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During the last few years, the interest in fabrication of computer-engineered removable complete dentures has grown intensively. Innovative clinical and technological advances are driving forces. They allow (i) the creation of new and more efficient workflows, (ii) an emergence of modified and easier procedures, and (iii) the use of alternative biomaterials with improved properties. The results are a better fit and retention of the digital complete dentures, as well as a generally high satisfaction of patient and clinician, while reducing the number of appointments and the technical input. The purpose of this narrative review is to present the historical, clinical, and technological developments in the field of digital removable complete dentures and to evaluate the future potential of this technology. The fabrication of a digital complete denture either by milling separately the base and the denture teeth set-up or by milling a monolithic denture is well investigated. Concurrently the trend for fabricating complete denture bases by using the 3D print technology is growing. There is plenty of research showing that milling dentures from standardized pre-polymerized polymethyl methacrylate pucks guarantee the fabrication of homogenous objects with excellent biomaterial properties. The results indicate a better base adaptation, a higher flexural strength, an improved resistance to denture staining, and no polymerization distortion while milling. Furthermore, a sophisticated milling strategy allows to obtain a detailed and accurate intaglio and cameo surface, which is even exceeded when 3D printing. The clinical and technological freedom, to either combine selectively analog and digital steps or to take a totally digital workflow ending with milling or 3D printing, opens countless opportunities in the field of removable complete dentures. Whatever steps are taken, whatever sophisticated technology is chosen, still only the professional and individual know-how of the dentist in combination with the manual skills and the experience of the dental technologist—including especially the finish of the final product—will lead to a superior teamwork result. Limitations inherent to the milling process are the waste of raw material, the wear of milling tools, and the challenge to access undercut areas; the reasons are the milling bur size, the number of milling axes, and the limited movements of the machining axes. The advantages of additive manufacturing lay in a high resolution of complex geometries and a reduced waste of the biomaterial. As a limitation, the accuracy of the object, i.e. deformation, may be affected by several fabrication parameters, such as the polymerization light intensity, the build direction and angle, the layer thickness and numbers, the amount of supporting structures, and the post-processing procedures. However, with improved materials and techniques, printing may also become a primary method for fabricating digital complete dentures. The available clinical and technical information and multiple research demonstrate that the integration of digital steps into the workflow for fabricating removable complete dentures opens countless options, leading to the achievement of an esthetically, functionally, biologically, and technically high-quality end product. However, a longer learning curve must be considered. To simplify the fabrication methods of complete dentures in specific clinical situations, with the aim to increase efficiency and to save resources, is indicated. However, the use of conventional step-by-step approaches may still be valid for complex clinical situations. It is foreseeable that for treating edentulous patients, the evolution of new biomaterials, the introduction of sophisticated digital methods, and the development of improved software will follow attractive workflows with more standardized, easier, achievable, and predictable results. It challenges the clinician to have a more direct impact on denture construction and to provide the patient with the opportunity to participate in the esthetic designing. A generally higher efficiency and satisfaction for all partners involved in the fabrication process of removable complete dentures—patient, dental technologist, and dentist/prosthodontist—is the result. For a dental technologist, it is a great challenge to set up esthetic and functional denture teeth in an edentulous 3D space defined by the maxilla, the mandible, and the oral soft tissues. It is a question of time and partly already existing that machine learning—a branch of artificial intelligence—has the capacity to recognize specific intramaxillary and intermaxillary situations and to deliver an acceptable functional and esthetic denture teeth set-up, at least as a working base. Furthermore, with the introduction of a face scanner, the patient becomes virtually present anytime. Transferring the virtual situation in a physical articulator makes judgments and changes possible in both worlds simultaneously. Innovations such as robot technology still are in their infancy; however, there are aspirations to automatically place denture teeth into a dental arch. There is a great responsibility for a dentist and a dental technologist for fabricating high-quality removable complete dentures. Factors, such as a meticulous diagnosis and treatment planning, a personal communication between the involved persons, and a profound knowledge of the clinical and technical possibilities, should lead to an easy, simple, cost-effective, and highly satisfying denture fabrication workflow. The digitalization in this field already has and will even more activate research and clinical opportunities in the near future. The globally existing many edentulous patients will highly appreciate the excellent results.

Microglia are known to shape brain sex differences critical for social and reproductive behaviors. Chemical exposures can disrupt brain sexual differentiation but there is limited data regarding how they may impact microglia distribution and function. We focused on the prevalent flame retardant mixture Firemaster 550 (FM 550) which is used in foam-based furniture and infant products including strollers and nursing pillows because it disrupts sexually dimorphic behaviors. We hypothesized early life FM 550 exposure would disrupt microglial distribution and reactivity in brain regions known to be highly sexually dimorphic or associated with social disorders in humans. We used prairie voles (Microtus ochrogaster) because they display spontaneous prosocial behaviors not seen in rats or mice and are thus a powerful model for studying chemical exposure-related impacts on social behaviors and their underlying neural systems. We have previously demonstrated that perinatal FM 550 exposure sex-specifically impacts socioemotional behaviors in prairie voles. We first established that, unlike in rats, the postnatal colonization of the prairie vole brain is not sexually dimorphic. Vole dams were then exposed to FM 550 (0, 500, 1000, 2000 µg/day) via subcutaneous injections through gestation, and pups were directly exposed beginning the day after birth until weaning. Adult offspring's brains were assessed for number and type (ramified, intermediate, ameboid) of microglia in the medial prefrontal cortex (mPFC), cerebellum (lobules VI-VII) and amygdala. Effects were sex- and dose-specific in the regions of interests. Overall, FM 550 exposure resulted in reduced numbers of microglia in most regions examined, with the 1000 µg FM 550 exposed males particularly affected. To further quantify differences in microglia morphology in the 1000 µg FM 550 group, Sholl and skeleton analysis were carried out on individual microglia. Microglia from control females had a more ramified phenotype compared to control males while 1000 µg FM 550-exposed males had decreased branching and ramification compared to same-sex controls. Future studies will examine the impact on the exposure to FM 550 on microglia during development given the critical role of these cells in shaping neural circuits.

