as did views on the ideal treatment plan. Conclusions There is a need for better understanding of the extent to which, and under which circumstances, sleep and/or awake bruxism can be seen as causal factors for the occurrence of oral implant complications.

BACKGROUND: To review the literature on the effect of dental implant surface roughness in patients with a history of periodontal disease. The present review addresses the following focus question: Is there a difference for implant survival, mean marginal bone loss, and the incidence of bleeding on probing in periodontally compromised patients receiving a machined dental implant or rough surface dental implant?METHODS: Electronic and manual literature searches were conducted on PubMed/MEDLINE and the Cochrane Library on studies published until May 2018 to collect information about the effect of machined, moderately rough, and rough dental implant surfaces in patients with a history of periodontal disease. The outcome variables implant survival, mean marginal bone level, and the incidence of peri-implantitis and bleeding on probing were evaluated. Meta-analysis was performed to obtain an accurate estimation of the overall, cumulative results.RESULTS: Out of 2411 articles, six studies were included in this systematic review. The meta-analysis of the implant survival and implant mean marginal bone loss revealed a risk ratio of 2.92 (CI 95% 0.45, 18.86) for implant failure and a total mean difference of - 0.09 (CI 95% - 0.31, 0.14) for implant mean marginal bone loss measured in a total group of 215 implants, both not statistically significant.CONCLUSIONS: Due to lack of long-term data (> 5 years), the heterogeneity and variability in study designs and lack of reporting on confounding factors, definitive conclusions on differences in implant survival, and mean marginal bone loss between machined and moderate rough implants in periodontally compromised patients cannot be drawn. Future well-designed long-term randomized controlled trials are necessary to reveal that machined surfaces are superior to moderately rough and rough surfaces in patients with a history of periodontal disease.

Purpose: The aim of this 1-year randomized trial was to determine the stability and the magnitude of the effect of converting patients' conventional mandibular dentures to implant overdentures (IODs) on their satisfaction and oral health-related quality of life (OHRQoL). The IODs were retained either with two immediately loaded interconnected standard-diameter implants or with four immediately loaded mini dental implants (MDIs). Materials and Methods: Fifty completely edentulous subjects complaining about insufficient retention of their mandibular dentures were randomly assigned to two groups; 25 patients received IODs retained with four MDIs and 25 patients received IODs retained with two standard-sized tissue level (STL) interconnected implants. All IODs were opposed by conventional maxillary dentures. Patients rated their satisfaction on a 100-mm visual analog scale (VAS) and their quality of life on a denture-specific short version of the oral health impact profile (OHIP-20) before assignment, and after 3 and 12 months. A two-way mixed analysis of variance (ANOVA) was conducted to assess the change in time and its interaction with treatment mode on patients' overall satisfaction ratings, the total OHIP-20, and their specific domain scores. Results: Immediate loading was possible for all the patients who received the MDIs. By contrast, the immediate loading protocol could be followed for only 15 of the patients allocated to the STL implant group. For the remaining patients, a delayed loading protocol was applied. There was a significant improvement in patients' general satisfaction between baseline and 3 months and between baseline and 12 months postoperatively (F2,44 = 81.006, P < .001). This increase did not differ between the treatment groups (F4,90 = 1.838, P = .128). The results also showed a decrease in mean overall OHIP score (F2,43 = 46.863, P < .001) between baseline and 3 months and between baseline and 12 months postoperatively, indicating a higher level of OHRQoL. In addition, patients scored lower 3 and 12 months after treatment than at baseline for all seven domains. This decrease did not differ between the treatment groups (F4,88 = 0.608, P = .658). Conclusion: The results suggested that in terms of patient-based outcomes, mandibular overdentures retained by immediately loaded MDIs can offer an improvement of equal magnitude with that achieved by overdentures retained by standard-sized implants.

OBJECTIVES The aim of this systematic review and meta-analysis was to summarize the existing evidence on patient-reported aesthetic outcome measures (PROMs) of implant-supported, relative to tooth-supported fixed dental prostheses. MATERIAL AND METHODS In April 2017, two reviewers independently searched the Medline (PubMed), EMBASE, and Cochrane electronic databases, focusing on studies including patient-reported aesthetic outcomes of implant- and tooth-supported fixed dental prostheses (FDPs). Human studies with a mean follow-up period of at least 1 year, a minimum of ten patients, and English, German, or French publication were included. For the comparison of subgroups, random-effects meta-regression for aggregate-level data was used. RESULTS The systematic search for implant-supported prostheses focusing on patient-reported outcomes identified 2,675 titles, which were screened by two independent authors. Fifty full-text articles were analyzed, and finally, 16 publications (including 19 relevant study cohorts) were included. For tooth-supported prostheses, no studies could be included. A total of 816 implant-supported reconstructions were analyzed by patients. Overall aesthetic evaluation by the patients' visual analogue scale (VAS) rating was high in implant-supported FDPs (median: 90.3; min-max: 80.0-94.0) and the surrounding mucosa (median: 84.7; min-max: 73.0-92.0). Individual restorative materials, implant neck design (i.e., tissue or bone level type implants), and the use of a fixed provisional had no effect on patients' ratings of the definitive implant-supported FDPs. CONCLUSIONS Aesthetics is an important patient-reported measure, which lacks in standardized methods; however, patients' satisfaction was high for implant-supported FDPs and the surrounding mucosa.

