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Abstract Objectives It was shown, that Connective Tissue Grafts (CTG) retrieved from the tuberosity tends to determine hyperplastic responses and may induce a beneficial over‐keratinization of non‐keratinized mucosa. Clinically evaluate and compare CTG from tuberosity ability to increase soft tissue thickness and the keratinization potential after recipient area is either prepared using split or full thickness flap in edentulous mandible. Materials and methods Fourty implants were placed in 10 edentulous patients with atrophied mandible (Class IV of Misch) presenting less than 1.0 mm of keratinized tissue using a flapless approach and immediately restored with acrylic temporary bridge on multi‐unit abutments. The surgical sites were split‐mouth randomized and prepared as CTG recipients by a tunneling procedure. Twenty benefited of a partial thickness approach and 20 of a full thickness one. The CTG was placed buccally using partial thickness or full thickness flap according to the randomization schedule. The width of keratinized tissue (KT), the horizontal soft tissue thickness (STT), the marginal hard and soft tissue levels as well as the implant success parameters were collected and analyzed. Results After a 3 year follow‐up period the increase of KT was statistically significantly (p

Adiponectin is an adipokine that sensitizes the body to insulin. Low levels of adiponectin have been reported in obesity, diabetes and periodontitis. In this study we established experimental periodontitis in male adiponectin knockout and diet-induced obesity mice, a model of obesity and type 2 diabetes, and aimed at evaluating the therapeutic potential of adiponectin. We found that systemic adiponectin infusion reduced alveolar bone loss, osteoclast activity and infiltration of inflammatory cells in both periodontitis mouse models. Furthermore, adiponectin treatment decreased the levels of pro-inflammatory cytokines in white adipose tissue of diet-induced obesity mice with experimental periodontitis. Our in vitro studies also revealed that forkhead box O1, a key transcriptional regulator of energy metabolism, played an important role in the direct signaling of adiponectin in osteoclasts. Thus, adiponectin increased forkhead box O1 mRNA expression and its nuclear protein level in osteoclast-precursor cells undergoing differentiation. Inhibition of c-Jun N-terminal kinase signaling decreased nuclear protein levels of forkhead box O1. Furthermore, over-expression of forkhead box O1 inhibited osteoclastogenesis and led to decreased nuclear levels of nuclear factor of activated T cells c1. Taken together, this study suggests that systemic adiponectin application may constitute a potential intervention therapy to ameliorate type 2 diabetes-associated periodontitis. It also proposes that adiponectin inhibition of osteoclastogenesis involves forkhead box O1.

This investigation aims to develop an angular stiffness sensor intended for measuring dental implant stability in bone. The sensor hardware included a tiny eccentric motor and an accelerometer to measure a flex constant of an implant with its abutment. The sensor software included a mechanics-based model to convert the flex constant to angular stiffness at the implant/abutment junction to indicate the stability. The sensor's accuracy and effectiveness are demonstrated through use of Sawbones slab models that mimic a mandibular premolar section. The models include a Branemark Mk III implant inserted into Sawbones slabs of 5 different densities with a locator abutment. An incremental insertion torque was first recorded while the implant was placed in the Sawbones models. Then benchtop experiments were conducted to measure resonance frequencies and angular stiffness. Results indicated that angular stiffness increased with Sawbones density, showing high correlation with the measured resonance frequency (R=0.977) and the incremental insertion torque (R=0.959). Finally, accuracy of the angular stiffness sensor is calibrated in light of the resonance frequency. Angular stiffness scores 99% and 95% accuracy for Sawbones models mimicking medium cancellous bones with and without a cortical layer, respectively.

Purpose: To retrospectively determine the cumulative survival rate (CSR) and marginal bone level change (ΔMBL) around novel hybrid design tissue-level (TL) dental implants that support multiple-screw-retained restorations., Materials and Methods: Implant CSRs were analyzed at the implant and patient level using Kaplan-Meier estimates. ΔMBL was measured by comparing the periapical loading and follow-up visit radiographs using an improved standardized digital methodology based on image gray levels. ΔMBL outcomes were subject to linear mixed regression to identify potential risk factors., Results: A total of 301 TL implants in 69 patients with an average age of 62.6 ± 11.7 years (range: 36 to 87 years) at the time of implant placement were considered for the analysis. All 301 implants were successfully restored and loaded. The 54-month CSRs at the implant and patient levels were 98.9% (95% CI: 96.7 to 99.6) and 95.3% (95% CI: 86.1 to 98.5), respectively. ΔMBL after a mean follow-up of 22 ± 10.7 months after loading was 0.00 ± 0.57 mm. None of the implant sites showed marginal bone loss exceeding 1.5 mm. Multivariate regression analysis revealed a significant association between ΔMBL and the loading protocol (P = .027) but not between ΔMBL and age or transgingival height., Conclusions: The high CSRs and stable peri-implant marginal bone levels support the use of recent TL implants, which have a hybrid design inherited from the bone-level implant-abutment connection, as a suitable treatment option for restoring partially or fully edentulous patients with a good mid-term prognosis. These results should be complemented by further prospective studies in a real-world multicenter private practice setup that represents the daily realities of implant treatment.

