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Objectives: To introduce a modified guided bone regeneration (GBR) technique using intact periosteum and deproteinized bovine bone mineral (DBBM) for peri‐implant augmentation and compare the clinical outcomes with those of conventional GBR. Materials and Methods: Patients who received peri‐implant augmentation in posterior sites between 2015 and 2021 were reviewed in this study. Group A was treated with a modified GBR technique, and Group B was treated with conventional GBR. For group comparison, propensity score matching was performed with a sensitivity analysis. The implant survival rate, dimensional changes in hard tissue, marginal bone loss (MBL), and peri‐implant parameters were evaluated. Results: In total, 114 implants from 98 patients were included. The implant survival rates were 95.74% in Group A and 95.00% in Group B during the follow‐up period. At 6 months, the median horizontal thickness was recorded at 0.87 mm (IQ1–IQ3 = 0.00–1.75 mm) in Group A, exhibiting a relatively lower value compared to the corresponding measurement of 0.98 mm (IQ1–IQ3 = 0.00–1.89 mm) in Group B (p =.937). Vertical height displayed no statistically significant intergroup difference between the two groups (p =.758). The mean follow‐up period was 25.83 ± 12.93 months after loading in Group A and 27.47 ± 21.29 months in Group B (p =.761). MBL and peri‐implant parameters were comparable between the two groups. Conclusions: Within the limitations of this study, the modified GBR technique using intact periosteum and DBBM grafting might be a viable alternative to correct bone defects around implants in molar and premolar sites. [ABSTRACT FROM AUTHOR]

Aim: CCR2 (C‐C chemokine receptor type 2) plays a crucial role in inflammatory and bone metabolic diseases; however, its role in peri‐implantitis remains unclear. This study aimed to explore whether CCR2 contributes to peri‐implantitis and the treatment effects of cenicriviroc (CVC) on peri‐implant inflammation and bone resorption. Materials and Methods: The expression of CCR2 was studied using clinical tissue analysis and an in vivo peri‐implantitis model. The role of CCR2 in promoting inflammation and bone resorption in peri‐implantitis was evaluated in Ccr2−/− mice and wild‐type mice. The effect of CVC on peri‐implantitis was evaluated using systemic and local dosage forms. Results: Human peri‐implantitis tissues showed increased CCR2 and CCL2 levels, which were positively correlated with bone loss around the implants. Knocking out Ccr2 in an experimental model of peri‐implantitis resulted in decreased monocyte and macrophage infiltration, reduced pro‐inflammatory cytokine generation and impaired osteoclast activity, leading to reduced inflammation and bone loss around the implants. Treatment with CVC ameliorated bone loss in experimental peri‐implantitis. Conclusions: CCR2 may be a potential target for peri‐implantitis treatment by harnessing the immune‐inflammatory response to modulate the local inflammation and osteoclast activity. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to assess patient‐reported outcomes (PROs) 8 years after dental implant rehabilitation in a sample with tooth loss due to periodontitis (TLP) and a sample with missing teeth for other reasons (MTOR). Materials and Methods: The Norwegian National Insurance Scheme registry of subsidized dental implant therapy was searched, and patients (n = 3083) rehabilitated with dental implants in 2014 were mailed a questionnaire. PROs were described by relative frequencies, and the TLP and MTOR subsamples were compared using chi‐square test. Multiple linear regression analyses were used to investigate variables potentially predicting PROs. Results: Of the respondents (n = 1299), more than 90% were partly or fully satisfied with the treatment outcome. Complications were reported by 44.2%. Patients who lost teeth due to periodontitis (n = 784) reported greater oral function improvement and better pre‐treatment information, and were more likely to experience complications when compared with patients who lost teeth for other reasons (n = 515). Age, level of education, self‐funded cost, pre‐treatment information, history of complications and the reason for missing teeth were found to predict PROs. Conclusions: In a Norwegian population rehabilitated with dental implants in 2014, satisfaction with the treatment outcome and the aesthetic outcome was high, irrespective of the reason for missing teeth. Self‐report of complications and lack of pre‐treatment information were the strongest predictors of inferior patient satisfaction and also predicted inferior oral function. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to evaluate the effects of the cushioned grind‐out technique transcrestal sinus floor elevation for simultaneous implant placement with ≤4 mm of residual bone height (RBH). Materials and Methods: This was a retrospective propensity score matching (PSM) study. Five PSM analyses included the confounding variables of Schneiderian membrane perforation, early and late implant failure, and peri‐implant apical and marginal bone resorption. After PSM, we compared the difference in five aspects between the RBH ≤ 4 and >4 mm groups. Results: A total of 214 patients with 306 implants were included in this study. After PSM, the generalized linear mixed model (GLMM) indicated that RBH ≤ 4 mm had no significantly higher risk of Schneiderian membrane perforation and early and late implant failure (p =.897, p =.140, p =.991, respectively). The implant cumulative 7‐year survival rate of the RBH ≤ 4 and >4 mm groups was 95.5% and 93.9%, respectively (log‐rank test: p =.900). Within at least 40 cases per group after PSM, two multivariate GLMMs indicated that RBH ≤ 4 mm could not be identified as the promotive factor of bone resorption of either endo‐sinus bone gain or crest bone level (RBH × time interaction p =.850, p =.698, respectively). Conclusions: Within the limitations, 3 months to 7 years of post‐prosthetic restoration review data indicated an acceptable mid‐term survival and success rate of applying the cushioned grind‐out technique in RBH ≤ 4 mm cases. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to develop an artificial intelligence (AI) model to support the determination of an appropriate implant drilling protocol using cone-beam computed tomography (CBCT) images. Methods: Anonymized CBCT images were obtained from 60 patients. For each case, after implant placement, images of the bone regions at the implant site were extracted from 20 slices of CBCT images. Based on the actual drilling protocol, the images were classified into three categories: protocols A, B, and C. A total of 1,200 images were divided into training and validation datasets (n = 960, 80%) and a test dataset (n = 240, 20%). Another 240 images (80 images for each type) were extracted from the 60 cases as test data. An AI model based on LeNet-5 was developed using these data sets. The accuracy, sensitivity, precision, F-value, area under the curve (AUC) value, and receiver operating curve were calculated. Results: The accuracy of the trained model is 93.8%. The sensitivity results for drilling protocols A, B, and C were 97.5%, 95.0%, and 85.0%, respectively, while those for protocols A, B, and C were 86.7%, 92.7%, and 100%, respectively, and the F values for protocols A, B, and C were 91.8%, 93.8%, and 91.9%, respectively. The AUC values for protocols A, B, and C are 98.6%, 98.6%, and 99.4%, respectively. Conclusions: The AI model established in this study was effective in predicting drilling protocols from CBCT images before surgery, suggesting the possibility of developing a decision-making support system to promote primary stability. [ABSTRACT FROM AUTHOR]

