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Background Short implants are proposed as a less invasive alternative with fewer complications than standard implants in combination with sinus lift. The aim of this systematic review and meta-analysis was to state the efficacy of placing short implants (≤ 6 mm) compared to standard-length implants (≥ 8 mm) performing sinus lift techniques in patients with edentulous posterior atrophic jaws. Efficacy will be evaluated through analyzing implant survival (IS) and maintenance of peri-implant bone (MBL). Methods Screening process was done using the National Library of Medicine (MEDLINE by PubMed), EMBASE, the Cochrane Oral Health, and Web of Science (WOS). The articles included were randomized controlled trials. Risk of bias was evaluated according to The Cochrane Collaboration’s tool. Weighted means were calculated. Heterogeneity was determined using Higgins (I2). A random-effects model was applied. Secondary outcomes such as surgical time, patient satisfaction, mucositis and peri-implantitis, pain, and swelling were analyzed. Results Fourteen studies (597 patients and 901 implants) were evaluated. IS was 1.02 risk ratio, ranging from 1.00 to 1.05 (CI 95%) (p = 0.09), suggesting that IS was similar when both techniques were used. MBL was higher in patients with standard-length implants plus sinus lift elevation (p = 0.03). MBL was 0.11 (0.01–0.20) mm (p = 0.03) and 0.23 (0.07–0.39) mm (p = 0.005) before and after 1 year of follow-up, respectively, indicating that the marginal bone loss is greater for standard-length implants. Discussion Within the limitations of the present study, as relatively small sample size, short dental implants can be used as an alternative to standard-length implants plus sinus elevation in cases of atrophic posterior maxilla. Higher MBL was observed in the groups where standard-length implants were used, but implant survival was similar in both groups. Moreover, with short implants, it was observed a reduced postoperative discomfort, minimal invasiveness, shorter treatment time, and reduced costs. Clinical Clinical relevance The low MBL promoted by short implants does contribute to a paradigm shift from sinus grafting with long implants to short implants. Further high-quality long-term studies are required to confirm these findings., Spanish Government, European Commission PID2020-114694RB-I00 MINECO/AEI/FEDER/UE

Background and objective Primary stability (PS) is remarkable for secondary stability and implant success. Surgical technique modifications seem to improve primary stability, especially in poor quality bone. The aim of this study was to compare the insertion torque (IT) and implant stability quotients (ISQ) of implants placed with underpreparation, expanders, and standard surgical instrumentation in different bone types. Material and methods This randomized controlled clinical trial enrolled 108 patients (n=108 implants) distributed in three study groups: group 1 (n=36) underpreparation technique, group 2 (n=36) expander technique, and group 3 (n=36) conventional drilling. IT was recorded with a torque indicator. ISQ was recorded with resonance frequency analysis immediately after surgery. Results ISQ values were associated with the patient’s bone quality and were higher in bone quality type II (76.65) and type III (73.60) and lower in bone quality type IV (67.34), with statistically significant differences (p, Universidad de Granada/ CBUA

Research has been conducted into the advantages of the systemic administration of antibiotics. The aim of this systematic review and meta-analysis was to assess the efficacy of systemic antibiotic administration in the treatment of peri-implantitis in terms of bleeding on probing (BoP) and probing pocket depth (PPD). Literature searches were performed across PubMed, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) to identify randomized controlled trials and observational clinical studies. After peri-implantitis treatment, PPD was reduced by 0.1 mm (p = 0.58; IC 95% [-0.24, 0.47]), indicating a non-significant effect of antibiotic administration on PPD. The BoP odds ratio value was 1.15 (p = 0.5; IC 95% [0.75, 1.75]), indicating that the likelihood of bleeding is almost similar between the test and control groups. Secondary outcomes were found, such as reduced clinical attachment level, lower suppuration and recession, less bone loss, and a reduction in total bacterial counts. In the treatment of peri-implantitis, the systemic antibiotic application reduces neither PPD nor BoP. Therefore, the systemic administration of antibiotics, in the case of peri-implantitis, should be rethought in light of the present results, contributing to address the problem of increasing antibiotic resistance., Ministry of Economy and Competitiveness, European Commission PID2020-114694RB-I00, Ministry of Universities FPU20/00450