We previously reported that maternal PFBS, an emerging pollutant, exposure is positively associated with preeclampsia which can results from aberrant trophoblasts invasion and subsequent placental ischemia. In this study, we investigated the effects of PFBS on trophoblasts proliferation/invasion and signaling pathways. We exposed a human trophoblast line, HTR8/SVneo, to PFBS. Cell viability, proliferation, and cell cycle were evaluated by the MTS assay, Ki-67 staining, and flow cytometry, respectively. We assessed cell migration and invasion with live cell imaging-based migration assay and matrigel invasion assay, respectively. Signaling pathways were examined by Western blot, RNA-seq, and qPCR. PFBS exposure interrupted cell proliferation and invasion in a dose-dependent manner. PFBS(100 μM) did not cause cell death but instead significant cell proliferation without cell cycle disruption. PFBS(10 and 100 μM) decreased cell migration and invasion, while PFBS (0.1 μM) significantly increased cell invasion but not migration. Further, RNA-seq analysis identified dysregulated HIF-1α target genes which are relevant to cell proliferation/invasion and preeclampsia, while Western Blot data showed the activation of HIF-1α, but not Notch, ERK1/2, (PI3K)AKT, and P38 pathways. In conclusions, PBFS exposure altered trophoblast cell proliferation/invasion which might be mediated by preeclampsia-related genes, suggesting a possible association between prenatal PFBS exposure and adverse placentation.

Pregnancy is a critical time of vulnerability for the development of the fetal brain. Exposure to environmental pollutants at any point in pregnancy can negatively impact many aspects of fetal development, especially the organization and differentiation of the brain. The placenta performs a variety of functions that can help protect the fetus and sustain brain development. However, disruption of any of these functions can have negative impacts on both the pregnancy outcome and fetal neurodevelopment. This review presents current understanding of how environmental exposures, specifically to endocrine disrupting chemicals (EDCs), interfere with placental function and, in turn, neurodevelopment. Some of the key differences in placental development between animal models are presented, as well as how placental functions such as serving as a xenobiotic barrier and exchange organ, immune interface, regulator of growth and fetal oxygenation, and a neuroendocrine organ, could be vulnerable to environmental exposure. This review illustrates the importance of the placenta as a modulator of fetal brain development and suggests critical unexplored areas and possible vulnerabilities to environmental exposure.

Prevalence of neurodevelopmental disorders (NDDs) with social deficits is conspicuously rising, particularly in boys. Flame retardants (FRs) have long been associated with increased risk, and prior work by us and others in multiple species has shown that developmental exposure to the common FR mixture Firemaster 550 (FM 550) sex-specifically alters socioemotional behaviors including anxiety and pair bond formation. In rats, FRs have also been shown to impair aspects of osmoregulation. Because vasopressin (AVP) plays a role in both socioemotional behavior and osmotic balance we hypothesized that AVP and its related nonapeptide oxytocin (OT) would be vulnerable to developmental FM 550 exposure. We used the prairie vole (Microtus ochrogaste) to test this because it is spontaneously prosocial. Using siblings of prairie voles used in a prior study that assessed behavioral deficits resulting from developmental FM 550 exposure across 3 doses, here we tested the hypothesis that FM 550 sex-specifically alters AVP and OT neuronal populations in critical nuclei, such as the paraventricular nucleus (PVN), that coordinate those behaviors, as well as related dopaminergic (determined by tyrosine hydroxylase (TH) immunolabeling) populations. Exposed females had fewer AVP neurons in the anterior PVN and more A13 TH neurons in the zona incerta than controls. By contrast, in FM 550 males, A13 TH neuron numbers in the zona incerta were decreased but only in 1 dose group. These results expand on previous work showing evidence of endocrine disruption of OT/AVP pathways, including to subpopulations of PVN AVP neurons that coordinate osmoregulatory functions in the periphery.

Purpose To evaluate the current scientific evidence on estimating cumulative risk for biologic complications relating to dental implants and to develop a patient-centered risk assessment tool for establishing aggregate risk. Materials and methods A review of the scientific literature on risk indicators relating to dental implants was completed with the goal of identifying and weighting individual risk indicators so aggregate biologic risk could be estimated. Three authors completed independent reviews of the literature, identifying 31 systematic reviews on risk indicators for biologic complications with dental implants, from which 24 potential risk indicators were considered. Due to inconclusive scientific data on risk indicators, a Delphi process was used to gather structured expert opinion to supplement findings from the literature. Eleven Delphi participants with expertise in prosthodontics or periodontics participated in two email exchanges and one face-to-face meeting to comment and debate on the initial identification and weighting of risk indicators, propose the addition or removal of risk indicators, and provide recommended clinical management for each risk indicator. Results After three rounds of debate, literature review, and additions and removals of various risk indicators, consensus (defined as 95% or more in agreement) was achieved on 20 risk indicators. The Delphi group concluded that the risk indicators of smoking, diabetes, antiresorptive agents, and cemented restorations should include subcategories to more accurately identify and represent patient-specific risk. Clinical recommendations based on individual and aggregate risk were established by consensus. Conclusion The literature on risk indicators for biologic complications was conflicting and inconclusive. The Delphi method was used to identify and establish the weighting of individual risk indicators, resulting in a risk assessment tool for estimating aggregate risk.

INTRODUCTION: Oxidative stress–mediated fetal membrane cell aging is activated prematurely in preterm premature rupture of membranes (PPROMs). The mechanism of this phenomenon is largely understudied. Progesterone receptor membrane component 1 (PGRMC1) has been recognized as a potential protective component for maintaining fetal membrane integrity and healthy pregnancies. We aimed to investigate the effects of oxidative stress (represented by hydrogen peroxide [H(2)O2]) on fetal membrane and chorion cell senescence, p38 mitogen-activated protein kinase (MAPK) phosphorylation, and sirtuin 3 (SIRT3) and to examine the roles of PGRMC1 in these effects. METHODS: Following serum starvation for 24 hours, full-thickness fetal membrane explants and primary chorion cells were treated with H(2)O2 at 100, 300, and 500 µM for 24 hours. Cells were fixed for cell senescence-associated β-galactosidase assay. Cell lysates were harvested for quantitive reverse transcription polymerase chain reaction to quantify SIRT3 messenger RNA. Cell lysates were harvested for Western blot to semi-quantify SIRT3 protein and p38 MAPK phosphorylation levels, respectively. To examine the role of PGRMC1, primary chorion cells underwent the same treatment mentioned above following PGRMC1 knockdown using validated PGRMC1-specific small-interfering RNA. RESULTS: Hydrogen peroxide significantly induced cell senescence and p38 MAPK phosphorylation, and it significantly decreased SIRT3 expression in full-thickness fetal membrane explants and chorion cells. These effects were enhanced by PGRMC1 knockdown. DISCUSSION: This study further demonstrated that oxidative stress–induced cell aging is one of the mechanisms of PPROM and PGRMC1 acts as a protective element for maintaining fetal membrane integrity by inhibiting oxidative stress–induced chorion cell aging.