Purpose: To evaluate the bone level changes in a new implant design (fully tapered with platform switching) with the one-abutment one-time protocol after 1 year of loading., Materials and Methods: Thirty patients received 1 or 2 implants (6-, 8-, or 10-mm length and 3.5-, 3.75-, or 4.5-mm diameter, bone-level design) to replace one or multiple edentulous sites. Only the mesial implant was assessed. Radiographic, clinical, and esthetic results and the survival and success rates were evaluated 1 year after final loading., Results: At 1 year, no peri-implant bone loss was seen in any of the cases. Mean marginal crestal bone loss between surgery and crown placement was 0.19 ± 0.17 mm (P < .0001). Between surgery and the 1-year follow-up, the mean marginal crestal bone loss was 0.25 ± 0.24 mm (P < .0001). The difference in the modified Plaque Index between 1 year of follow-up and crown placement was significant for in the mesial (0.33 ± 0.54 mm; P = .003) and distal surfaces (0.5 ± 0.73 mm; P = .001). The probing pocket depth was statistically significantly deeper at 1 year than at crown placement at the mesial and distal aspects (average depth = 0.75 mm; P < .0005). No statistically significant differences were found for any other clinical or esthetic parameters. The overall survival and success rates after 1 year were 100%., Conclusions: The fully tapered, deep-thread, platform-switched implant design placed with the one-abutment one-time protocol demonstrated minimal marginal crestal bone loss and crestal bone stability at 1 year of follow-up.

Purpose: To evaluate the 3-year success and survival rates of fixed prostheses supported by 4-mm extra-short implants splinted to 10-mm implants in patients with shortened maxillary arches and low maxillary sinus floors., Methods: A total of 11 patients with reduced alveolar bone heights due to low maxillary sinus floors received two or three titanium-zirconium tissue-level implants: one or two extra-short (4 mm) implants, and one implant 10 mm in length. After 6 months, prosthetic rehabilitation with splinted crowns connecting the 4- and 10-mm implants was performed. Follow-up visits and maintenance protocols were implemented every 4 to 6 months., Results: The 11 patients were treated with 11 10-mm implants and 17 4-mm implants. One extra-short implant failed and was removed before loading, and its planned design was modified from three splinted crowns to a bridge between the 10- and 4-mm implants. After 36 months, all (11/11) prosthetic rehabilitations connecting the 10-mm (11/11) and 4-mm (16/16) implants were functional. At the 10-mm implant sites, the median (interquartile range [IQR]) probing depth and marginal bone loss measured 2.9 mm (2.3 to 3.2) and 1.3 mm (1.0 to 1.5), respectively. At the 4-mm implant sites, the median (IQR) probing depth and marginal bone loss measured 2.9 mm (2.4 to 3.1) and 0.3 mm (0.1 to 0.5), respectively., Conclusion: Prosthetic rehabilitation with splinted crowns connecting 4-mm and 10-mm implants showed promising outcomes in shortened maxillary dental arches after 3 years. Additional studies are needed to further validate these findings.

The purpose of this case series was to assess the application of a novel self-cutting, tapered implant (Straumann® BLX, Institut Straumann AG, Basel, Switzerland) in combination with a digital integrated prosthetic workflow for the immediate placement and restoration. Fourteen consecutive patients, requiring replacement of a single hopeless maxillary or mandibular tooth, meeting the clinical and radiographic indication criteria for immediate implant placement, were treated. All cases followed the same digitally-guided procedure of extraction and immediate implant placement. Immediate temporization with full contoured screw-retained provisionals was performed using an integrated digital workflow. After implant placement and dual-zone bone and soft tissue augmentation, connecting geometries and emergence profiles were finalized. The average implant insertion torque was 53.2 ± 14.9 Ncm and ranged between 35 and 80 Ncm, allowing immediate provisional restoration in all cases. Final restorations were delivered three months after implant placement. An implant survival rate of 100% was observed at the 1-year recall after loading. The results of this case series suggest that immediate placement of novel tapered implants and immediate provisionalization using an integrated digital workflow can result in predictable functional and esthetic results for the immediate transition of failing single teeth in the esthetic area.

