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Cysts and other intrabony lesions can grow asymptomatic until being diagnosed by occasionally done radiologic examination. Missing tooth and malposition of adjacent teeth should induce clinicians to perform X-Ray diagnostic.A 37-year-old, male patient was admitted with a hopeless tooth 36, to be extracted and replaced with an implant. Clinical examination revealed also missing one of lower incisors and malposition of remaining lower incisors. Cone-beam computed tomography revealed horizontally impacted lower incisor surrounded by bone defect -15 × 20 × 8 mm with the bone thickness remaining only 3.5 mm in the narrowest area. The basis on strong masticatory muscles and low thickness of bone after surgical removal of tooth and lesion, prophylactic osteosynthesis was planned. To explain the surgery to the patient model of the mandible was 3D printed.Two treatment plans were presented to the patient: 1. custom plate production according to the bone defect and the shape of remaining bone and 2. choosing a standard plate and adjusting it on the 3D printed model. Costs of the material were 10 times higher in a custom solution. Plan 2 was then accepted. 1.2 mm straight plate was prebend on the model and sterilized. Lesion and impacted tooth were removed in local anesthesia. Prepared plates were fixed.In the presented case custom 3D printed osteosynthesis plate was about 10 times more expensive compared to the standard osteosynthesis plate used. 3D printing of bone model may be helpful for prebending chosen standard plate and planning the surgery.

Typically, healing or temporary abutments are connected and disconnected several times between implant placement and definitive restoration delivery, and soft tissue disruption occurs each time the abutment is disconnected and reconnected. This histologic event is supposed to cause bone resorption around the implant after second-stage surgery. To minimize this clinical scenario, immediately placing and never removing a definitive abutment the day of implant insertion (one-stage protocol) or at second-stage surgery in cases of submerged implants (two-stage protocol) was suggested. This paper details the prosthetic protocol and presents strategies and rationales for placing a definitive abutment the day of implant insertion or at second-stage surgery with cement- and screw-retained restorations. This protocol seems to be an efficient strategy to preserve peri-implant hard and soft tissues. However, positive outcomes in peri-implant bone and soft level changes should be viewed with caution, as their clinical significance is still uncertain.

To compare the clinical and radiographic outcomes of platform switching (PS) and regular platform (RP) implants.This study was designed as a randomised controlled split-mouth trial. Eighteen patients, with bilaterally missing single premolars or molars to be restored with implant-supported single crowns, were consecutively enrolled. Implant sites were randomly assigned to be treated according to the PS concept (PS group), or with matching implant-abutment diameters (RP group). A total of 36 implants were placed in healed bone, with an insertion torque between 35 and 45 Ncm, according to a one-stage protocol. All the implants were loaded with a screw-retained provisional crown 3 months after implant insertion. Definitive screw-retained single crowns were delivered 2 months later. Outcome measures were implant and prosthetic survival rates, biological and prosthetic complications, marginal bone level (MBL) changes, pocket probing depth (PPD) and bleeding on probing (BOP). Clinical data were collected at implant placement (baseline), implant loading (3 months later) and at 9, 36 and 60 months after loading.One patient dropped out after 4 years of follow-up. No implant failed and no prosthetic complications were recorded during the study period. One patient experienced mucosal inflammation with positive BOP (RP group) after 3 months and three patients had bilateral peri-implant mucosal inflammation with positive BOP at 6, 24 and 36 months, respectively. No other biological complications were recorded up to 60 months of follow-up. There were no statistically significant differences between groups for complications (3/18 versus 4/18; P = 1.0). Nine months after loading the mean MBL was 0.93 ± 0.26 mm (95% CI 0.81 to 1.05) for RP implants and 0.84 ± 0.23 mm (95% CI 0.73 to 0.95) for PS implants. No statistically significant difference was observed between the groups (P = 0.18). Thirty-six months after loading, the mean MBL was 1.09 ± 0.31 mm (95% CI 0.95 to 1.24) in the RP group and 1.06 ± 0.24 mm (95% CI 0.94 to 1.17) in the PS group, with no statistically significant difference between groups (P = 0.70). Sixty months after loading the mean MBL was 1.24 ± 0.39 mm (95% CI 1.05 to 1.43) in the RP group and 1.20 ± 0.21 mm (95% CI 1.01 to 1.39) in the PS group, with no statistically significant difference between the groups (P = 0.85). The mean PPD was 2.58 ± 0.58 mm (95% CI 2.32 to 2.84) in the RP group and 2.40 ± 0.72 mm (95% CI 2.21 to 2.59) in the PS group at 60 months follow-up, with no statistically significant difference between the groups (P = 0.49). The mean BOP was 0.90 ± 0.88 (95% CI 0.58 to 1.22) in the RP group and 0.93 ± 0.97 (95% CI 0.51 to 1.35) in the PS group at 60 months of follow-up, with no statistically significant difference between the groups (P = 0.85).Implants restored according to the PS concept and matching implant-abutment diameters showed comparable clinical and radiographic results up to 5 years after loading.

OBJECTIVES To evaluate implant survival rate, any complications, and changes in residual alveolar bone height (RABH) using saline or platelet-rich fibrin (PRF) filling after hydraulic transcrestal sinus lifting. METHODS Dental implants were placed after hydraulic transcrestal sinus lifting and the filling of saline (20 patients) or PRF (20 patients). Outcome measurements were implant survival, any complications, and RABH changes. Cone-beam computed tomography (CBCT) scans were taken and compared preoperatively (T0), immediately postoperatively (T1), at 3 months (T2), 6 months (T3), and 12 months postoperatively (T4), respectively. RESULTS In a total of 40 patients, 45 implants with a mean length of 10.4 ± 0.8 mm were placed in posterior maxilla of a mean RABH of 6.8 ± 1.1 mm. The increase in RABH peaked at T1, and continuous drooping of the sinus membrane was observed but stabilized at T3. Meanwhile, the gradual increase in the radiopacities was found below the lifted sinus membrane. The PRF filling induced the radiographic intrasinus bone gain of 2.6 ± 1.1 mm, which was significantly more than 1.7 ± 1.0 mm of saline filling at T4 (p

Purpose To present the different definitions of peri-implantitis proposed in the literature and to propose a new evidence-based etiology-driven classification of peri-implantitis to accurately and fully describe the etiology of peri-implantitis. Materials and methods Full-text papers on the selected topic were obtained for all abstracts and titles that appeared to meet the inclusion criteria. Additional papers were included from the reference lists of the selected studies. No methodologic and reporting quality of the included papers was applied in order to collect the greatest number of articles. Results One hundred twenty-two studies were found according to the search criteria. After filter activation, abstract evaluation, and duplicate removal, 16 articles were deemed useful for the aim of the present narrative review. A manual search using personal contact and references of published works and contributions by the authors included another 16 articles, resulting in a total of 32 articles. After full-text article selection and reading, 15 articles were finally included. Conclusion There is not a generally accepted classification system of the various degrees of peri-implantitis. An etiology-driven classification was proposed as a tool to assist the clinician in properly detecting and classifying etiology-based peri-implantitis. This classification may also support the assignment of prognosis, and if needed, therapy to arrest/prevent peri-implantitis.

The purpose of this study was to evaluate clinical and radiologic outcomes using a newly developed device for maxillary sinus membrane elevation. Patients with a residual bone height of at least 3 mm were enrolled. Crestal sinus lift elevation and sinus graft were performed using the crestal approach sinus (CAS) kit. Graft was avoided if the residual bone crest was ≤ 2 mm less than the length of the planned implant. Outcome measures were implant and prosthesis failure, any biologic or technical complications, and marginal bone loss (MBL). A total of 35 consecutive patients underwent 49 crestal elevations of the sinus membrane. All the implants were followed for at least 2 years after placement (mean follow-up 37.3 months; range 24 to 54 months). No implants or prostheses failed during follow-up, and no membrane tears or other intraoperative or postoperative adverse events were observed. At the 2-year follow-up, mean MBL was 0.33 ± 0.24 mm (95% confidence interval: 0.08 to 0.30 mm). A total of 32 implants were placed after filling the sinus with anorganic bovine bone, while 17 implants were placed without grafting the sinus. Post-hoc analysis was performed using the sinus grafting remodeling index (SGRI) to evaluate radiographically the tissue remodeling patterns. The SGRI was statistically significantly higher when the sinus was grafted (P = .000). The CAS kit may provide a new option for minimally invasive crestal sinus surgery. Long-term randomized controlled trials with larger sample size are needed to confirm these preliminary results.

Hydraulic sinus lift and augmentation may be successfully performed using a dedicated implant device designed according to residual bone height (RBH). The aim of this study was to evaluate whether a flapless surgical approach might negatively influence the outcome. A total of 40 consecutive patients (16 men and 24 women) were included in the study, 20 in each group (minimal flap/control versus flapless/study). Inclusion criteria were ≥ 3 mm RBH, ≥ 6 mm width of the residual alveolar ridge according to preoperative cone beam computerized tomography, and ≥ 8 mm buccopalatal keratinized gingiva for the flapless group. Primary outcome parameters included intraoperative membrane perforation. Secondary outcome parameters included postoperative infection, soft tissue healing, bone gain, and short-term dental implant survival. Mean RBH was 4.6 mm. No intraoperative membrane perforations and no postoperative infections were observed. Mean bone gain height was similar for both groups, at 11 mm. Soft tissue healing was observed within 2 months. In all cases, second-stage surgery allowed generation of at least 2 mm of keratinized gingiva buccally. All implants were osseointegrated at second-stage surgery. The use of a flapless approach to maxillary sinus augmentation using an implant device based on RBH yields predictable results.

Introduction The aim of the present systematic review was to evaluate whether there were any differences in the three-dimensional accuracy and the implant survival rate of implants placed using computer-assisted planning and surgical templates with or without metallic sleeves. Sources This systematic review was written according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered to the PROSPERO (International prospective register of systematic reviews) database. Study selection PICOS (population, intervention, control, outcomes, and studies) question was assessed, too. Search strategy encompassed the online (MedLine) literature from 1990 up to December 2020 published in English, and evaluating the accuracy of Surgical Templates with and without metallic sleeves in partial or complete patients. Only in vivo, randomized controlled trial and observational studies were included. Quality assessment of selected full text articles was performed according to the CONSORT (CONsolidated Standards of Reporting Trials) and STROBE (Strengthening the Reporting of Observational studies in Epidemiology) statement guidelines, respectively. For data analysis, the three-dimensional accuracy and the overall implant survival rate was calculated and compared between implants placed using surgical templates with or without metallic sleeves. Data A total of 12 articles fulfilled the inclusion/exclusion criteria. Data from 264 patients with 614 implants were subjected to quality assessment (templates with metallic sleeves: 279 implants and 136 patients; templates without metallic sleeves: 335 implants and 128 patients). In all the three deviation parameters (angular, vertical, and horizontal), the differences in average accuracy were noticed (angular 2.33° ± 2.01° versus 3.09° ± 1.65°, vertical: 0.62 ± 0.36 [mm] versus 0.95 ± 0.42 [mm]; and horizontal: 0.62 ± 0.41 [mm] and 1.11 ± 0.57 [mm]. No differences was found regarding overall implant survival rate (0.4891). Conclusions With the limitations of the present study, the surgical templates without metallic sleeves demonstrated high level of accuracy in all the three-dimensional measurements, when used to rehabilitate partial edentulous patients. Further randomized controlled trials, reporting according to the CONSORT guidelines are needed to confirm that the differences in accuracy depended on the type of used templates.

