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Background and Objectives: The influence of the quantity and quality of peri-implant soft tissue on implant health and long-term maintenance is controversial. This consensus aimed to assess the importance of peri-implant soft tissue by analyzing four aspects: the role of keratinized mucosa (KM), the efficacy of specific collagen matrix, the influence of abutment material, and soft-tissue thickness. Materials and Methods: Active members of the Italian Academy of Osseointegration (IAO) participated in the consensus. Four systematic reviews were conducted, and their results were discussed to provide guidelines on the importance of soft tissue around implants. The first review evaluated the effect of KM on soft-tissue health, peri-implant bone loss, and patient-related variables. The second one analyzed if there was a specific type of matrix that provided better results in terms of peri-implant buccal soft-tissue thickness and keratinized mucosa width compared to autogenous soft-tissue graft. The third review evaluated the influence of different abutment materials on the soft tissues, and the fourth assessed the effect of soft-tissue thickness on peri-implant marginal bone loss (MBL). Results and Conclusions: The agreements reached by the assembly were as follows: the presence of supra-periosteal keratinized tissue is considered to favorably influence peri-implant health and aesthetics but had no relation to preventing bone crest resorption unrelated to infection. It facilitates patient cleaning around implants and reduces patient-reported pain. The free gingival graft (FGG) is considered the best in terms of supra-periosteal KM increase. Connective tissue grafts (CTG) perform better than volume-stable collagen matrices to increase soft-tissue thickness. Collagen matrices reduce surgical time and patient morbidity and can give better camouflaging. The influence of abutment material (titanium or zirconia) on MBL remains controversial, and no conclusion could be reached on this issue. Peri-implant soft-tissue health and recession seem not to be influenced by abutment material, but data are limited to zirconia and titanium. Although this systematic review highlighted the absence of a correlation between soft-tissue thickness and MBL, the assembly failed to find a consensus on this issue.

Among different therapeutic strategies proposed in the case of bone volume deficit, guided bone regeneration (GBR) is a consolidated surgical procedure. The objective of this study is to retrospectively evaluate the behavior of two bone grafts with different consistencies in the GBR procedure by measuring the volumetric tissue changes 1 year after surgery. For this retrospective analysis, 25 cases of GBR with simultaneous implant insertion were selected. A total of 13 were grafted with a porcine cortico-cancellous bone mix (CCBM group), and 12 were grafted with a pre-hydrated granulated cortico-cancellous bone mix of porcine origin blended with 20% TSV gel (Collagenated-CCBM). A collagen membrane was fixed to cover the bone defect. A total of 42 implants were placed with computer-guided surgery. Preoperative and 12-month postoperative digital impressions were used to evaluate dimensional changes. Student’s t-test used for independent samples showed no statistically significant differences between the integrated distance (p = 0.995) and mean distance (p = 0.734). The mean integrated distance in the CCBM group was 41.80 (SD. 101.18) compared to a mean of 42.04 (SD. 66.71) in the Collagenated-CCBM group. Given the limitations of this study, in patients with peri-implant bone dehiscence, simple heterologous and collagenated heterologous cortico-cancellous bone grafts are suitable for filling the bone defect to promote bone regeneration, although further studies are needed.

Abstract Objective The aim of the present systematic review was to test the hypothesis that the diameter of implants inserted in the posterior area affects implant survival rate, prosthetic survival rate and peri-implant parameters (bleeding on probing (BoP), marginal bone loss (MBL), pocket probing depth (PPD)). Materials and methods An electronic search of studies published until December 2021 was done on three databases (Pubmed, Scopus, Cochrane) independently by two authors. Clinical trials comparing implant survival rate, BoP, MBL and PPD among narrow diameter implants (NDI: ≥ 3.0 mm to

Background: Restorative materials might significantly affect load transmission in peri-implant bone. The aim of the present study is to evaluate the shock absorption capacity of two different polymeric materials to be used for implant-supported prostheses. Methods: A masticatory robot was used to compare the shock absorption capacity of veneered and non-veneered polyetherketoneketone (PEKK), Pekkton®ivory (Cendres+Mètaux), and the glass fiber-reinforced composite (GFRC), TRINIATM (Bicon). Five identical sample crowns for each of the three groups were tested. Forces transmitted at the simulated peri-implant bone were recorded and statistically analyzed. Results: The statistical analysis of forces transmitted at the simulated dental implant revealed significant differences between the materials tested and between these materials and zirconia, glass ceramic, composite resin, and acrylic resin. Only differences between PEKK and veneered PEKK and between PEKK and one of the previously tested composite resins were not statistically significant. PEKK samples demonstrated significantly greater shock absorption capacity compared to GFRC. Conclusions: PEKK revealed optimal shock absorption capacity. Further studies are needed to evaluate its efficacy in the case of long-span prostheses with reduced prosthetic volume.