Resonance frequency analysis (RFA) provides an evaluation of implant stability over time. This analysis is a non-invasive, precise, and objective method. Several studies compare the RFA system with other devices. However, few investigations analyze repeatability and reproducibility between different operators. The aim of this study was to evaluate the intra- and inter-operator concordance of the Osstell® ISQ.RFA measurements were performed with Osstell® ISQ in a total of 37 implants placed in 21 patients. At the time of implant placement, 6 measurements per implant were taken by three different experienced operators. Three measurements were carried out consecutively and three by removing and placing the SmartPeg-Osstell® to assess intra-operator and inter-operator agreement.Intra-operator concordance according to the intraclass correlation coefficient (ICC) showed high concordance. The ICC values were higher than 0.9 (p 0.0001) for consecutive measures and alternative measures, being almost perfect of LandisKoch classification. For inter-operator concordance The ICC was 0.709 (p 0.0001) and 0.670 (p 0.0001) for consecutive and alternative measures, respectively, both estimates being in the substantial category. In torque and ISQ values, no statistically significant differences were observed when operators and measurements were compared.Osstell® ISQ system was stable both in intra-operator and inter-operator measurements. This device has excellent repeatability and reproducibility, demonstrating reliability to measure the stability of dental implants.Resonance frequency analysis (RFA) is a non-invasive, objective, and reliable diagnostic method to determine the ideal moment to load the implant, as well as to predict possible failures.

Jorge Moreno-Fernandez was supported by a Postdoctoral Contract (Contrato Puente) from the University of Granada and Maria Jesus Lisbona-Gonzalez thanks to the doctoral program in clinical medicine and public health., This study investigated the antimicrobial effects of a mouthwash containing propolis and the effect of a propolis paste formulation on dental healing after teeth extraction in patients with periodontal disease. In the mouthwash experience, the population comprised 40 patients, which were divided as follows: the control mouthwash, 0.2% chlorhexidine (v/v) mouthwash, 2% (w/v) propolis mouthwash, and propolis + chlorhexidine mouthwash. The study of the propolis paste comprised a population of 60 patients with periodontal disease, and a total of 120 symmetric tooth extractions were performed. Propolis showed antimicrobial activity by itself, and especially with the chlorhexidine association. Three days after surgery in the teeth treated with control paste, only 13.4% had completely healed; however, with propolis paste, in 90% of the periodontal sockets, healing was complete. In addition, a reduction in Streptococci mutans and Lactobacilli cfu was observed with propolis, and especially with the association of chlorhexidine + propolis. Propolis mouthwash reduced bacterial proliferation, especially in association with chlorhexidine. Propolis paste is a viable alternative for socket healing after dental extraction. The knowledge gained from these findings will provide a foundation for similar propolis therapies in order to improve the healing process after dental surgery., University of Granada