Purpose: A novel attachment system for implant-retained overdentures (IRODs) with novel material combinations for improved mechanical resilience and prosthodontic success (Novaloc) has been recently introduced as an alternative to an existing system (Locator). This study investigated whether differences between the Novaloc and Locator attachment systems translate into differences in implant survival, implant success, and patient-centered outcomes when applied in a real-world in-practice comparative setting in patients restored with mandibular IRODs supported by 2 interforaminal implants (2-IRODs)., Methods: This prospective, intra-subject crossover comparison compared 20 patients who received 2 intra-foraminal bone level tapered implants restored with full acrylic overdentures using either the Locator or Novaloc attachment system. After 6 months of function, the attachment in the corresponding dentures was switched, and the definitive attachment system type was delivered based on the patient's preference after 12 months. For the definitive attachment system, implant survival was evaluated after 24 months. The primary outcomes of this study were oral health-related quality of life and patient preferences related to prosthetic and implant survival. Secondary outcomes included implant survival rate and success, prosthetic survival, perceived general health, and patient satisfaction., Results: Patient-centered outcomes and patient preferences between attachment systems were comparable, with relatively high overall patient satisfaction levels for both attachment systems. No difference in the prosthetic survival rate between study groups was detected. The implant survival rate over the follow-up period after 24 months in both groups was 100%., Conclusions: The results of this in-practice comparison indicate that both attachment systems represent comparable candidates for the prosthodontic retention of 2-IRODs. Both systems showed high rates of patient satisfaction and implant survival. The influence of material combinations of the retentive system on treatment outcomes between the tested systems remains inconclusive and requires further investigations., Competing Interests: The study was supported by Institut Straumann AG, Basel, Switzerland. The authors disclose that Straumann AG Basel specifically covered the costs for the implants and prosthetic parts that were used as part of the study. Prof. M. Dard and Dr. Susy Linder are employees of Institut Straumann AG, Basel, Switzerland. No author of this manuscript has any conflict of interest concerning this study., (Copyright © 2023. Korean Academy of Periodontology.)

The report describes the rehabilitation of a maxillary arch with limited bone volume in a 67-year-old female taking antiresorptives due to osteopenia. One 10-mm and two extra-short 4-mm implants were inserted, and implant-supported splinted crowns were fabricated. The 5-year follow-up showed stable bone levels, despite poor initial stability (ISQ: 14-51)., Competing Interests: No conflict of interest relevant to this article is reported by the authors., (© 2023 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.)

Purpose: To assess the clinical performance of a two-piece zirconia implant system (PURE Ceramic Implants, Straumann, Basel, Switzerland) in the maxilla after a follow-up period of more than 1 year., Materials and Methods: A total of 19 patients in three centres received 24 single-tooth implants in the maxilla. The implants were restored after a mean healing period of 7.1 ± 0.4 months (range 7 to 9 months). Implant survival, implant success, Plaque Index, probing pocket depth, bleeding on probing, mucosal recession/creeping attachment, width of keratinised mucosa, papilla index and pink aesthetic score were evaluated after prosthetic loading (T0), after 6 months (T1) and at the final follow-up (T2, mean 15.0 ± 2.1 months, range 12 to 19 months)., Results: All implants survived and were suitable for retaining prostheses. Low values were recorded for Plaque Index (0.38 ± 0.68) and probing pocket depth (2.49 ± 0.49 mm). Bleeding on probing increased significantly from T0 (21.7%) to T1 (50.0%) (P = 0.0342) and then remained stable (50.0% at T2). No recession was detected around any of the implants. A statistically significant increase in attachment level was observed from T0 to T2 (0.79 ± 0.88 mm; P = 0.0196). A papilla index of 2.27 ± 0.81 and pink aesthetic score of 11.67 ± 1.60 at T2 indicated a completely satisfying aesthetic result., Conclusion: Within the limitations of the present study, the two-piece zirconia implant system investigated achieved fully satisfying functional and aesthetic results.