This study was conducted to compare the effects of an innovative plasma surface treatment device that does not need a gas supply for titanium disks with two different surface topographies: the prototypical machined surface (MAC) and one of the most diffused roughened ones (SL) obtained through grit blasting and acid etching. A total of 200-MAC and 200-SL titanium disks were used. Each group of disks was divided into four sub-groups of 40 samples each that were subjected to five different tests. Among these, 150-MAC and 150-SL were considered the test group, and they were treated with plasma for 15, 30, and 60 s after being removed from the sterile packaging. On the other hand, 50-MAC and 50-SL were considered the control group, and they were only removed from sterile plastic vials. The samples were analyzed to evaluate the capability of the plasma treatment in influencing protein adsorption, cell adhesion, proliferation, and microbial growth on the test group disks when compared to the untreated disks. Protein adsorption was significantly enhanced after 20 min of plasma treatment for 15 and 30 s on the MAC and SL disks. Plasma treatment for 15 and 30 s significantly increased the level of adhesion in both treated samples after 30 min. Furthermore, the MAC samples showed a significant increase in cell adhesion 4 h after plasma treatment for 15 s. The SEM analysis highlighted that, on the treated samples (especially on the MAC disks), the cells with a polygonal and flat shape prevailed, while the fusiform- and globular-shaped cells were rare. The encouraging results obtained further confirm the effectiveness of plasma treatments on cell adhesion and fibroblast activity.

Abstract Purpose Biofilm-free implant surface is ultimate prerequisite for successful soft and bone tissue integration. Objective of the study was to estimate the effects of argon plasma healing abutment pre-treatment (PT) on peri-implant soft-tissue phenotype (PiSP), inflammation, plaque accumulation and the microbiome (PiM) between non-treated (NPT) and treated (PT) abutments following 3-months healing period. The hypothesis was that cell-conductive and antimicrobial properties of PT would yield optimal conditions for soft tissue integration. Material and Methods Two months following second-phase surgery, microbiological and clinical parameters were assessed around thirty-six healing abutments with two types of microtopography, smooth surface (MACHINED) and ultrathin threaded microsurface (ROUGH). A two level randomization schema was used to achieve equal distribution and abutments were randomly divided into rough and machined groups, and then divided into PT and NPT groups. PiM was assessed using next-generation DNA sequencing. Results PiM bacterial composition was highly diverse already two months post-implantation, consisting of key-stone pathogens, early and late colonizers, while the mycobiome was less diverse. PT was associated with lower plaque accumulation and inflammation without significant impact on PiSP, while in NPT clinical parameters were increased and associated with periopathogens. NPT mostly harbored late colonizers, while PT exerted higher abundance of early colonizers suggesting less advanced plaque formation. Interaction analysis in PT demonstrated S. mitis co-occurrence with pro-healthy Rothia dentocariosa and co-exclusion with Parvimonas micra, Porphyromonas endodontalis and Prevotella oris. PiSP parameters were generally similar between the groups, but significant association between PiM and keratinized mucosa width was observed in both groups, with remarkably more expressed diversity in NPT compared to PT. PT resulted in significantly lower BOP and PI around rough and machined abutments, respectively, without specific effect on PiM and PiSP. Conclusions PT contributed to significantly the less advanced biofilm accumulation and inflammation without specific effects on PiSP.

Background: The aim of the present study was to highlight clinical and radiographical differences among implants sharing the same macro-geometry but with two different prosthodontic connections. Methods: Patients requiring at least 2 implants in the posterior area of the jaw were randomly divided into two groups (Conical (CS) and Internal Hexagonal (IH) connection). At implant surgery (T0), insertion torque, implant stability quotient (ISQ values recorded by resonance frequency analysis, RFA), and soft tissue thickness (STH) were assessed. A 1-abutment/1-time protocol was applied, and the prosthesis was realized following a fully digital workflow. At the 36-month follow-up periapical x-rays were taken. In order to statistically analyse differences among the two groups and the different variables, paired T-test was used. Linear regression analysis was conducted to analyze how marginal bone loss (MBL) was affected by other independent variables. A neural network created to predict the success (good or not good) of the implant itself was implemented. Results: 30 out of 33 patients (14 males, 16 females, mean age: 68.94 ± 13.01 years) (32 CS and 32 IH) were analyzed. No implants failed. Marginal bone loss at the 3-year time-point was 0.33 ± 0.34 mm and 0.43 ± 0.37 mm respectively for CS and IH with a significant difference between the two groups (p = 0.004). The presence of keratinized gingiva (p = 0.034) significantly influenced MBL. Conclusions: Both the implant connections investigated presented optimal clinical outcomes with minimal marginal bone loss; however, CS implants and implants with the presence of a greater width of keratinized tissue presented significantly lower MBL.