In order to improve the performance of business processes often Information Technologies (ITs) are introduced. However, business processes are known to be complex and distributed among multiple business entities. As a result, the impact of new IT on an entire business process is typically hard to assess as quantitative methods for evaluation are missing. Therefore, in this paper, we propose a process-oriented methodology for evaluating the impact of IT on a business process ahead of its implementation. In our method, process mining and discrete event simulation are key ingredients. Based on automatically stored data, process mining allows for obtaining detailed knowledge on a business process, e.g., it can be discovered how a business process is actually executed. Using discrete event simulation, a model can be built which accurately mimicks the discovered process and which can subsequently be used for exploring and evaluating various redesign of the same process. Our method is evaluated by means of a detailed case study. For a complex dental process, it turns out that the introduction of new digital technologies is largely beneficial for patients and dental lab owners, whereas for dentists there is hardly any benefit. Keywords: Business process simulation; Discrete event simulation; Process mining; Digital dentistry

Purpose The purpose of this study was to compare patient-reported outcomes for maxillary implant-supported overdentures with and without palatal coverage. Materials and Methods Twenty-one maxillary edentulous patients (six women, 15 men) were included. In total, 42 implants were inserted in the anterior maxilla. All patients received implant-supported overdentures on two retentive anchors with palatal coverage for 2 months. Thereafter, patient satisfaction was assessed by means of questionnaires capturing the oral health impact profile (OHIP) on functional limitation, physical pain, psychological discomfort, physical, psychological and social disability, and handicap. Additionally, cleaning ability, general satisfaction, speech, comfort, esthetics, stability, and chewing ability were rated. Subsequently, palatal coverage was reduced, and the patients wore the overdentures for another 2 months. Patient satisfaction was obtained in the same way as above, and the evaluated parameters were compared for the two overdenture designs. Results There were no significant differences between implant-supported overdentures with and without palatal coverage for any of the OHIP domains. The evaluation of additional parameters revealed significantly higher patient satisfaction for esthetics (mean difference 8.8 mm ± 24.6) and taste (mean difference 28.4 mm ± 29.9) without palatal coverage, p

ObjectivesGraft resorption remains a major disadvantage of the various employed materials in maxillary sinus augmentation. Our aim was to assess the percentage of graft volume reduction in deproteinized bovine bone (DBB) using cone beam computed tomography (CBCT).Materials and MethodsA retrospective analysis of 29 augmented sinuses in 19 patients was conducted. The graft material was either DBB alone or DBB mixed with autologous bone chips (80% DBB/20% bone chips). CBCT scans of the augmented sinuses were obtained pre- and post-operatively up to 2-year follow-up.ResultsIn total, 55 dental implants were placed in the posterior maxillary region following sinus augmentation. The mean height of the alveolar ridge pre-operative was 2.7 ± 1.2 mm and post-operative was 14.13 ± 4.6 mm. The mean percentages of alveolar ridge height reduction were 18.58% (SD14.23%) and 27.62% (SD12.70%), and the mean percentages of graft volume reduction were 19.30% (SD9.19%) and 19.85% (SD9.61%) for DBB and DBB + bone chips, respectively.ConclusionsThe results indicate that DBB graft volume resorption is approximately (20 ± 10%) following 2-year follow-up. CBCT is a useful radiographic tool to follow-up changes in sinus graft volumes.

Purpose To repair large-size bone defects, most bone-defect-filling materials in clinic need to obtain osteoinductivity either by mixing them with particulate autologous bone or adsorbing bone morphogenetic protein 2 (BMP2). However, both approaches encounter various limitations. In this study, we hypothesized that our novel particles of biomimetic BMP2-coprecipitated calcium phosphate (BMP2-cop.BioCaP) could serve as an independent and biodegradable osteoinducer to induce bone formation efficiently for these bone-defect-filling materials, for example, deproteinized bovine bone (DBB). Materials and Methods We alternately layer-by-layer assembled amorphous and crystalline CaP triply to enable a "bamboo-like" growth of the particles. We functionalized BioCaP by coprecipitating BMP2 into the most outer layer of BioCaP. We monitored the degradation, osteoinductivity, and foreign-body reaction of either BMP2-cop.BioCaP or its combination with DBB in an ectopic site in rats. Results After 5 weeks, the BMP2-cop.BioCaP significantly induced new bone formation not only alone but also when mixed with DBB. Its osteoinductive efficiency was 10-fold higher than the adsorbed BMP2. Furthermore, BMP2-cop.BioCaP also reduced significantly the host foreign-body reaction to DBB in comparison with the adsorbed BMP2. After a 5-week implantation, more than 90% of BMP2-cop.BioCaP degraded. Conclusions These findings indicate a promising clinical potential for BMP2-cop.BioCaP in the repair of large-size bone defects.