This work was funded by the Ministry of Economy and Competitiveness and European Regional Development Fund( MINECO/AEI/FEDER/UE) Project number PID2020-114694RBI00. Funding for open access charge: University of Granada / CBUA., Objective. To investigate the effect of novel polymeric nanoparticles (NPs) doped with melatonin (ML) on nano-hardness, crystallinity and ultrastructure of the formed hydroxyapatite after endodontic treatment. Methods. Undoped-NPs and ML-doped NPs (ML-NPs) were tested at radicular dentin, after 24 h and 6 m. A control group without NPs was included. Radicular cervical and apical dentin surfaces were studied by nano-hardness measurements, X-ray diffraction and transmission electron microscopy. Mean and standard deviation were analyzed by ANOVA and StudentNewman-Keuls multiple comparisons (p < 0.05). Results. Cervical dentin treated with undoped NPs maintained its nano-hardness values after 6 m of storage being [24 h: 0.29 (0.01); 6 m: 0.30 (0.02) GPa], but it decreased at apical dentin [24 h: 0.36 (0.01); 6 m: 0.28 (0.02) GPa]. When ML-NPs were used, nano-hardness was similar over time [24h: 0.31 (0.02); 6 m: 0.28 (0.03) GPa], at apical dentin. Root dentin treated with ML-NPs produced, in general, high crystallinity of new minerals and thicker crystals than those produced in the rest of the groups. After 6 m, crystals became organized in randomly oriented polyhedral, square polygonal block-like apatite or drop-like apatite polycrystalline lattices when ML-NPs were used. Undoped NPs generated poor crystallinity, with preferred orientation of small crystallite and increased microstrain. Significance. New polycrystalline formations encountered in dentin treated with ML-NPs may produce structural dentin stability and high mechanical performance at the root. The decrease of mechanical properties over time in dentin treated without NPs indicates scarce remineralization potential, dentin demineralization and further potential degradation. The amorphous stage may provide high hydroxyapatite solubility and remineralizing activity., Ministry of Economy and Competitiveness and European Regional Development Fund( MINECO/AEI/FEDER/UE) PID2020-114694RB-I00, University of Granada/CBUA

This work was supported by: (1) the Ministry of Economy and Competitiveness and European Regional Development Fund [Project MAT2017-85999-P MINECO/AEI/FEDER/UE], (2) University of Granada/Regional Government of Andalusia Research Fund from Spain and European Regional Development Fund (A-BIO-157-UGR-18/FEDER). This research is part of C.V.'s PhD research study., Soft tissues have been shown to be critical for the maintenance of both teeth and implants. Currently, regenerative soft tissue techniques propose the use of collagen matrices, which can avoid the drawbacks derived from the obtainment of autogenous tissue graft. A systematic review and meta-analysis were conducted to ascertain the efficacy of collagen matrices (CM) compared to autogenous connective tissue graft (CTG) to improve soft tissue dimensions. An electronic and manual literature searches were performed to identify randomized clinical trials (RCT) or controlled clinical trials (CCT) that compared CTG and CM. Pooled data of width of keratinized tissue (KT) and mucosal thickness (MT) were collected and weighted means were calculated. Heterogeneity was determined using Higgins (I-2). If I-2 > 50% a random-effects model was applied. Nineteen studies were included based on the eligibility criteria. When using CTG a higher MT gain (0.32 mm, ranging from 0.49 to 0.16 mm) was obtained than when employing CM. Similar result was obtained for the width of KT gain, that was 0.46 mm higher (ranging from 0.89 to 0.02 mm) when employing CTG. However, it can be stated that, although autogenous CTG achieves higher values, CM are an effective alternative in terms of total width of KT and MT gain., Ministry of Economy and Competitiveness MAT2017-85999-P MINECO/AEI/FEDER/UE, European Commission MAT2017-85999-P MINECO/AEI/FEDER/UE A-BIO-157-UGR-18/FEDER, University of Granada/Regional Government of Andalusia Research Fund from Spain