The choice of the proper restorative material is essential for the long-term success of implant-supported rehabilitations. This study aimed to analyze and compare the mechanical properties of four different types of commercial abutment materials for implant-supported restorations. These materials included: lithium disilicate (A), translucent zirconia (B), fiber-reinforced polymethyl methacrylate (PMMA) (C), and ceramic-reinforced polyether ether ketone (PEEK) (D). Tests were carried out under combined bending–compression conditions, which involved applying a compressive force tilted with respect to the abutment axis. Static and fatigue tests were performed on two different geometries for each material, and the results were analyzed according to ISO standard 14801:2016. Monotonic loads were applied to measure static strength, whereas alternating loads with a frequency of 10 Hz and a runout of 5 × 106 cycles were applied for fatigue life estimation, corresponding to five years of clinical service. Fatigue tests were carried out with a load ratio of 0.1 and at least four load levels for each material, and the peak value of the load levels was reduced accordingly in subsequent levels. The results showed that the static and fatigue strengths of Type A and Type B materials were better than those of Type C and Type D. Moreover, the fiber-reinforced polymer material, Type C, showed marked material–geometry coupling. The study revealed that the final properties of the restoration depended on manufacturing techniques and the operator’s experience. The findings of this study can be used to inform clinicians’ choice of restorative materials for implant-supported rehabilitation, considering factors such as esthetics, mechanical properties, and cost.

Abstract Background In a previous experimental study, new bone was found growing within granules of HA/β-TCP. In vitro and experimental studies have shown increased protein adsorption and cell adhesion graft material bioactivated with Argon plasma. The aims of the present experiment were to study new bone ingrowth into β-TCP/HA granules used as filler material for sinus lifting and the influence on the healing of the bioactivation of the graft with argon plasma. Methods Sinus lifting was carried out in 20 rabbits using 60% HA and 40% β-TCP as filler material either bio-activated with argon plasma (plasma group) or left untreated (control group). The antrostomies were closed with collagen membranes. Biopsies representing the healing after 2 and 10 weeks were collected, and ground sections were prepared for histomorphometric analyses. Various regions of the elevated space were analyzed both around (outer bone; OB) and inside (interpenetrating bone network, IBN) the graft particles. Results After 2 weeks of healing, 8.2% and 9.3% (n = 10; p = 0.635) of total new bone (OB + IBN) was found in the plasma and control groups, respectively. Small fractions of IBN were found, spreading from the periphery inward of the graft particles. After 10 weeks of healing, the total new bone was 34.0% in the plasma and 31.3% in Control groups (n = 9; p = 0.594). The respective fractions of IBN were 18.0% and 16.0%. New bone was penetrating from the peripheral regions inside the remnants of graft particles, where it was forming a network of bridges in continuity to the remnants of biomaterial through its porosities. The biomaterial decreased in proportion between 2 and 10 weeks from 52.1 to 28.3% in the plasma group, and from 52.5% to 31.9% in the control group. Conclusion The bio-activation with argon plasma on a synthetic graft composed of 60% HA and 40% β-TCP used as filler material for sinus lifting showed a tendency to improve bone formation; however, the difference with the control group was neither statistically significant nor clinically relevant.

The aim of the present systematic review is to summarize current knowledge regarding the analysis of biomarkers extracted from peri-implant crevicular fluid (PICF) as predictors of peri-implant bone loss (BL). An electronic search was conducted on three databases, PubMed/MEDLINE, Cochrane Library, and Google Scholar, to find clinical trials published until 1 December 2022 suitable to answer the following focused question: in patients with dental implants, are biomarkers harvested from PICF predictive of peri-implant BL? The initial search yielded a total of 158 entries. After a full-text review and application of the eligibility criteria, the final selection consisted of nine articles. The risk of bias in included studies was assessed using the Joanna Briggs Institute Critical Appraisal tools (JBI). According to the present systematic review, some inflammatory biomarkers harvested from PICF (collagenase-2, collagenase-3, ALP, EA, gelatinase b, NTx, procalcitonin, IL-1β, and several miRNAs) seem to be correlated with peri-implant BL and may assist in the early diagnosis of pathological BL, that characterizes peri-implantitis. MiRNA expression demonstrated a predictive potential of peri-implant BL that could be useful for host-targeted preventive and therapeutic purposes. PICF sampling may represent a promising, noninvasive, and repeatable form of liquid biopsy in implant dentistry.