This article describes the autotransplantation of third molars to replace heavily damaged premolars and molars. Specifically, this article reports on the use of preoperative cone-beam computed tomographic planning and 3-dimensional (3D) printed replicas of donor teeth to prepare artificial tooth sockets. In the present case, an 18-year-old patient underwent autotransplantation of 3 third molars to replace 1 premolar and 2 molars that were heavily damaged after trauma. Approximately 1 year after the traumatic incident, autotransplantation with the help of 3D planning and rapid prototyping was performed. The right maxillary third molar replaced the right maxillary first premolar. The 2 mandibular wisdom teeth replaced the left mandibular first and second molars. During the surgical procedure, artificial tooth sockets were prepared with the help of 3D printed donor tooth copies to prevent iatrogenic damage to the actual donor teeth. These replicas of the donor teeth were designed based on the preoperative cone-beam computed tomogram and manufactured with the help of 3D printing techniques. The use of a replica of the donor tooth resulted in a predictable and straightforward procedure, with extra-alveolar times shorter than 2 minutes for all transplantations. The transplanted teeth were placed in infraocclusion and fixed with a suture splint. Postoperative follow-up showed physiologic integration of the transplanted teeth and a successful outcome for all transplants. In conclusion, this technique facilitates a straightforward and predictable procedure for autotransplantation of third molars. The use of printed analogues of the donor teeth decreases the risk of iatrogenic damage and the extra-alveolar time of the transplanted tooth is minimized. This facilitates a successful outcome.

Maxillary sinus augmentation is a well-documented procedure with long-term success in implant dentistry. Assessing graft volume changes over time is crucial, since resorption remains a major concern. CBCT is commonly employed to assess the quantity and quality of the available bone at the implant receptor site. However, its applicability in following graft volume changes is yet to be determined. The study aimed to assess CBCT accuracy in following simulated graft resorption ex vivo.4 differently sized autogenous bone blocks harvested from the zygomatic buttress were bilaterally placed in the maxillary sinus of 12 human cadavers. The Accuitomo (J Morita, Kyoto, Japan) CBCT system was employed to scan each one of the 4 grafts in each of the 12 cadavers using identical settings. Gold standard graft measurements were obtained using micro-CT. One independent observer assessed the volume of each graft on CBCT images twice. Intraobserver reliability was assessed using Cohen's kappa and one-sample t-test was used to compare CBCT with micro-CT volumetric measurements.The mean micro-CT graft volumes were 97.12 ± 1.4, 197.32 ± 3.4, 361.41 ± 4.2 and 1040.11 ± 3.2 mmIn every case, CBCT overestimated the maxillary graft volume in comparison with micro-CT. However, the measurement differences were limited and might not influence clinical performance.

Objectives: The aim of this study was to introduce a new concept for computer-assisted template-guided placement of a custom 3D-designed/3D-printed implant with congruent custom 3D-designed/3D-printed surgical tooling and to test the feasibility and accuracy of this method in-vitro.Materials and methods: One partially edentulous human mandibular cadaver was scanned with a cone-beam computed tomography (CBCT) system and intra-oral scan system. The 3D data of this cadaver were imported in specialized software and used to analyse the region of a missing tooth. Based on the functional and anatomical parameters, an individual implant with congruent surgical tooling and surgical guided template was designed and 3D-printed. The guided osteotomy was performed, and the custom implant inserted. To evaluate the planned implant position in comparison with the placed implant position, the mandible with implant was scanned again with the CBCT system and software matching was applied to measure the accuracy of the procedure.Results: The angular deflection with the planned implant position was 0.40°. When comparing the 3D positions of the shoulder, there is a deviation of 0.72 mm resulting in an apical deviation of 0.72 mm.Conclusion: With the use of currently available technology, it is very well feasible to create in a virtual simulation a custom implant with congruent custom surgical tooling and to transfer this to a clinical setting. However, further research on multiple levels is needed to explore this novel approach.

Background and Objective: The aim of the study was to compare the detection of Porphyromonas gingivalis using a fluorescence resonance energy transfer (FRET) technology with commonly used diagnostic methods in salivary and subgingival plaque samples from subjects with dental implants. P. gingivalis was considered as a marker for a pathogenic microbiota. Material and Methods: Ninety-seven adult subjects were recruited, including periodontally healthy controls with no dental implants, implant controls with no peri-implant disease and patients with peri-implant disease. Saliva and subgingival/submucosal plaque samples were collected from all subjects and were analyzed using culture, real-time PCR and FRET technology employing P. gingivalis-specific substrates. Results: It was found that the P. gingivalis-specific substrates were highly suitable for detecting the presence of P. gingivalis in saliva and in subgingival plaque samples, showing comparable specificity to culture and real-time PCR. Conclusion: We applied the FRET technology to detect P. gingivalis in implant patients with or without an implant condition and in controls without implants. The technique seems suitable for detection of P. gingivalis in both plaque and saliva samples. However, with all three techniques, P. gingivalis was not very specific for peri-implantitis cases. Future work includes fine-tuning the FRET technology and also includes the development of a chair-side application.