Purpose: To report survival rate, early surgical template-related complications, and prevalence of periimplantitis of dental implants placed in private practices using computer-guided, template-assisted surgery and followed between 1 and 10 years. Materials and Methods: The present retrospective multicenter study evaluated data collected from fully or partially edentulous patients, with anodized-surface implants placed using computer-guided, template-assisted surgery between January 2006 and December 2015. The outcome measures were implant cumulative survival rate (CSR), early surgical complications involving the surgical template, and prevalence of peri-implantitis. Results: A total of 694 implants were placed in 141 patients. Ten patients (7.1%) with 48 implants (6.9%) dropped out during the study period. One hundred seventeen patients, who received 121 surgical and prosthetic procedures, were treated according to a double-scan protocol, while the remaining 24 patients were treated by using the integrated treatment workflow. Most of the implants were immediately loaded (528 implants, 76.1%; 112 patients, 79.4%). Overall, 107 complete full-arch restorations (supported by four to eight implants each) were delivered in 103 patients (73%) with 595 implants (85.7%), while 13 single and 30 partial restorations (two to five implants each) were delivered in 38 patients (27%) with 99 implants (14.3%). Patients were followed for up to 10 years (mean: 58.2 months, range: 12 to 120 months). Implant- and patient-level CSR (Kaplan-Meier estimation) at the 10-year follow-up was 97.4% (95% CI: 1.0309 to 0.9161) and 92.1% (95% CI: 1.1575 to 0.6836), respectively. All failed implants were lost before definitive prosthesis delivery (early failure). Ten (7.1%) minor template-related complications were experienced and resolved chairside. Over the entire follow-up period, four patients (2.8%) with 12 implants (1.7%) showed signs of peri-implantitis at the 1- (four implants), 2- (four implants), and 4-year (four implants) visits. Conclusion: High long-term survival rates and low complications and prevalence of peri-implantitis were observed for a large cohort of anodized-surface implants placed in private practices. Further studies are needed to confirm these preliminary results.

To compare accuracy and complications of computer-assisted template-based implant placement using conventional impression and scan of a physical stone cast or intraoral scanning to rehabilitate partially edentulous patients.Any partially edentulous patients with at least five residual teeth, requiring at least one implant to be planned on three-dimensional (3D) cone beam computed tomography (CBCT) scan according to a computer-assisted template-based protocol were enrolled. Patients were randomised according to a parallel-group design into two arms: intraoral digital impression (fully digital group) or conventional impression and scan model (conventional group). Implants were placed flapless or with a minimally invasive flap, and conventionally loaded after 5 months. Outcome measures were implant and prosthetic success, complications, accuracy and peri-implant marginal bone loss. Three deviation parameters (angular, horizontal and vertical) were defined to evaluate the discrepancy between the planned and placed implant positions. Results were compared using a mixed-model repeated-measures analysis of variance (α = 0.05).Twenty patients (11 females and 9 males; mean age 44.6 years old) were randomised to the fully digital group (10 patients with 28 implants) or conventional group (10 patients with 29 implants). No patients dropped out. No implant or prosthesis failed up to 1 year after loading. One implant in the fully digital group was placed freehand due to limited inter-arch space. No biological or mechanical complications were experienced during follow-up. Difference between groups were not statistically significant (P = 0.999). The mean error in angle was 2.25 ± 1.41 degrees (range 0.30 to 5.00 degrees; 95% CI: 1.38 to 3.12 degrees) in the fully digital group and 2.10 ± 1.18 degrees (range 0.30 to 5.80 degrees; 95% CI: 1.37 to 2.83 degrees) in the conventional group. The difference was not statistically significant (-0.15 ± 1.63 degrees; range -3.20 to 2.90 degrees; 95% CI: -0.87 to 0.57 degrees; P = 0.668); in the horizontal plane (mesio-distal), the mean error was 0.52 ± 0.30 mm (range 0.10 to 1.10 mm; 95% CI: 0.33 to 0.70 mm) in the fully digital group and 0.44 ± 0.26 mm (range 0.10 to 0.90 mm; 95% CI: 0.27 to 0.60 mm) in the conventional group. The difference was not statistically significant (-0.08 ± 0.38 degrees; range -1.0 to 0.60 degrees; 95% CI: -0.32 to 0.16 degrees; P = 0.279); in the vertical plane (apico-coronal), the mean error was 0.58 ± 0.44 mm (range 0.00 to 1.60 mm; 95% CI: 0.31 to 0.85) in the fully digital group and 0.46 ± 0.34 mm (range 0.00 to 1.20 mm; 95% CI: 0.25 to 0.67) in the conventional group. The difference was not statistically significant (-0.12 ± 0.59 degrees; range -1.20 to 1.00 degrees; 95% CI: -0.49 to 0.24 degrees; P = 0.250). One year after loading, the mean marginal bone loss was 0.14 ± 0.12 mm (range -0.10 to 0.40 mm; 95% CI: 0.07 to 0.21 mm) in the fully digital group and 0.18 ± 0.13 mm (range -0.10 to 0.60 mm; 95% CI: 0.09 to 0.26 mm). The difference was not statistically significant (-0.04 ± 0.19 mm; range -0.50 to 0.30 mm; 95% CI: -0.16 to 0.08 mm; P = 0.294).With the limitations of the present trial, implant rehabilitations planned using intraoral digital impressions showed similar results compared to conventional impression and scan model. Digital impression may be a viable option for the rehabilitation of partial edentulous patients when computer-guided template-assisted implant placement is used.

Background Cawood-Howell class IV atrophies, also known as "knife-edge" ridges, represent a serious horizontal defect, making the placement of regular implants challenging. Aim To clinically and radiographically evaluate bone regeneration of severe horizontal bone defects with 3 years of follow-up. Materials and methods This study was designed as a single cohort, prospective clinical trial. Patients having horizontal bone width of 4 mm or less in the posterior mandible or maxilla were treated with resorbable collagen membranes and a 1:1 mixture of anorganic bovine bone (ABB) and autogenous bone. Implants were inserted and loaded 7 months later. Outcomes were implant and prosthetic survival rates, any biological and prosthetic complications, horizontal and volumetric bone dimensional changes measured on cone beam computer tomography (CBCT), peri-implant marginal bone level (MBL) changes measured on periapical radiographs, plaque index (PI), and bleeding on probing (BOP). Results Eighteen patients received 55 implants. No patient dropped-out. No implant and prosthetic failures and no complications were recorded. Super imposition of pre and 7-month postoperative CBCT scans revealed an average horizontal bone gain of 5.03 ± 2.15 mm (95% CI: 4.13-5.92 mm). After 3 years, mean MBL was 1.15 ± 0.28 mm (95% CI 0.84-1.22 mm). The PI was 11.6%, and BOP was 5.2%. Conclusion Within the limitations of the present study, high implant survival rate and high average bone augmentation seem to validate the use of collagen resorbable membranes with a 1:1 mixture of particulate ABB and autogenous bone for the reconstruction of Cawood-Howell class IV alveolar ridge atrophies.

Biochemical modification of titanium surfaces (BMTiS) entails immobilization of biomolecules to implant surfaces in order to induce specific host responses. This crossover randomized clinical trial assesses clinical success and marginal bone resorption of dental implants bearing a surface molecular layer of covalently-linked hyaluronan in comparison with control implants up to 36 months after loading. Patients requiring bilateral implant rehabilitation received hyaluronan covered implants in one side of the mouth and traditional implants in the other side. Two months after the first surgery, a second surgery was undergone to uncover the screw and to place a healing abutment. After two weeks, the operator proceeded with prosthetic procedures. Implants were evaluated by periapical radiographs and the crestal bone level was recorded at mesial and distal sites&mdash, at baseline and up to 36 months. One hundred and six implants were positioned, 52 HY-coated, and 48 controls were followed up. No differences were observed in terms of insertion and stability, wound healing, implant success, and crestal bone resorption at any time considered. All interventions had an optimal healing, and no adverse events were recorded. This trial shows, for the first time, a successful use in humans of biochemical-modified implants in routine clinical practice and in healthy patients and tissues with satisfactory outcomes.

To compare outcomes of immediate non-occlusal loading with delayed implant loading in the bilateral replacement of mandibular first molars.This study was designed as a split-mouth, randomised controlled trial. Twenty patients with bilaterally missing mandibular first molars randomly received immediately or conventionally loaded single implants. One molar was restored with a non-occlusal temporary crown within 24 hours after implant placement (immediate loading group, IL) while the contralateral molar was restored with a definitive crown 4 to 5 months later (delayed loading group, DL). A total of 40 implants were installed. All implants were inserted in healed bone with an insertion torque between 35 and 45 Ncm. Outcome measures were implant failure, complications, radiographic marginal bone level changes, probing pocket depths (PPDs) and bleeding on probing (BOP). Clinical data were collected at implant placement, and after 6, 12 and 60 months.No patients dropped out and no implant failed. Only minor prosthetic complications were observed (two provisional acrylic crown fractures in the IL group and four ceramic chipping in the DL group). Two patients had bilateral peri-implant mucosal inflammation with BOP after 6 months. The differences between groups were not statistically significant (OR = 0.500; 95% CI: 0.045 to 3.489; P = 0.6831). At the 1-year follow-up examination, the mean marginal bone level was 0.83 ± 0.16 mm (95% CI: 0.75 to 0.91) in the IL group and 0.86 ± 0.16 mm (95% CI: 0.78 to 0.94) in the DL group, with no statistically significant differences between groups (difference = 0.03 ± 0.15 mm; 95% CI: -0.07 to 0.07; P = 0.53). After 5 years, mean marginal bone level was 1.06 ± 0.38 mm (95% CI: 0.97 to 1.15) in the IL group and 1.07 ± 0.32 mm (95% CI: 0.95 to 1.16) in the DL group, with no statistically significant differences between groups (difference = 0.01 ± 0.22 mm; 95% CI: -0.10 to 0.10; P = 0.96). The mean marginal bone loss after 5 years was 0.62 ± 0.45 mm in the IL group and 0.69 ± 0.33 mm in the DL group (difference = 0.07 ± 0.32 mm; 95% CI: -0.10 to 0.18; P = 0.567). At the 5-year follow-up the mean PPD and BOP values were 2.82 ± 0.65 mm and 1.17 ± 0.92 in the IL group, and 2.85 ± 0.53 mm and 1.17 ± 0.86 in the DL group, respectively. No significant differences were found (difference = 0.03 ± 0.15 mm; 95% CI: -0.15 to 0.21; P = 0.990; and 0.01 ± 0.07; 95% CI: -0.06 to 0.08; P = 1.000, respectively).Within the limitations of this study, the present data seem to confirm the hypothesis that the clinical outcome of immediate versus delayed loading of implants in mandibular fist molar sites is comparable.