Background: Bone grafting in post-extractive site improves tissue regeneration. Soft tissue sealing of the grafted post-extractive alveolus is supposed to limit microbiological contamination from the oral cavity and to stabilize the coagulum. Several techniques are presented in the literature to reach this goal using different heterologous matrices or autogenous grafts. In addition, recently, a technique based on the use of granulation tissue in the post-extractive alveolus has been proposed. Aim: To compare the effect of different graft sealing approaches in post-extractive sites by qualitatively evaluating their healing process. Materials and Methods: This retrospective investigation included 30 patients requiring post-extractive site regeneration in the aesthetic area. Post-extractive sites were regenerated using a bovine bone matrix and patients were divided into three groups (10 patients in each group) according to the material used to seal the alveolar socket. In the UD group, the granulation tissue was used to seal the defect; in the PC group, epithelial-connective soft tissue graft was used, and in the COLL group, a collagen-based membrane was employed. Images of the post-extractive sites at different follow-up periods (2 and 12 weeks) were taken and the healing process was blindly evaluated by two independent practitioners. The Healing Index (HI) by Landry, Turnbull and Howley was used to assess the quality of the healing process. The combination of presence/absence of five clinical criteria defines an HI ranging from 1 (very poor) to 5 (excellent). Patients’ clinical-pathological variables were recorded. One-way ANOVA was used to explore the dependence of HI on the different socket preservation protocols. Results: Based on clinical-pathological characteristics of the included patients, there were no statistically significant differences among the different sealing techniques. At the 2-week follow-up appointment, HI did not differ among the socket preservation protocols evaluated. Moreover, smoking status and reason for extraction did not influence the HI among the three groups (two-way ANOVA p-value = 0.686, p-value = 0.248 respectively). At the 2-week follow-up appointment, HI was significantly different among the socket preservation protocols investigated. Specifically, the group undergoing collagen-based socket preservation procedure reported the highest HI, compared to the other two techniques (COLL mean 4.60 ± 0.5; PC mean 3.5 ± 1.2; UD mean 3.4 ± 0.5, one-way ANOVA p-value 0.006). Conclusions: The use of collagen porcine membranes may represent a suitable option to improve the patient healing process in grafted post-extractive sites together with reducing the surgical intervention time compared to alternative sealing techniques.

(1) Background: Different techniques and tools have been developed for implant site preparation. In this clinical scenario, Hybrid Funnel Technique (HFT), a novel osteotomy procedure, has been proposed. (2) Aim: The aim of this retrospective observational study was to consider the different responses to compression of the histological bony compartments (cancellus and cortical). HFT involves the use of multiple drills for the cortical layer preparation and of an osteotome for the osteocompaction of the cancellous bone. (3) Materials and Methods: Following computer-supported implant planning and guided surgery, 10 osteotomies with HFT were performed and 10 implants with the same length and diameter were placed in seven healthy and no daily smoking patients. Periapical X-ray and intraoral photographs were performed at baseline and after 12 months of follow-up to evaluate marginal bone level (MBL) changes and aesthetic results obtained from implant prosthetic rehabilitation. (4) Results: At 1 year of follow-up, 100% of the implants were successfully integrated, MBL change mean value was 0.17 mm ± 0.21. No differences in terms of MBL were noted between thin and thick biotypes. Pink esthetic score (PES) and white esthetic score (WES), assessed one year after definitive restoration placement, were 7.5 ± 2.3 and 8.5 ± 1.1, respectively. (5) Conclusions: Based on the findings of this preliminary clinical study, HFT has led to stability of peri-implant tissues and could represent a reliable technique for surgical preparation of the implant site.

Aim: The aim of the present study was to investigate quantitative histological examination of bone reconstructed with non-resorbable high-density polytetrafluoroethylene membrane (d-PTFE), left intentionally exposed in post extraction sockets grafted with anorganic bone material, and removed after four weeks, versus extraction and guided bone regeneration (GBR), performed two months later. Materials and Methods: This study was designed as a multicenter randomized controlled trial of parallel-group design. Patients were selected and consecutively treated in three centers in Italy. Patients randomly received intentionally exposed non-resorbable d-PTFE membrane (group A), or guided bone regeneration (group B), to treat post-extractive alveolar bone defects with implant-supported restorations. Outcomes were: the implant failure, any mechanical and biological complications, patient satisfaction, and qualitative and histomorphometric evaluation of the collected bone samples. Results: Eighteen patients were consecutively enrolled in the trial. Of these, six out of 18 patients were male. All the included patients were treated according to the allocated interventions, and no drop out occurred. No implant failure and no complications were experienced, and all the patients were fully satisfied with the function and aesthetic of their implant-supported restoration, without difference between groups. Morphological analysis revealed no sign of tissue reaction, such as fibrosis or necrosis. Regenerated bone was well mineralized in both groups, but it seemed more mature in group B than in group A. Three samples showed a minimal number of lymphocytes. Several blood vessels of small size occupied the medullary spaces, where the tissue resulted in more maturity, indicating the activity of the tissue in progress. The histomorphometric evaluation showed no statistically significant differences in the tissue volume fractions between the two groups of patients. Conclusions: With the limitation of the present study, buccal plate reconstruction with an intentionally exposed non-resorbable membrane is an effective and easy procedure for regenerating a resorbed buccal bone plate, reducing the need for guided bone regeneration.