Purpose: The aim of the study was to compare the differences in the long-term clinical and radiologic effects for three different treatment strategies with implant-supported overdentures in the edentulous mandible, with a special emphasis on smoking. Materials and methods: In a randomized- controlled clinical trial, 110 edentulous patients participated. Thirty-six patients were treated with an overdenture supported by two implants with ball attachments (2IBA), 37 patients with an overdenture supported by two implants with a bar (2ISB) and 37 patients with an overdenture supported by four implants with a triple bar (4ITB). After a mean evaluation period of 8.3 years, the clinical and radiographic parameters were evaluated. Results: Ninety-four out of the original 110 patients (=85%) were evaluated. In the 2IBA group, the plaque index was significantly lower (vs. 2ISB, P=0.013; vs. 4ITB, P=0.001) than in the other groups, but there was no correlation with the other peri-implant parameters. In the 4ITB group, the marginal bone loss was significantly higher than that in the two implant groups. The maximal probing depth was correlated with peri-implant bone loss (P=0.011). Smoking almost doubled marginal bone loss irrespective of the treatment strategy chosen. Conclusions: Patients with two implants show less marginal bone loss than those with four implants. Smoking is a risk factor for the survival of dental implants in the long run.

Objectives: To test an extended subtraction method for measuring changes in bone along dental implants depicted on non-standardized panoramic radiographs. Material and methods: The measuring method consisted of a subtraction module extended with modules correcting gray values, correcting geometry and defining the region of interest mesial and distal of dental implants. It was applied to an archive of panoramic radiographs of implant patients who had been monitored up to 16 years. Results: Significant loss of gray value was demonstrated at a constant rate of 0.6 units per month throughout the study. This indicates gradual bone loss on the mesial and/or distal sides of the implants. Females were found to lose bone at a higher rate than males. Smokers and non-smokers, and various implant strategies yielded the same rate of bone loss. Conclusions: The measuring method is a helpful tool to monitor changes around implants even when non-standardized radiographs are being used. Whereas changes of marginal bone level are increased five to eight times during the first year after surgery, the present method shows gradual loss of bone during 15 years after surgery.

The purpose of this multicentre observational study was to determine patient satisfaction with either conventional dentures or mandibular 2-implant overdentures in a 'real world' setting. Two hundred and three edentulous patients (mean age 68·8 ± 10·4 years) were recruited at eight centres located in North America, South America and Europe. The patients were provided with new mandibular conventional dentures or implant overdentures supported by two implants and ball attachments. At baseline and at 6 months post-treatment, they rated their satisfaction with their mandibular prostheses on 100-mm visual analogue scale questionnaires. One hundred and two (50·2%) participants had valid baseline and 6-month satisfaction data. Although both groups reported improvements, the implant overdenture group reported significantly higher ratings of overall satisfaction, comfort, stability, ability to speak and ability to chew. These results suggest that edentulous patients who choose mandibular implant overdentures have significantly greater improvements in satisfaction, despite their relatively higher cost, than those who choose new conventional dentures.

PURPOSE: The aim of this study was to present the clinical outcomes of the immediate loading of two bar-splinted implants retaining a mandibular overdenture. MATERIALS AND METHODS: In a clinical trial, 124 edentulous patients were treated according to a new treatment concept, which involves the immediate loading of two bar-splinted SLActive implants with an implant-retained mandibular overdenture. The new conventional mandibular denture is used as a template for implant positioning and as an impression tray, and for mounting the retention clip by the dental laboratory. At the same day the implants are placed, the conventional denture is converted into an implant-retained overdenture. During the healing and evaluation period, resonance frequency analysis (RFA) was undertaken to assess the effect of loading on implant stability and survival. RESULTS: The survival rate of the implants was 98.8% during the evaluation period (12-40 months). Only 3 of the 248 implants were lost. During the healing (osseointegration) phase, the implant-stability quotient increased significantly (p = .0001). During the evaluation period, four patients (3%) needed a relining of their mandibular overdenture, whereas 13 patients (11%) needed relining of the maxillary denture. CONCLUSIONS: Two interconnected implants can be successfully loaded by a mandibular overdenture at the same day of implant placement with a high survival rate of the implants. Only a few patients needed additional relining of the overdenture. Repeated RFA measurements can be useful in gauging implant stability and survival.

The aim of this study was to determine the intra- and interobserver reliability and validity of the instrumental assessment of primary dental implant stability, using resonance frequency analysis (RFA). Sixteen tapered implants and 16 cylindrical implants were installed in eight unfixed dry human mandibles (Cawood classification IV/V). Implant stability quotients (ISQ; the outcome variable of RFA) and peak removal torque were determined. Both the intra-observer reliability and the interobserver reliability of the RFA measurements were fair-to-good, while no significant correlations between the ISQ values and removal torque were found. The removal torque of the cylindrical implants was higher than that of the tapered implants. The smallest detectable difference was almost nine ISQ units. Within the limitations of the present dry cadaver study, it was concluded that (i) primary dental implant stability can be assessed reliably with RFA measurements, (ii) the concurrent validity between RFA measurements and removal torque is poor, (iii) cylindrical implants may be more stable than tapered ones and (iv) two subsequent readings of RFA measurements need to differ at least nine ISQ units before the difference between the two measurements can be considered statistically significant. More research is needed to see whether these conclusions can be extrapolated to the clinical situation, including the assessment of implants during function (secondary stability).