The prevalence of neurodevelopmental disorders (NDDs) is rapidly rising, suggesting a confluence of environmental factors that are likely contributing, including developmental exposure to environmental contaminants. Unfortunately, chemical exposures and social stressors frequently occur simultaneously in many communities, yet very few studies have sought to establish the combined effects on neurodevelopment or behavior. Social deficits are common to many NDDs, and we and others have shown that exposure to the chemical flame retardant mixture, Firemaster 550 (FM 550), or paternal deprivation impairs social behavior and neural function. Here, we used a spontaneously prosocial animal model, the prairie vole (Microtus ochrogaster), to explore the effects of perinatal chemical (FM 550) exposure alone or in combination with an early life stressor (paternal absence) on prosocial behavior. Dams were exposed to vehicle (sesame oil) or 1000 µg FM 550 orally via food treats from conception through weaning and the paternal absence groups were generated by removing the sires the day after birth. Adult offspring of both sexes were then subjected to open-field, sociability, and a partner preference test. Paternal deprivation (PD)-related effects included increased anxiety, decreased sociability, and impaired pair-bonding in both sexes. FM 550 effects include heightened anxiety and partner preference in females but reduced partner preference in males. The combination of FM 550 exposure and PD did not exacerbate any behaviors in either sex except for distance traveled by females in the partner preference test and, to a lesser extent, time spent with, and the number of visits to the non-social stimulus by males in the sociability test. FM 550 ameliorated the impacts of parental deprivation on partner preference behaviors in both sexes. This study is significant because it provides evidence that chemical and social stressors can have unique behavioral effects that differ by sex but may not produce worse outcomes in combination.

Pregnancy is a critical time of vulnerability for the development of the fetal brain. Exposure to environmental pollutants at any point in pregnancy can negatively impact many aspects of fetal development, especially the organization and differentiation of the brain. The placenta performs a variety of functions that can help protect the fetus and sustain brain development. However, disruption of any of these functions can have negative impacts on both the pregnancy outcome and fetal neurodevelopment. This review presents current understanding of how environmental exposures, specifically to endocrine disrupting chemicals (EDCs), interfere with placental function and, in turn, neurodevelopment. Some of the key differences in placental development between animal models are presented, as well as how placental functions such as serving as a xenobiotic barrier and exchange organ, immune interface, regulator of growth and fetal oxygenation, and a neuroendocrine organ, could be vulnerable to environmental exposure. This review illustrates the importance of the placenta as a modulator of fetal brain development and suggests critical unexplored areas and possible vulnerabilities to environmental exposure.

Preterm premature rupture of membranes is a leading cause of preterm births. Cytokine induced matrix metalloproteinase1 and interleukin 8 production from amnion mesenchymal cells may contribute to fetal membrane weakening and rupture. Progestins inhibit inflammation induced fetal membrane weakening but their effect on the inflammatory response of amnion mesenchymal cells is unknown. This study was designed to determine the role of progesterone receptor membrane component 1 and the glucocorticoid receptor in mediating the effects of progestins on interleukin-1 induced matrix metalloproteinase 1 and interleukin-8 expression in human amnion mesenchymal cells. Primary amnion mesenchymal cells harvested from human fetal membranes were passaged once and treated with vehicle, progesterone or medroxyprogesterone acetate at 10-6 M for 1 h followed by stimulation with interleukin-1 at 1 ng/ml for 24h. Medroxyprogesterone acetate but not progesterone inhibited interleukin-1-induced interlukin-8 and matrix metalloproteinase 1 mRNA expression. In subsequent dose response studies, medroxyprogesterone acetate, but not progesterone, at doses of 10-6 to 10-8 M inhibited interleukin-1 induced interleukin-8 and matrix metalloproteinase 1 mRNA expression. We further demonstrated that inhibition of glucocorticoid receptor expression, but not progesterone receptor membrane component 1 knockdown with small interfering RNA transfection, resulted in a reversal in medroxyprogesterone acetate’s (10-7M) inhibition of interleukin-1- induced matrix metalloproteinase 1 mRNA expression and interleukin-8 mRNA expression and protein expression. Our findings demonstrate that medroxyprogesterone acetate exerts its anti-inflammatory effect primarily through the glucocorticoid receptor in human amnion mesenchymal cells. Modulation of glucocorticoid receptor signalling pathways maybe a useful therapeutic strategy for preventing inflammation induced fetal membrane weakening leading to preterm premature rupture of membranes.

Background: Health is generally regarded as a very high good, and oral health may substantially affect the quality of life of patients. Oral health–related quality of life has usually been investigated by means of disease-specific descriptive instruments, such as the Oral Health Impact Profile and the General Oral Health Assessment Index. These instruments, however, do not enable a comparison of oral health–related quality of life with other medical diseases. Economic methods, such as the time trade-off technique, enable a comparison of the impact of oral health with other medical diseases and thus provide a means to build a bridge in quality-of-life assessments between medicine and dentistry. Methods: We included in our study a total of 58 patients who received a complete denture in our clinic in the last 10 y (between January 2001 and May 2012) and who were ≥65 y old. Patient preferences for the edentulous and poorest imaginable oral health state were assessed via the time trade-off method. Results: Edentulous patients rated their current oral health state as 0.73 (SD, 0.25) and the poorest oral health state as 0.43 (SD, 0.33) on a scale between 0 (death) and 1 (best possible health state). These results are comparable to patient preferences for other serious diseases, such as breast cancer (0.75), asymptomatic HIV infection (0.69), depression (0.44), and osteoarthritis of the hip (0.44). Conclusion: In conclusion, our results suggest that oral health may substantially affect quality of life no less than other medical diseases. Knowledge Transfer Statement: Health is generally considered the highest good of humankind. In the present article, we show that oral health substantially affects quality of life. In particular, we show that loss of teeth (i.e., being edentulous) reduces quality of life no less than other systemic diseases. Treatment modalities for the edentulous patient may therefore substantially improve the patient’s well-being and should be a research priority.