This work was funded by the Ministry of Economy and Competitiveness and European Regional Development Fund (MINECO/FEDER MAT2017-85999P). University of Granada/Regional Government of Andalusia Research Fund from Spain and European Regional Development Fund (A-BIO-157-UGR-18/FEDER). This research is part of M.T-O.'s Ph.D. research study., The data presented in this study are available on request from the corresponding author., Alveolar bone ridge resorption occurred after natural teeth loss and it can restrict the possibility of dental implants placement. The use of bone regenerative procedures is frequently required. The existing evidence regarding the efficacy of horizontal bone ridge augmentation trough guided bone regeneration (GBR) using polymeric membranes was stated. A systematic review and meta-analysis were performed. Electronic and manual literature searches were conducted. Screening process was done using the National Library of Medicine (MEDLINE by PubMed), Embase, and the Cochrane Oral Health. Included articles were randomized controlled trials and observational studies. Weighted means were calculated. Heterogeneity was determined using Higgins (I2). If I2 > 50% a random-effects model was applied. It was found that the mean of horizontal bone gain was 3.95 mm, ranging from 3.19 to 4.70 mm (confidence interval 95%). Heterogeneity is I2 = 99% (confidence interval 95%) and significance of the random-effects model was p < 0.001. The complications rate was 8.4% and membrane exposure was the most frequent. Through this study, we were able to conclude that the existing scientific evidence suggests that GBR using polymeric membranes is a predictable technique for achieving horizontal bone augmentation, thus, permitting a proper further implant placement., Ministry of Economy and Competitiveness MINECO/FEDER MAT2017-85999P, European Commission MINECO/FEDER MAT2017-85999P A-BIO-157-UGR-18/FEDER, University of Granada/Regional Government of Andalusia Research Fund from Spain

Cyanoacrylate tissue adhesive is proposed to promote soft tissue healing in oral surgery and minimize complications (pain, inflammation, and bleeding) associated with wound healing by secondary intention. The objective was to compare cyanoacrylate tissue adhesive (test group) with suture (control group) in terms of postoperative complications, operative time, and wound healing in the palatal donor area after harvesting a de-epithelialized gingival graft. A randomized controlled clinical trial was performed in 24 patients randomly assigned to one of two study groups. Data were gathered on wound bleeding, operative time, postoperative pain, inflammation, hyperesthesia, necrosis, and donor area healing time. Operative time was almost 50% shorter in the tissue adhesive cyanoacrylate group, a significant between-group difference (p = 0.003). Spontaneous bleeding in the donor area during the first 24 h was observed in 11.1% of the tissue adhesive cyanoacrylate group versus 88.9% of the suture group—a significant difference. No significant between-group difference was observed in postoperative pain, inflammation, or degree of healing over time. There were no cases of hyperesthesia or wound necrosis. Utilization of tissue adhesive cyanoacrylate rather than suture in palatal de-epithelialized gingival graft harvesting reduces postoperative bleeding during the first 24 h, as well as the operative time.

Implant stability is one of the main indicators of successful osseointegration. Although it has been measured in numerous studies, there has been little research on implant stability in regenerated bone. The study compares primary and secondary stability between implants placed in regenerated versus native bone and evaluates the influence of bone quality on the results. Sixty implants were placed in 31 patients: 30 implants inserted in native bone (non-regenerated) after a healing period of at least 6 months post-exodontia and 30 inserted in regenerated bone at 6 months after grafting with xenograft. Resonance frequency analysis (RFA) was used to obtain implant stability quotient (ISQ) values at baseline (implant placement), 8 weeks, and 12 weeks. Statistically significant differences were found between implants placed in regenerated bone and those placed in native bone at all measurement time points (p &lt, 0.05). ISQ values were significantly influenced by bone quality at baseline (p &lt, 0.05) but not at 8 or 12 weeks. Greater stability was obtained in implants placed in native bone, however, those placed in regenerated bone showed adequate primary and secondary stability for prosthetic loading. Bone quality influences the primary but not secondary stability of the implants in both native and regenerated bone.