Objective Crestal bone loss around dental implants is a criterion for success as this could prevent loss of implant and superstructure. The macrogeometry of the implant could influence bone remodelling when the implant–abutment connection is placed at crestal bone level or above. The aim of this study was to evaluate crestal bone remodelling in a randomized clinical prospective trial in macrogeometrically similar implants with the prosthetic connection at the crestal bone level and 2.5 mm above. The null hypothesis was that there was no difference in crestal bone loss after 1 year of early loading. Material and methods Patients were referred to Academic Centre of Dentistry Amsterdam for implant placement. Patients were subjected to inclusion and exclusion criteria and received a minimum of two implants: an implant with the prosthetic abutment connection at the crestal bone level (minimized collar [MC], bone level) and one with the prosthetic abutment connection 2.5 mm supracrestal (long collar [LC], tissue level). The mesial or distal location of each implant type was blinded for the patient and randomized. The implants were loaded splinted after 3 weeks of healing. The primary outcome was bone-level change assessed after 1 year of loading. Results Thirty-three patients fulfilled the inclusion criteria. Thirty-nine Thommen SPI ELEMENT LC implants and 39 MC were placed, and each fixed dental prosthesis was supported by one LC and one MC implant. The intraclass correlation of measures performed by the first and second X-ray examiner was as follows: on the mesial side of the MC implant 0.990 (0.980–0.995; 95% confidence interval [CI]), 0.980 (0.962–0.990; 95% CI) on the distal side of the MC implant, 0.979 (0.959–0.989; 95% CI) and 0.988 (0.978–0.994; 95% CI) on the mesial and distal side of the LC implant, respectively. The mean bone loss of the MC implant was 0.4 ± 0.4 mm. The mean bone loss of the LC implant was 0.2 ± 0.5 mm. The paired samples t-test showed a statistically significant difference (P

Purpose To integrate extra-oral facial scanning information with CAD/CAM complete dentures to immediately rehabilitate terminal dentition. Materials and methods Ten patients with terminal dentition scheduled for total extraction and immediate denture placement were recruited for this study. The patients were submitted to a facial scanning procedure using the in-office PritiMirror scanner with bite registration records in-situ. Definitive stone cast models and bite records were subsequently submitted to a lab scanning procedure using the lab scanner (iSeries DWOS; Dental Wings). The scanned models were used to create a virtual teeth setup of a complete denture. Using the intra-oral bite records as a reference, the virtual setup was incorporated in the facial scan thereby facilitating a virtual clinical evaluation (teeth try-in) phase. After applying necessary adjustments, the virtual setup was submitted to a CAM procedure where a 5-axis industrial milling machine (M7 CNC; Darton AG General) was used to fabricate a full-milled PMMA immediate provisional prosthesis. Results Total extractions were performed, the dentures were immediately inserted, and subjective clinical fit was evaluated. The immediate provisional prostheses were inserted and clinical fit, occlusion/articulation, and esthetics were subjectively assessed; the results were deemed satisfactory. All provisional prostheses remained three months in function with no notable technical complications. Conclusion Ten patients with terminal dentition were treated using a complete digital approach to fabricate complete dentures using CAD/CAM technology. The proposed technique has the potential to accelerate the rehabilitation procedure starting from immediate denture to final implant-supported prosthesis leading to more predictable functional and aesthetics outcomes.

ObjectivesIn this study, a novel biomimetic calcium phosphate bone substitute (BioCaP) is introduced as a dual-drug release system with two drug/protein delivery modes: protein is incorporated into (i) the interior of BioCaP (an internal depot); and (ii) a superficial calcium phosphate coating on BioCaP (a surface-coated depot). Our aim is to investigate each of the two delivery modes of BioCaP. Our hypotheses are that (i) both of the drug delivery modes, in in vitro as well as in vivo environment, can achieve a sustained cell-mediated protein release; and (ii) BioCaP with these two delivery modes with incorporated bone morphogenetic protein-2 (BMP-2) promotes bone formation.Materials and MethodsTablets of BioCaP were prepared with different carrying modes using bovine serum albumin (BSA) as model protein. The release of this protein was analysed (n = 6 per group). Granules of BioCaP with different carrying modes of BMP-2 were implanted subcutaneously in rats (n = 6 animals per group). Samples were collected after 5 weeks for histomorphometric analysis.ResultsIn vitro data showed that the internal and surface-coated depots of BSA resulted in a sustained osteoclast-mediated release, while the adsorbed BSA was rapidly released, and this release was not affected by osteoclasts. In vivo data showed that the volume densities of bone, bone marrow, and blood vessels were significantly higher in samples where BMP-2 was incorporated internally or in the coating compared with granules with adsorbed growth factor. Osteoclast-like cells were associated with the granules, and resorption lacunae were frequently observed.ConclusionIt is shown that different modes of incorporation of BMP-2 on and in BioCaP granules have a beneficial effect on the formation of ectopic bone. This dual-drug release system makes BioCaP granule a promising tool for delivering multiple therapeutic agents for different clinical applications.