A digital workflow by means of intraoral scanners and computer tomography has been used in dental implantology, allowing clinicians to be potentially more accurate and precise. Computer-Aided Design and Computer-Aided Manufacturing (CAD-CAM) and 3D models facilitate the process from treatment planning to the surgical procedure, up to the implant placement and final prosthesis. The aim of the present retrospective study was to evaluate a fully digital workflow for single-tooth implant rehabilitation. A total of 19 patients (22 implants) were included in the present study, with a mean follow-up time of 2 years. A fully digital workflow was performed on each patient through the planning, design and printing of a surgical guide, following a digital impression made with an intraoral scanner, computer-tomography-guided implant placement and, finally, with the delivery of a CAD-CAM crown. The two-year follow-up results were satisfactory in terms of the aesthetic yield and precision of the prosthesis. In single-implant-supported restorations, due to digital protocols and digital planning, a reduced number of clinical sessions was registered and the treatment plan results were more predictable. Future studies are needed to understand the application of fully digital protocols in cases of partially or totally edentulous patients.

(1) Background: The aim of this study is to understand from a microscopic point of view whether bicarbonate air-abrasive powders associated with ultrasonic instruments can decontaminate nine different surfaces used for the abutment/implant junction. Fibroblast growth was carried out on decontaminated surface in order to understand if there are significative differences in terms of biocompatibility. (2) Methods: After taking samples of patient plaque, nine different surfaces were contaminated and analyzed by SEM, then their wettability was evaluated. Fibroblasts were cultured on the decontaminated surfaces to understand their ability to establish a connective tissue seal after decontamination. The results were analyzed from a statistical point of view to hypothesize a mathematical model capable of explaining the properties of the surfaces. (3) Results: A negative correlation between roughness and contamination has been demonstrated, whereas a weak correlation was observed between wettability and decontamination capacity. All surfaces were topographically damaged after the decontamination treatment. Grade 5 titanium surfaces appear tougher, whereas anodized surfaces tend to lose the anodizing layer. (4) Conclusions: further studies will be needed to fully understand how these decontaminated surfaces affect the adhesion, proliferation and differentiation of fibroblasts and osteoblasts.

The use of dental implants has grown over the years and has led to higher success rates. To further enhance surgical outcomes, many research groups and companies have shifted their focus to surfaces roughness, wettability and chemistry. In a recent study a new dry salt bioactivate surface has been described from a chemical and physical point of view. The aim of this study is to evaluate the osteogenic response of pre-osteoblast cell lines to dry bioactivated surface. MC3T3-E1 osteogenic cell lines were cultured on SM (sandblasted and dual acid-etched surface) and HNS (SM surface with dry salts bioactive technology). Cell adhesion assay, proliferation assay and cell morphology were performed. Osteogenic activity was performed using Alizarin Red S and alkaline phosphatase. The results showed that SM surface determines a slighter but significant increase in cell adhesion and proliferation in a shorter time compared to HNS. On the contrary, HNS surface has long and intertwining filopodia that could be a response to surface HNS-topography that results in a higher stage of differentiation. The nature of the HNS surface is more prone to determine massive deposition of calcium minerals. This study is the first investigating the role of this interesting dry-salts bioactive surface during the first phase of healing and its potential biochemical advantage could be validated by future animal studies with the aim of evaluate the rate of bone implant contact in the early stages of healing.

This study aimed to retrospectively investigate the effect of bone graft after extraction of wisdom teeth impacting with the distal aspect of the second molar, on soft tissue wound healing, bone loss, and periodontal parameters. Sixteen patients treated an for impacted mandibular wisdom tooth at least one year ago were re-called (18 teeth). Dental panoramic tomography and periodontal parameters were assessed. A graft material was used to fill the post-extractive sockets in the test group (GUIDOR easy-graft CRYSTAL), whereas in the control group, the socket was filled using a collagen sponge and blood clot (Hemocollagene, Septodont, Matarò, Spain). The radiographic bone loss was measured at the distal aspect of the second molar. The Wilcoxon singed-rank test for paired data was performed to evaluate statistical differences. In the test group, only two cases out of nine showed bone loss, with an average of 0.55 ± 1.30 mm. Conversely, in the control group, five teeth out of nine showed bone resorption with an average of 1.22 ± 1.30 mm. However, the differences were not statistically significant. Periodontal parameters at the second molar demonstrated similar behavior between the test and control groups. Soft tissue healing complications were lower in the grafted compared to the comparator sites without reaching statistical significance. Within the limitations of the present study, no difference was found between the two groups.

