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The aim of this article is to propose a simplified digital protocol for the treatment of the fully edentulous patient, using an immediate implant and immediate loading protocol to deliver a polymethyl methacrylate metal-reinforced hybrid prosthesis. Ten consecutive patients were treated with this approach. At the end of 1 year, there was an implant survival rate of 97.8% and a prosthetic success rate of 100%. Based on the responses to the quality of life questionnaire, patients had a high acceptance rate for this treatment protocol. Within the limits of this case series, the proposed simplified digital protocol could be utilized for reconstruction in the fully edentulous patient and for delivering an implant-supported prosthesis immediately after implant placement.

Made available in DSpace on 2022-04-29T08:37:18Z (GMT). No. of bitstreams: 0 Previous issue date: 2022-03-01 Background: Antimicrobial photodynamic therapy (aPDT) is used in endodontics to improve orthograde root canal disinfection as an adjunct to standard treatments. Conversely, evidence concerning the application of aPDT in retrograde endodontic surgery is limited. Thus, the aim of the present study was to provide additional data regarding the use of aPDT in the surgical endodontic treatment of periapical lesions. Methods: A total of 25 consecutive patients presenting teeth with periapical radiolucency eventually associated with clinical signs and symptoms of apical periodontitis were included. Following access flap completion, osteotomy, mechanical debridement, root apical third resection, and preparation of the root-end cavity, aPDT was applied to decontaminate the surgical site using phenothiazine chloride dye at a concentration of 10 mg/mL and irradiation with a hand-held 100-mW diode laser with a wavelength of 660 ± 10 nm. At the latest follow-up visit, healing was evaluated as successful, uncertain, or failure according to well-established clinical and radiological criteria. Results: Overall, 31 periapical lesions were treated with aPDT. Healing proceeded uneventfully. The mean follow-up time was 36.19 months, with times ranging from 12 to 85 months. A total of 25 (80.65%) cases were classified as successful, 5 (16.13%) as uncertain, and only one (3.22%) as failure. Irrespective of the treatment outcome, all treated teeth were still functional, with no symptoms reported by the patients. Conclusion: aPDT as an adjunctive treatment modality in the surgical endodontic treatment of periapical lesions showed promising medium-term results associated with preservation of all diseased teeth. Implant Center for Edentulism and Jawbone Atrophies Maxillofacial Surgery and Odontostomatology Unit Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico University of Milan, Via Commenda 10 Department of Surgery and Integrated Clinic Araçatuba Dental School São Paulo State University “Júlio de Mesquita Filho” - UNESP Rua José Bonifácio, 1193 - Vila Mendonca Clinical Dermatology IRCCS Istituto Ortopedico Galeazzi University of Milan, Via Riccardo Galeazzi 4 Department of Surgery and Integrated Clinic Araçatuba Dental School São Paulo State University “Júlio de Mesquita Filho” - UNESP Rua José Bonifácio, 1193 - Vila Mendonca

Purpose The aim of this long-term retrospective study was twofold: (1) to evaluate the survival and success rates of stepped screw titanium implants with a sandblasted and acid-etched surface, and (2) to assess the influence of hypothetical predictors of implant failure on the survival rate. Materials and methods From 75 possible candidates, 67 patients contributing 346 Frialit-2 (DPS Frialit-2 implant system, Friatech) implants placed between 1997 and 2005 were retrospectively evaluated. The inclusion criteria consisted of implants placed in either native or augmented bone, rehabilitated with an implant-supported prosthesis, and radiographically documented at the time of prosthetic loading (T0). At the follow-up recall performed between January and October 2018 (T1), clinical and radiologic examinations were conducted to evaluate the survival and success rates. The influence of specific variables on the survival rate was subsequently investigated, including gender and smoking habits, location and size of the implants, and bone augmentation procedures. Cox regression and shared frailty models were used, with the patient representing the statistical unit. Results A survival rate of 91.62% over a median observation time of 189 months with a range of 11 to 20 years was observed. A total of 14 out of 29 implants failed before delivery of the provisional prosthesis. Overall, the median marginal bone loss was 1.25 mm, with an annual increase of 0.12 mm. Different from the other variables, the results of the multivariate model indicated that smoking was strongly correlated with implant failure (P = .002). Conclusion Considering the limitations of this study, stepped screw titanium implants with a sandblasted and acid-etched surface provided a good survival rate. Smoking might be considered a relevant risk factor for implant failure.