Author(s): Wiens, Jonathan P; Koka, Sreenivas; Graser, Gerald; White, Shane N; Marinello, Carlo P; Curtis, Donald A

Purpose: Two interforaminal dental implants in is a common treatment option for denture retention in edentulous patients. Economic methods to assess the patient’s quality of life include the willingness to pay (WTP) for implant treatment and willingness to accept (WTA) to forgo implant treatment. The purpose of this study was to assess the monetary value of implant retained complete dentures using WTP and WTA. Methods: We included a convenience sample of 16 patients from a previously published cohort study on the survival of immediately loaded implants in edentulous patients to assess WTP and WTA for this treatment option. Results: The average maximum WTP for implant treatment was 4606 (95% CI: 2991-6222) Swiss Francs. Out of the 16 patients, only 5 were willing to trade their implants for money, with a mean WTA of CHF 33'500 (range: 3000-100'000). All patients would agree to undergo the implant surgery procedure again. Conclusion: The results of the present study show that most patients are not willing to trade the increase in quality of life after implant surgery against money, suggesting that WTA exceeds by large WTP for the same health condition.

OBJECTIVE: To investigate the effects of tooth loss on gait stability in a healthy elderly population. METHODS: A case-control study was conducted among healthy and prosthetically well-restored seniors over the age of 65 years. The test group comprised 24 edentulous participants who were restored with complete dentures in the upper jaw and an overdenture fixed on two implants in the lower jaw. The control group comprised 25 dentate participants who either still had their natural teeth or were restored with conventional fixed partial dentures. Gait stability was evaluated by measuring the parameters 'gait velocity' and 'cycle-time variability' during self-selected normal walking speed and under dual-task performance conditions. Measurements were conducted using the GAITRite(®) electronic walkway system. RESULTS: Dentated and fixed restored participants (the control group) had a significantly higher gait velocity compared with denture wearers (the test group) under both normal walking (p = 0.03) and dual-task performance conditions (p = 0.01). In each test condition, among edentulous participants, gait velocity did not significantly differ according to whether the participant wore their dentures. CONCLUSION: The present results suggest that tooth loss in healthy seniors is associated with lower gait velocity and therefore may have a negative impact on gait stability. Language: en

Statement of problem Loss of retention of implant-retained overdentures due to wear of the patrix or matrix of the attachment system is a common clinical problem. Purpose The purpose of this controlled clinical trial was to compare the wear of ceramic and titanium ball attachments and their corresponding gold matrices after 1 year of clinical function in subjects with implant-retained mandibular overdentures. Material and methods Forty subjects who had been treated with a 2-implant-retained overdenture received either 2 ruby ball attachments (20 subjects) or 2 titanium ball attachments (20 subjects). The diameter of the ball attachments and the thickness of the matrix were measured optically before insertion and after 1 year of clinical function. Differences among groups were then compared with the Wilcoxon rank sum test (α=.05). To estimate any correlation between clinical parameters and wear, the Spearman rank test was used. Results There was no significant difference ( P =.73) in the median wear of ball attachments for the titanium group (5.3 μm; median 1.3 μm) and for the ceramic group (1.3 μm; median 1.3 μm). In the ceramic group, a fracture rate of 30% was observed. The mean wear of the matrices in the titanium group was 3.1 μm (median 6.8 μm) and in the ceramic group 2.1 μm (median 3.4 μm), P =.01. No correlation was found between ball attachment wear and matrix insert wear (Spearman rank test). Wear of matrices was weakly correlated with an increase in divergence between implant axes in the sagittal plane ( P =−.28 and P =.021). Ball attachment wear was associated with an increase in divergence between matrix axes in the sagittal plane ( P =−.34 and P =.047). Conclusions Matrices on ceramic ball attachments showed less wear than those placed on titanium ball attachments. However, the use of ruby ball attachments cannot be recommended because of a high fracture rate.

Hemodynamic and global oxygen transport variables have failed to reflect splanchnic hypoperfusion, resulting in a failure to recognize inadequately treated hemorrhagic shock. Volemic expansion after fluid resuscitation is essential to improve global and regional oxygen in hemorrhagic shock. We hypothesized that, in contrast to conventional plasma expanders, the smaller volemic expansion from 7.5 NaCl/6% hydroxyethyl starch (HHES) solution administration in hemorrhagic shock may provide lesser systemic oxygen delivery and gastric perfusion. We used hemorrhaged dogs to compare intravascular volume expansion and the early systemic oxygenation and gastric perfusion effects of fixed fluid bolus administration, which are usually used in clinical situations with severe hemorrhage, of HHES, lactated Ringer (LR), and 6% hydroxyethyl starch (HES) solutions.Thirty dogs were bled (30 mL · kg(-1)) to hold mean arterial blood pressure at 40 to 50 mm Hg over 45 minutes and were resuscitated in 3 groups: LR (n = 10) at 3:1 ratio to shed blood; HES (mean molecular weight 130 kDa, degree of substitution 0.4) (n = 10) at 1:1 to shed blood; and HHES (n = 10), 4 mL · kg(-1). Intravascular volume expansion (Evans blue and hemoglobin dilution), hemodynamic, systemic oxygenation, venous-to-arterial CO(2) gradient (Pv-aCO(2)), and gastric intramucosal-arterial PCO(2) gradient (PCO(2) gap) variables were measured at baseline, after 45 minutes of hemorrhage, and 5, 45, and 90 minutes after fluid resuscitation.HHES increased blood volume because of the high volume expansion efficiency, but intravascular volume expansion with this solution was the smallest of the solutions (P0.05). All 3 solutions induced a similar hemodynamic performance but HHES showed lower mixed venous PO(2) and higher systemic oxygenation extraction, Pv-aCO(2), and PCO(2) gap than LR and HES (P0.05).In dogs submitted to pressure-guided hemorrhagic shock and fixed-volume resuscitation, the smaller intravascular volume expansion from HHES solutions provides worse recovery of systemic oxygenation and gastric perfusion compared with LR and HES solutions despite its high volume expansion efficiency, which was limited by low infused volume.