In a randomized controlled clinical trial carried out at the Ignatius teaching hospital in Breda, The Netherlands, 110 edentulous patients with severe mandibular bone loss were treated with implants of the ITI Dental Implant System using 3 different treatment strategies: a mandibular overdenture supported by either 2 implants with ball attachments, 2 implants with an interconnecting bar, or by 4 interconnected implants. In this study, results of clinical and radiographic parameters were evaluated and compared over a period of 19 months after implant placement. A total of 283 ITI Dental Implants were placed. Six implants (2%) were lost during the osseointegration period. No further implant losses occurred after that. At the 19 month evaluation mean values and standard deviations for bleeding index were 0.51 +/- 0.5 (bleeding incidence = 70%) and for plaque index they were 0.46 +/- 0.5 (plaque incidence = 45%). The mean values and standard deviations for probing depth and loss of attachment were 2.7 +/- 1.1 mm and 0.26 +/- 0.6 mm respectively. The radiographic evaluation showed a mean bone loss of 1.5 mm +/- 0.26 after 19 months for all the implants. In cases with 4 interconnected implants there was significantly more bone loss around the central 2 implants (2.1 +/- 0.31 mm) in comparison with the lateral 2 (1.4 +/- 0.25 mm). No significant correlations were found between plaque and bleeding indices and bone loss.

The objective of this study was to investigate the effect of different cone beam CT scan parameters on trabecular bone microstructure measurements. A human mandibular cadaver was scanned using a cone beam CT (3D Accuitomo 170; J.Morita, Kyota, Japan). 20 cone beam CT images were obtained using 5 different fields of view (4X4 cm, 6x6 cm, 8X8 cm, 10x10 cm and 10X5 cm), 2 types of rotation steps (180 degrees and 360 degrees) and 2 scanning resolutions (standard and high). Image analysis software was used to assess the trabecular bone microstructural parameters (number, thickness and spacing). All parameters were measured twice by one trained observer. Intraclass correlation coefficients showed high intraobserver repeatability (intraclass correlation coefficient, 0.95-0.97) in all parameters across all tested scan parameters. Trabecular bone microstructural measurements varied significantly, especially in smaller fields of view (p = 0.001). There was no significant difference in the trabecular parameters when using different resolutions (number, p = 0.988; thickness, p = 0.960; spacing, p = 0.831) and rotation steps (number, p = 1.000; thickness, p = 0.954; spacing, p = 0.759). The scan field of view significantly influences the trabecular bone microstructure measurements. Rotation steps (180 degrees or 360 degrees) and resolution (standard or high) selections are not relevant.

The purpose of this study was to compare patient-reported outcomes for maxillary implant-supported overdentures with and without palatal coverage.Twenty-one maxillary edentulous patients (six women, 15 men) were included. In total, 42 implants were inserted in the anterior maxilla. All patients received implant-supported overdentures on two retentive anchors with palatal coverage for 2 months. Thereafter, patient satisfaction was assessed by means of questionnaires capturing the oral health impact profile (OHIP) on functional limitation, physical pain, psychological discomfort, physical, psychological and social disability, and handicap. Additionally, cleaning ability, general satisfaction, speech, comfort, esthetics, stability, and chewing ability were rated. Subsequently, palatal coverage was reduced, and the patients wore the overdentures for another 2 months. Patient satisfaction was obtained in the same way as above, and the evaluated parameters were compared for the two overdenture designs.There were no significant differences between implant-supported overdentures with and without palatal coverage for any of the OHIP domains. The evaluation of additional parameters revealed significantly higher patient satisfaction for esthetics (mean difference 8.8 mm ± 24.6) and taste (mean difference 28.4 mm ± 29.9) without palatal coverage, p .01.Within the limits of this study, maxillary overdentures supported by two implants were equally satisfactory with and without palatal coverage.

To repair large-size bone defects, most bone-defect-filling materials in clinic need to obtain osteoinductivity either by mixing them with particulate autologous bone or adsorbing bone morphogenetic protein 2 (BMP2). However, both approaches encounter various limitations. In this study, we hypothesized that our novel particles of biomimetic BMP2-coprecipitated calcium phosphate (BMP2-cop.BioCaP) could serve as an independent and biodegradable osteoinducer to induce bone formation efficiently for these bone-defect-filling materials, for example, deproteinized bovine bone (DBB).We alternately layer-by-layer assembled amorphous and crystalline CaP triply to enable a "bamboo-like" growth of the particles. We functionalized BioCaP by coprecipitating BMP2 into the most outer layer of BioCaP. We monitored the degradation, osteoinductivity, and foreign-body reaction of either BMP2-cop.BioCaP or its combination with DBB in an ectopic site in rats.After 5 weeks, the BMP2-cop.BioCaP significantly induced new bone formation not only alone but also when mixed with DBB. Its osteoinductive efficiency was 10-fold higher than the adsorbed BMP2. Furthermore, BMP2-cop.BioCaP also reduced significantly the host foreign-body reaction to DBB in comparison with the adsorbed BMP2. After a 5-week implantation, more than 90% of BMP2-cop.BioCaP degraded.These findings indicate a promising clinical potential for BMP2-cop.BioCaP in the repair of large-size bone defects.