Purpose The timing for soft tissue augmentation during implant therapy is still debated. Therefore, the present study clinically evaluated whether immediate versus delayed soft tissue augmentation procedures had an impact on the stability of peri-implant mucosal thickness (PMT). Materials and Methods Patients requiring a single implant posterior to the canines in association with soft tissue augmentation procedures at the buccal aspect of single implants using a connective tissue graft (CTG) were enrolled. Patients were randomly allocated to 2 different timing protocols: simultaneous implant and CTG placement (test group) or implant placement and then CTG placement after 3 months (control group). PMT was measured clinically at the mid-buccal aspect of the implant site by bone sounding with an endodontic K-file using customized acrylic stents. PMT measurements were recorded before and after implant placement and at 1, 2, 3, 4, 6, 9, and 12 months after implant insertion. Parametric statistical tests were used to compare PMT between the test and control groups at each study period and to evaluate changes in PMT over time. The level of significance was set at a P value less than .05. Results Fourteen implants placed in 14 patients were available for statistical comparison. At 12 months, the difference in PMT between the test and control groups was 0.12 ± 0.51 mm. This difference was not statistically significant (P = .54). A significant increase in PMT was observed from baseline to 12 months after implantation in the test (P = .004) and control (P Conclusions The present study indicated that changes in PMT after CTG placement were not influenced by the timing of soft tissue augmentation and remained stable up to 1 year after implant insertion.

Purpose To evaluate the long-term outcome of dental implants placed with a staged procedure in resorbed alveolar ridges reconstructed with iliac crest autogenous onlay grafts. Materials and methods All consecutive patients treated with iliac crest onlay bone grafts and dental implants were retrospectively evaluated. During the appointment, clinical and radiological examinations were conducted to assess implant survival. A survived implant was defined as an implant still stable and in function at the follow-up visit. Implant survival was estimated at the implant level using Kaplan-Meier analyses. The cumulative survival rate was estimated using a life-table analysis. Subgroup analyses were performed for age, position, and type of retention using the log-rank test. A p-value of Results The cohort consisted of 21 female subjects receiving a total of 140 rough-surface titanium implants. Of them, 128 survived and 12 failed, yielding a cumulative survival rate of 91.1% over a median survival time of 312 months. Implants supporting cement-retained prostheses exhibithed lower survival rate compared to screw-retained restorations (p = 0.001). Conclusion Implants placed in bone augmented with iliac crest onlay grafts showed high long-term survival rates. Cement-retained restorations were more prone to develop implant failures.

Aim: The present study evaluated the clinical and radiological stability of hard and soft tissues following alveolar socket preservation (ASP) procedure with a follow-up of 5year from implant insertion. Materials and methods: The initial sample consisted of seven patients who underwent single tooth extraction and ASP procedure by means of demineralized bovine bone mineral particles covered with a porcine-derived non-cross-linked collagen matrix (CM). Each patient received a submerged single implant in the healed site. Mesial and distal peri-implant marginal bone resorption (MBR) rates were assessed radiographically at 1year (T1) and 5years (T2) after implant placement (baseline value). Results and Statistics: No dropouts occurred up to 5years. At T1, the MBR was 0.08 ± 0.16mm at the mesial aspect and 0.1 ± 0.12mm at the distal aspect. This difference was not statistically significant (P = 0.867). At T2, the mesial MBR was 0.15 ± 0.17mm and the distal MBR was 0.11 ± 0.14mm, with a non-statistically significant difference (P = 0.532). Therefore, no statistically significant differences were detected comparing mesial and distal MBR at any time point. With respect to the intra-group comparisons, no differences were observed comparing the different study periods within each variable. Indeed, the comparison between T0, T1 and T2 was non-statistically significant at both mesial (P = 0.06) and distal (P = 0.06) aspects. After 5years, the volume of the soft tissues appeared clinically well maintained with a natural aspect around dental implants and adjacent teeth. Conclusion: ASP using demineralized bovine bone mineral in combination with CM proved to be an effective technique to maintain stable dimensional volumes of both hard and soft tissues.