The aim of the present study was to analyze some features of the peri-implant mucosa at sites in the dog model which had been exposed to plaque accumulation for periods up to 9 months. The experiment was carried out in 5 labrador dogs. The mandibular right and left 2nd, 3rd and 4th premolars (2P2, 3P3, 4P4) and the 1st molars (1M1) were extracted. Following a 3-month healing period, 3 titanium fixtures (Nobelpharma AB, Göteborg, Sweden) were installed in the edentulous premolar/molar regions. Abutment connection was performed 3 months later and a meticulous plaque control period of 3 months was initiated. A clinical examination was performed at the end of this preparatory period and a main study period of 9 months continued. During this period, the plaque control regimen was maintained in the mesial and central (left: L1, 2 and right: R1, 2) implant segments, whereas plaque was allowed to accumulate on the distal implants, i.e.. L3 and R3. At the end of the main study period, i.e., 12 months after abutment connection, the clinical examination was repeated, the animals perfused and biopsies obtained. Semi-thin sections were produced for histometric and morphometric analyses. The peri-implant mucosa at implant sites exposed to daily and comprehensive plaque control at biopsy was clinically noninflamed and the connective tissue lateral to a junctional epithelium was devoid of accumulations of inflammatory cells.(ABSTRACT TRUNCATED AT 250 WORDS)

Objectives: The purpose of this study was to analyze the expression of adhesion molecules on endothelial cells in the alveolar ridge mucosa, the gingiva and the periimplant mucosa in humans. Material and methods: Twelve partially edentulous subjects were included in the study. In each subject, one soft tissue biopsy was harvested from the edentulous alveolar ridge mucosa, one from a tooth site and one from an implant site. After 3 weeks of undisturbed plaque accumulation, an additional biopsy was obtained from one tooth and one implant site in each subject. The tissue samples were snap frozen and prepared for immunohistochemical analysis. Results: In the alveolar ridge mucosa, smaller proportions of endothelial cells expressing ICAM-1, ELAM-1 and VCAM-1 were observed than in the gingiva. ELAM-1-positive cells occurred in lower numbers than in periimplant mucosa. After 21 days of plaque accumulation, ELAM-1 was increased in tooth sites, but decreased in periimplant mucosa. Conclusion: The results of the present study indicated that the proportions of activated endothelial cells and the extravasation of leukocytes is larger in gingiva and periimplant mucosa than in alveolar ridge mucosa. This might be due to the less permeable keratinized epithelial layer in the edentulous ridge mucosa, which offers proper protection against microbial pathogens. The greater expression of endothelial cell adhesion molecules during experimental gingivitis, compared to periimplant mucositis, may reflect its longer history of repeated antigenic assaults.

Objectives: The purpose of this study was to examine reactions of gingiva and peri-implant mucosa (PiM) to de novo plaque accumulation in humans. Material and Methods: Prior to the start of the study, which included 12 partially edentulous subjects, a 3-week plaque control program was performed. Ethical approval was granted by the local ethics committee. On day 0, 2 soft tissue biopsies were harvested, 1 from a tooth and 1 from an implant site in every subject. After 3 weeks of undisturbed plaque accumulation (day 21), 2 additional biopsies were obtained from the gingiva and PiM in each subject. The tissue samples, each 4×4 mm in size, were snap frozen and prepared for immunohistochemical analysis. Results: The size of the infiltrate (ICT) in the day 0 biopsies, was about 0.03 mm2 in both the gingiva and PiM. At the end of the plaque accumulation period, the size of the lesion had significantly increased in both groups and occupied an area of 0.26 mm2 in the gingiva and 0.14 mm2 in PiM. In the biopsies presenting day 0, the proportions of the various cell populations examined were similar in the gingiva and in PiM. The tissue fractions of almost all types of cells increased during the 3 weeks, but the mean change for each cell type was greater in the gingiva than in PiM. The CD3/CD19 ratio decreased in the gingiva between day 0 and 21, but increased in PiM. Conclusion: The results of the present study indicated that plaque accumulation induced an inflammatory response characterized by increased proportions of T- and B-cells in the ICT of both the gingiva and the PiM. Although not statistically significant, the host response in the gingiva tended to be more pronounced than in the peri-implant mucosa.

Statement of problem: Distinct clinical parameters determine whether fixed or removable implant-supported prostheses are indicated to restore the edentulous maxilla. However, there is a strong belief that fixed implant prostheses meet with greater patient acceptance and satisfaction, but this may differ from the patients' perceptions, their psychological responses to treatment, and their assessments of the treatment outcome. Purpose: This prospective clinical study compared the treatment outcomes of fixed and removable implant-supported restorations in the edentulous maxilla with the main emphasis on the patient's point of view. Material and methods: Twenty patients who requested an implant-supported superstructure to restore the edentulous maxilla were asked to complete a questionnaire measuring their satisfaction with the present situation and the psychologic impact of their oral health status with their responses marked on a Visual Analog Scale (VAS). Ten patients were treated with a fixed, screw-retained implant prosthesis (group 1), and 10 were treated with a removable, implant-supported and bar-retained overdenture (group 2). Six months after prosthetic rehabilitation, patients were again given the questionnaire to assess their psychologic well-being and satisfaction with the implant-supported restoration. Results: Both prosthesis designs were associated with significant improvements in comfort and retention, function, esthetics and appearance, taste, speech, and self-esteem. No difference was found between the 2 groups with respect to how the patients assessed the implant therapy. However, the results indicated that patients in group 2 experienced greater differences between pretreatment and posttreatment scores for the parameters esthetics, taste, and speech. Treatment costs per unit were significantly higher in group 1 than in group 2. Conclusion: Patients in groups 1 and 2 were similarly satisfied with their implant-supported prostheses in the edentulous maxilla with regard to their well-being and the cost-utility, irrespective of whether the restoration was fixed or removable. (J Prosthet Dent 2000;83:424-33.)

The purpose of this study was the clinical and microbiological re-examination of dental hygienists, who, 30 months before, had shown remarkably high supragingival levels of periodontitis-associated micro-organisms. Interdental plaque was collected from the same molar sites and investigated by the same immunofluorescence assay with taxa-specific monoclonal antibodies as at the initial examination. On average, the 15 re-examined subjects showed slightly increased plaque levels but unchanged bleeding on probing scores (0.3-1.4). Pocket formation was restricted to a single subject. Prevotella intermedia/P. nigrescens and Peptostreptococcus micros were present in every plaque sample. Prevalences of Actinobacillus actinomycetemcomitans, Bacteroides forsythus and Campylobacter rectus were again between 20-40%, but some fluctuation within subjects was noted. The data confirm supragingival plaque as a natural habitat for periodontitis-associated bacteria in periodontially healthy persons, and indicate that colonization with A. actinomycetemcomitans, B. forsythus or C. rectus is mostly stable in spite of better than average personal plaque control.