To ascertain whether in the presence of a previously endodontically treated tooth with periapical pathology and/or symptoms and an uncertain prognosis, it is better to endodontically retreat it or to replace the tooth with a single-implant-supported crown.Twenty patients requiring the treatment of a previously endodontically treated tooth, with periapical pathology and/or symptoms of endodontic origin and an uncertain prognosis, as judged by the recruiting investigator, were randomly allocated to endodontic retreatment (Endo group, 10 patients) or tooth extraction and replacement with an implant-supported crown (Implant group, 10 patients) according to a parallel-group design at a single centre. Patients were followed to 3 years after completion of the treatment. Outcome measures were: failure of the procedure, complications, marginal bone level changes at both teeth and implants, endodontic radiographic success (teeth only), number of patients' visits and days to complete the treatment, patients' chair time, costs, aesthetics assessed using the pink aesthetic score (PES) for the soft tissues and the white aesthetic score (WES) for the tooth/crown recorded by independent assessors.No patient dropped out. One endodontically retreated tooth fractured and another had a crown loosening. There were no statistically significant differences for treatment failure or complications (difference in proportions = 0.10; 95% CI: -0.09 to 0.29; P (Fisher exact test) = 1.000). The mean marginal bone levels at endodontic retreatment/implant insertion were 2.10 ± 0.66 mm for the Endo group and 0.05 ± 0.15 mm for the Implant group. Three years after completion of the treatment, teeth lost on average 0.23 ± 0.82 mm and implants 0.62 ± 0.68 mm, the difference not being statistically significant (mean difference = -0.39 mm; 95% confidence interval [CI]: -1.12 to 0.33; P (t test) = 0.267). Three years after completion of the endodontic retreatment, of the four teeth that originally had a periapical radiolucency, one was lost, two showed complete healing, and one showed radiographic improvement. There were no statistically significant differences for the number of patients' visits (Endo = 6.67 ± 0.71; Implant = 6.10 ± 0.74; mean difference = 0.57; 95% CI: -0.14 to 1.27; P (t test) = 0.106). It took significantly more days to complete the implant rehabilitation (Endo = 61 ± 12.97; Implant = 191.40 ± 75.04; mean difference = -130.40; 95% CI: -184.45 to -76.35; P (t test)0.001) but less patients' chair time (Endo = 629.44 ± 43.62 min; Implant = 326 ± 196.99 min; mean difference = 303.44; 95% CI: 160.87 to 446.02; P (t test) = 0.001). Implant treatment was significantly more expensive (Endo = €1,588.89 ± 300.81; Implant = €2,095 ± 158.90; mean difference = €-506.11; 95% CI: -735.41 to -276.82; P (t test)0.001). Three years after treatment completion, mean PES were 11.11 ± 1.97 and 6.50 ± 2.46 and mean WES were 7.78 ± 1.30 and 6.80 ± 2.39 in the Endo group and Implant group, respectively. Soft tissues aesthetics (PES) were significantly better at endodontically retreated teeth (mean difference 4.61; 95% CI: 2.44 to 6.78; P (t test)0.001) whereas no significant differences were observed for tooth aesthetics (WES) (mean difference 0.98; 95% CI: -0.89 to 2.85; P (t test) = 0.281) between treatments.The present preliminary results suggest that both endodontic retreatment and replacement of previously endodontically treated teeth with persisting pathology and a dubious endodontic prognosis provided similar short-term success rates. Aesthetics of the soft tissues and time needed to complete treatment were in favour of endodontic retreatment whereas implant rehabilitation required half of the chair time than endodontic retreatment, but was significantly more expensive. Much larger patient populations and longer follow-ups are needed to fully answer this question; however, in this scenario the less invasive endodontic retreatment could be the first therapeutic option to be considered.

Introduction Plasma application can lead to an improved adhesion between soft tissue and abutments and promotes cell spreading. Objective A triple-blinded randomized controlled clinical trial was performed to in vivo test the effect of cleaning abutment titanium surfaces with plasma of argon on cell adhesion and collagen fiber orientation at an early healing time. Material and methods Thirty healthy patients with 30 submerged implants, at the second surgery, randomly received either a specially designed abutment with no additional treatment (as they come from industry; control group, G1) or cleaned by plasma of argon (test group, G2). Two weeks thereafter, a small biopsy including abutment and soft tissues around the abutment was performed. Abutments were analyzed using scanning electron microscopy to assess cell adhesion to the abutment surface. Outcome measures were the following: percentage of area occupied by cells, the presence or absence of cells, aspect of adhered cells, and the presence of contaminants. At the same time, the soft tissue histological analysis evaluated density and orientation of collagen fibers. Statistical analysis was performed using the Kolmogorov–Smirnov normality test and Levene variance homogeneity test. Data were analyzed using a nonparametric ranking test. The associations between the different qualitative variables were studied using Pearson's chi-squared test. The Mann–Whitney U-test (for two independent samples) was applied for quantitative variables. Results Mean percentages of area occupied by cells were 15.14% (range 2.91–44.27) and 33.75% (range 2.37–68.4) for G1 and G2, respectively. Differences were close to significance (P = 0.089). The proportion of samples presenting adhered cells was homogeneous between the two groups (P = 0.142). In all cases, cells presented a flattened aspect, but not in three cases in the G2; in 17 cases, cells were efficiently adhered, and in 11 cases, cells presented filopodia with no statistical differences between groups (P > 0.05). No case from G2 showed contamination with cocobacteria with statistical differences between groups (P = 0.006). Collagen fiber density was higher in the basal, medial, and coronal area of G2 compared to G1 with a statistical difference in the internal area (P

Purpose To evaluate clinical and radiographic performance of a novel implant system that allows for hydraulic Schneiderian membrane elevation and simultaneously bone graft augmentation. Materials and methods Sixty-two consecutive patients with a mean age of 53.1 years and a severe atrophy of the posterior maxilla (3.0 to 7.0 mm) underwent 64 transcrestal sinus floor elevations and submerged implant placement. The following clinical and radiographic parameters were assessed: implant failure, any complications and bone gain measured using cone beam computed tomography. Results No patient dropped out. No implants failed and all the prostheses were uneventful at the last follow-up examination (mean 23.0 months; range 12–45). All the procedures were completed successfully, with elevation of the sinus membrane and insertion of bone graft and the dental implant at the planned site. No intraoperative or postoperative adverse events were observed, such as membrane tears or facial hematoma. The mean residual alveolar ridge height was 5.2 ± 1 mm (range 3.3–7.0 mm). Mean bone gain was 10.9 ± 2.43 mm (range 5.3–16.5) after an average healing period of 8 months. Conclusions Hydraulic elevation of the Schneiderian membrane using the iRaise sinus-lift system (Maxillent Ltd) can be considered a valuable treatment option for the rehabilitation of atrophic edentulous posterior maxillae.

The aim of this study was to evaluate retrospectively biologic and technical complications as well as clinical and radiographic outcomes of patients treated with 4 implants according to the All-on-4 protocol and followed up to 7 years of function. Data from 56 consecutive patients presenting complete edentulous jaw, aged 18 years or older, treated between January 2008 and December 2013, were evaluated. The outcomes were implant and prosthetic survival and success rates, any complications, and marginal bone loss (MBL). Two-hundred twenty-four implants were placed in 56 patients. During the entire follow-up, 1 maxillary implant but no prosthesis failed during the healing process. Fourteen patients experienced 1 complication each (10 technical, 4 biologic). The overall implant and prosthetic success rate was 98.2% and 82.1%, respectively. All complications were considered as minor and successfully resolved chairside. A mean MBL of 1.30 ± 0.63 mm was observed at the last follow-up. Statistically significant difference was found for postextractive implants (0.79 ± 0.26) vs implants placed in healed sites (1.03 ± 0.46; P = 0.024). Within the limits of the present study, the All-on-4 concept may be a valuable surgical and prosthetic option for the treatment of complete edentulous jaws. However, minor technical and biologic complications can occur. Further long-term prospective data with primary outcomes focused on success rates are needed.

The aim of this in vitro study was to evaluate the early cell response and protein adsorption elicited by the argon plasma treatment of different commercially available titanium surfaces via a chair-side device. Sterile disks made of grade 4 titanium ( n = 450, 4-mm diameter) with 3 surface topographies (machined, plasma sprayed, and zirconia blasted and acid etched) were allocated to receive 4 testing treatments (2% and 10% protein adsorption and cell adhesion with MC3T3-E1 and MG-63). Furthermore, the specimens were divided to undergo 1) argon plasma treatment (10 W, 1 bar for 12 min) in a plasma reactor, 2) ultraviolet (UV) light treatment for 2 h (positive control group), or 3) no treatment (control group). Pretreatment surface analyses based on a scanning electron microscope and profilometer images were also performed. Profilometric analysis demonstrated that the evaluated specimens perfectly suit the standard parameters. The use of argon plasma was capable of affecting the quantity of proteins adsorbed on the different surfaces, notwithstanding their roughness or topographic features at a low fetal bovine serum concentration (2%). UV light treatment for 2 h attained similar results. Moreover, both the plasma of argon and the UV light demonstrated a significant increase in the number of osteoblasts adherent at 10 min in all tested surfaces. Within its limitations, this in vitro study highlights the potential biological benefits of treating implant surfaces with plasma of argon or UV, irrespective of the roughness of the titanium surface. However, in vivo experiments are needed to confirm these preliminary data and settle the rationale of a treatment that might be clinically relevant in case of bone-reparative deficiencies.

Background The insertion of dental implants by means of computer-assisted template-based surgery is an established method. Purpose To investigate the accuracy of a newly developed sleeve-designed template and to evaluate differences between maxillary and mandibular implants as well as anterior versus posterior area. Materials and methods Any partially edentulous patients requiring at least one implant to be planned on three-dimensional cone beam computed tomography scan, according to a computer-assisted template-based protocol, were consecutively enrolled at two centers. Any potential implant position was considered eligible for the present trial. Outcome measures were: implant failure, complications, and accuracy. Results A total of 39 patients with 119 implants were evaluated. No patients dropped out during the study period (mean follow-up 12.4 ± 7.1 months). Three implants failed at centre two, whereas, one complication was experienced at centre one (limited access in posterior area). Differences were not statistically significant (P > .05). The mean deviations were 0.53 ± 0.46 mm (range 0.05-3.38 mm; 95% CI 0.32-0.48 mm) in the horizontal plan (mesio-distal); 0.42 ± 0.37 mm (range 0.0-1.53 mm; 95% CI 0.26-0.40 mm) in the vertical plan (apico-coronal); and 1.43 ± 1.98° (range 0.03-11.8°; 95% CI 0.31-1.01°) in angle. Differences between centers were compared using the nonparametric Mann-Whitney U test (P > .05). More accurate results were found for anterior implants in both horizontal plan and angle. Conclusion This study showed good precision in all the parameters measured. The results were thus in a range equal to or better than the mean precision found in numerous clinical trials described in the literature. Posterior implants were less accurate because of the use of open sleeves template.

To compare planning and patient rehabilitation using 3D implant planning software and dedicated surgical templates with conventional freehand implant placement for the rehabilitation of partially or fully edentulous patients using flapless or mini-flap procedures and immediate loading.Patients requiring at least two implants to be restored with a single prosthesis, having at least 7 mm of bone height and 4 mm in bone width were consecutively enrolled. Patients were randomised according to a parallel group study design into two groups: computerguided group or conventional freehand group. Implants were loaded immediately with a provisional prosthesis, replaced by a definitive prosthesis 4 months later. Outcome measures assessed by a blinded independent assessor were: implant and prosthesis failures, any complications, marginal bone levels, number of treatment sessions, duration of treatment, post-surgical pain and swelling, consumption of pain killers, surgical and prosthetic time, time required to solve complications, and patient satisfaction. Patients were followed up to 5 years after loading.Ten patients (32 implants) were randomised to the computer-guided group and 10 patients (30 implants) were randomised to the freehand group. At the 5-year follow-up examination one patient of the computer-guided group and one of the freehand group dropped-out (both moved to another country). No prostheses failed during the entire follow-up. Two implants failed in the conventional group (6.6%) vs none in the computer-guided group (P = 0.158). Ten patients (five in each group) experienced 11 complications (six in the computer-guided group and five in the freehand group), that were successfully solved. Differences between groups for implant failures and complications were not statistically significant. Five years after loading, the mean marginal bone loss was 0.87 mm ± 0.40 (95% CI: 0.54 to 1.06 mm) in the computer-guided group and 1.29 mm ± 0.31 (95% CI: 1.09 to 1.51 mm) in the freehand group. The difference was statistically significant (difference 0.42 mm ± 0.54; 95% CI: 0.05 to 0.75; P = 0.024). Patient self-reported post-surgical pain (P = 0.037) and swelling (P = 0.007) were found to be statistically significant higher in patients in the freehand group. Number of sessions from patient's recruitment to delivery of the definitive prosthesis, number of days from the initial CBCT scan to implant placement, consumption of painkillers, averaged surgical, prosthetic, and complication times, were not statistically significant different between the groups. At the 5-year followup, all the patients were fully satisfied with the function and aesthetics of their definitive prostheses.Both approaches achieved successful results over the 5-year follow-up period. Statistically higher post-operative pain and swelling were experienced at sites treated freehand with flap elevation. Less marginal bone loss (0.4 mm) was observed in the computer-guided group, at 5 years follow-up.