Prevention of peri-implantitis involves the early diagnosis of peri-implant mucositis. This article presents a protocol of hygienic maintenance in different implant prosthetic scenarios: single crown, fixed partial prosthesis, fixed full-arch, and overdentures. Others clinical conditions have to be taken into consideration: patient compliance; history of periodontitis; implants placed in augmented bone; short, zygomatic, pterygoid, and tilted implants; and complex prosthesis with false gingiva. Two levels of implant maintenance are described: ordinary, performed by dental hygienist, and extraordinary, carried out by both dentist and hygienist. Extraordinary maintenance also involves the removal and decontamination of the prosthetic structure. To obtain an effective prevention of peri-implantitis, one must plan ordinary and extraordinary hygiene in relation to the type of rehabilitation and clinical parameters.

Background: The aim of this study was to evaluate the macro- and micro-structure and the chemical composition of the surface of 5 different commercially available dental implants. Roughness values were also calculated. Materials and Methods: 1 zirconia implant (NobelPearl of Nobel Biocare) and 4 titanium implants, Syra (Sweden&Martina), Prama (Sweden&Martina), T3 (Biomet 3i), and Shard (Mech&Human), were analyzed through SEM-EDX analysis and quantitative evaluation of surface roughness (1 sample), and XPS chemical analysis (1 sample). Surface roughness was quantitatively assessed using the stereo-SEM method (SSEM). The following area roughness parameters were calculated, according to ISO25178: Sa, Sz, and Sdr. Results: From the SEM observations, all the implants analyzed presented modern well-developed micro-structures as the result of the specific process of double acid etching alone or combined with other additional treatments. Roughness values were generally greater at the level of the implant body and lower at the collar. The chemical characterization of the implant surfaces exhibited excellent results for all of the implants and indicated good care in the production processes. Conclusions: All the samples were well-conceived in terms of topography and surface roughness, and clean in terms of chemical residues.

Background: Attaining an effective mucosal attachment to the transmucosal part of the implant could protect the peri-implant bone. Aim: To evaluate if chair side surface treatments (plasma of Argon and ultraviolet light) may affect fibroblast adhesion on different titanium surfaces designed for soft tissue healing. Methods: Grade 5 titanium discs with four different surface topographies were subdivided into 3 groups: argon-plasma; ultraviolet light, and no treatment. Cell morphology and adhesion tests were performed at 20 min, 24 h, and 72 h. Results: Qualitative observation of the surfaces performed at the SEM was in accordance with the anticipated features. Roughness values ranged from smooth (MAC Sa = 0.2) to very rough (XA Sa = 21). At 20 min, all the untreated surfaces presented hemispherical cells with reduced filopodia, while the cells on treated samples were more spread with broad lamellipodia. However, these differences in spreading behavior disappeared at 24 h and 72 h. Argon-plasma, but not UV, significantly increased the number of fibroblasts independently of the surface type but only at 20 min. Statistically, there was no surface in combination with a treatment that favored a greater cellular adhesion. Conclusions: Data showed potential biological benefits of treating implant abutment surfaces with the plasma of argon in relation to early-stage cell adhesion.

Objectives. To identify whether there is a relationship between different implant shoulder positions/orientations/designs and prosthetic and/or implant failures, biological or mechanical complications, radiographic marginal bone loss (MBL), peri-implant buccal recession (RC), aesthetic scores (Papilla Index, PES, and WES), and patient satisfaction after a minimum of 1 year function in the aesthetic zone, compared to the two-piece, conventional implant neck architecture. Materials and Methods. The systematic review was written according to the PRISMA guidelines. The search strategy encompassed the English literature from 1967 to September 2016 and was performed online (in the PubMed database of the U.S. National Library of Medicine, Embase, and the Cochrane Library) to identify relevant studies that met the inclusion criteria. The assessment of quality and risk of bias of the selected manuscripts was performed according to the guidelines provided by CONSORT and STROBE statements. Results. A total of 16 articles (7 randomized controlled trials, 4 observational comparative studies, and 5 systematic reviews) were selected to fulfill the inclusion criteria. A trend of higher implant failure and prosthetic complications were experienced in the one-piece group compared to the two-piece group, although no statistically significant differences were found. Higher marginal bone loss was found in the test group (one-piece, scalloped implants) compared to the control group (two-piece, flat implants). No comparative studies reporting data on sloped implants were found that fulfilled the inclusion and exclusion criteria of this systematic review. No differences were experienced between groups regarding aesthetic outcomes and patient satisfaction. Conclusions. There was sufficient evidence that different implant shoulder positions/orientations/designs (scalloped, sloped, and one piece) offer no benefit when compared to two-piece, conventional flat implants. Current evidence is limited due to the quality of available studies.