This work was supported by: 1) the Ministry of Economy and Competitiveness and European Regional Development Fund [Project PID2020-114694RB-I00]. Funding for open access charge: University of Granada/CBUA., Objectives: The aim of this systematic review and meta-analysis was to state the efficacy of local administration of antibiotics in the treatment of peri-implantitis in terms of peri-implant probing depth (PPD) and bleeding on probing (BoP) reduction. Data, sources and study selection: Electronic and manual literature searches were conducted. Screening process was done using the National Library of Medicine (MEDLINE by PubMed), Embase and the Cochrane Oral Health. Included articles were randomized controlled trials and observational studies. Weighted means were calculated. Heterogeneity was determined using Higgins (I2). Due to the encountered heterogeneity between the studies being combined, random-effects models were applied in order to analyze effect sizes. Twelve studies (365 patients and 463 implants) were included in the systematic review. After peri-implantitis treatment with local antibiotics, PPD was reduced 1.40 mm (95% confidence interval: 0.82-1.98). When local antibiotics were applied, a 0.30 mm higher reduction of PPD was obtained than in the control group (95% confidence interval: 0.07-0.53). BoP attained an odds ratio value of 1.82 (95% confidence interval: 1.09-3.04), indicating that the likehood of bleeding is almost two-fold when antibiotics are not locally administrated. Adverse effects were not found after applying local antibiotics. Conclusions: The local antibiotic administration does reduce, without adverse effects, both peri-implant probing depths and bleeding on probing in patients affected by peri-implantitis, if compared to control groups without local antibiotic application. Clinical significance: Patients with dental implants frequently suffer from peri-implantitis. Clinical features of periimplantitis lesions include the presence of bleeding on probing and increased peri-implant probing depths. Both BoP and PPD have become reduced after local administration of antibiotics., Ministry of Economy and Competitiveness PID2020-114694RB-I00, European Commission PID2020-114694RB-I00, University of Granada/CBUA

This work was supported by: (1) the Ministry of Economy and Competitiveness and European Regional Development Fund [Project PID2020-114694RB-100 MINECO/AEI/FEDER/UE], (2) University of Granada/Regional Government of Andalusia Research Fund from Spain and European Regional Development Fund (A-BIO-157-UGR-18/FEDER)., Collagen membranes are currently the most widely used membranes for guided bone regeneration; however, their rapid degradation kinetics means that the barrier function may not remain for enough time to permit tissue regeneration to happen. The origin of collagen may have an important effect on the resistance to degradation. The aim of this study was to investigate the biodegradation pattern of five collagen membranes from different origins: Biocollagen, Heart, Evolution X-fine, CopiOs and Parasorb Resodont. Membranes samples were submitted to different degradation tests: (1) hydrolytic degradation in phosphate buffer saline solution, (2) bacterial collagenase from Clostridium histolyticum solution, and (3) enzyme resistance using a 0.25% porcine trypsin solution. Immersion periods from 1 up to 50 days were performed. At each time point, thickness and weight measurements were performed with a digital caliper and an analytic microbalance, respectively. ANOVA and Student–Newman–Keuls tests were used for comparisons (p < 0.05). Differences between time-points within the same membranes and solutions were assessed by pair-wise comparisons (p < 0.001). The Evolution X-fine collagen membrane from porcine pericardium attained the highest resistance to all of the degradation tests. Biocollagen and Parasorb Resodont, both from equine origin, experienced the greatest degradation when immersed in PBS, trypsin and C. histolyticum during challenge tests. The bacterial collagenase solution was shown to be the most aggressive testing method., Ministry of Economy and Competitiveness PID2020-114694RB-100, European Commission PID2020-114694RB-100 A-BIO-157-UGR-18/FEDER, University of Granada/Regional Government of Andalusia Research Fund from Spain A-BIO-157-UGR-18/FEDER

Objective Impacted third molar extraction is associated with acute moderate-to-severe pain for up to 48 hours post-surgery. This trial was designed to compare the analgesic effectiveness, swelling, and adverse events after impacted third molar surgery following multimodal therapy with 75 mg tramadol hydrochloride plus 25 mg dexketoprofen or monotherapy with 400 mg ibuprofen. Methods Seventy-two patients were randomly assigned to receiving ibuprofen (n = 36) or tramadol-dexketoprofen (n = 36). Postoperative pain intensity and swelling were measured using a visual analog scale (VAS); pain relief experienced was reported using a 4-point verbal rating scale; the rescue medication requirement, adverse effects, and global impression of the medication were recorded. Results No statistically significant between-group difference in pain intensity was observed at any time point; however, pain relief was significantly higher in the tramadol-dexketoprofen treated-group at 6 and 36 hours. Self-reported verbal rating scale assessments showed significantly lower swelling in the tramadol-dexketoprofen group at 24 hours post-surgery but not at 48 or 72 hours, and VAS-swelling scores showed no significant between-group difference. The frequency of postoperative nausea and dizziness was significantly higher in the tramadol-dexketoprofen group. Conclusions Multimodal therapy proved more effective to manage moderate-severe pain after impacted third molar surgery in comparison to monotherapy. However, the improvement in relief must be balanced against the increased risk of adverse effects when considering this multimodal approach.