The purpose of this study was to establish a mechanical and histological basis for the development of biocompatible maxillofacial reconstruction implants by combining 3D-printed porous titanium structures and surface treatment. Improved osseointegration of 3D-printed titanium implants for reconstruction of maxillofacial segmental bone defect could be advantageous in not only quick osseointegration into the bone tissue but also in stabilizing the reconstruction. Various macro-mesh titanium scaffolds were fabricated by 3D-printing. Human mesenchymal stem cells were used for cell attachment and proliferation assays. Osteogenic differentiation was confirmed by quantitative polymerase chain reaction analysis. The osseointegration rate was measured using micro computed tomography imaging and histological analysis. In three dimensional-printed scaffold, globular microparticle shape was observed regardless of structure or surface modification. Cell attachment and proliferation rates increased according to the internal mesh structure and surface modification. However, osteogenic differentiation in vitro and osseointegration in vivo revealed that non-mesh structure/non-surface modified scaffolds showed the most appropriate treatment effect. 3D-printed solid structure is the most suitable option for maxillofacial reconstruction. Various mesh structures reduced osteogenesis of the mesenchymal stem cells and osseointegration compared with that by the solid structure. Surface modification by microarc oxidation induced cell proliferation and increased the expression of some osteogenic genes partially; however, most of the markers revealed that the non-anodized solid scaffold was the most suitable for maxillofacial reconstruction. [Display omitted] • Cellular responses and osseointegration of anodized 3D printed titanium implants with various mesh structures were compared. • Anodization may inhibit osteoclastogenesis. • Non-anodized solid scaffold was most suitable for maxillofacial reconstruction in terms of osseointegration. [ABSTRACT FROM AUTHOR]

Abstract Background To introduce a theoretical solution to a posteriori describe the pose of a cylindrical dental fixture as appearing on radiographs; to experimentally validate the method described. Methods The pose of a conventional dental implant was described by a triplet of angles (phi-pitch, theta-roll, and psi-yaw) which was calculated throughout vector analysis. Radiographic- and simulated-image obtained with an algorithm were compared to test effectiveness, reproducibility, and accuracy of the method. The length of the dental implant as appearing on the simulated image was calculated by the trigonometric function and then compared with real length as it appeared on a two-dimensional radiograph. Results Twenty radiographs were analyzed for the present in silico and retrospective study. Among 40 fittings, 37 resulted as resolved with residuals ≤ 1 mm. Similar results were obtained for radiographic and simulated implants with absolute errors of − 1.1° ± 3.9° for phi; − 0.9° ± 4.1° for theta; 0° ± 1.1° for psi. The real and simulated length of the implants appeared to be heavily correlated. Linear dependence was verified by the results of the robust linear regression: 0.9757 (slope), + 0.1344 mm (intercept), and an adjusted coefficient of determination of 0.9054. Conclusions The method allowed clinicians to calculate, a posteriori, a single real triplet of angles (phi, theta, psi) by analyzing a two-dimensional radiograph and to identify cases where standardization of repeated intraoral radiographies was not achieved. The a posteriori standardization of two-dimensional radiographs could allowed the clinicians to minimize the patient’s exposure to ionizing radiations for the measurement of marginal bone levels around dental implants.

Abstract Background In this research the biomechanical properties of a bone model was examined. Porcine ribs are used as experimental model. The objective of this research was to investigate and compare the biomechanical properties of the bone model before and after implant placement. Methods The bone samples were divided in three groups, Group 1 where ALL-ON-FOUR protocol was used during pre-drilling and placing the implants, Group 2 where ALL-ON-FOUR protocol was used during pre-drilling, and implants were not placed, and Group 3 consisting of intact bones served as a control group. Static and dynamic loading was applied for examining the model samples. Kruskal–Wallis statistical test and as a post-hoc test Mann–Whitney U test was performed to analyze experimental results. Results According to the results of the static loading, there was no significant difference between the implanted and original ribs, however, the toughness values of the bones decreased largely on account of predrilling the bones. The analysis of dynamic fatigue measurements by Kruskal–Wallis test showed significant differences between the intact and predrilled bones. Conclusion The pre-drilled bone was much weaker in both static and dynamic tests than the natural or implanted specimens. According to the results of the dynamic tests and after a certain loading cycle the implanted samples behaved the same way as the control samples, which suggests that implantation have stabilized the skeletal bone structure.

This study aims to investigate the effects of a novel ZnCuO nanoparticle coating for dental implants—versus those of conventional titanium surfaces—on bacteria and host cells. A multispecies biofilm composed of Streptococcus sanguinis, Actinomyces naeslundii, Porphyromonas gingivalis, and Fusobacterium nucleatum was grown for 14 days on various titanium discs: machined, sandblasted, sandblasted and acid-etched (SLA), ZnCuO-coated, and hydroxyapatite discs. Bacterial species were quantified with qPCR, and their viability was examined via confocal microscopy. Osteoblast-like and macrophage-like cells grown on the various discs for 48 h were examined for proliferation using an XTT assay, and for activity using ALP and TNF-α assays. The CSLM revealed more dead bacteria in biofilms grown on titanium than on hydroxyapatite, and less on sandblasted than on machined and ZnCuO-coated surfaces, with the latter showing a significant decrease in all four biofilm species. The osteoblast-like cells showed increased proliferation on all of the titanium surfaces, with higher activity on the ZnCuO-coated and sandblasted discs. The macrophage-like cells showed higher proliferation on the hydroxyapatite and sandblasted discs, and lower activity on the SLA and ZnCuO-coated discs. The ZnCuO-coated titanium has anti-biofilm characteristics with desired effects on host cells, thus representing a promising candidate in the complex battle against peri-implantitis. [ABSTRACT FROM AUTHOR]

Abstract Objectives Diet‐induced metabolic dysfunction such as type 2 diabetes mellitus increases the risk of implant failure in both dental and orthopaedic settings. We hypothesised that a diet high in fat and fructose would adversely affect peri‐implant bone structure and function including osseointegration. Materials and methods Thirty female Sprague‐Dawley rats were divided into three groups (n = 10), control group (normal chow) and two intervention groups on a high‐fat (60%), high‐fructose (20%; HFHF) diet. Titanium implants were placed in the proximal tibial metaphysis in all groups either before commencing the diet (dHFHF group) or 6 weeks after commencing the diet (HFHF group) and observed for an 8‐week healing period. Fasting blood glucose levels (fBGLs) were measured weekly. Structural and functional features of the peri‐implant bone, including bone‐to‐implant contact (BIC), were analysed post euthanasia using microcomputed tomography, pull‐out tests, and dynamic histomorphometry. Results The fBGLs were unchanged across all groups. Peri‐implant trabecular bone volume was reduced in the HFHF group compared with controls (p = .02). Percentage BIC was reduced in both HFHF group (25.42 ± 3.61) and dHFHF group (28.56 ± 4.07) compared with the control group (43.26 ± 3.58, p < .05) and reflected the lower pull‐out loads required in those groups. Osteoblast activity was reduced in both intervention groups compared with the control group (p < .05). Conclusion The HFHF diet compromised osseointegration regardless of whether the implant was placed before or after the onset of the diet and, despite the absence of elevated fBGLs, confirming that changes in bone cell function affected both the initiation and maintenance of osseointegration independent of blood glucose levels.