To present the medium-term results of one-stage guided bone regeneration (GBR) using autologous bone and anorganic bovine bone, placed in layers, in association with resorbable collagen membranes, for the reconstruction of horizontal bony defects.This study was designed as an uncontrolled prospective study. Partially edentulous patients, having less than 6.0 mm and more than 4.0 mm of residual horizontal bone width were selected and consecutively treated with simultaneously implant installation and bone regeneration by using 2.0 mm of autologous bone and 2.0 mm of anorganic bovine bone that was placed in layers and then covered with a resorbable collagen membrane. Outcome measures were: implant and prosthesis failures, any complications, peri-implant marginal bone level changes, probing pocket depth (PPD) and bleeding on probing (BOP).In total, 45 consecutive patients (20 male, 25 female) with a mean age of 52.1 years each received at least one GBR procedure, with contemporary placement of 63 implants. At the 3-year follow-up examination, no patient had dropped out and no deviation from the original protocol had occurred. No implant or prosthesis failed. In six patients (13.3%) the collagen membrane was slightly exposed 1 to 2 weeks after bone reconstruction. Four of these patients were moderate smokers. Post-hoc analysis using Fisher's exact test found significant association (P = 0.0139) between a smoking habit and early membrane exposure. Mean marginal bone loss experienced between initial loading and 30 months afterwards was 0.60 ± 0.20 mm (95% CI 0.54 - 0.66). The mean BOP values measured at the definitive restoration delivery were 1.23 ± 0.93, while 2 years later they were 1.17 ± 0.78. The difference was not statistically significant (-0.06 ± 0.76; P = 0.569). The mean PPD values measured at the definitive restoration delivery were 2.62 ± 0.59 mm, while 2 years later they were 2.60 ± 0.54 mm. The difference was not statistically significant (-0.03 ± 0.62; P = 0.765).Within the limitations of the present study, the use of a 2.0 mm layer of particulated autologous bone on the implant threads, and a 2.0 mm layer of anorganic bovine to cover the resorbed ridge, in combination with the resorbable collagen membrane, seems to be a viable treatment option for the reconstruction of horizontal bony defects.

Purpose. Instead of original abutments, compatible abutments are often selected for financial reasons. The present study aimed to evaluate mechanical outcomes, microleakage, and marginal accuracy at the implant-abutment interface of original versus nonoriginal implant abutments. Study Selection. Search strategy encompassed literature from 1967 up to March 2017 to identify relevant studies meeting the inclusion criteria. The following electronic databases were consulted: PubMed database of the U.S. National Library of Medicine, Embase (Excerpta Medica dataBASE), and the Grey Literature Database (New York Academy of Medicine Grey Literature Report). Quality assessment of the full-text articles selected was performed. Abutments were classified in original (produced by the same implant manufacturer), nonoriginal certified (produced by a third-party milling center, certified by implant companies), and nonoriginal compatible (produced by a third-party milling center for similar connections). Results. A total of 16 articles fulfilled inclusion criteria and quality assessment and were selected for the qualitative analysis. All of the included studies were in vitro research with high or moderate risk of bias and reported data from 653 implant abutments. Original and nonoriginal certified abutments showed better results in terms of mechanical outcomes, microleakage, and marginal accuracy compared to nonoriginal compatible abutments. Conclusions. Following the clear warnings coming from the present systematic review, clinical suggestions regarding the effect of a nonoriginal abutment can be drawn. However, in vivo, long-term, randomized controlled trials are needed to provide definitive clinical conclusion about the long-term clinical outcomes of original and nonoriginal abutments.

Objective To evaluate the 3-year clinical and radiographic data of fixed implant-supported dental prosthesis delivered to patients having taken alendronate 35–70 mg weekly for at least 3 years before implant placement. Materials and Methods Forty consecutive patients treated with oral bisphosphonates and requiring an implant-supported restoration were recruited in two private centers between January 2008 and December 2011. Implants were inserted through minimally invasive approach under antibacterial and antibiotic treatment, 6 months after alendronate administration stopping. After 4 months of submerged healing, implants underwent prosthetic loading. Hygiene maintenance and clinical assessments were scheduled every 4 months for 3 years. Outcome measures were the following: implant and prosthetic success, survival rates, any observed clinical complications, marginal bone remodeling, probing pocket depth and bleeding-on-probing. Results At the end of the study, eight patients dropped out. The final sample size resulted in 32 consecutive partially or fully edentulous patients (32 females; mean age 64.6 years) with 98 submerged implants. In only one patient, maxillary implant failed during healing period. No prosthesis failed during the entire follow-up, and no major complications were recorded. Implant and prostheses success resulted in an overall survival rate of 98, 98% and 100%, respectively. Three-year mean marginal bone loss was 1.35 ± 0.21 (CI 95% 1.24–1.38). Successful soft tissue parameters were found around all implants. Conclusions Oral bisphosphonate therapy did not appear to significantly affect implant survival and success in case of accurate treatment time selection, minimally invasive surgical approach and constant follow-up. Further prospective studies involving larger sample sizes and longer durations of follow-up are required to confirm these results.

To evaluate the clinical and radiographic outcomes of a one-stage crestal sinus elevation procedure using a self-tapping endosseous implant system (iRaise, Maxillent, Herzliya, Israel) developed for sinus augmentation, 1 year after loading.Patients needing restoration in the posterior maxilla with a residual alveolar crest of 3 to 8 mm in height and 5 mm in width distal to the canine as measured on CBCT scan were treated using the iRaise sinus lift system. Outcome measures were: implant and prosthetic failures, any complications, increased bone height (iBH), marginal bone loss (MBL), implant stability quotient (ISQ), radiographic tissue remodelling patterns using the sinus grafting remodelling index (SGRI), volumetric measurements of sinus graft, patient self-reported post-surgical swelling, consumption of pain medication and histological analysis.A total of 30 consecutive participants with a mean age of 54.2 ± 9.4 years underwent a transcrestal elevation of the sinus membrane, insertion of bone graft, and implant placement. A total of 50 implants were placed (30 iRaise system implants and 20 adjunctive iSure implants, Maxillent). The mean follow-up was 15.8 ± 2.1 months after implant loading. One patient dropped out at the 1-year after loading follow-up examination. No implants and no prostheses failed during the entire follow-up. One patient experienced a small membrane tear. Before implant insertion, the mean residual alveolar ridge height was 4.64 ± 0.86 mm (range: 3.4-6.4 mm; 95% CI: 4.39-5.01 mm). One year after loading, the bone height was 16.86 ± 3.13 mm (95% CI 15.83-18.07 mm). At the 1-year after loading follow-up, the mean MBL was 0.19 ± 1.05 mm (95% CI 0.02-0.78 mm). The mean ISQ at implant placement was 65.2 ± 5.4 (95% CI 63.6-67.4) and increased during the healing period reaching the mean value of 73.6 ± 3.7 (95% CI 73.1-75.9; range 62-79). The difference was statistically significant (8.4 ± 5.3; 95% CI 5.9-39.7; P = 0.0000). One year after loading, SGRI score was evaluated in 23 implants. Overall, the mean SGRI value was 2.29 ± 2.41 mm (95% CI 1.22-2.98 mm). Bone volume at implant placement was 2.41 ± 0.25 CC (95% CI 2.22-2.48 CC). During the 6-month, submerged healing period, a slight bone contraction of 11.3% were observed. (2.13 ± 0.24 CC;95% CI 2.02-2.26; difference = 0.27 ± 0.25 CC; 95% CI 0.10-0.36; P = 0.0011). At the first year post-loading period, the bone graft remained stable (2.11 ± 0.22 CC; 95% CI 2.02-2.24). The difference was not statistically significant (0.02 ± 0.07 CC; 95% CI 0.01-0.04; P = 0.2166). From the patient's point of view, the mean pain value was 0.52 ± 0.74 (range 0-3); mean swelling value was 0.27 ± 0.52 (range 0-2); and the mean consumption of analgesic was 0.87 ± 4.94 tablets (range 0-4) 3 days after surgery. Morphological and histomorphometric analyses showed that all the samples had a normal structure without inflammatory infiltrate, six months after healing. The following fractions (%) were found: bone (immature bone + mature bone): 44.07 ± 4.91; residual biomaterial: 23.98 ± 2.64; medullary spaces: 31.95 ± 3.16.Sinus floor augmentation can be successfully accomplished with a transcrestal approach using a dedicated implant system. A physiologic contraction of 11.3% of the original volume of the bone graft was experienced during the first 6 months of healing; afterwards, no additional graft volume reduction was observed. Long-term clinical studies are needed to confirm these preliminary results.