Made available in DSpace on 2021-06-25T10:53:23Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-12-01 Implant Center for Edentulism and Jawbone Atrophies Maxillofacial Surgery and Odontostomatology Unit Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico University of Milan Department of Surgery and Integrated Clinic Araçatuba Dental School São Paulo State University Júlio de Mesquita Filho-UNESP Department of Surgery and Integrated Clinic Araçatuba Dental School São Paulo State University Júlio de Mesquita Filho-UNESP

Background: bone augmentation by means of manually shaped titanium mesh is an established procedure to regenerate atrophic alveolar ridges and recreate a proper contour of the peri-implant bone anatomy. Conversely, current literature on the use of preformed titanium meshes instead of traditional grids remains lacking. Therefore, the aim of the present prospective study was to evaluate the use of preformed titanium mesh to support bone regeneration simultaneously to implant placement at dehiscence-type defects from clinical, radiological, and patient-related outcomes. Methods: 8 implants showing buccal dehiscence defects were treated with preformed titanium mesh directly fixed to flat abutments screwed to the implant. Intrasurgical clinical measurements and radiographic evaluations by means of cone-beam computed tomography scans were performed to assess the horizontal bone gain after 8 months from the augmentation surgery. Biological and patient-centered outcomes were also evaluated., Results: clinically, a mean horizontal bone gain of 4.95 &plusmn, 0.96 mm, and a mean horizontal thickness of the buccal plate of 3.25 &plusmn, 0.46 mm were found. A mean horizontal bone gain of 5.06 &plusmn, 0.88 mm associated with a mean horizontal thickness of the buccal plate of 3.45 &plusmn, 0.68 mm were observed radiographically. From a macroscopic aspect, the remodeled graft appeared well integrated with the host bone. Well vascularized newly formed bone-like tissue was observed in intimate contact with the implants. Conclusions: preformed titanium mesh may be effective in supporting simultaneous horizontal bone regeneration at dehiscence-type peri-implant defects. Titanium mesh exposure still remain an issue in this type of surgery.

The aim of the present case report was to show the 17-year hard and soft tissues stability of guided bone regeneration procedure associated with dental implants insertion. A 52-year-old male patient presented with a partial edentulism in the upper right maxilla. A graft consisting of deproteinized bovine bone mineral and autogenous bone stabilized by a non-resorbable expanded polytetrafluoroethylene membrane was used to reconstruct the missing bone applying the biological principles of guided bone regeneration. Dental implants were inserted simultaneously in a prosthetically driven position. Soft tissues were managed with a coronally positioned palatal sliding flap technique to obtain a primary intention healing. The healing proceeded uneventfully, and after 8 months the re-entry procedure was carried out. The defect was three-dimensionally filled by newly formed bone in an ongoing maturation phase. The regenerated bone appeared strictly integrated within the surrounding hard tissue and well vascularized....

Insufficient crown height space, particularly in the interforaminal region of edentulous ridges with knife-edge morphology, may prevent successful prosthetic rehabilitation. Such conditions require osteoplasty, which might complicate computer-guided implant placement. This clinical report illustrates the treatment of a patient with complete edentulism rehabilitated with a mandibular implant-supported fixed dental prosthesis by using a virtually guided approach. Both alveolar ridge reduction and prosthetically driven implant insertions were computer-guided by surgical stents to increase accuracy and predictability. This approach enabled the immediate loading of the implants with an interim prosthesis before the delivery of a definitive screw-retained fixed prosthesis. At the 1-year follow-up visit, clinical and radiographic examination revealed a stable outcome.