Background: To introduce a theoretical solution to a posteriori describe the pose of a cylindrical dental fixture as appearing on radiographs; to experimentally validate the method described. Methods: The pose of a conventional dental implant was described by a triplet of angles (phi-pitch, theta-roll, and psi-yaw) which was calculated throughout vector analysis. Radiographic- and simulated-image obtained with an algorithm were compared to test effectiveness, reproducibility, and accuracy of the method. The length of the dental implant as appearing on the simulated image was calculated by the trigonometric function and then compared with real length as it appeared on a two-dimensional radiograph. Results: Twenty radiographs were analyzed for the present in silico and retrospective study. Among 40 fittings, 37 resulted as resolved with residuals ≤ 1 mm. Similar results were obtained for radiographic and simulated implants with absolute errors of − 1.1° ± 3.9° for phi; − 0.9° ± 4.1° for theta; 0° ± 1.1° for psi. The real and simulated length of the implants appeared to be heavily correlated. Linear dependence was verified by the results of the robust linear regression: 0.9757 (slope), + 0.1344 mm (intercept), and an adjusted coefficient of determination of 0.9054. Conclusions: The method allowed clinicians to calculate, a posteriori, a single real triplet of angles (phi, theta, psi) by analyzing a two-dimensional radiograph and to identify cases where standardization of repeated intraoral radiographies was not achieved. The a posteriori standardization of two-dimensional radiographs could allowed the clinicians to minimize the patient's exposure to ionizing radiations for the measurement of marginal bone levels around dental implants. [ABSTRACT FROM AUTHOR]

Aim: To evaluate tramadol hydrochloride, an atypical opioid with potential analgesic properties, as a viable alternative to lignocaine hydrochloride in supraperiosteal anesthesia for dental implants., Materials and Methods: A split-mouth, double-blind, randomized controlled trial was conducted in patients requiring maxillary dental implants. Patients meeting inclusion criteria received either 5% tramadol hydrochloride with adrenaline or 2% lignocaine hydrochloride with adrenaline via supraperiosteal infiltration. Onset, duration of anesthesia, visual analog scale (VAS) pain scores, and adverse effects were recorded., Results: Forty patients were included, with a mean age of 39.35 years, 62.5% male. No significant differences were observed in VAS pain scores between tramadol (2.08 ± 1.328) and lignocaine (2.05 ± 1.260) groups ( p = 0.931). Onset of anesthesia showed no significant difference between the tramadol (128.00 ± 18.207 seconds) and lignocaine (128.30 ± 18.287 seconds) groups ( p = 0.736). The duration of anesthesia was comparable between tramadol (59 ± 12.092 minutes) and lignocaine (59.90 ± 11.705 minutes) groups ( p = 0.0736). Adverse effects included nausea in two tramadol and one lignocaine patient., Conclusion: Tramadol hydrochloride demonstrated comparable local anesthetic efficacy to lignocaine hydrochloride in dental implant surgery Clinical significance: Both drugs provided effective pain control with similar onset and duration of anesthesia. Tramadol may offer an alternative for patients with lignocaine contraindications, although further studies are warranted to validate its safety and efficacy in dental procedures. How to cite this article: Parlawar AN, Mundada BP. Assessing Tramadol Hydrochloride as an Alternative to Lignocaine Hydrochloride in Dental Implant Procedures: A Randomized Trial. J Contemp Dent Pract 2024;25(7):639-644.

Macrophages have been described as a critical cell population regulating bone regeneration and osseointegration, and their polarization phenotype is of particular importance. Several studies have shown that calcitonin gene-related peptide-α (CGRP) might modulate macrophage polarization in inflammatory response and bone metabolism. This study aimed to investigate the effect of CGRP on macrophage polarization in titanium osseointegration. In vitro, bone marrow-derived macrophages (BMDMs) from C57BL/6 or CGRP–/– mice were obtained and activated for M1 and M2 polarization. Flow cytometry and real-time PCR were used to evaluate the M1/M2 polarization and inflammatory function. In vivo, mice were divided into 3 groups: wild-type, CGRP–/–, and CGRP–/– mice with CGRP lentivirus. After extraction of the maxillary first molar, 0.6 mm × 1.25 mm titanium implants were emplaced. Bone formation and inflammation levels around implants were then observed and analyzed. The results of flow cytometry demonstrated that CGRP deficiency promoted M1 polarization and inhibited M2 polarization in BMDMs, which was consistent with pro-inflammatory and anti-inflammatory cytokine expression levels in real-time PCR. In vivo, compared with the CGRP–/– group, the CGRP gene transfection group displayed better osseointegration and lower inflammation levels, close to those of the wild-type group. These results revealed that CGRP might play roles in macrophage polarization. In addition, CGRP deficiency could inhibit osseointegration in murine maxillae, while CGRP recovery by lentivirus transfection could improve osseointegration and regulate macrophage phenotype expression.

Background: In this research the biomechanical properties of a bone model was examined. Porcine ribs are used as experimental model. The objective of this research was to investigate and compare the biomechanical properties of the bone model before and after implant placement. Methods: The bone samples were divided in three groups, Group 1 where ALL-ON-FOUR protocol was used during pre-drilling and placing the implants, Group 2 where ALL-ON-FOUR protocol was used during pre-drilling, and implants were not placed, and Group 3 consisting of intact bones served as a control group. Static and dynamic loading was applied for examining the model samples. Kruskal–Wallis statistical test and as a post-hoc test Mann–Whitney U test was performed to analyze experimental results. Results: According to the results of the static loading, there was no significant difference between the implanted and original ribs, however, the toughness values of the bones decreased largely on account of predrilling the bones. The analysis of dynamic fatigue measurements by Kruskal–Wallis test showed significant differences between the intact and predrilled bones. Conclusion: The pre-drilled bone was much weaker in both static and dynamic tests than the natural or implanted specimens. According to the results of the dynamic tests and after a certain loading cycle the implanted samples behaved the same way as the control samples, which suggests that implantation have stabilized the skeletal bone structure. [ABSTRACT FROM AUTHOR]

Macrophages have been described as a critical cell population regulating bone regeneration and osseointegration, and their polarization phenotype is of particular importance. Several studies have shown that calcitonin gene-related peptide-α (CGRP) might modulate macrophage polarization in inflammatory response and bone metabolism. This study aimed to investigate the effect of CGRP on macrophage polarization in titanium osseointegration. In vitro , bone marrow-derived macrophages (BMDMs) from C57BL/6 or CGRP –/– mice were obtained and activated for M1 and M2 polarization. Flow cytometry and real-time PCR were used to evaluate the M1/M2 polarization and inflammatory function. In vivo , mice were divided into 3 groups: wild-type, CGRP –/– , and CGRP –/– mice with CGRP lentivirus. After extraction of the maxillary first molar, 0.6 mm × 1.25 mm titanium implants were emplaced. Bone formation and inflammation levels around implants were then observed and analyzed. The results of flow cytometry demonstrated that CGRP deficiency promoted M1 polarization and inhibited M2 polarization in BMDMs, which was consistent with pro-inflammatory and anti-inflammatory cytokine expression levels in real-time PCR. In vivo , compared with the CGRP –/– group, the CGRP gene transfection group displayed better osseointegration and lower inflammation levels, close to those of the wild-type group. These results revealed that CGRP might play roles in macrophage polarization. In addition, CGRP deficiency could inhibit osseointegration in murine maxillae, while CGRP recovery by lentivirus transfection could improve osseointegration and regulate macrophage phenotype expression. [ABSTRACT FROM AUTHOR]