Although the use of zirconia abutments for implant-supported restorations has gained momentum with the increasing demand for esthetics, little informed design rationale has been developed to characterize their fatigue behavior under different clinical scenarios. However, to prevent the zirconia from fracturing, the use of a titanium connection in bi-component aesthetic abutments has been suggested.ObjectiveMechanical testing of customized thin-walled titanium-zirconia abutments at the connection with the implant was performed in order to characterize the fatigue behavior and the failure modes for straight and angled abutments.Material and MethodsTwenty custom-made bi-component abutments were tested according to ISO 14801:2007 either at a straight or a 25° angle inclination (n=10 each group). Fatigue was conducted at 15 Hz for 5 million cycles in dry conditions at 20°C±5°C. Mean values and standard deviations were calculated for each group. All comparisons were performed by t-tests assuming unequal variances. The level of statistical significance was set at p≤0.05. Failed samples were inspected in a polarized-light and then in a scanning electron microscope.ResultsStraight and angled abutments mean maximum load was 296.7 N and 1,145 N, the dynamic loading mean Fmax was 237.4 N and 240.7 N, respectively. No significant differences resulted between the straight and angled bi-component abutments in both static (p=0.253) and dynamic testing (p=0.135). A significant difference in the bending moment required for fracture was detected between the groups (p=0.01). Fractures in the angled group occurred mainly at the point of load application, whereas in the straight abutments, fractures were located coronally and close to the thinly designed areas at the cervical region.ConclusionAngled or straight thin-walled zirconia abutments presented similar Fmax under fatigue testing despite the different bending moments required for fracture. The main implication is that although zirconia angled or straight abutments presented similar mechanical behavior, the failure mode tended to be more catastrophic in straight (fracture at the cervical region) compared to angled abutments.

Although the use of zirconia abutments for implant-supported restorations has gained momentum with the increasing demand for esthetics, little informed design rationale has been developed to characterize their fatigue behavior under different clinical scenarios. However, to prevent the zirconia from fracturing, the use of a titanium connection in bi-component aesthetic abutments has been suggested. Objective Mechanical testing of customized thin-walled titanium-zirconia abutments at the connection with the implant was performed in order to characterize the fatigue behavior and the failure modes for straight and angled abutments. Material and Methods Twenty custom-made bi-component abutments were tested according to ISO 14801:2007 either at a straight or a 25° angle inclination (n=10 each group). Fatigue was conducted at 15 Hz for 5 million cycles in dry conditions at 20°C±5°C. Mean values and standard deviations were calculated for each group. All comparisons were performed by t-tests assuming unequal variances. The level of statistical significance was set at p≤0.05. Failed samples were inspected in a polarized-light and then in a scanning electron microscope. Results Straight and angled abutments mean maximum load was 296.7 N and 1,145 N, the dynamic loading mean Fmax was 237.4 N and 240.7 N, respectively. No significant differences resulted between the straight and angled bi-component abutments in both static (p=0.253) and dynamic testing (p=0.135). A significant difference in the bending moment required for fracture was detected between the groups (p=0.01). Fractures in the angled group occurred mainly at the point of load application, whereas in the straight abutments, fractures were located coronally and close to the thinly designed areas at the cervical region. Conclusion Angled or straight thin-walled zirconia abutments presented similar Fmax under fatigue testing despite the different bending moments required for fracture. The main implication is that although zirconia angled or straight abutments presented similar mechanical behavior, the failure mode tended to be more catastrophic in straight (fracture at the cervical region) compared to angled abutments.