Reverse total shoulder replacement (RTSR) depends on adequate deltoid function for a successful outcome. However, the anterior deltoid and/or axillary nerve may be damaged due to prior procedures or injury. The purpose of this study was to determine the compensatory muscle forces required for scapular plane elevation following RTSR when the anterior deltoid is deficient. The soft tissues were removed from six cadaver shoulders, except for tendon attachments. After implantation of the RTSR, the shoulders were mounted on a custom-made shoulder simulator to determine the mean force in each muscle required to achieve 30° and 60° of scapular plane elevation. Two conditions were tested: 1) Control with an absent supraspinatus and infraspinatus; and 2) Control with anterior deltoid deficiency. Anterior deltoid deficiency resulted in a mean increase of 195% in subscapularis force at 30° when compared with the control (p = 0.02). At 60°, the subscapularis force increased a mean of 82% (p < 0.001) and the middle deltoid force increased a mean of 26% (p = 0.04). Scapular plane elevation may still be possible following an RTSR in the setting of anterior deltoid deficiency. When the anterior deltoid is deficient, there is a compensatory increase in the force required by the subscapularis and middle deltoid. Attempts to preserve the subscapularis, if present, might maximise post-operative function.

Markov models are mathematical models that can be used to describe disease progression and evaluate the cost-effectiveness of medical interventions. Markov models allow projecting clinical and economic outcomes into the future and are therefore frequently used to estimate long-term outcomes of medical interventions. The purpose of this paper is to demonstrate its use in dentistry, using the example of resin-bonded bridges to replace missing teeth, and to review the literature. We used literature data and a four-state Markov model to project long-term outcomes of resin-bonded bridges over a time horizon of 60 years. In addition, the literature was searched in PubMed Medline for research articles on the application of Markov models in dentistry.

The present experiment in the Labrador dog was performed to study tissue alterations that occurred in a peri-implantitis lesion following ligature removal. The study was carried out in 5, 1-year old Labrador dogs. The mandibular right and left 1st molars and 4th and 3rd premolars were extracted to establish recipient sites for implants. After 3 months of healing, 4 titanium fixtures, 2 in each jaw quadrant, were installed and abutment connection carried out in a 2nd stage procedure after another 3 months. After a 6-month period of healing, cotton floss ligatures were placed in a submarginal position around the neck of the fixture abutments. The ligatures were forced into a position "apical" of the margin of the peri-implant mucosa and secured. When the tissue destruction after 4-6 weeks was found to amount to about 25% of the original bone height at each individual implant, the ligatures were removed. 2 dogs were sacrificed 1 month and 3 dogs 3 months after ligature removal. The animals were perfused with a fixative and block biopsies were obtained from the implant sites. The biopsies were prepared for histometric and morphometric analyses.(ABSTRACT TRUNCATED AT 250 WORDS)

Immediate loading of two unsplinted mandibular implants by means of an overdenture may be a viable and cost-effective treatment option to improve the patient's oral health-related quality of life. We therefore conducted a prospective observational study to estimate implant survival and patient satisfaction after an immediate loading protocol in edentulous patients.Twenty edentulous patients who received two interforaminal implants (Straumann Standard implant, length 12 mm) were included in our study. Immediately after implant placement, ball attachments with a diameter of 2.25 mm were placed on the implants and the respective matrices were directly incorporated in the existing complete denture. Clinical recalls were scheduled 1 week, 1, 3, 6 months, and 1 and 2 years after implant placement. The following clinical parameters were assessed: gingival bleeding index (GBI), visual plaque index (VPI), and soft tissue overgrowth. In addition, we also assessed radiological bone level change (RBLC) using panoramic radiographs, and patient satisfaction using a visual analogue scale at baseline, after 6 months and 2 years.No implant failures occurred during the 2-year observation period, resulting in a survival rate of 100%. The mean RBLC was 0.67 mm (95% Confidence Interval [95% CI]: 0.47-0.86 mm) two years after surgery. The GBI and VPI after two years were 24 (95% CI: 9-38)% and 36 (95% CI: 19-53)%, respectively. Soft tissue overgrowth was 1.6 mm (95% CI: 1.1-2.1) on average after two years. In a multivariate regression model, patients with a GBI ≥50% on average showed an increased RBLC (-0.6 mm, p = 0.007). High patient ratings were recorded for overall satisfaction. Overall patient satisfaction measured on a scale between one and ten was 5.2 (95% CI: 2.1-8.5) before implant placement and 9.5 (95% CI: 9.1-10) after 2 years.Immediate loading of two unsplinted interforaminal implants in overdenture patients using ball attachments is a clinically viable treatment option that leads to a high survival rate and oral health-related quality of life.

Statement of problem Alumina-core crowns have become a standard treatment option in contemporary dental practice. The short-term survival of alumina crowns has been well documented. However, there is still a paucity of long-term survival data. Purpose The purpose of this prospective cohort study was to estimate long-term survival of alumina crowns in anterior and posterior areas over an observation period of up to 10 years. Material and Methods Between 1997 and 2005, 155 alumina crowns were placed in 50 subjects. Clinical and technical parameters were assessed at baseline. In 2005 and 2008, the crowns were clinically assessed using modified U.S. Public Health Service (USPHS) guidelines. Treatment failure was defined as crown or tooth loss and separated into technical or biological failures. Survival probabilities were estimated using the Kaplan-Meier method. Results In 2008, 29 subjects with 112 alumina crowns, including 86 (77%) posterior and 26 (23%) anterior crowns, were available for clinical assessment. The average observation period for these subjects was 7.8 years, with a range from 3 to 10.7 years. In total, 3 technical and 8 biological failures were observed. The estimated survival probability considering technical failures only was 95% (95% Confidence Interval (CI), 89% to 100%). The estimated overall survival probability after 10 years was 84% (95% CI, 74% to 95%). There was no significant difference in treatment failures in posterior as compared to anterior crowns (all failures: P=.713; technical failures: P=.352). Conclusions The results suggest that the expected 10-year survival rate of alumina crowns due to technical failures is 95% (95% CI, 89% to 100%).