Purpose: To analyse randomised controlled clinical trials (RCTs) and prospective cohort studies reporting on the survival and failure rates of functionally loaded short implants (SI) based on the actual length of time in function. Materials and methods: This meta‐analysis was conducted according to PRISMA guidelines for systematic reviews. Electronic and manual searches were conducted to identify RCTs and prospective cohort studies reporting survival and complication rates of short dental implants (≤6 mm) based on the time in function. Secondary outcomes included the location (maxilla or mandible), type of restoration (single crown [SC] versus fixed dental prosthesis [FDP]) and marginal bone loss (MBL). Results: A total of 20 studies (11 RCTs and 9 prospective) fulfilled the inclusion criteria and featured a total of 1238 SI placed in 747 patients. The overall (early and late) mean percentage of short implant failure was 4%. SI with up to 1‐year follow‐up presented failure rate of 2%, while SI followed up for >3 years showed a failure rate of 10%. SI restored with SC presented a late failure rate of 4% while SI restored with FPD 2%. The late failure rate did not differ in terms of location (maxilla or mandible) both with 3%. Conclusion: Short implants in function for more than 3 years presented higher failure rates compared to SI in function for <3 years. Splinting crowns supported by SIs in the posterior area should be considered. However, SI is a valid option for selected cases given their relatively high long‐term survival rates. [ABSTRACT FROM AUTHOR]

The identification of metal ions and particles in the vicinity of failed implants has raised the concern that biomedical titanium alloys undergo corrosion in healthy and infected tissues. Various surface modifications and coatings have been investigated to prevent the deterioration and biocorrosion of titanium alloys but so far with limited success. Graphene is a cytocompatible atom-thick film made of carbon atoms. It has a very high surface area and can be deposited onto metal objects with complex shapes. As the carbon lattice has a very small pore size, graphene has promising impermeability capacity. Here, we show that graphene coating can effectively protect Ti-6Al-4V from corrosion. Graphene nanocoatings were produced on Ti-6Al-4V grade 5 and 23 discs and subjected to corrosive challenge (0.5M NaCl supplemented with 2-ppm fluoride, pH of 2.0) up to 30 d. The linear polarization resistance curves and electrochemical impedance spectroscopy analysis showed that the graphene-coated samples presented higher corrosion resistance and electrochemical stability at all time points. Moreover, the corrosion rate of the graphene-coated samples was very low and stable (~0.001 mm/y), whereas that of the uncoated controls increased up to 16 and 5 times for grade 5 and 23 (~0.091 mm/y) at the end point, respectively. The surface oxidation, degradation (e.g., crevice defects), and leaching of Ti, Al, and V ions observed in the uncoated controls were prevented by the graphene nanocoating. The Raman mappings confirmed that the graphene nanocoating presented high structural stability and resistance to mechanical stresses and chemical degradation, keeping >99% of coverage after corrosion challenge. Our findings open the avenues for the use of graphene as anticorrosion coatings for metal biomedical alloys and implantable devices. [ABSTRACT FROM AUTHOR]

Objectives: Diet‐induced metabolic dysfunction such as type 2 diabetes mellitus increases the risk of implant failure in both dental and orthopaedic settings. We hypothesised that a diet high in fat and fructose would adversely affect peri‐implant bone structure and function including osseointegration. Materials and methods: Thirty female Sprague‐Dawley rats were divided into three groups (n = 10), control group (normal chow) and two intervention groups on a high‐fat (60%), high‐fructose (20%; HFHF) diet. Titanium implants were placed in the proximal tibial metaphysis in all groups either before commencing the diet (dHFHF group) or 6 weeks after commencing the diet (HFHF group) and observed for an 8‐week healing period. Fasting blood glucose levels (fBGLs) were measured weekly. Structural and functional features of the peri‐implant bone, including bone‐to‐implant contact (BIC), were analysed post euthanasia using microcomputed tomography, pull‐out tests, and dynamic histomorphometry. Results: The fBGLs were unchanged across all groups. Peri‐implant trabecular bone volume was reduced in the HFHF group compared with controls (p =.02). Percentage BIC was reduced in both HFHF group (25.42 ± 3.61) and dHFHF group (28.56 ± 4.07) compared with the control group (43.26 ± 3.58, p <.05) and reflected the lower pull‐out loads required in those groups. Osteoblast activity was reduced in both intervention groups compared with the control group (p <.05). Conclusion: The HFHF diet compromised osseointegration regardless of whether the implant was placed before or after the onset of the diet and, despite the absence of elevated fBGLs, confirming that changes in bone cell function affected both the initiation and maintenance of osseointegration independent of blood glucose levels. [ABSTRACT FROM AUTHOR]

Zirconia (ZrO2) dental implants provide good biocompatibility, have good corrosion resistance, and have a color that is similar to that of natural teeth. Unfortunately, ZrO2 is a bioinert material and therefore achieves osseointegration difficultly. In this study, we sought to enhance osseointegration by producing rough ZrO2 surfaces that contain hydroxyl groups (designated ZSA) through the use of sandblasting in conjunction with alkaline treatment. We immobilized type I collagen on ZSA surfaces using the natural cross-linker, procyanidin. Our results further showed that surfaces produced in ZSA-P/C featured more and steadier type I collagen than surfaces produced in ZSA-C. The ZSA-P/C also presented superior cell responses in terms of adhesion, proliferation, and mineralization of human bone marrow mesenchymal stem cells. The enhanced cell responses in the ZSA-P/C were induced through the prolonged activation of focal adhesion kinase, AKT (the phosphoinositide 3-kinase pathway), and p38 (the mitogen-activated protein kinase pathway). The simple and novel approach to immobilize type I collagen on roughened ZrO2 surfaces presented in this article can likely benefit dental implant applications. [ABSTRACT FROM AUTHOR]

Abstract The experimental determination of local bone deformations due to implant loading would allow for a better understanding of the biomechanical behavior of the bone-implant-prosthesis system as well as the influence of uneven force distribution on the onset of implant complications. The present study aimed at describing an innovative in vivo strain gauge measurement technique to evaluate implant-to-bone force transmission, assessing whether and how oral implants can transfer occlusal forces through maxillary bones. In vivo force measurements were performed in the maxillary premolar region of a male patient who had previously received a successful osseointegrated titanium implant. Three linear mini-strain gauges were bonded onto three different buccal cortical bone locations (i.e. coronal, middle, apical) and connected to strain measuring hardware and software. A customized screw-retained abutment was manufactured to allow for vertical and horizontal loading tests. As to the vertical load test, the patient was instructed to bite on a load cell applying his maximum occlusal force for 20 s and then recovering for 10 s to restore the bone unstrained state; the test was repeated 20 times consecutively. As regards the horizontal load test, the implant was subjected to a total of 20 load applications with force intensities of 5 and 10 kg. During the tests, the recorded signals were plotted in real time on a graph as a function of time by means of a strain analysis software. The described strain gauge measurement technique proved to be effective in recording the forces transmitted from osseointegrated implants to the cortical bone. Horizontal loads caused higher deformations of cortical bone than vertical biting forces; in both situations, the deformation induced by the force transferred from the implant to the bone progressively decreased from the coronal to the apical third of the alveolar ridge. At approximately 9 mm from the implant neck, the effect of occlusal force transmission through osseointegrated titanium implants was negligible if compared to the apical region. [ABSTRACT FROM AUTHOR]