ABSTRACT Ideally root canal irrigants should have, amongst other properties, antimicrobial action associated with a lack of toxicity against periapical tissues. Sodium hypochlorite (NaOCl) is a widely used root canal irrigant, however it has been shown to have a cytotoxic effect on vital tissue and therefore it is prudent to investigate alternative irrigants. Sterilox's Aquatine Alpha Electrolyte® belongs to the group of the super-oxidized waters; it consists of a mixture of oxidizing substances, and has been suggested to be used as root canal irrigant. Super-oxidized waters have been shown to provide efficient cleaning of root canal walls, and have been proposed to be used for the disinfection of medical equipment. OBJECTIVE: To compare the antimicrobial action against Enterococcus faecalis of NaOCl, Optident Sterilox Electrolyte Solution® and Sterilox's Aquatine Alpha Electrolyte® when used as irrigating solutions in a bovine root canal model. METHODOLOGY: Root sections were prepared and inoculated with E. faecalis JH2-2. After 10 days of incubation the root canals were irrigated using one of three solutions (NaOCl, Optident Sterilox Electrolyte Solution®and Sterilox's Aquatine Alpha Electrolyte®) and subsequently sampled by grinding dentin using drills. The debris was placed in BHI broth and dilutions were plated onto fresh agar plates to quantify growth. RESULTS: Sodium hypochlorite was the only irrigant to eliminate all bacteria. When the dilutions were made, although NaOCl was still statistically superior, Sterilox's Aquatine Alpha Electrolyte® solution was superior to Optident Sterilox Electrolyte Solution®. CONCLUSIONS: Under the conditions of this study Sterilox's Aquatine Alpha Electrolyte® appeared to have significantly more antimicrobial action compared to the Optident Sterilox Electrolyte Solution® alone, however NaOCl was the only solution able to consistently eradicate E. faecalis in the model.

Objectives: Bioactive surfaces were designed to increase the interaction between the surface and the cells. This may speed up the biological stability and loading protocols. Materials and methods: 36 patients with D3-D4 bone density were recruited and allocated into two groups. 30 bioactive (test group) and 30 traditional (control group) surfaced implants were placed. Insertion torque value (Ncm), insertion torque curve integral (cumulative torque, Ncm), torque density (Ncm/sec), implant stability quotient (ISQ) measured at three timepoints (baseline (T0), 30 (T30) and 45 (T45) days after surgery), and marginal bone loss (MBL) at 6 months of loading were assessed. Results: The mean ISQ and standard deviation at T0, T30, T45 were respectively 74.57 ± 7.85, 74.78 ± 7.31, 74.97 ± 6.34 in test group, and 77.12 ± 5.83, 73.33 ± 6.13, 73.44 ± 7.89 in control group, respectively. Data analysis showed significant differences between groups in ΔISQ at T0-T30 (p = 0.005) and T30-T45 (p = 0.012). Control group showed a significant decrease in ISQ at T30 (p = 0.01) and T45 (p = 0.03) compared to baseline, while no significant change was observed in test group. Due to the stability of the ISQ value ≥ 70, 26 test group and 23 control group implants were functionally loaded after 45 days. Conversely, due to the ISQ < 70 at T45, four test group implants and one control group implant were loaded after 90 days, and 6 control group implants were loaded after 180 days. Neither insertion torque nor ISQ at baseline were correlated with bone density (in Hounsfield units). There was no significant correlation between cumulative torque and ISQ at baseline. There was a significant positive slope in the correlation between torque density and ISQ at baseline, more accentuated in D3 than D4. This correlation remained significant for the test group in D3 bone at day 30 and 45 (p < 0.01 in both time frames), but not in D4 bone, and it was not significant in CG. Conclusions: The bioactive surface showed better behavior in terms of implant stability in D3-D4 bone quality in the early stages of bone healing. Clinical relevance This study demonstrated that the transition from primary to secondary stability is improved using bioactive surface, especially in cases of poor bone environment (D3/D4 bone). [ABSTRACT FROM AUTHOR]

Abstract Different surgical treatment strategies for peri-implantitis with the use of graft material and membranes have been suggested without any longitudinal remarkable success rate. The present preliminary study was aimed to analyze a new clinical approach based on the disinfection of the implant connection, the disinfection of the implant surface and GBR approach in the treatment of circumferential and semi-circumferential bony defect resulting from peri-implantitis. Six consecutive patients were selected for the present study. After removal of factors that could potentially influence peri-implant pathology, the prosthetic rehabilitation was always removed and a full thickness flap was elevated to allow access to the peri-implant defect and the exposed implant surface. Once the defect was degranulated and the implant surface cleaned, a mixture (50:50) of autogenous bone and allograft was used. Guided bone regeneration technique using membranes was adopted and the flaps were closed for a submerged healing. Six months thereafter, a new re-opening procedure was performed and cleaned superstructures and crowns were repositioned. Patients were followed for one year thereafter and recalled for a customized oral hygiene every three months. Radiological and periodontal analysis was performed before surgery and every six months. The studied procedure was associated with a pronounced increase in REC and CAL with stable peri-implant conditions at 6 and 12 months. PI, BOP and PD values were significantly reduced both at 6 and 12 months. At 12 months, a mean PD gain of 4.5 mm and a bone loss reduction of 5.1 mm was obtained. Within the limitation of the present preliminary study, the proposed technique might represent a promising result for treatment of circumferential and semi-circumferential bone defects around implants affected by peri-implantitis.