Objectives The aim was to state the different applications and the effectiveness of polymeric zinc-doped nanoparticles to achieve dentin remineralization. Data, sources and study selection Literature search was conducted using electronic databases, such as PubMed, MEDLINE, DIMDI, Embase, Scopus and Web of Science. A narrative exploratory review was undertaken. Conclusions Polymeric nanospheres (NPs) were efficiently loaded with zinc. NPs sequestered calcium and phosphate in the presence of silicon, and remained effectively embedded at the hybrid layer. NPs incorporation did not alter bond strength and inhibited MMP-mediated dentin collagen degradation. Zn-loaded NPs remineralized the hybrid layer inducing a generalized low-carbonate substitute apatite precipitation, chemically crystalline with some amorphous components, and an increase in mechanical properties was also promoted. Viscoelastic analysis determined that dentin infiltrated with Zn-NPs released the stress by breaking the resin-dentin interface and creating specific mineral formations in response to the energy dissipation. Bacteria were scarcely encountered at the resin-dentin interface. The combined antibacterial and remineralizing effects, when Zn-NPs were applied, reduced biofilm formation. Zn-NPs application at both cervical and radicular dentin attained the lowest microleakage and also promoted durable sealing ability. The new zinc-based salt minerals generated covered the dentin surface totally occluding cracks, porosities and dentinal tubules. Clinical significance Zinc-doped NPs are proposed for effective dentin remineralization and tubular occlusion. This offers new strategies for regeneration of eroded cervical dentin, effective treatment of dentin hypersensitivity and in endodontically treated teeth previous to the canal filling. Zn-NPs also do reduce biofilm formation due to antibacterial properties.

This work was supported by the Ministry of Economy and Competitiveness and European Regional Development Fund [MAT2017-85999PMINECO/AEI/FEDER/UE]. The authors affirm that no actual or potential conflict of interest including any financial, personal or other relationships with other people or organizations within three years of beginning the submitted work that could inappropriately influence, or be perceived to influence, their work. Any other potential conflict of interest is disclosed., The objective was to state zinc contribution in the effectiveness of novel zinc-doped dentin cements to achieve dentin remineralization, throughout a literature or narrative exploratory review. Literature search was conducted using electronic databases, such as PubMed, MEDLINE, DIMDI, Embase, Scopus and Web of Science. Both zinc-doping silicate and hydroxyapatite-based cements provoked an increase of both bioactivity and intrafibrillar mineralization of dentin. Zinc-doped hydroxyapatite-based cements (oxipatite) also induced an increase in values of dentin nano-hardness, Young’s modulus and dentin resistance to deformation. From Raman analyses, it was stated higher intensity of phosphate peaks and crystallinity as markers of dentin calcification, in the presence of zinc. Zinc-based salt formations produced low microleakage and permeability values with hermetically sealed tubules at radicular dentin. Dentin treated with oxipatite attained preferred crystal grain orientation with polycrystalline lattices. Thereby, oxipatite mechanically reinforced dentin structure, by remineralization. Dentin treated with oxipatite produced immature crystallites formations, accounting for high hydroxyapatite solubility, instability and enhanced remineralizing activity., This work was supported by the Ministry of Economy and Competitiveness and European Regional Development Fund [MAT2017-85999PMINECO/AEI/FEDER/UE].