The clinical condition involving dental implants, characterized by soft tissue inflammation, bleeding, suppuration and rapid bone loss is widely known as peri implantitis. The main objective in the treatment of peri-implantis is to arrest the progression of the disease and at the same time to keep the dental implant in the mouth solving the inflammations signs of bleeding and pain. The aim of this paper is to highlight the effectiveness of the use of titanium brush and antimicrobial photodynamic therapy (aPDT) to decontaminate the implant surface, in association with regenerative procedures by means of autologous bone and demineralized bovine bone mineral (DBBM) in the treatment of peri-implantitis defects.

Background When keratinized tissue width around dental implants is poorly represented, the clinician could resort to autogenous soft tissue grafting. Autogenous soft tissue grafting procedures are usually associated with a certain degree of morbidity. Collagen matrices could be used as an alternative to reduce morbidity and intra-operatory times. The aim of this study was to assess the efficacy of a xenogeneic collagen matrix as a substitute for soft tissue grafting around dental implants. Methods Fifteen consecutive patients underwent a vestibuloplasty and keratinized tissue reconstruction around dental implants, both in the mandible and the maxilla, with a porcine collagen matrix. The so obtained keratinized tissues were measured and evaluated after 6 months and 1, 4, and 5 years. Results The average gain of keratinized tissue was 5.7 mm. After 6 months, it was observed a resorption of 37%, after 1 year 48%, and after 5 years 59%. The mean gain of keratinized tissue after 5 years was 2.4 mm. Hemostatic effect and post-operative pain were evaluated too. All subjects referred minimal pain with no bleeding. No adverse reaction nor infection was noted. Conclusions The present study showed the efficacy of a porcine collagen matrix in keratinized tissue augmentation. The possibility to use a soft tissue substitute is a great achievement as morbidity decreases and bigger areas can be treated in a single surgery.

An adequate amount of bone all around the implant surface is essential in order to obtain long-term success of implant restoration. Several techniques have been described to augment alveolar bone volume in critical clinical situations, including guided bone regeneration, based on the use of barrier membranes to prevent ingrowth of the epithelial and gingival connective tissue cells. To achieve this goal, the use of barriers made of titanium micromesh has been advocated.A total of 13 patients were selected for alveolar ridge reconstruction treatment prior to implant placement. Each patient underwent a tridimensional bone augmentation by means of a Ti-mesh filled with intraoral autogenous bone mixed with deproteinized anorganic bovine bone in a 1:1 ratio. Implants were placed after a healing period of 6 months. Panoramic x-rays were performed after each surgical procedure and during the follow-up recalls. Software was used to measure the mesial and the distal peri-implant bone loss around each implant. The mean peri-implant bone loss was 1.743 mm on the mesial side and 1.913 mm on the distal side, from the top of the implant head to the first visible bone-implant contact, at a mean follow-up of 88 months.The use of Ti-mesh allows the regeneration of sufficient bone volume for ideal implant placement. The clinical advantages related to this technique include the possibility of correcting severe vertical atrophies associated with considerable reductions in width and the lack of major complications if soft-tissue dehiscence and mesh exposures do occur.

Ectodermal dysplasia (ED) is an inherited disorder characterized by abnormality of ectodermally derived structures. A recurrent oral finding is oligodontia, which in turn leads to a severely hypotrophic alveolar process with typical knife-edge morphology and adverse ridge contours. This unfavorable anatomy can seriously hamper proper implant placement. Fresh-frozen bone (FFB) allografts recently have been proposed to augment the residual bone volume for implant placement purposes; however, scientific evidence concerning the use of FFB to treat ED patients is absent. Similarly, data reporting computer-aided template-guided implant placement in medically compromised patients are limited. Thus the purpose of this report is to illustrate the oral rehabilitation of a female patient affected by ED and treated with appositional FFB block grafts and consecutive computer-guided flapless implant placement in a 2-stage procedure. Fixed implant-supported dental prostheses were finally delivered to the patient, which improved her self-esteem and quality of life. During the follow-up recall 1 year after the prosthetic loading, the clinical examination showed healthy peri-implant soft tissues with no signs of bleeding on probing or pathologic probing depths. The panoramic radiograph confirmed the clinical stability of the result. Peri-implant marginal bone levels were radiographically stable with neither pathologic bone loss at the mesial and distal aspects of each implant nor peri-implant radiolucency. Within the limitations of this report, the use of FFB allografts in association with computer-aided flapless implant surgery might be considered a useful technique in patients affected by ED.