Alveolar bone is a mechanosensitive tissue that provides structural support for teeth. Alveolar bone loss is common with aging, menopause, tooth loss, and periodontitis and can lead to additional tooth loss, reduced denture fixation, and challenges in placing dental implants. The current studies suggest that sclerostin and DKK1, which are established osteocyte-derived inhibitors of bone formation, contribute to alveolar bone loss associated with estrogen ablation and edentulism in rats. Estrogen-deficient ovariectomized rats showed significant mandibular bone loss that was reversed by systemic administration of sclerostin antibody (SAB) alone and in combination with DKK1 antibody (DAB). Osteocytes in the dentate and edentulous rat maxilla expressed Sost (sclerostin) and Dkk1 (DKK1) mRNA, and molar extraction appeared to acutely increase DKK1 expression. In a chronic rat maxillary molar extraction model, systemic SAB administration augmented the volume and height of atrophic alveolar ridges, effects that were enhanced by coadministering DAB. SAB and SAB+DAB also fully reversed bone loss that developed in the opposing mandible as a result of hypo-occlusion. In both treatment studies, alveolar bone augmentation with SAB or SAB+DAB was accompanied by increased bone mass in the postcranial skeleton. Jaw bone biomechanics showed that intact sclerostin-deficient mice exhibited stronger and denser mandibles as compared with wild-type controls. These studies show that sclerostin inhibition, with and without DKK1 coinhibition, augmented alveolar bone volume and architecture in rats with alveolar bone loss. These noninvasive approaches may have utility for the conservative augmentation of alveolar bone. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate the extent of cortical bone remodeling between two different drilling protocols by means of histomorphometric, µ‐CT, and biomechanical analyses. Material and methods: A total of 48 implants were inserted into the mandible of six sheep following two drilling protocols: Group A (Test, n = 24), undersized preparation; Group B (Control, n = 24), non‐undersized preparation. The animals were euthanatized to obtain 5 and 10 weeks of implantation time. Removal torque (RTQ) was measured on 12 implants of each group and the peri‐implant bone was µ‐CT scanned. Bone volume density (BV/TV) was calculated in pre‐determined cylindrical volumes, up to 1.5 mm from implant surface. Non‐decalcified histology was prepared on the remaining 12 implants from each group, where total bone‐to‐implant contact (totBIC) and newly‐formed BIC (newBIC) was measured. Bone Area Fraction Occupancy (BAFO) was determined in pre‐determined areas up to 1.5 mm from implant surface. Paired sample t test or Wilcoxon signed‐rank test was used to investigate differences between the groups. Results: Group A presented significantly increased RTQ value at 5 weeks, while no difference was observed at 10 weeks. Group B presented increased BV/TV value at 5 weeks. Both groups showed comparable values for totBIC at both time‐points. However, Group A presented significantly lower newBIC at 5 weeks. Higher BAFO was observed in Group B at 5 weeks. Conclusions: Implants inserted into undersized sites has an increased biomechanical performance, but provoked major remodeling of the cortical bone during the early healing period compared to non‐undersized preparations. After 10 weeks, no difference was observed. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the barrier function of platelet-induced epithelial sheets on titanium surfaces. The lack of functional peri-implant epithelial sealing with basal lamina (BL) attachment at the interface of the implant and the adjacent epithelium allows for bacterial invasion, which may lead to peri-implantitis. Although various approaches have been reported to combat bacterial infection by surface modifications to titanium, none of these have been successful in a clinical application. In our previous study, surface modification with protease-activated receptor 4-activating peptide (PAR4-AP), which induced platelet activation and aggregation, was successful in demonstrating epithelial attachment via BL and epithelial sheet formation on the titanium surface. We hypothesized that the platelet-induced epithelial sheet on PAR4-AP-modified titanium surfaces would reduce bacterial attachment, penetration, and invasion. Titanium surface was modified with PAR4-AP and incubated with platelet-rich plasma (PRP). The aggregated platelets released collagen IV, a critical BL component, onto the PAR4-AP-modified titanium surface. Then, human gingival epithelial cells were seeded on the modified titanium surface and formed epithelial sheets. Green fluorescent protein (GFP)-expressing Escherichia coli was cultured onto PAR4-AP-modified titanium with and without epithelial sheet formation. While Escherichia coli accumulated densely onto the PAR4-AP titanium lacking epithelial sheet, few Escherichia coli were observed on the epithelial sheet on the PAR4-AP surface. No bacterial invasion into the interface of the epithelial sheet and the titanium surface was observed. These in vitro results indicate the efficacy of a platelet-induced epithelial barrier that functions to prevent bacterial attachment, penetration, and invasion on PAR4-AP-modified titanium. [ABSTRACT FROM AUTHOR]

Cellular adhesion is essential for successful integration of dental implants. Rapid soft tissue integration is important to create a seal around the implant and prevent infections, which commonly cause implant failure and can result in bone loss. In addition, soft tissue management is important to obtain good dental aesthetics. We previously demonstrated that the salivary peptide histatin 1 (Hst1) causes a more than 2-fold increase in the ability of human adherent cells to attach and spread on a glass surface. Cells treated with Hst1 attached more rapidly and firmly to the substrate and to each other. In the current study, we examine the potential application of Hst1 for promotion of dental implant integration. Our results show that Hst1 enhances the attachment and spreading of soft tissue cell types (oral epithelial cells and fibroblasts) to titanium (Ti) and hydroxyapatite (HAP), biomaterials that have found wide applications as implant material in dentistry and orthopedics. For improved visualization of cell adhesion to Ti, we developed a novel technique that uses sputtering to deposit a thin, transparent layer of Ti onto glass slides. This approach allows detailed, high-resolution analysis of cell adherence to Ti in real time. Furthermore, our results suggest that Hst1 has no negative effects on cell survival. Given its natural occurrence in the oral cavity, Hst1 could be an attractive agent for clinical application. Importantly, even though Hst1 is specific for saliva of humans and higher primates, it stimulated the attachment and spreading of canine cells, paving the way for preclinical studies in canine models. [ABSTRACT FROM AUTHOR]