The purpose of the present study was to examine the relationship between the form of the crowns in the maxillary front tooth segment and (1) a group of morphological characteristics and (2) the thickness of the gingiva. 108 subjects devoid of symptoms of destructive periodontal disease were examined regarding, e.g., probing depth, thickness of the free gingiva, width of the keratinized gingiva and the contour of the marginal gingiva. From clinical photographs of the maxillary front tooth region, the width (at the apical third – CW) and the length (CL) of the crowns of the 6 front teeth were determined. A CW/ CL-ratio was calculated for each tooth and averaged for each tooth region. The individual mean CW/CL-ratio values for the central incisors were ranked. After correction for incisal attrition, the 10 subjects ranked highest and the 10 ranked lowest were selected as having either a long-narrow (group N) or a short-wide (group W) form of the crown of the tooth. The data for each of the examined parameters were averaged for each tooth region in each subject and mean values for subjects in groups W and N were compared using the Student t-test. Stepwise multiple regression analysis, including data from the whole sample, was performed for each tooth region with the thickness of the free gingiva as the dependent variable. The results from the analyses demonstrated that individuals with a long-narrow form of the central incisors displayed, compared to individuals with a short-wide crown, form (i) a narrow zone of keratinized gingiva, (ii) shallow probing depth, and (hi) a pronounced “scalloped” contour of the gingival margin. There was no significant difference between groups N and W with respect to the thickness of the free gingiva. The CW/CL-ratio data revealed that a certain form of the crowns in the central incisors was accompanied by a similar form in the lateral incisor and canine tooth region. The regression analyses demonstrated that the thickness of the free gingiva in central incisors was significantly related to (i) the width of the keratinized gingiva, (ii) the buccolingual width of the crown and (iii) the presence of an interproximal gingival groove. In lateral incisors, the thickness of the free gingiva was associated with the probing depth at the buccal surface. No single variable was significantly related to the thickness of the gingiva in canines.

The experiment was performed to evaluate the effects of long-standing plaque on the gingiva and peri-implant mucosa. 5 beagle dogs were used in the study. The mandibular right premolars were extracted. 3 months later, 3 titanium fixtures were installed and after another 3 months, abutment connection was performed. Plaque control, in the implant as well as the contralateral tooth regions, was maintained during a 4-month period prior to the start of the main experiment. On Day 0, the teeth and implant sections were examined with respect to plaque and gingivitis. The plaque control program was terminated. The animals were subsequently fed a diet which allowed gross plaque accumulation. After 90 days of undisturbed plaque formation, the dogs were re-examined and biopsies harvested from implants and contralateral teeth. On day 90, all teeth and implants had accumulated large amounts of plaque. The soft tissue at implants and teeth bled on gentle probing. The histological examination of the gingiva and the peri-implant mucosa revealed: (i) both tissues contained an inflammatory cell infiltrate; ICT, (ii) the apical extension of ICT was more pronounced in the peri-implant mucosa than in the gingiva and (iii) the composition of the 2 lesions had many features in common.

The objective of the present experiment was to study lesions in the peri-implant and periodontal tissues resulting from ligature placement and subgingival plaque formation. The experiment was performed in 5 beagle dogs which at the start of the study were about 15 months old. They were given a diet which allowed gross plaque formation. The mandibular right premolars were extracted, 3 fixtures (a.m. Branemark) installed and abutment connection performed. Towards the end of a 6-month plaque control period, a clinical and radiographic examination was performed. Ligatures were placed in a subgingival position at 2 of the implants and the contralateral premolars. Plaque was allowed to accumulate. After 6 weeks, the ligatures were removed. 1 month later, the clinical and radiographical examination was repeated and samples from the subgingival microbiota obtained. Biopsies from the teeth and implant sites were harvested and processed for histometric and morphometric analyses. The results from the clinical and histological examinations revealed that: (i) clinical and radiographic signs of tissue destruction were more pronounced at implants than at teeth; (ii) the size of the soft tissue lesion was larger at implants than at teeth; (iii) the lesion at implants but not at teeth extended into the bone marrow.

The aim of the present investigation was to assess the effect of de novo plaque formation on the gingiva and masticatory mucosa around teeth and implants. The study was performed in 5 beagle dogs which at the initiation of the experiment were 15 months old. During a preparatory period, the mandibular right premolars were extracted, 3 fixtures installed, abutment connection performed and a 4-month period of plaque control completed. A clinical examination was performed and biopsies of the second mandibular premolar (P2) and the contralateral implant site (2P) were sampled. The dogs were allowed to form plaque during a period of 3 weeks. The clinical examination was repeated and biopsies harvested from the 2 remaining implants and the contralateral tooth sites. The tissue samples were prepared for histometric and morphometric analysis. Both the masticatory mucosa at implants and the gingiva responded to de novo plaque formation with the development of an inflammatory lesion. The size as well as the composition of the lesions in the 2 tissues had many features in common. It was concluded that the mucosa around implants and the gingiva around teeth had a similar potential to respond to early plaque formation.

Im vorliegenden Kapitel werden Dentalwerkstoffe erlautert (Tabelle 88.2), die in der Prothetik, in der konservierenden Zahnheilkunde, der Parodontologie, der Kieferchirurgie, der Kieferorthopadie und in der Kinderzahnmedizin eingesetzt werden [1]. Die Dentalwerkstoffe sind dem sehr agressiven Mundmilieu ausgesetzt. Es werden dabei folgende intraorale Einflusse wirksam

Im vorliegenden Kapitel werden Dentalwerkstoffe erlautert (Tabelle 69.2), die in der Prothetik, in der konservierenden Zahnheilkunde, der Parodontologie, der Kieferchirurgie, der Kieferorthopadie und in der Kinderzahnmedizin eingesetzt werden [1]. Die Dentalwerkstoffe sind dem sehr agressiven Mund milieu ausgesetzt. Es werden dabei folgende intraorale Einflusse wirksam: Speichel: Wasser (99%), organische Bestandteile (z. B. Proteine), anorganische Bestandteile (z. B. Chlorid-Ionen), geloste Gase (z. B. O2), Induktion von Korrosion [2] Nahrung: variierende chemische Zusammensetzung, Variation des pH-Werts, Temperaturwechsel Medikamente (chemische Einflusse) Karieshemmende Mittel: Fluoride Bakterien: Freisetzung von Sauren Mechanische Beanspruchungen: Kauen (Materialermudung, -abrieb) Bursten, Bruxismus usw. Hochste und geringste gemessene Kaudruckkrafte werden von 216 N bis 637 N angegeben [4, 5]. Unter Bruxismus versteht man den unbewussten Zahnkontakt mit Kaubewegungen, die zu einer Abrasion der Zahne fuhrt [3]. Bei den Metallen finden beispielsweise folgende Normen Anwendung: EN ISO 1562: 1995 „Dental-Goldgusslegierungen“, EN ISO 8891: 1995 „Dental-Gusslegierungen mit einem Edelmetallanteil von 25% bis unter 75%“, EN ISO 9693: 1994 „Metall- Keramik-Systeme fur zahnarztliche Restaurationen“.