Purpose The aim of the present study was to retrospectively investigate the influence of potential risk indicators on the development of peri-implant disease. Methods Overall, 103 patients referred for implant treatment from 2000 to 2012 were randomly enrolled. The study sample consisted of 421 conventional-length (>6 mm) non-turned titanium implants that were evaluated clinically and radiographically according to pre-established clinical and patient-related parameters by a single investigator. A non-parametric Mann-Whitney U test or Kruskal-Wallis rank test and a logistic regression model were used for the statistical analysis of the recorded data at the implant level. Results The diagnosis of peri-implant mucositis and peri-implantitis was made for 173 (41.1%) and 19 (4.5%) implants, respectively. Age (≥65 years), patient adherence (professional hygiene recalls, Graphical Abstract

Maxillary sinus floor elevation via a lateral approach is a predictable technique to increase bone volume of the edentulous posterior maxilla and consequently for dental implants placement. The sinus floor is elevated and it can be augmented with either autologous or xenogeneic bone grafts following an opening bone window created on the facial buccal wall. Maxillary septa are walls of cortical bone within the maxillary sinus. The septa shape has been described as an inverted gothic arch arising from the inferior or lateral walls of the sinus and may even divide the sinus into two or more cavities. Some authors have reported a higher prevalence of septa in atrophic edentulous areas than in nonatrophic ones. Radiographic identification of these structures is important in order to perform the right design of the lateral window during sinus lift. Aim of this investigation is to highlight the correct steps for doing sinus lift surgery in presence of those anatomic variations. Clinicians should always perform clinical and radiographic diagnosis in order to avoid complications related to the sinus lift surgery.

Physiologic resorption due to remodeling processes affects autogenous corticocancellous grafts in the treatment of atrophic jawbone alveolar ridges. Such a situation in the past made overgrafting of the recipient site mandatory to get enough bone support to dental implants in order to perform a prosthetic rehabilitation. Anorganic bovine bone, conventionally used to treat alveolar bone deficiencies in implant surgery, showed a high osteoconductive property thanks to its micro and macrostructure very similar to that of human hydroxyapatite. An original technique provides for the application of a thin layer of anorganic bovine bone granules and a collagen membrane on the top of the corticocancellous onlay bone grafts to reduce in a remarkable way the graft resorption due to remodeling. The results of a clinical prospective study and a histomorphometric analysis done on autogenous grafts harvested from the iliac crest showed that the proposed technique is able to maintain the original bone volume of the corticocancellous blocks.

The reconstruction of the atrophic alveolar ridges for implant placement is today a common procedure in dentistry daily practice. The surgical reconstruction provides for the optimization of the supporting bone for the implants and a restoration of the amount of keratinized gingiva for esthetic and functional reasons. In the past, tissue regeneration has been performed with autogenous bone and free gingival or connective tissue grafts. Nowadays, bone substitutes and specific collagen matrix allow for a complete restoration of the atrophic ridge without invasive harvesting procedures. A maxillary reconstruction of an atrophic ridge by means of tissue substitutes and its histological features are then presented.