• OSM could promote the osseointegration of dental and femur implants via YAP. • OSM-YAP was involved in regulating M1/M2 polarization of macrophages. • YAP knock-out of inhibited the osseointegration, while OSM could restore the effect. Oncostatin M(OSM), secreted by monocytes and macrophages, has been noted to participate in bone homeostasis and macrophage polarization, which might be regulated by yes-associated protein (YAP). This study aimed to elucidate the influence and mechanisms of OSM-YAP on macrophages polarization in osseointegration. In vitro, flow cytometry, real-time PCR, and Elisa were performed to evaluate inflammatory function in bone marrow-derived macrophages (BMDMs) with OSM, siOSMR, and YAP inhibitor verteporfin (VP). In vivo, macrophage-specific YAP-deficient mice were generated to investigate the role of OSM via YAP signaling in osseointegration. This study demonstrated that OSM could inhibit the M1 polarization, promote the M2 polarization, and induce the expression of osteogenic-related factors via VP. The conditional knock-out of YAP inhibited the osseointegration in mice, and promoted the inflammatory reaction around the implants, while OSM could restore the effect. Our results demonstrated that OSM might play an important role in the polarization of BMDMs, and bone formation around dental and femoral implants. This effect was closely conducted by Hippo-YAP pathway. Understanding the role and mechanism of OSM in macrophage polarization around dental implants could improve comprehension of signal network of osseointegration, and it might offer a potential target of therapies to accelerate osseointegration and reduce inflammatory reactions. [ABSTRACT FROM AUTHOR]

In the area of dentistry, there is a wide variety of designs of dental implant and materials, especially titanium, which aims to avoid failures and increase their clinical durability. The purpose of this review was to evaluate fatigue behavior in different connections and implant materials, as well as their loading conditions and response to failure. In vitro tests under normal and dynamic loading conditions evaluating fatigue at implant and abutment connection were included. A search was conducted in PubMed, Scopus, and Science Direct. Data extraction was performed independently by two reviewers. The quality of selected studies was assessed using the Cochrane Handbook proposed by the tool for clinical trials. Nineteen studies were included. Fourteen studies had an unclear risk and five had high risk of bias. Due to the heterogeneity of the data and the evaluation of the quality of the studies, meta-analysis could not be performed. Evidence from this study suggests that both internal and morse taper connections presented a better behavior to failure. However, it is necessary to unify criteria in the methodological design of in vitro studies, following methodological guidelines and establishing conditions that allow the homogenization of designs in ISO (International Organization for Standardization) standards.

Purpose This study aimed to develop an artificial intelligence (AI) model to support the determination of an appropriate implant drilling protocol using cone-beam computed tomography (CBCT) images.Methods Anonymized CBCT images were obtained from 60 patients. For each case, after implant placement, images of the bone regions at the implant site were extracted from 20 slices of CBCT images. Based on the actual drilling protocol, the images were classified into three categories: protocols A, B, and C. A total of 1,200 images were divided into training and validation datasets (n = 960, 80%) and a test dataset (n = 240, 20%). Another 240 images (80 images for each type) were extracted from the 60 cases as test data. An AI model based on LeNet-5 was developed using these data sets. The accuracy, sensitivity, precision, F-value, area under the curve (AUC) value, and receiver operating curve were calculated.Results The accuracy of the trained model is 93.8%. The sensitivity results for drilling protocols A, B, and C were 97.5%, 95.0%, and 85.0%, respectively, while those for protocols A, B, and C were 86.7%, 92.7%, and 100%, respectively, and the F values for protocols A, B, and C were 91.8%, 93.8%, and 91.9%, respectively. The AUC values for protocols A, B, and C are 98.6%, 98.6%, and 99.4%, respectively.Conclusions The AI model established in this study was effective in predicting drilling protocols from CBCT images before surgery, suggesting the possibility of developing a decision-making support system to promote primary stability.

We previously reported that dental stem cell-mediated bioengineered tooth root (bio-root) regeneration could restore tooth loss in a miniature pig model. As a potential new method for tooth restoration, it is essential to compare this method with the widely used commercial dental implant-based method of tooth restoration. Tooth loss models were created by extracting mandibular incisors from miniature pigs. Allogeneic periodontal ligament stem cells (PDLSCs) and dental pulp stem cells (DPSCs) were isolated and cultured. A PDLSC sheet was prepared by adding 20.0 µg/mL vitamin C to the culture medium; in addition, a hydroxyapatite tricalcium phosphate (HA/TCP)/DPSC graft was fabricated and cultured in a 3-dimensional culture system. A total of 46 bio-root implantations and 9 dental implants were inserted, and crown restorations were performed 6 mo after implantation. Histological, radiological, biomechanical, and elemental analyses were used to evaluate and compare tissue-engineered bio-roots and dental implants to the natural tooth roots. After 6 mo, both computed tomography scans and histological examinations showed that root-like structures and dentin-like tissues had formed. Three months after crown restoration, clinical assessments revealed that tooth function was equivalent in the regenerated bio-root and the dental implant. Biomechanical testing showed that the bio-roots were similar to natural tooth roots in compressive strength, modulus of elasticity, and torsional force; however, these properties were significantly higher in the dental implants. Elemental analysis revealed a higher similarity in elemental composition between bio-roots and natural tooth roots than between bio-roots and dental implants. However, the dental implant success rate was 100% (9 of 9) and the bio-root success rate was only 22% (10 of 46). Taken together, we showed that an allogeneic HA/TCP/DPSC/PDLSC sheet could successfully build a bio-root with structure and function similar to the natural tooth root; however, tissue engineering procedures must be optimized further to improve the success rate. [ABSTRACT FROM AUTHOR]

Objectives Retrospective evaluation of the biological and technical complications in implant-supported single-tooth molar restorations performed in a private practice after functional periods of ≥4 years. Material and Methods Sixty-five patients (34 females, age 51.7 ± 10.6 years) with 112 implants received annual follow-up examinations and participated in a maintenance program. The survival ( in situ) and success (complication-free) rates of implants and superstructures were evaluated. Time-dependent peri-implantitis rates were calculated, and the influencing factors were identified using a multiple Cox regression. Results The implant survival rate was 100%. Three of 112 crowns required replacement (prosthetic survival rate = 98.1%). Thirty technical complications were observed: loss of retention (16), ceramic fracture (10), and screw loosening (4). The success rate of the superstructures was 79.0% after 7 years. Overall, 9.2% of the patients developed peri-implantitis (probing depth ≥5 mm, BOP, suppuration, bone loss ≥3.5 mm); (smokers: 41.6%, non-smokers: 1.8%). After 7 years, the time-dependent implant success rate (free of peri-implantitis) was 100% for non-smokers and 58.6% for smokers. Multiple analysis showed a significant effect of smoking (hazard ratio, 19.5; P = 0.008) on peri-implantitis. Conclusions Implants with cemented single-tooth restorations in the molar region constitute a reliable treatment in private practice. Smokers have a significantly increased peri-implantitis rate. [ABSTRACT FROM AUTHOR]