Crouzon syndrome is characterized by cranial and facial abnormalities and exophtalmos. Mental retardation is sometimes observed. The objective of this study was to correlate brain malformations, timing for surgery and also social classification of families and parents education to the neuropsychological evaluation and to the quality of life of these families. Eleven patients with Crouzon syndrome were studied, whose ages were between 16 and 132 months. The multidisciplinary evaluation included : social evaluation, cognitive evaluation, brain studies by magnetic resonance imaging and quality of life evaluation. The intelligence quotient values observed were between 46 and 102 (m=84.2) and was correlated (inverted correlation) to the factor IV of the short-form of the Questionnaire on Resources and Stress. Mental development was not correlated to brain malformation, neither to the age at time of operation or to the level of family environment and parents education.

Edentulous patients with denture problems benefit from implant treatment with overdenture prostheses. The aim of this prospective study was to investigate a method of analyzing cost effectiveness in dentistry. As an example, overdenture treatment with two or four implants was compared to the conventional complete denture (CD).In a self-selected trial, 20 patients each were treated with implant-retained overdentures (two implants, IRET), implant-supported overdentures (four implants, ISUP), or CDs (control group) in the edentulous mandible. A cost-effectiveness analysis was performed from the patient's perspective, with a time horizon of 6 months. Direct health-care costs were calculated in Swiss Francs (in 2000), and effects were defined as improvements in perceived chewing ability compared with the baseline value before treatment (measured on a VAS). Point estimates for mean incremental cost-effectiveness ratios were complemented with cost-effectiveness acceptability curves to account for uncertainties associated with costs and effects.Mean incremental costs were CHF 4,329 (IRET-CD), CHF 13,360 (ISUP-CD), and CHF 9,031 (ISUP-IRET); these cost differences were all statistically significant. The mean incremental effects at 6 months were 19% (IRET-CD), 23% (ISUP-CD), and 4% (ISUP-IRET). Incremental cost-effectiveness ratios were CHF 228 (IRET-CD), CHF 581 (ISUP-CD), and CHF 2,258 (IRET-ISUP) per percentage increase in chewing ability.From an economic point of view, IRETs were more attractive than ISUPs. The latter were associated with a statistically significant improvement in perceived chewing ability compared to CDs, but at substantially higher costs.

Background: The purpose of this study was to evaluate the effect of a bioabsorbable collagen barrier (CB) in combination with a composite bone substitute (deproteinized bovine bone mineral with collagen, DBBM + C) in periodontal regeneration of angular bone defects in humans using a new application technique. Methods: Twelve patients participated, each contributing at least 1 defect site, which exhibited a probing depth (PD) of ≥5 mm, a clinical attachment level (CAL) of ≥6 mm, and was positive for bleeding on probing (BOP) following initial therapy. Twenty-two angular bone defects were filled with DBBM + C. A hole was placed in the membrane, which was then pulled over the tooth. The observation period was 2 years and included measurements of plaque, gingivitis, tooth mobility, PD, CAL, soft tissue recession, and bone level as assessed from standardized radiographs. Results: The residual PD and CAL were reduced to 3.3 mm (PD) and 5.6 mm (CAL) with a CAL gain of 3.2 mm at 24 months. The radiographic defect reduction (bone fill) was 4.0 mm after surgery and 2.2 mm at 24 months. The changes measured clinically and radiographically were more pronounced in sites with a deep intrabony defect component than in sites with shallow ones. Conclusions: These findings indicate that angular bone defects can be successfully treated with DBBM + C in combination with CB. A degradation of the filler material seems to occur particularly during the first 6 months, but without affecting the clinical parameters, which improved consistently. J Periodontol 2003;74:687-694.

Based on the need for provisionalization to provide sufficient phonetics, adaptation, and function following implant therapy, simultaneous placement of immediate provisional implants has evolved to allow abutment positioning following initial surgery. This modality allows the patient to be restored with a stable, functional, and aesthetic restoration during soft tissue healing prior to the removal of the provisional implants. This article presents the clinical protocol for treatment of the edentulous mandible using an immediately provisionalized implant supported overdenture.

The purpose of this study was to analyze the expression of adhesion molecules on endothelial cells in the alveolar ridge mucosa, the gingiva and the periimplant mucosa in humans.Twelve partially edentulous subjects were included in the study. In each subject, one soft tissue biopsy was harvested from the edentulous alveolar ridge mucosa, one from a tooth site and one from an implant site. After 3 weeks of undisturbed plaque accumulation, an additional biopsy was obtained from one tooth and one implant site in each subject. The tissue samples were snap frozen and prepared for immunohistochemical analysis.In the alveolar ridge mucosa, smaller proportions of endothelial cells expressing ICAM-1, ELAM-1 and VCAM-1 were observed than in the gingiva. ELAM-1-positive cells occurred in lower numbers than in periimplant mucosa. After 21 days of plaque accumulation, ELAM-1 was increased in tooth sites, but decreased in periimplant mucosa.The results of the present study indicated that the proportions of activated endothelial cells and the extravasation of leukocytes is larger in gingiva and periimplant mucosa than in alveolar ridge mucosa. This might be due to the less permeable keratinized epithelial layer in the edentulous ridge mucosa, which offers proper protection against microbial pathogens. The greater expression of endothelial cell adhesion molecules during experimental gingivitis, compared to periimplant mucositis, may reflect its longer history of repeated antigenic assaults.

The aim of the present study was to investigate the healing of alveolar ridge defects augmented with cancellous bovine bone mineral. In six partially edentulous patients, bone augmentation was necessary prior to implant placement because of severe alveolar ridge resorption. The defect sites, all located in the maxilla, were filled with Bio-Oss and covered with the resorbable collagen membrane Bio-Gide. Biopsies were obtained from the defect sites 6 to 7 months following grafting and were processed for ground sectioning. The histologic analysis revealed that the Bio-Oss particles occupied 31% of the total biopsy area. An intimate contact between woven bone and Bio-Oss was detected along 37% of the particle surfaces. A mixed type of bone was found; it contained woven bone and parallel-fibered bone, which demonstrates features of remodeling activity. Signs of resorption of the grafting material were observed in the histologic sections, which indicates that the material takes part in the remodeling process. It is suggested that Bio-Oss may be a very suitable material for staged localized ridge augmentation in humans.