ObjectiveThe aim of the present prospective clinical study was to compare patient-reported outcomes for maxillary conventional dentures and maxillary implant-supported dentures.Material and methodsTwenty-one patients (6 women and 15 men) being edentulous in the maxilla and encountering problems with their existing dentures were included. Twelve patients (4 women and 8 men) received a new set of conventional dentures, due to insufficient dentures. In nine patients (2 women and 7 men), the existing dentures were adjusted by means of relining or rebasing. All patients received implant-supported dentures on two retentive anchors. In total, 42 implants were inserted in the anterior maxilla. The participants rated their satisfaction on their existing conventional dentures, 2 months after insertion of new conventional dentures and 2 months after insertion of implant-supported dentures. Thereby, patients responded to questionnaires capturing the oral health impact profile (OHIP) using visual analog scales. Seven domains (functional limitation, physical pain, psychological discomfort, physical, psychological and social disability and handicap) were assessed. Higher scores implied poorer patient satisfaction. In addition, the questionnaire involved the evaluation of cleaning ability, general satisfaction, speech, comfort, esthetics, stability, and chewing ability. Higher scores implied higher patient satisfaction.ResultsPatient satisfaction significantly increased for implant-supported dentures compared with old dentures in all seven OHIP subgroups, as well as for cleaning ability, general satisfaction, ability to speak, comfort, esthetics, and stability (P < 0.05). The comparison of new conventional dentures and implant-supported dentures revealed a statistically significantly increased satisfaction for functional limitation (difference of 33.2 mm), psychological discomfort (difference of 36.7 mm), physical disability (difference of 36.3 mm), and social disability (difference of 23.5 mm), (P < 0.05). Additionally, general satisfaction, chewing ability, speech, and stability significantly improved in implant-supported dentures (P < 0.05).ConclusionsWithin the limits of this study, maxillary dentures retained by two implants provided some significant short-term improvements over conventional dentures in oral- and health-related quality of life.

Traditional Chinese medicines have been recommended for bone regeneration and repair for thousands of years. Currently, the Herba Epimedii and its multi-component formulation are the attractive native herbs for the treatment of osteoporosis. Icariin, a typical flavonol glycoside, is considered to be the main active ingredient of the Herba Epimedii from which icariin has been successfully extracted. Most interestingly, it has been reported that icariin can be delivered locally by biomaterials and that it has an osteoinductive potential for bone tissue engineering. This review focuses on the performance of icariin in bone tissue engineering and on blending the information from icariin with the current knowledge relevant to molecular mechanisms and signal pathways. The osteoinductive potential of icariin could be attributed to its multiple functions in the musculoskeletal system which is involved in the regulation of multiple signaling pathways in anti-osteoporosis, osteogenesis, anti-osteoclastogenesis, chondrogenesis, angiogenesis, and anti-inflammation. The osteoinductive potential and the low price of icariin make it a very attractive candidate as a substitute of osteoinductive protein-bone morphogenetic proteins (BMPs), or as a promoter for enhancing the therapeutic effects of BMPs. However, the effectiveness of the local delivery of icariin needs to be investigated further.

To evaluate the air powder abrasive treatment as an implant surface cleaning method for peri-implantitis based on the existing literature.A PubMed search was conducted to find articles that reported on air powder abrasive treatment as an implant surface cleaning method for peri-implantitis. The studies evaluated cleaning efficiency and surface change as a result of the method. Furthermore, cell response toward the air powder abrasive-treated discs, reosseointegration, and clinical outcome after treatment is also reported.The PubMed search resulted in 27 articles meeting the inclusion criteria. In vitro cleaning efficiency of the method is reported to be high. The method resulted in minor surface changes on titanium specimens. Although the air powder abrasive-treated specimens showed sufficient levels of cell attachment and cell viability, the cell response decreased compared with sterile discs. Considerable reosseointegration between 39% and 46% and improved clinical parameters were reported after treatment when applied in combination with surgical treatment. The results of the treatment are influenced by the powder type used, the application time, and whether powder was applied surgically or nonsurgically.The in vivo data on air powder abrasive treatment as an implant surface cleaning method is not sufficient to draw definitive conclusions. However, in vitro results allow the clinician to consider the method as a promising option for implant surface cleaning in peri-implantitis treatment.

To assess the reliability of cone beam computed tomography (CBCT) voxel gray value measurements using Hounsfield units (HU) derived from multislice computed tomography (MSCT) as a clinical reference (gold standard).Ten partially edentulous human mandibular cadavers were scanned by two types of computed tomography (CT) modalities: multislice CT and cone beam CT. On MSCT scans, eight regions of interest (ROI) designating the site for preoperative implant placement were selected in each mandible. The datasets from both CT systems were matched using a three-dimensional (3D) registration algorithm. The mean voxel gray values of the region around the implant sites were compared between MSCT and CBCT.Significant differences between the mean gray values obtained by CBCT and HU by MSCT were found. In all the selected ROIs, CBCT showed higher mean values than MSCT. A strong correlation (R=0.968) between mean voxel gray values of CBCT and mean HU of MSCT was determined.Voxel gray values from CBCT deviate from actual HU units. However, a strong linear correlation exists, which may permit deriving actual HU units from CBCT using linear regression models.