To ascertain whether in the presence of a previously endodontically treated tooth with a periapical pathology and/or symptoms and an uncertain prognosis, it is better to endodontically retreat it or to replace the tooth with a single implant-supported crown.Forty patients requiring the treatment of a previously endodontically treated tooth, with a periapical pathology and/or symptoms of endodontic origin and an uncertain prognosis, as judged by the recruiting investigators, were randomly allocated to endodontic retreatment (endo group; 20 patients) or tooth extraction and replacement with an implant-supported crown (implant group; 20 patients) according to a parallel group design at two different centres. Patients were followed to 1 year after completion of the treatment. Outcome measures were: failure of the procedure, complications, marginal bone level changes at both teeth and implants, endodontic radiographic success (teeth only), number of patients' visits and days to complete the treatment, patients' chair time, costs, aesthetics assessed using the pink esthetic score (PES) for the soft tissues and the white esthetic score (WES) for the tooth/crown recorded by independent assessors.No patient dropped out and no complications occurred during the entire follow-up; however, one endodontically retreated tooth (5%) and one implant (5%) fractured, the difference for treatment failures being not statistically significant (difference in proportions = 0; 95% CI -0.14 to 0.14; P Fisher's exact test) = 1.000). The mean marginal bone levels at endo retreatment/implant insertion were 2.34 ± 0.88 mm for the endo and 0.23 ± 0.35 mm for the implant group, which was statistically significantly different (mean difference = 2.11 mm; 95% CI: 1.68 to 2.55; P (t-test)0.001). One year after completion of the treatment, teeth lost on average 0.32 ± 0.53 mm and implants 0.48 ± 0.72, the difference not being statistically significant (mean difference = -0.16 mm; 95% CI: -0.58 to 0.27; P (t-test) = 0.457). One year after completion of the endodontic retreatment, of the 13 teeth that originally had a periapical radiolucency, one was lost, six showed complete healing; four a radiographic improvement; and two showed no changes/worsening. Two of the teeth originally without a lesion developed a lesion. There were no statistically significant differences for the number of patients' visits (endo = 5.2 ± 1.8; implant = 5.5 ± 1.1; mean difference = -0.03 95% CI: -1.24 to 0.64; P (t-test) = 0.522). It took significantly more days to complete the implant rehabilitation (endo = 48.9 ± 19.5; implant = 158.5 ± 67.2; mean difference = -109.60; 95% CI: -141.26 to -77.94; P (t-test)0.001), but less patients' chair time (endo = 405.5 ± 230.3 min; implant = 260.0 ± 154.6 min; mean difference = 45.50; 95% CI: 19.35 to 271.65; P (t-test) = 0.025). Implant treatment was significantly more expensive (endo = 1195 ± 503.7 €; implant = 1907.5 ± 232.4 €; mean difference = -712.50; 95% CI: -963.59 to -461.41; P (t-test)0.001). One year after treatment completion, the mean PES was 10.92 ± 1.93 and 7.07 ± 2.87 and the mean WES was 7.67 ± 1.83 and 7.60 ± 2.32 in the endo group and implant group, respectively. Soft tissues aesthetics (PES) was significantly better at endodontically retreated teeth (mean difference 3.85; 95% CI 1.94 to 5.76; P (t-test)0.001) whereas no significant differences were observed for tooth aesthetics (WES) (mean difference 0.07; 95% CI -1.62 to 1.76; P (t-test) = 0.936) between treatments.The preliminary results suggest that both endodontic retreatment and replacement of previously endodontically treated teeth with persisting pathology and a dubious endodontic prognosis provided similar short-term success rates. Aesthetics of the soft tissues and time needed to complete treatment were in favour of endodontic retreatment, whereas implant rehabilitation required half of the chair time than endodontic retreatment, but was significantly more expensive. Although much larger patient populations and longer follow-ups are needed to fully answer this question, in this scenario the less invasive endodontic retreatment could be the first therapeutic option to be considered.

The purpose of this prospective cohort study was to investigate, over an 18-month period, soft and hard tissue response to a transmucosal implant with a convergent collar inserted in the anterior maxillary esthetic area.From June 2013 to January 2014, 14 consecutive patients were enrolled (7 men and 7 women; mean age 63.7 ± 14 years) with 20 implants, needing at least one implant-supported restoration between the canines in the maxillary anterior esthetic area. Six months after hopeless tooth extraction and an alveolar socket graft, a transmucosal-type implant with convergent collar walls was inserted in a midcrestal position with mini-flap surgery. An impression was taken 2 months later, and a definitive abutment with a provisional restoration was positioned. The final restoration was seated 2 weeks later. Clinical parameters, photographs, radiographs, and impressions were taken at this timepoint, and after 6 and 18 months. Using dedicated software, radiographic analysis (to detect marginal bone-level changes) and cast analysis (to detect soft tissue vertical and horizontal changes) were performed.At the 18-month follow-up, all implants were clinically osseointegrated, stable, and showed no sign of infection. At baseline, interproximal radiographs revealed no bone defect around the implant. After an initial minimal bone loss (0.09 ± 0.144 mm), radiographic analysis showed a stable condition of bone remodeling (mean value 0.09 ± 0.08; range 0.0 to 0.5 mm) at the 18-month follow-up. No statistically significant horizontal dimensional changes of the alveolar ridge were observed between each timepoint. Mean soft tissue levels significantly improved between baseline and 18 months. The mean heights of the mesial papilla (MP) and distal papilla (DP) changes were 0.38 ± 0.22 and 0.47 ± 0.31, respectively. The level of the labial gingival margin (LGM) was 1.01 ± 0.63. Periodontal parameters never exceeded the physiological levels.Within the limitations of this preliminary study, the analyzed implants produced positive results in these esthetically demanding cases. This outcome should encourage long-term studies in order to assess, through controlled clinical trials, whether this convergent collar design offers advantages over other designs. Furthermore, due to the peculiar crestal module, together with the use of delayed implant insertion and a postextraction ridge preservation technique with biomimetic hydroxyapatite, the analyzed implants seem to help prevent the negative bone remodeling typically associated with two-piece implant systems, but without the well-known drawbacks of traditionally designed transmucosal implants. Therefore, wherever crestal bone preservation is a critical issue for clinical success in the anterior maxillary area can be considered of particular interest.

Purpose To assess whether repeated abutment disconnections and reconnections have any impact on peri-implant bone resorption and soft tissue healing. Materials and Methods Electronic and manual searches were conducted for English-language articles published up to March 2017 that identified a relation between repeated disconnections of implant abutments (PA group) and prosthetic or implant failures, complications, marginal bone loss (MBL), soft tissue healing, and esthetic evaluation (pink esthetic score [PES]) after at least 1 year of function compared with implants receiving a final abutment at the time of implant placement (DA group). Results Fourteen articles (535 patients with 994 implants) were selected for qualitative analysis. Six of these were included in the meta-analysis. Five prostheses failed in the PA group and 1 failed in the DA group (P = .1047). Seven biologic complications occurred in the PA group and 6 occurred in the DA group (P = .8121). MBL was significantly less in the DA group (difference, 0.279 mm; P = .000). Greater buccal recession occurred in the PA group (difference, 0.198 mm; P = .0004). The PES evaluation showed no differences between groups (P = .289). Conclusions Repeated abutment disconnections and reconnections considerably increased MBL and buccal recession. Further studies are needed to confirm these results.

To test the hypothesis that there is no difference in clinical, radiographic and aesthetic outcomes positioning single post-extractive 7 mm-diameter implants or waiting 4 months after molar extraction and socket preservation procedure.Patients requiring one implant-supported single restoration to replace a failing tooth in the molar region of both maxilla and mandible were selected. Patients were randomised according to a parallel group design into two arms: implant installation in fresh extraction sockets grafted with cortico-cancellous heterologous bone and porcine derma (group A) or delayed implant installation 4 months after tooth extraction and socket preservation using the same materials (group B). Implants were submerged for 4 months. The primary outcome measures were the success rates of the implants and prostheses and the occurrence of any surgical and prosthetic complications during the entire follow-up. Secondary outcome measures were: peri-implant marginal bone level (MBL) changes, resonance frequency analysis (ISQ) and pink esthetic score (PES) values at implant placement (baseline) up to 1 year after loading.Twelve patients were randomised to group A and 12 to group B. No patient dropped out within 1 year after loading. No implant and prosthesis failed and no complications occurred during the entire follow-up. One year after loading, statistically significant higher mean MBL loss was experienced in group A (0.63 mm ± 0.31 mm) compared to group B (0.23 mm ± 0.06 mm); difference 0.41 mm (95% CI 0.17-0.53; P = 0.001). Six months after implant placement, mean ISQ value was 78.8 ± 2.8 for group A and 79.9 ± 3.6 for group B, showing no statistically significant difference between groups (difference 1.1; 95% CI: 0.04 to 2.96; P = 0.422). One year after loading, mean PES was 10.6 ± 1.8 [range: 8 to13] in group A and 12.2 ± 1.2 [range: 11 to 14] in group B. The difference was statistically significant (1.6 ± 2.7; 95% CI -0.55-2.55; P = 0.019) with better results for group B.Within the limitations of this study, both procedures achieved successful results over the 1-year follow-up period, but waiting 4 months after tooth extraction and socket preservation procedure was associated with less marginal bone loss and a better aesthetic outcome. Conflict-of-interest statement: Dr Marco Tallarico is Research Project Manager of Osstem AIC Italy. However no company supported this study and all authors declare no conflicts of interest.

The aim of this randomized, match-paired, triple-blinded, controlled clinical trial was to assess the 6-year radiographic changes around customized platform-switched abutments placed according to the one abutment-one time concept, with and without plasma of argon cleaning treatment. A total of 20 periodontally healthy patients received one maxillary implant between the premolars. Immediately before stage 2 surgery and abutment connection, patients were randomly assigned to the control (cleaning protocol by steam) or test group (plasma of argon treatment). Periapical standardized digital radiographs were taken at the time of crown connection (T₀) and at 12 (T₁), 24 (T₂), 48 (T₄), 60 (T₅), and 72 months (T₆) after the final restoration delivery. Primary outcome measures were the success rates of the implants and prostheses and the occurrence of any technical and biologic complications during the follow-up period. Secondary outcome measures were peri-implant marginal bone level changes, bleeding on probing, and plaque score. Two patients (one in test and one in control group) dropped out at the last follow-up. Neither implant nor prosthetic complications were detected in the analyzed patients of both groups during the 6-year follow-up examinations. Radiographic analysis revealed a statistically significant higher mean bone loss in the control group than in the test group at T₂ (0.4 ± 0.28 mm; P = .018), T₄ (0.52 ± 0.63 mm; P = .037), T₅ (0.61 ± 0.70 mm; P = .038), and T₆ (0.71 ± 0.66 mm; P = .011), but not at T₁ (P = .131). From baseline to the 6-year follow-up, intragroup comparisons showed an absence of statistically significant difference in the test group (P = .08). Conversely, significant differences were found in the control group (P = .01). All implants demonstrated successful periodontal parameters, with no significant differences between groups. The results of this present study indicate that contaminant and bacterial removal from abutments in two-stage implants using plasma of argon could represent a positive strategy to minimize peri-implant bone resorption and longitudinally stabilize esthetic outcomes.

Aim To evaluate the 10-year post-loading radiological and esthetic outcomes of implants inserted in post-extraction sites and restored with or without platform-switching protocol. Material and methods Twenty-two patients were scheduled for maxillary post-extractive implant, using a 13 mm in length and 5.5 mm in diameter implant (Global, Sweden & Martina, Padua, Italy). They randomly received definitive restorations using platform-switching concept (abutment 3.8 mm in diameter: test group) or standard restoration (abutment 5.5 mm in diameter: control group). Outcome measures were survival rates of implants and prostheses, peri-implant marginal bone loss and periodontal indices 10 years after prosthetic loading. Moreover, esthetic parameters including soft tissue buccal peri-implant mucosal levels (REC) and mesial and distal papilla height (PH) were taken at definitive restoration, 2 and 10 years thereafter. Results Nineteen implants were analyzed after 10 years of follow-up. No implants nor prostheses failed. The postoperative radiographs demonstrated an overall mean bone loss of 0.18 ± 0.14 mm in the test group and of 0.80 ± 0.40 mm in the control group (P = 0.00108). Test group showed 0.23 ± 0.51 mm of REC gain and PH was of 0.21 ± 0.33 mm on average. On the other side, the control group presented a REC = −0.59 ± 0.80 mm with PH = −1.12 ± 0.55 mm, demonstrating a slight continuous soft tissue shrinkage during the entire follow-up. The mean values were statistically significant different between test and control group for both REC gain (P = 0.01174) and PH (P = 0.0009). Conclusions With the limitations of this study, immediate single implant restorations rehabilitated with platform-switching protocol may provide peri-implant alveolar bone-level stability and avoid continuous soft tissue shrinkage after 10 years of prosthetic loading compared to a platform-matching restoration. Further studies involving larger sample sizes are required to confirm these preliminary results.