Background In addition to traditional clinical parameters, the need to include patient-reported assessments into dental implant research has been emphasized. Aim The aim of this study was to evaluate patient-reported outcomes following implant-supported restorative therapy in a randomly selected patient sample. Material and Methods Four thousand seven hundred and sixteen patients were randomly selected from the data register of the Swedish Social Insurance Agency. A questionnaire containing 10 questions related to implant-supported restorative therapy was mailed to each of the individuals about 6 years after therapy. Associations between questionnaire data, and (i) patient-related, (ii) clinician-related and (iii) therapy-related variables were identified by multivariate analyses. Results Three thousand eight hundred and twenty-seven patients (81%) responded to the questionnaire. It was demonstrated that the overall satisfaction among patients was high. Older patients presented with an overall more positive perception of the results of the therapy than younger patients and males were more frequently satisfied in terms of esthetics than females. While clinical setting did not influence results, patients treated by specialist dentists as opposed to general practitioners reported a higher frequency of esthetic satisfaction and improved chewing ability. In addition, patients who had received extensive implant-supported reconstructions, in contrast to those with small reconstructive units, reported more frequently on improved chewing ability and self-confidence but also to a larger extent on implant-related complications. Conclusion It is suggested that patient-perceived outcomes of implant-supported restorative therapy are related to (i) age and gender of the patient, (ii) the extent of restorative therapy and (iii) the clinician performing the treatment. [ABSTRACT FROM AUTHOR]

This study was designed to evaluate laser-sintered early-loaded 1-piece implants (OPI) based on clinical and radiographic findings. Thirty OPI were placed in the mandibular premolar area and subjected to early loading after 3 weeks of initial placement; patients were followed up for 6 months. Clinical evaluation included pocket depth, gingival health, implant stability, and esthetics. Periapical radiographs were used to measure the marginal bone loss (MBL). All implants were considered successful resulting in a survival rate of 100%. A remarkable difference (P < 0.01) existed when comparing MBL levels at 1 month with those at 3 and 6 months. Significant differences (P < 0.01) existed when comparing implant stability at 1 month to 3 months and at 3 months to 6 months. Moreover, significant differences (P < 0.01) were observed when comparing peri-implant probing depth at 1 month to that at 3 and 6 months on both the mesial and distal sides. The mean value of pink esthetic score was 11 at time of final restoration. The laser-treated early-loaded OPI design is associated with satisfactory clinical and radiographic follow-up results and it is a good alternative to the 2-piece design. [ABSTRACT FROM AUTHOR]

Our aim was to describe and evaluate the outcome of ridge-splitting and simultaneous implantation combined with ridge expansion osteotomy and sandwich-bone augmentation in the aesthetic zone. Thirty-one patients aged from 21-55 years who presented with narrow edentulous ridges (2.88∼5.08 mm) were treated by ridge-splitting together with ridge expansion osteotomy and sandwich-bone augmentation to correct the osseous deficiency for simultaneous implantation. Bicon ® implants were used. Calipers were used for biometric evaluation of the width of the ridge at both the first and second operations. Cone-beam computed tomography (CT, Morita, Kyodo, Japan) was used to assess the morphology of the ridge and the outcome of the operation. Forty-three implants were placed in the 31 patients selected, and none failed. At follow up all the implants functioned well and we saw no sign of gingival recession. Biometric evaluation at the surgical sites showed that the mean (SD) amount of augmentation of the ridge in the buccopalatal dimension was 2.8 (0.7) mm, p < 0.01). For a narrow edentulous ridge in an aesthetic zone, ridge splitting together with ridge expansion osteotomy and sandwich-bone augmentation is a reliable technique. [ABSTRACT FROM AUTHOR]

Objectives Implant surface topography is a key determinant affecting osteoblastic differentiation and cell-cell signaling of implant-adherent cells. Materials and methods To assess the early osteoinductive and cell-cell signaling events in adherent cells, commercially pure titanium implants (2.2 × 5 mm) with nanotopography ( HF-treated Ti O2 grit-blasted) were compared with micron-scale topography Ti O2 grit-blasted (micron-scale, control) implants in vivo. Six implants ( n = 3/surface) were placed in 10 systemically healthy subjects and removed by reverse threading at 1, 3, and 7 days. Gene expression profiles of adherent cells were interrogated using low-density RT- PCR arrays. Results Osteoinduction was not observed at day 1 on either surface. At 3 days, elevated levels of BMP6, osteopontin, and osterix ( OSX) were observed in RNA of cells adherent to both micron-scale and nanotopography surfaces. Both surfaces supported osteoinductive gene expression at 7 days; however, modest elevations of most m RNAs and significantly higher OSX mRNA levels were measured for cells adhered to nanotopography implants. Further, chemokine and cytokine profiles including CXCL10, CXCL14, IL-9, IL-22, and TOLLIP were upregulated on nanotopographic surfaces as compared with microtopographic surfaces. Conclusions Implants with superimposed nanoscale topography generate a greater induction of genes linked to osteogenesis and cell-cell signaling during the early phases of osseointegration. [ABSTRACT FROM AUTHOR]

Objective The aim of this study was to report on the failure rates of two distinct dental implant systems in a clinical practice setting. Materials and methods Date of implant placement and loss were entered prospectively in a data registry system. Failure rates of two commercially pure titanium implants, one with a porous oxydized surface ( POS) and the other with a chemically altered surface ( CAS), were assessed using a quality control chart and survival analyses. Results A total of 860 POS and 759 CAS implants were placed. A warning of an increased failure rate of the CAS implant was identified by means of the quality control chart. Survival analyses indicated that the CAS implant failure rate was twice that of the POS implant (Hazard Ratio: 2.08; 95% CI: 1.33-3.28, P-value < 0.0012). After adjusting for alternative explanations, the CAS implant remained associated with a 95% increased failure rate (95% CI: 1.14-3.35; P-value = 0.0146). Abandoning the CAS implant and returning to a POS implant was associated with a non-significant 64% drop in the implant failure rate within less than a year ( HR: 0.36; 95% CI: 0.12-1.14; P-value < 0.0826). Conclusion The difference between a 4% failure rate with the POS implant and an 8% failure with the CAS implant appears inconsistent with the assumption of substantial equivalence. [ABSTRACT FROM AUTHOR]

Introduction: Although healing abutments are designated for single use by most implant manufacturers, it is common practice for clinicians to reuse healing abutments. However, there is a lack of adequate references that describe detailed sterilization protocols for reuse of healing abutments., Objectives: The purpose of this systematic review was to compile, organize, and describe the most common techniques for the sterilization of healing abutments and their efficiency in eliminating traces of microorganisms., Methods: An electronic search in 5 different databases was performed, including the National Library of Medicine (MEDLINE via PubMed), Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Google Scholar from January 2000 to December 2020. Search variables included were dental implant, healing abutment, contaminate, contamination, reuse, and sterilization. Studies reporting with a minimum sample size of 10 healing abutments (5 per group) published in the English language were evaluated. Risk of bias assessment was elaborated for included investigations., Results: In total, 812 articles were identified, of which 8 were included in the analysis. Steam autoclave was the most widely used form of resterilization. Not a single protocol, however, was able to achieve 100% virgin surface of the healing abutments., Conclusion: Although reuse of dental implant healing abutments is a cost-effective measure in dental practice, thorough surface decontamination followed by resterilization is highly recommended before reuse., Knowledge Transfer Statement: With consideration of cost and patient preference, results of this review would be useful in knowing various sterilization protocols for reusing healing abutments that could lead to more appropriate therapeutic decisions.