The purpose of the present study was to assess the cumulative survival rate (CSR) of 192 implants placed in association with guided bone regeneration (GBR) procedures to evaluate the long-term predictability of this technique. Moreover, the Kaplan Meier survival analysis was applied to the data in order to evaluate predictors of implant failures, including the source of the graft, the type of membrane, and the timing of implant placement. The CSR of the sample was 95.6% over a mean follow-up period of 78 months (range, 1–175 months). Considering the source of graft, a 95.0%, 93.3%, and 97.7% CSR was obtained for demineralized bovine bone mineral (DBBM), autologous, and 1:1 ratio mixture of autologous and DBBM grafts,, respectively. The CSR referred to bioabsorbable membranes was 96.5%, whereas 94.6% was the CSR reported for nonresorbable membranes. The CSR of simultaneous surgeries was 96.8%, whereas staged surgeries showed a CSR of 94.5%. According to the data, implants placed in conjunction with GBR procedures presented a satisfying survival rate even in the long term. All the procedures performed with different bone grafts and type of membranes guaranteed optimal results both in one- and two-stage approaches. No statistically significant differences could be detected among the groups; indeed, the use of DBBM associated with resorbable membranes may be suggested to reduce patients' morbidity and treatment time. Therefore, the dental implants placed in association with bone regenerative procedures presented safe and predictable long-term clinical results.

Objectives The aim of the present long-term study was to retrospectively evaluate the survival rate of implants placed in regenerated maxillary sinuses and to assess the influence of hypothetical predictors of implant failure. Methods A database including 218 patients who received dental implants after sinus lift procedures was analyzed. The following variables were systematically included and evaluated: type of graft material used, number of surgeries performed, and use of membranes to cover the lateral antrostomy and/or to repair accidental Schneiderian membrane perforations. The Kaplan–Meier estimator was used for comparisons among the groups. Results A total of 589 dental implants were positioned in 246 grafted sinuses and were in function for 3–186 months. The Kaplan–Meier cumulative survival rate was 98.3% after 15.5 years of follow-up. All implant losses occurred within 52 months (4.3 years) after augmentation. According to the log-rank test, no statistically significant difference was shown between each patient/implant variable (p > 0.05). Conclusions Despite the limitations inherent in this type of study, no statistically significant differences between the groups could be found. Intraoperative Schneiderian membrane perforations did not affect the outcome of the implants positioned. Clinical significance The present long-term study is intended as a reference for clinicians approaching sinus floor elevation surgery in order to provide them with relevant operative findings. Since all the drawbacks occurred within the first 5 years, medium-term follow-up studies could be suitable for further retrospective evaluations.

Purpose: Aim of the present study was to present the results of a retrospective analysis of maxillary sinus augmentation procedures performed with platelet-rich plasma (PRP) with a mean follow-up of about 5 years. The analysis was focused on implant survival rates and on the dimensional stability of the subantral cavity filling. Materials and Methods: Between 2000 and 2006, 28 patients were recruited for a maxillary sinus augmentation procedure performed with PRP. Two patients did not answer to the calling for the examination at distance, so they were excluded from the sample. The study involved 26 patients, for a total amount of 33 sinus augmentations, with an average follow-up of 65 months. In 26 procedures the grafting material used was a mixture of autologous bone taken from the oral cavity, deproteinized bovine bone Bio-Oss® in a relationship of 1:3 and PRP, while in seven cases, the combination of Bio-Oss and PRP. The dimensional stability of grafting material was investigated through X-ray measurements carried out during X-ray postexaminations. Results: After a mean follow-up time of about 5 years, the implant survival rate registered was 95.9%, while the radiographical variables used to assess the dimensional stability of grafts, showed a mean decrease respectively of 9.38% and 14.61%. Discussion: Very good long-term results were achieved using autologous bone+Bio-Oss+PRP and Bio-Oss+PRP as filling materials in the maxillary sinus augmentation. Dimensional stability of cavity filling seems to represent a very important factor for implant procedures success. It is difficult to estimate the influence of PRP on a long-term basis. Conclusion: The implant survival rate obtained in this study was similar to the expected rate on the areas not subject to bone graft. The method applied showed to be reliable for bone regeneration in subantral cavities, showing a very good dimensional stability and a slight reabsorption over the years.