To test the hypothesis that platform switching and regular platform implants would have different outcomes in single-tooth replacement against the alternative hypothesis of no difference.This study was designed as a randomised controlled split-mouth trial. Eighteen patients with bilaterally missing single premolars or molars to be restored with implant-supported single crowns, were consecutively enrolled. Implant sites were randomly assigned to be treated according to the platform switching concept (PS group), or with matching implant-abutment diameters (RP group). A total of 36 Nobel Replace Tapered Groovy implants were installed. All the implants were inserted in healed bone, with an insertion torque between 35 and 45 Ncm, according to a one-stage protocol. Both implant types were loaded with a screw-retained temporary crown 3 months after implant insertion. Definitive screw-retained single crowns were delivered 2 months later. Outcome measures were implant and prosthetic survival rates, biological and prosthetic complications, radiographic marginal bone level (MBL) changes, pocket probing depth (PPD) and bleeding on probing (BOP). Clinical data was collected at implant placement (baseline), and at 3, 9 and 36 months after loading.No patients dropped out and no implant failed. No prosthetic complications were recorded. One patient experienced mucosal inflammation with positive BOP (RP group) after 3 months, three patients had bilateral peri-implant mucosal inflammation with positive BOP at 6, 24 and 30 months after loading, respectively. There were no statistically significant differences between groups for complications (3/18 versus 4/18; P = 1.0; Odds Ratio = 1.333; 95% CI: 0.3467 to 5.1272). Nine months after loading, the mean MBL was 0.93 ± 0.26 mm in the RP group and 0.84 ± 0.23 mm in the PS group, with no statistically significant differences between groups (mean difference = 0.09 mm, 95% CI: -0.22 to 0.04, P = 0.18). Three years after loading, mean MBL was 1.09 ± 0.31 mm in the RP group and 1.06 ± 0.24 mm in the PS group, with no statistically significant differences between groups (mean difference = 0.02 mm, 95% CI: -0.06 to 0.10, P = 0.70). Marginal bone level changes between 3 years and baseline were 0.72 ± 0.28 mm in the RP group and 0.71 ± 0.27 mm in the PS group, with no statistically significant differences between the groups (mean difference = -0.00 mm, 95% CI: -0.07 to 0.07, P = 0.89). Mean PPD was 2.70 ± 0.52 mm in the RP group and 2.46 ± 0.69 mm in the PS group at 36 months after loading, with no statistically significant differences between the groups (mean difference = 0.23 mm, 95% CI: -0.05 to 0.35, P = 0.43). Mean BOP was 0.83 ± 0.96 mm in the RP group and 0.89 ± 0.99 mm in the PS group at 36 months after loading, with no statistically significant differences between the groups (mean difference = 0.07 mm, 95% CI: -0.03 to 0.17, P = 0.77). Conclusions: The clinical and radiographic outcomes of implants restored according to the platform-switching concept versus implants restored with the matching implant-abutment diameters are comparable, 3 years after loading. Conflict of interest statement: This study was not supported by any company. All authors declare no conflict of interest.

The aim of this study was to evaluate clinical and radiologic outcomes of a novel device that allows simultaneous hydraulic sinus membrane elevation, bone grafting, and implant placement. A sample of 18 consecutive participants with severe atrophy of the posterior maxilla underwent transcrestal elevation of the sinus membrane and implant placement. At the 6-month follow-up, the following parameters were assessed: implant success, any complications, marginal bone loss (MBL), three-dimensional (3D) graft measurements, implant stability quotient (ISQ), and graft density. No implants failed during follow-up (10.8 ± 2.8 months; range: 7-14 months). No membrane tears or other adverse events were observed. Mean residual alveolar ridge height was 4.78 ± 0.88 mm. Six months after the procedure, the mean MBL was 0.18 mm. The mean sinus membrane elevation was 12.78 ± 2.18 mm (range: 10.7-14.23). Along the basic 3D reference planes, the dimensions of grafted bone measured around implants were as follows: axial area = 239.7 ± 57.68 mm2; sagittal area = 257.0 ± 60.83 mm2; coronal area = 143.3 ± 29.46 mm2. The mean volume of the graft was 2.38 ± 0.26 mL at baseline and 2.05 ± 0.24 mL 6 months after graft maturation (difference: 0.33 ± 0.29 mL, P = .0090). Graft density (in Hounsfield units [HU]), improved during healing from 322.0 ± 100.42 HU to 1,062.0 ± 293.7 HU; difference 740.0 ± 295.35 HU (P = .0001). The mean ISQ value was 65.5 at implant placement, and it increased to 74.1 at the 6-month examination (P = .0014). Of 18 patients, 12 experienced no pain (66.6%) and 10 experienced no swelling (55.5%). No severe pain or swelling was reported in any of the cases. The mean number of analgesic tablets consumed was 0.78 ± 0.67. Mean surgical time was 24.0 ± 4.07 minutes. The iRaise Sinus Lift System may provide a new option for minimally invasive transcrestal sinus surgery with minimal patient discomfort. A physiologic contraction of 13.9% of its original volume was experienced during healing. Long-term clinical studies are needed to confirm these preliminary results.

T he original Branemark protocol for successful implant osseointegration required a healing period of 3–6 months during which the implants were submerged for protection from premature loading. As a result, the use of provisional implants during the osseointegration period, as a means of stabilization of a full-arch interim fixed restoration, has gained popularity in implant prosthodontic treatment. Recently, implant reconstructive dentistry has strongly evolved into 1-stage surgery, such as immediate postextraction, implant placement, and immediate (occlusal/nonocclusal) loading. Nowadays, the cumulative implant survival rate after 10-year-in-function ranges between 96.52% and 98.05% for implants placed in healed and postextractive sites, respectively. One of the main contributions to the successful, long-term, clinical outcomes has been the development of an oxidized implant surface that may improve bone-toimplant contact in virgin healed bone, as well as regenerated bone. On the other hand, the treatment of periodontally susceptible patients is still controversial. Patients with periodontitis often experience early tooth loss that requires implant therapy. Nevertheless, smoking and a history of periodontitis have been associated with a higher prevalence of peri-implantitis. Since their introduction in the early 1970s, fixed partial dentures and implant-supported milled bar overdentures have developed into reliable treatment options in cases of partial as well as total edentulism in both the mandible and the maxilla. A high success rate for implant-retained overdentures has been reported, even if some late implant failures have been observed. Biomechanical evaluation suggests that implant overload is a major contributor to cortical bone loss. A favorable prognosis requires proper bar design and selection of the attachment system, based not only on retention or cost, but also on biomechanics since the attachment is the most fragile link between prosthesis and implant. This case report describes long-term results of a patient with a history of trauma from a motorcycle accident, chronic periodontal disease, recurrent decay, American Society of Anesthesiology (ASA) III clinical condition, insulin-dependent diabetes, and previous implants that had not been restored. The patient was treated in both jaws with multiple extractions of all remaining teeth, immediate implant placement, and implant-retained bar overdentures. Immediate provisional implants (IPIs) were placed between submerged implants to provide support and esthetics for a provisional restoration during healing. A multifactorial approach as well as a clinician-patient relationship was needed in order to ensure optimal treatment planning and a long-term successful result. 1 Cleveland ClearChoice Dental Implant Center, Pepper Pike, Ohio; Case School of Dental Medicine, Case Western Reserve University, Cleveland, Ohio. 2 Department of Oral Rehabilitation, University of Rome Tor Vergata, Rome, Italy. * Corresponding author, e-mail: cab@thedentalimplantcenter.com DOI: 10.1563/AAID-JOI-D-12-00311

Statement of problem In patients with an altered skeletal maxillomandibular relationship and bone resorption, the rehabilitation of edentulous jaws by combining 4 implants, 2 straight medially and 2 tilted distally, may be preferred to avoid a bone augmentation procedure. Purpose The purpose of this single cohort 1-year prospective study was to evaluate the clinical performance of a 4-implant overdenture fully supported by a computer-aided designed and computer-aided manufactured (CAD-CAM) titanium bar. Material and methods This single cohort prospective study included edentulous participants rehabilitated with a 4-implant overdenture in 1 of the 2 jaws. The outcomes were implant and prosthetic survival and success rates, any biologic and technical complications, periimplant marginal bone loss, changes in the oral health impact profile (OHIP), bleeding on probing, and the plaque index. Results Eighteen participants received 72 implants. One year after implant placement, no implants or prosthesis had failed, and no biologic or technical complications had been observed. At the 1-year follow-up, the mean marginal bone loss was 0.29 ±0.16 mm. The OHIP summary scores demonstrated a significant improvement in oral health-related quality of life. At the 1-year follow-up, positive bleeding was found in 2 participants (11.1%) around 3 implants (4.1%). Three participants (16.6%), accounting for 5 implants (6.9%), showed a slight amount of plaque. Conclusions A 4-implant overdenture supported by a CAD-CAM titanium bar may be a reliable option for the treatment of the edentulous mandible and maxilla over a 1-year period. Oral health-related quality of life significantly improved in all treated participants.

High primary implant stability is considered one of the main factors necessary for achieving predictable treatment outcomes with immediately loaded implant-supported screw-retained fixed complete denture prosthesis (FCDP).To evaluate the 5-year clinical and radiographic outcomes of immediately loaded implants placed in edentulous patients using computer-assisted template-guided surgery to support a FCDP.Patients in need to be restored with a FCDP in the mandible or maxilla were included in this prospective study/ and treated using computer-assisted template-guided surgery. Implant sites were prepared in order to achieve an insertion torque ranging between 35-45 Ncm in the mandible and 45-55 Ncm in the maxilla. A prefabricated screw-retained provisional prosthesis was delivered the day of the surgery. Outcomes were: implant and prosthesis cumulative survival rate (CSR), any complications, and peri-implant marginal bone loss (MBL).Sixty-six patients received 356 implants to support 68 FCDPs. Each patient received 4-8 implants. Seven implants failed in six patients, resulting in a CSR of 98.1%. Two definitive prostheses failed resulting in CSR of 97.1%. Mean MBL of 1.62 ± 0.41 mm was reported at the 5-year follow-up. Five implants (1.4%) showed a mean mesio-distal peri-implant bone loss greater than 3.0 mm and received nonsurgical therapy.immediately loaded implants placed in edentulous patients using computer-assisted template-guided surgery to support a FCDP is a valid treatment concept in the medium term follow-up, for edentulous patients.

To clinically and radiographically evaluate bone regeneration of severe horizontal bone defects.This study was designed as a single cohort, prospective clinical trial. Partially or fully edentulous patients, having less then 4 mm of residual horizontal bone width were selected and consecutively treated with resorbable collagen membranes and a 1:1 mixture of particulated anorganic bovine bone and autogenous bone, 7 months before implant placement. Tapered body implants were inserted and loaded 3 to 6 months later with a screw retained crown or bridge. Outcomes were: implant survival rate, any biological and prosthetic complications, horizontal alveolar bone dimensional changes measured on cone beam computed tomography (CBCT) taken at baseline and at implant insertion, peri-implant marginal bone level changes measured on periapical radiographs, plaque index (PI), and bleeding on probing index (BoP).Eighteen consecutive patients (11 females, 7 males) with a mean age of 56.8 years (range 24-78) and 22 treated sites received 55 regular platform implants. No patient dropped-out and no implants failed during the entire follow-up, resulting in a cumulative implant survival rate of 100%. No prosthetic or biological complications were recorded. Supraimposition of pre- and 7-month post-operative CBCT scans revealed an average horizontal bone gain of 5.03 ± 2.15 mm (95% CI: 4.13-5.92 mm). One year after final prosthesis delivery, mean marginal bone loss was 1.03 ± 0.21 mm (95% CI 0.83-1.17 mm). PI was 11.1% and BoP was 5.6%.Within the limitation of the present study, high implant survival rate and high average bone augmentation seem to validate the use of collagen resorbable membranes with a 1:1 mixture of particulated anorganic bovine bone and autogenous bone, for the reconstruction of severe horizontal ridge defects.