To review the literature on decontamination of titanium implant surfaces following peri-implantitis and the effect of various cleaning methods on re-osseointegration.An electronic search of the literature at PubMed was conducted on the studies published between 1966 and October 2010. In vitro, animal, and clinical studies were included.Of 597 studies retrieved, 74 manuscripts were selected for the review. Various implant surface decontamination methods using various chemical and mechanical agents have been suggested for treatment and re-osseointegration following periimplantitis. It has been shown that re-osseointegration of contaminated implant surfaces is possible; this largely depends upon the surface of the implant and the types of decontamination techniques and bone regenerative materials used. Complete re-osseointegration cannot be achieved by surface decontamination alone. Titanium implants with titanium plasma-sprayed or sandblasted and acid-etched surfaces may be effectively decontaminated by applying chlorhexidine and saline-soaked gauze or by repeated rinsing with these solutions.Both mechanical and chemical decontamination techniques should be applied alongside regenerative surgical procedures to obtain optimum re-osseointegration and successfully treat peri-implantitis. In recent years, lasers and photodynamic therapy have shown minor beneficial results, which need to be confirmed by long-term clinical studies with comparable groups.

To evaluate the performance of a computer-aided three-dimensional planning protocol in combination with previously inserted reference mini-implants and CAD/CAM technology to restore completely edentulous patients. The study evaluated implant and superstructure survival in a prospective clinical trial.The plan protocol called for treatment of 35 patients who were edentulous in either arch. Mini implants were used to establish a platform for computed tomography and fixation of the surgical template. The planning software based on three-dimensional simulation was used to plan ideal implant placement, digitally integrating the future prosthetic and anatomical situations to design the definitive superstructure.A total of 35 patients, 20 with edentulous maxillae, 10 with edentulous mandibles, and 5 patients with edentulism in both arches were treated. All patients received definitive prostheses on the day of surgery. The majority of patients treated in maxilla underwent a sinus graft procedure to achieve sufficient bone to place implants. A total of 40 superstructures were inserted and immediately loaded. Of the 240 inserted implants, 229 (95.4%) survived, with 146 (93.6%) and 83 (98.8%) implants in the maxillary and mandibular arches, respectively. Of the 10 implants that failed in the maxilla, 9 occurred in patients with an augmented sinus. All definitive restorations demonstrated clinically acceptable fit.When evaluating implant and superstructure survival, reference-based guided surgery seems to be a reliable treatment option for edentulous patients. The CAD/CAM superstructure, inserted and loaded immediately after guided implant insertion, demonstrated acceptable fit to the underlying implants.

ObjectiveThe aim of this study was to evaluate the cleaning efficiency on intraorally contaminated titanium discs by using calcium phosphate and air powder abrasive (APA) treatment. The modification of titanium surface (SLA) was evaluated and compared with the conventional air powder abrasive methods and phosphoric acid. This treatment modality might give new perspectives for peri-implant surface treatment.Materials and MethodsA total of 36 SLA surface titanium discs were kept in the human mouth for 48 h by 14 volunteers. The intraorally contaminated discs were stained with erythrosine dye to make the biofilm visible. Discs were randomly assigned to one of the six groups: APA without powder-only water and air (Control).APA with Hydroxylapatite (HA).APA with Hydroxylapatite and Calcium Phosphate (HA + TCP).APA with Titanium Dioxide (TiO2).APA with EMS Soft Subgingival powder (EMS).Phosphoric Acid.Light microscope photos were taken during the treatment. Following the cleaning, the residual biofilm, surface changes, and surface chemical content were evaluated using Scanning Electron Microscopy (SEM) and Energy Dispersive X-Ray Spectroscopy (EDS). A systematic random sampling protocol and a point counting method were applied for the quantitative evaluation of the remaining biofilm.Multiple comparisons within and between groups are performed by Kruskall Wallis test and if significant Mann-Whitney U-test as post hoc testing is applied. The significance level was P < 0.05.ResultsAll methods with the exception of phosphoric acid could decrease the initial amount of biofilm significantly. Among all air powder abrasive treatments, the HA + TCP group showed the best results with 99% biofilm removal, followed by HA and EMS powders. The cleaning method caused minimal changes to the surface structure. With the exception of the control group, all air powder applications caused sharp edges around the grooves in the implant surface to be rounded. TiO2 powder caused less change than HA and HA + TCP. Phosphoric acid did not cause a visible surface change on the SEM photos. Powder particles remnants were observed on and impacted in the titanium surface. In the HA and HA + TCP group, a Ca content was observed varying between 2% and 5%. In the control group, saliva and biofilm-related elements were observed.ConclusionsUsing the air powder abrasive method with calcium phosphate powders on contaminated titanium discs, an efficient implant cleaning and surface modification can be achieved. This method should be further improved as it has possible potential to be used as an implant surface treatment method for implants involved with peri-implantitis.