Introduction: Few interspecies comparisons of alveolar bone have been documented, and this knowledge gap raises questions about which animal models most accurately represent human dental conditions or responses to surgical interventions., Objectives: The objective of this study was to employ state-of-the-art quantitative metrics to directly assess and compare the structural and functional characteristics of alveolar bone among humans, mini pigs, rats, and mice., Methods: The same anatomic location (i.e., the posterior maxillae) was analyzed in all species via micro-computed tomographic imaging, followed by quantitative analyses, coupled with histology and immunohistochemistry. Bone remodeling was evaluated with alkaline phosphatase activity and tartrate-resistant acid phosphatase staining to identify osteoblast and osteoclast activities. In vivo fluorochrome labeling was used as a means to assess mineral apposition rates., Results: Collectively, these analyses demonstrated that bone volume differed among the species, while bone mineral density was equal. All species showed a similar density of alveolar osteocytes, with a highly conserved pattern of collagen organization. Collagen maturation was equal among mouse, rat, and mini pig. Bone remodeling was a shared feature among the species, with morphologically indistinguishable hemiosteonal appearances, osteocytic perilacunar remodeling, and similar mineral apposition rates in alveolar bone., Conclusions: Our analyses demonstrated equivalencies among the 4 species in a plurality of the biological features of alveolar bone. Despite contradictory results from older studies, we found no evidence for the superiority of pig models over rodent models in representing human bone biology., Knowledge Transfer Statement: Animal models are extensively used to evaluate bone tissue engineering strategies, yet there are few state-of-the-art studies that rigorously compare and quantify the factors influencing selection of a given animal model. Consequently, there is an urgent need to assess preclinical animal models for their predictive value to dental research. Our article addresses this knowledge gap and, in doing so, provides a foundation for more effective standardization among animal models commonly used in dentistry.

Objectives: Dental services in many countries are funded out-of-pocket by patients whose acceptance of a dental treatment depends on their valuation of it. Using a willingness-to-pay (WTP) strategy, this study aimed to determine how people who do not wear dentures value the benefits of dentures retained by implants and what factors explain variations in WTP among subjects., Methods: Telephone numbers of a representative Canadian sample were obtained from a consumer database provider. Respondents completed either an internet-based or telephone survey with 3 payment scenarios: paying oneself (out-of-pocket), coverage with private health insurance, and publicly financed through additional taxes. Personal information data (e.g., age, income) were used as independent variables in regression models to assess the determinants of WTP amounts., Results: Among 1,096 respondents, 317 participated in the survey (response rate, 28.9%). The mean WTP of participants (mean ± SD age: 41.2 ± 0.6 y; 54.3% male) who were dentate/partially edentate was $5,347 for implant overdentures. Considering a 1 in 5 chance of becoming edentate, they were willing to pay $26.93 as monthly payments for private insurance. They were also willing to pay an additional yearly tax of $103.63 to support a public program. WTP private payments increased substantially with increase in household income and dental needs., Conclusion: This preference study provides information to dentists, insurance companies, and policy makers on what dentate people are willing to pay for implant overdentures, whether directly or with insurance/government coverage., Knowledge Transfer Statement: This study provides results of interest to many stakeholders. For clinicians, the results reveal what people are willing to pay for implant overdentures for themselves. It also provides information to employers and insurance companies on how people value having coverage for this kind of service. Furthermore, it provides public policy makers the value that people place on public funding of such treatments and how they would support a decision to publicly fund such a treatment.

Objectives: Although inequalities in dental implant use based on educational level have been reported, no study has used income as a proxy for the socioeconomic status. We examined: (i) income inequalities in implant use; and (ii) whether income or education has a stronger association with implant use in elder Japanese., Methods: In 2016, a self-reported questionnaire was mailed to participants aged 65 years or older living across Japan as part of the ongoing Japan Gerontological Evaluation Study. We used data from 84,718 respondents having 19 or fewer teeth. After multiple imputation, multi-level logistic regression estimated the association of dental implant use with equivalised income level and years of formal education. Confounders were age, sex, and density of dental clinics in the residential area., Results: 3.1% of respondents had dental implants. Percentages of dental implant use among the lowest (≤ 9 years) and highest (≥ 13 years) educational groups were 1.8 and 5.1, respectively, and among the lowest (0 < 12.2 '1,000 USD/year') and highest (≥ 59.4 '1,000 USD/year') income groups were 1.7 and 10.4, respectively. A fully adjusted model revealed that both income and education were independently associated with dental implant use. Odds ratios for implant use in the highest education and income groups were 2.13 [95% CI = 1.94-2.35] and 4.85 [95% CI = 3.78-6.22] compared with the lowest education and income groups, respectively. From a model with standardised variables, income showed slightly stronger association than education., Conclusion: This study reveals a public health problem that even those with the highest education but low income might have limited accessibility to dental implant services., (© 2019 FDI World Dental Federation.)

In the area of dentistry, there is a wide variety of designs of dental implant and materials, especially titanium, which aims to avoid failures and increase their clinical durability. The purpose of this review was to evaluate fatigue behavior in different connections and implant materials, as well as their loading conditions and response to failure. In vitro tests under normal and dynamic loading conditions evaluating fatigue at implant and abutment connection were included. A search was conducted in PubMed, Scopus, and Science Direct. Data extraction was performed independently by two reviewers. The quality of selected studies was assessed using the Cochrane Handbook proposed by the tool for clinical trials. Nineteen studies were included. Fourteen studies had an unclear risk and five had high risk of bias. Due to the heterogeneity of the data and the evaluation of the quality of the studies, meta-analysis could not be performed. Evidence from this study suggests that both internal and morse taper connections presented a better behavior to failure. However, it is necessary to unify criteria in the methodological design of in vitro studies, following methodological guidelines and establishing conditions that allow the homogenization of designs in ISO (International Organization for Standardization) standards. [ABSTRACT FROM AUTHOR]

People wearing mandibular two-implant overdentures (IOD) chew food with less difficulty than those wearing conventional complete dentures (CD). However, there is still controversy over whether or not this results in better dietary intake. In this randomized clinical trials (RCT), the amounts of total dietary fiber (TDF), macronutrients, 9 micronutrients, and energy in diets consumed by persons with IOD and CD were compared. Male and female edentate patients ≥ 65 yrs (n = 255) were randomly divided into 2 groups and assigned to receive a maxillary CD and either a mandibular IOD or a CD. One year following prosthesis delivery, 217 participants (CD = 114, IOD = 103) reported the food and quantities they consumed to a registered dietician through a standard 24-hour dietary recall method. The mean and median values of TDF, macro- and micronutrients, and energy consumed by both groups were calculated and compared analytically. No significant between-group differences were found (ps > .05). Despite quality-of-life benefits from IODs, this adequately powered study reveals no evidence of nutritional advantages for independently living medically healthy edentate elders wearing two-implant mandibular overdentures over those wearing conventional complete dentures in their dietary intake at one year following prosthesis delivery (International Clinical Trials ISRCTN24273915). [ABSTRACT FROM PUBLISHER]