To compare the 5-year clinical and radiological outcomes of patients rehabilitated with four or six implants placed using guided surgery and immediate function concept.Forty patients randomly received four (All-on-4) or six (All-on-6) immediately loaded implants, placed using guided surgery, to support a cross-arch fixed dental prosthesis. Outcome measures were survival rates of implants and prostheses, complications, peri-implant marginal bone loss, and periodontal parameters.No drop-out occurred. Seven implants failed at the 5-year follow-up examination: six in the All-on-6 group (5%) and one in the All-on-4 group (1.25%), with no statistically significant differences (p = .246). No prosthetic failure occurred. Both group experienced some technical and biologic complications with no statistically significant differences between groups (p = .501). All-on-4 treatment concept demonstrated a trend of more complications during the entire follow-up period. A trend of more implant failure was experienced for the All-on-6 treatment concept. Marginal bone loss (MBL) from baseline to the 5-year follow-up was not statistically different between All-on-4 (1.71 ± 0.42 mm) and All-on-6 (1.51 ± 0.36 mm) groups (p = .12). For periodontal parameters, there were no differences between groups (p .05).Both approaches may represent a predictable treatment option for the rehabilitation of complete edentulous patients in the medium term. Longer randomized controlled studies are needed to confirm these results.

International audience; Objective: To investigate whether specific predictive profiles for patient-based risk assessment/ diagnostics can be applied in different subtypes of peri-implantitis.Materials and methods: This study included patients with at least two implants (one or more presenting signs of peri-implantitis). Anamnestic, clinical, and implant-related parameters were collected and scored into a single database. Dental implant was chosen as the unit of analysis, and a complete screening protocol was established. The implants affected by peri-implantitis were then clustered into three subtypes in relation to the identified triggering factor: purely plaque-induced or prosthetically or surgically triggered peri-implantitis. Statistical analyses were performed to compare the characteristics and risk factors between peri-implantitis and healthy implants, as well as to compare clinical parameters and distribution of risk factors between plaque, prosthetically and surgically triggered peri-implantitis. The predictive profiles for subtypes of peri-implantitis were estimated using data mining tools including regression methods and C4.5 decision trees.Results: A total of 926 patients previously treated with 2812 dental implants were screened for eligibility. Fifty-six patients (6.04%) with 332 implants (4.44%) met the study criteria. Data from 125 peri-implantitis and 207 healthy implants were therefore analyzed and included in the statistical analysis. Within peri-implantitis group, 51 were classified as surgically triggered (40.8%), 38 as prosthetically triggered (30.4%), and 36 as plaque-induced (28.8%) peri-implantitis. For peri-implantitis, 51 were associated with surgical risk factor (40.8%), 38 with prosthetic risk factor (30.4%), 36 with purely plaque-induced risk factor (28.8%). The variables identified as predictors of peri-implantitis were female sex (OR = 1.60), malpositioning (OR = 48.2), overloading (OR = 18.70), and bone reconstruction (OR = 2.35). The predictive model showed 82.35% of accuracy and identified distinguishing predictive profiles for plaque, prosthetically and surgically triggered peri-implantitis. The model was in accordance with the results of risk analysis being the external validation for model accuracy.Conclusions: It can be concluded that plaque induced and prosthetically and surgically triggered peri-implantitis are different entities associated with distinguishing predictive profiles; hence, the appropriate causal treatment approach remains necessary. The advanced data mining model developed in this study seems to be a promising tool for diagnostics of peri-implantitis subtypes.

Contamination of implant abutments could potentially influence the peri-implant tissue inflammatory response. The aim of the present study is to assess the radiographic bone changes around customized, platform-switched abutments placed according to the "one-abutment-one-time" protocol, with and without plasma of argon cleaning treatment.Thirty healthy patients with thin gingival biotype (1 mm) and history of periodontal disease received one maxillary implant each. Immediately before abutment connection, patients were randomly assigned to control group (cleaning protocol by steaming) or test group (plasma of argon treatment). Outcome measures were: 1) success rate of implants and prostheses; 2) biologic and prosthetic complications; 3) peri-implant marginal bone loss (MBL); 4) esthetic and periodontal parameters; and 5) patient satisfaction.Neither implants nor prostheses were lost in either group at the 5-year follow-up examination. Overall, both groups showed a slight amount of peri-implant bone loss from baseline to 5 years. A statistically higher mean MBL was found in the control group compared with the test group at 6, 24, and 60 months after crown connection. Nevertheless, during the entire follow-up period, intragroup comparison demonstrated statistically significant mean MBL in the control group, but not in the test group. The test group showed a higher mean gain at the soft tissue margin, but not for the papilla. All implants showed good periodontal parameters, with no significant differences between groups.Plasma of argon could be used to disinfect implant abutments before insertion to minimize future peri-implant bone resorption.

Tooth extraction generally results in an alveolar bone loss and structural changes in the overlying soft tissue. The amount of this relocation might jeopardize prosthetically driven implant placement. Thus, there is a high interest in techniques, materials and timing to minimizing tissue resorption, using postextraction ridge preservation procedures.To assess by histological techniques, the outcomes of a socket preservation technique at 4 or 12 months after treatment with a magnesium-enriched hydroxyapatite (Mg-e HA).Postextraction site in 20 patients underwent ridge preservation procedure. Mg-e HA granules were mixed with blood and grafted into the socket. A bone specimen was collected from each site before implant placement after 4 or 12 months randomly. Each biopsy was processed for undecalcified histological analysis. All ground sections were observed under light and polarized microscope. A semi-quantitative analysis by mean of stereological method was performed to evaluate the average volume fractions of bone, biomaterial and medullary spaces, and the percentage of blood vessels for both timepoints. Nonparametric Mann-Whitney U test for unpaired data was used to detect eventual statistical differences between groups.Histologically, the biomaterial appeared surrounded by newly formed bone in both groups without inflammatory infiltrate. At 4 months, the remodeling process of collagen matrix was starting from the apical portion toward coronal direction and was more active around grafted particles. At 12 months, the alveolar socket was completely regenerated and filled with mineralized and well-organized bone tissue around the residual biomaterial particles. In both groups, vessels were present to supply tissues around the graft (at 4 months: 4.95% ± 2.49; at 12 months: 7.45% ± 2.57). Tissue fractions at 4 versus 12 months were respectively: 31.85% ± 6.99 versus 41.32% ± 9.37 for bone (p = .021), 40.82% ± 6.71 versus 26.28% ± 11.49 for residual Mg-e HA (p = .009), and 27.33% ± 7.72 versus 32.40% ± 9.87 for medullary spaces.Data from the present study show that Mg-e HA allows the complete healing of the tissue. Additionally, graft material demonstrated to undergo significant resorption during the experimental time frame.

The study aims to evaluate clinically the thickness of the alveolar ridge mucosa underneath a zirconia implant-supported restoration with a modified ovate pontic.Sixty-five patients, 32 women and 33 men (mean age: 65.5 years; range 38-81), were included. A total of 383 implants (303 in the maxilla; 80 in the mandible), supporting 81 full or partial fixed dental prostheses (65 in the maxilla; 16 in the mandible), were either cement- or screw-retained. Three years after loading, a total of 219 pontic sites (153 in the maxilla; 66 in the mandible) were measured, and the thickness of the alveolar ridge mucosa between the prosthetic surface and the underlying bone crest were recorded.The overall implant and prosthesis survival rates at 3 years were 98.7% and 100%, respectively. No implant complications were reported, scoring a cumulative implant success rate of 100%. In the maxilla, the overall mean thickness of the alveolar ridge mucosa was 2.32 ± 0.57 mm. In the mandible, the overall mean thickness of the alveolar ridge mucosa was 2.20 ± 0.62 mm. There was no statistical difference between the overall mean values in the maxilla and mandible (p = .471).This radiologic retrospective study suggests the existence of a physiological barrier, named prosthetic biological width, underneath a novel pontic-designed restoration.

To compare epithelial connective tissue graft vs porcine collagen matrix for sealing postextraction sockets grafted with deproteinised bovine bone.A total of 30 patients, who needed a maxillary tooth to be extracted between their premolars and required a delayed, fixed, single implant-supported restoration, had their teeth atraumatically extracted and their sockets grafted with deproteinised bovine bone. Patients were randomised according to a parallel group design into two arms: socket sealing with epithelial connective tissue graft (group A) vs porcine collagen matrix (group B). Outcome measures were: implant success and survival rate, complications, horizontal and vertical alveolar bone dimensional changes measured on Cone Beam computed tomography (CBCT) scans at three levels localised 1, 3, and 5 mm below the most coronal aspect of the bone crest (levels A, B, and C); and between the palatal and buccal wall peaks (level D); and peri-implant marginal bone level changes measured on periapical radiographs.15 patients were randomised to group A and 15 to group B. No patients dropped out. No failed implants or complications were reported 1 year after implant placement. Five months after tooth extraction there were no statistically significant differences between the 2 groups for both horizontal and vertical alveolar bone dimensional changes. At level A the difference was 0.13 ± 0.18; 95% CI 0.04 to 0.26 mm (P = 0.34), at level B it was 0.08 ± 0.23; 95% CI -0.14 to 0.14 (P = 0.61), at level C it was 0.05 ± 0.25; 95% CI -0.01 to 0.31 mm (P = 0.55) and at level D it was 0.13 ± 0.27; 95% CI -0.02 to 0.32 mm (P = 0.67). One year after implant placement there were no statistically significant differences between the 2 groups for peri-implant marginal bone level changes (difference: 0.07 ± 0.11 mm; 95% CI -0.02 to 0.16; P = 0.41).When teeth extractions were performed atraumatically and sockets were filled with deproteinised bovine bone, sealing the socket with a porcine collagen matrix or a epithelial connective tissue graft showed similar outcomes. The use of porcine collagen matrix allowed simplification of treatment because no palatal donor site was involved.

PURPOSE: To evaluate the clinical and radiological performance of an immediately loaded novel implant design over a 3-year period. MATERIALS AND METHODS: This prospective study includes 54 consecutive partially edentulous patients treated between December 2010 and October 2011. Outcome measures were: implant and prosthetic failures; biological and mechanical complications; marginal bone loss (MBL); sulcus bleeding index (SBI); and plaque score (PS). RESULTS: A total of 118 (29 narrow platform, 70 regular platform and 19 wide platform) NobelReplace Conical Connection implants were placed in both post-extraction sockets and healed sites and immediately loaded. The mean insertion torque was 63.4 ± 7.1 Ncm. One hundred out of 118 implants (84.7%) were inserted with a torque ranging between 55 and 70 Ncm. Each patient received a single prosthesis. At the 3-year follow-up, no patient dropped out and only two post-extractive implants failed (1.7%) in two patients (3.7%). The only complication (1.9%) observed was an event of periimplantitis, consisting of a mean mesiodistal peri-implant bone loss of 3.2 mm reported in a healed site of a smoker patient at the 2-year follow-up examination. No prosthesis failures were detected. The cumulative mean MBL between implant placements at the 3-year follow-up was 0.68 mm (95% CI: 0.44, 0.92). At the 3-year follow-up session, the SBI and PS were 5.7% and 15.4%, respectively. CONCLUSIONS: The NobelReplace Conical Connection implant can be considered as a valuable treatment option for immediate implant placement and loading in the partially edentulous patients over a 3-year period. Insertion torques ranging between 55 and 70 Ncm are not detrimental to osseointegration.

Aim: The aim of this prospective clinical study is to assess the 4-year outcomes of implant-supported restorations performed using a computer-guided template-assisted flapless implant surgery approach in patients reconstructed with fibula or iliac crest free flaps. Materials and methods: Twelve jaws in 10 patients were reconstructed with osteomyocutaneous free flap after tumour resection or gunshot wound, after complete healing computer-assisted template-based flapless implant placement, based on prosthetic and aesthetic analysis, was performed using a customized protocol. Treatment success was evaluated using the following parameters: survival of implants/prostheses, prosthetic and biologic complications, marginal bone remodelling, soft tissue parameters and patient satisfaction. Results: A total of 56 implants were placed; the implants ranged between 8 and 16 mm in length and were either 3.5, 4.3 or 5 mm wide. All the patients have reached the 4-year follow-up. Three implants were lost accounting for an overall implant survival rate of 94.6%. No prosthesis were lost. Some complications were recorded. Four years after loading the mean marginal bone loss was 1.43 ± 0.49 mm at the palatal/lingual site and 1.48 ± 0.46 mm at the vestibular site. All the patients showed healthy soft tissues with stable probing depth (4 .93 ± 0.75%) and successful bleeding on probing values (12 ± 5.8%); 90% of patients were satisfied of the treatment at the 4-year follow-up. Conclusions: Computer-guided template-assisted flapless implant surgery seems to be a viable option for patients undergoing reconstruction with free flaps after tumour resection or gunshot trauma, although many challenges remain. A high degree of patient satisfactorily was reported. © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

To compare planning and patient rehabilitation using a 3D dental planning software and dedicated surgical guides with conventional rehabilitation of partially or fully edentulous patients using flapless or mini-flap procedures and immediate loading.Fifty-one fully or partially edentulous patients requiring at least 2 implants to be restored with a single prosthesis, having at least 7 mm of bone height and 4 mm in bone width, had their implant rehabilitation planned on three-dimensional (3D) cone beam computed tomography (CBCT) scans using a dedicated software. Afterwards they were randomised according to a parallel group study design into two arms: computer-guided implant placement aided with templates (computer-guided group) versus conventional implant placement without templates (conventional group) in three different centres. Implants were to be placed flapless and loaded immediately; if inserted with a torque over 35 Ncm with reinforced provisional prostheses, then replaced, after 4 months, by definitive prostheses. Outcome measures, assessed by masked assessors were: prosthesis and implant failures, complications, peri-implant bone level changes, number of treatment sessions, duration of treatment, post-surgical pain and swelling, consumption of pain killers, treatment time, time required to solve complications, additional treatment cost, patient satisfaction. Patients were followed up to 1 year after loading.Twenty-six patients were randomised to the conventional treatment and 25 to computerguided rehabilitation. No patient dropped out. One provisional prosthesis failed, since one of the two supporting implants failed 11 days after implantation in the conventional group (P = 1.0). Four patients of the conventionally loaded groups experienced one complication each, versus five patients (6 complications) in the computer-guided group (P = 0.726). There were no statistically significant differences between the two groups for any of the tested outcomes with the exception of more postoperative surgical pain (P = 0.002) and swelling (P = 0.024) at conventionally treated patients.When treatment planning was made on 3D CBTC scan using a dedicated software, no statistically significant differences were observed between computer-guided and a free-hand rehabilitations, with the exception of more postoperative pain and swelling at sites treated freehand because more frequently flaps were elevated.

To compare the clinical and radiological outcomes of two implant designs with different prosthetic interfaces and neck configurations.Thirty-four partially edentate patients randomly received at least one NobelActive implant (Nobel Biocare, Göteborg, Sweden) with back-tapered collar, internal conical connection and platform shifting design, and one NobelSpeedy implant (Nobel Biocare) with external hexagon and flat-to-flat implant-abutment interface according to a split-mouth design. Follow-up continued to 3 years post-loading. The primary outcome measures were the success rates of the implants and prostheses, and the occurrence of any surgical and prosthetic complications during the entire follow-up. Secondary outcome measures were: horizontal and vertical peri-implant marginal bone level (MBL) changes, resonance frequency analysis values at implant placement and loading (4 months), sulcus bleeding index (SBI) and plaque score (PS).No drop-out occurred. No implants and prostheses failures were observed to the 3-year follow-up. MBL changes were statistically significant different with better results for the NobelActive implants for both horizontal and vertical measurements (P = 0.000). After 3 years post-loading, the NobelActive implants underwent a mean vertical bone resorption of 0.66 mm, compared with 1.25 mm for the NobelSpeedy Groovy implants (P = 0.000); the mean horizontal bone resorption was 0.19 mm for the NobelActive implants and 0.60 mm for the NobelSpeedy Groovy implants (P = 0.000). A high ISQ value was found for both implants, and no statistically significant difference was found for ISQ mean values between interventions (P = 0.941 at baseline; P = 0.454 at implantabutment connection; P = 0.120 at prosthesis delivery). All implants showed good periodontal health at the 3-year-in-function visit, with no significant differences between groups.The results of this research suggest that in well-maintained patients, the MBL changes could be affected by the different implant design. After 4 months of unloaded healing, as well as after 3 years in function, both implants provided good results, however vertical and horizontal bone loss had statistically significant differences between the two groups (difference of 0.58 ± 0.10 mm for the vertical MBL, and 0.4 ± 0.05 mm for the horizontal MBL), with lower values in the Nobel Active implants, compared to the NobelSpeedy Groovy implants.

To compare two different impression techniques for implants in totally edentulous patients.A total of 38 patients had impressions taken both using plaster and splinted vinyl polysiloxane (splinted-VPS). Two casts per patient were generated and allocated as test (plaster) and control (splinted-VPS) cast groups according to a randomised cross-over design. One of the two casts from each patient was randomly selected as master cast according to a parallelgroup design and used to fabricate the definitive prosthesis. Outcome measures were implant and prosthetic success rates, complications, marginal bone level (MBL) changes, patient satisfaction, chair time required to take the impressions, inter-implant discrepancy between the casts, sulcus bleeding index (SBI) and plaque score (PS).In total, 76 impressions were taken in 38 patients. Two plaster impressions failed. Furthermore, 38 computer-aided design/computer-assisted manufacturing screw-retained complete-arch prostheses were fabricated onto the master cast (18 from plaster and 20 from splinted-VPS impressions) and the patients were followed up for 3 years after loading. No drop-out occurred and no implants or prostheses failed, accounting for a cumulative implant and prosthesis survival rate of 100% over the 3-year post-loading period. Plaster impressions yielded significantly greater patient satisfaction and shorter chair time. The discrepancy between the casts was 0.055 ± 0.067 mm (P = 0.931). Mixed model analysis revealed a significant main effect from both the implant number and the inter-implant distance, while no difference was found with regard to implant angulation. Five chip-off fractures of the porcelain veneer occurred in 5 of the 38 patients (3 in restorations fabricated onto the plaster cast group and 2 in the splinted-VPS cast group) with no effect from the type of impression on the prosthetic success rate (P = 0.331). However, all of the patients were functionally and aesthetically satisfied with their prostheses. Furthermore, mean MBL, SBI and PS showed no significant differences (P0.05) between the groups.The clinical outcome of plaster impressions for completely edentulous patients was found to be the same as that for splinted-VPS impressions. The intraoral pre-scan resin framework try-in can be avoided. Plaster impressions may be less time consuming and thus more comfortable for the patient, but sometimes may have to be repeated due to fractures.All materials used in this study were purchased by the authors and there were no commercial or institutional interests.

This article describes the clinical and radiologic long-term results of a healthy, nonsmoker women aged 62 at the time of treatment, with severely resorbed edentulous jaws in which bar and clip supported complete dentures were delivered in both jaws and followed for 8 years after prosthesis delivery. The patient had been edentulous in both arches since she was 50 years old. Treatment included the placement of four mandibular implants with maximum spacing anterior to the mandibular nerve, and four maxillary implants anterior to sinus wall without tilting the posterior implants, because of the insufficient bone quantity necessary to angulate implants. Guided bone regeneration was required in the maxilla, due to a bone atrophy that limited the placement of conventional dental implants. After 4 months, a second-stage surgery was performed, and after 1 month of healing time the patient received definitive restorations. Implant survival rate, patient satisfaction, marginal bone maintenance, and soft tissue conditions at the modified titanium surface of the dental implants were evaluated after 8 years of function. A multifactorial approach, clinician-patient relationship, and vigilant maintenance of oral hygiene were needed in order to ensure an optimal treatment and a long-term successful result. Positive results regarding bone maintenance in the long-term perspective, also on regenerated bone, were observed using implants with implant-retained bar overdentures, when adequate levels of oral hygiene and prosthodontic adjustments are maintained.

This study was carried on to assess the clinical performance of a novel restorative concept consisting in single monolithic lithium disilicate full-contour crowns bonded on computer-aided design/computer-aided manufacturing (CAD/CAM) zirconia complete-arch implant bridges, to overcome the drawbacks related to the chipping of porcelain fused to zirconia restorations. Sixteen patients received 18 implant-supported hybrid screw-cement-retained complete-arch restorations, consisting of single monolithic lithium disilicate full-contour crowns bonded on CAD/CAM zirconia frameworks. The restorations were supported by 4–8 implants. All patients were followed up for at least 3 years on function (range 36 to 60 months, mean 49.3 months). Clinical controls were scheduled every 4 months. The outcomes were implant and prosthetic survival and success rates, any complications, patient satisfaction, and soft tissue parameters. No dropouts occurred. The overall implant and prosthesis survival rates were 100%. One of 18 restorations (1 of 236 dental units) showed a chip-off fracture of the veneering ceramic that was polished intraorally without any additional treatment, scoring a cumulative prosthetic success rate of 100%, according to the California Dental Association index. All patients were functionally and esthetically highly satisfied with their restorations. Successful soft tissue parameters were found around all implants. Single monolithic lithium disilicate full-contour crowns, bonded on CAD/CAM screw-retained complete-arch zirconia frameworks, showed favorable preliminary outcomes with medium-term follow-up. However, randomized controlled studies of this technique are required for further conclusive recommendations.

The purpose of this study is to retrospectively evaluate the implant and prosthetic survival and success rates of zirconia-based, implant-supported, screw-retained, cross-arch restorations up to 5 years after placement.Twenty-two consecutive edentulous patients (11 males and females, each; mean age 68.3 years) received 26 CAD/CAM cross-arch zirconia implant bridges (NobelProcera™ Implant Bridge Zirconia; Nobel Biocare AG, Zurich, Switzerland) supported by 4 to 10 implants each. All patients were followed for at least 3 years (range 36-60 months, mean 42.3 months). Clinical assessments were scheduled every 4 months during hygiene maintenance. Outcomes were implant and prosthetic survival rates, prosthetic success rate, any observed clinical complications, patient satisfaction, and soft tissue parameters. Fisher's exact test was used to assess associations between categorical variables.No dropouts occurred. The overall implant and prostheses survival rate up to 5 years was 100%. Three out of 26 restorations (five out of three hundred forty eight dental units) showed an adhesive chip-off fracture of the veneering ceramic, scoring a cumulative prosthetic success rate of 88.5% at the prosthetic level and 98.6% at the unit level. All 22 patients were functionally and aesthetically highly satisfied with their restorations. Successful soft tissue parameters were found around all implants.Industrially manufactured, zirconia-based, implant-supported, screw-retained, cross-arch restorations are a viable alternative to conventionally manufactured porcelain-fused-to-metal restorations for rehabilitating the edentulous patient.