Background and Objective: To take major advantage of erbium-doped yttrium aluminium garnet (Er:YAG) lasers in osteotomy-like freedom of cutting geometries and high accuracy-the integration and miniaturization of the robot, laser, and navigation technology was tried and applied to minipigs. The investigators hypothesized laser osteotomy would render acceptable bone healing based on the intraoperative findings and postoperative cut surface analysis., Study Design/materials and Methods: We designed and implemented a comparative bone-cutting surgery in the minipig mandible with a cold ablation robot-guided Er:YAG laser osteotome (CARLO) and a piezoelectric (PZE) osteotome. The sample was composed of different patterns of defects in the mandibles of six grown-up female Goettingen minipigs. The predictor variable was Er:YAG osteotomy and PZE osteotomy. The outcome variable was the cut surface characteristics and bone healing at 4 and 8 weeks postoperatively. Descriptive and qualitative comparison was executed., Results: The sample was composed of four kinds of bone defects on both sides of the mandibles of six minipigs. We observed more bleeding during the operation, open-cut surfaces, and a faster healing pattern with the laser osteotomy. There was a possible association between the intraoperative findings, postoperative cut surface analysis, and the bone healing pattern., Conclusions: The results of this study suggest that characteristic open-cut surfaces could explain favorable bone healing after laser osteotomy. Future studies will focus on the quantification of the early healing characteristics after laser osteotomy, its diverse application, and the safety feature. Lasers Surg. Med. © 2020 Wiley Periodicals LLC., (© 2020 Wiley Periodicals LLC.)

Purpose: The aim of this study was to evaluate the survival and success rates of oral rehabilitations in a shortened maxillary dental arch and expanded maxillary sinus with 4-mm extrashort implants splinted to longer ones., Materials and Methods: One 10-mm and one/two extrashort 4-mm titanium-zirconium SLActive tissue-level dental implants were inserted into 11 patients with limited vertical bone availability due to an expanded maxillary sinus antrum. Immediately and 6 months after insertion, implant stability resonance frequency analysis (RFA) values were assessed with an Osstell device. Splinted crowns combining 4- and 10-mm implants were supplied to all 11 cases., Results: In 10 cases, the bone quality was type III, and in one case, type IV. Among 17 4-mm and 11 10-mm implants, the median RFA values were 61 (interquartile ranges [IQR]: 59 to 64) and 66 (IQR: 64 to 72). One 4-mm implant failed to osseointegrate and was removed. After 6 months of healing, secondary-stability measurements of 16 of the remaining 4-mm implants increased to 68 (IQR: 62 to 72) and of 10-mm implants to 78 (IQR: 77 to 80). After 1 year, all (11/11) oral rehabilitations supported by 10-mm (11/11) and 4-mm (16/16) implants were functional. The medians and IQRs of the probing depths (median: 2.8 mm, IQR: 2.3 to 3.1 mm vs median: 2.9 mm, IQR: 2.4 to 3.1 mm) and the crestal bone loss (median: 0.75 mm, IQR: 0 to 0.9 mm vs median: 0.22 mm, IQR: 0 to 0.4 mm) for the 10-mm and 4-mm implants, respectively, were similar., Conclusion: Rehabilitations with splinted crowns combining 4- and 10-mm implants demonstrated a favorable 1-year performance in a shortened maxillary dental arch.

This study aimed to rehabilitate shortened maxillary dental arch with splinted crowns by connecting ultra-short implants with longer ones. In the posterior maxilla of 11 patients, one 10-mm (n = 11) and one or two ultra-short 4-mm (n = 17) dental implants were inserted. The insertion torque was lower than 20 Ncm in 55% of the 10-mm implants and in 94% of the 4-mm implants ( P > .05). Median (range) implant stability quotients at the time of insertion and after 6 months were 61 (14 to 72) and 68 (51 to 79), respectively, for 4-mm implants, and 66 (52 to 78) and 78 (60 to 83), respectively, for 10-mm implants ( P < .05). One 4-mm implant failed to integrate. All patients were restored with splinted metal-ceramic crowns connecting 4- and 10-mm implants. Median (range) clinical crown/implant ratios of 4-mm and 10-mm implants were 2.79 (1 to 3.66) and 1.06 (0.85 to 1.46), respectively ( P < .05). Six months after prosthetic rehabilitation, the median (range) crestal bone loss was 0.3 mm (-0.7 to 1.7 mm) for 4-mm implants and was 0.5 mm (-0.8 to 3.5 mm) for 10-mm implants ( P > .05). Splinted crowns combining 4- and 10-mm implants may contribute to a better force distribution in the treatment with ultra-short implant-supported prosthesis in the posterior maxilla.

Objectives: This study aimed to verify the effectiveness of EMD-liquid in combination with a synthetic bone substitute in a rabbit calvarial model., Material and Methods: Four 7-mm outer diameter circular slits were created in the calvaria of 10 New Zealand white rabbits, and polycarbonate cylinders were inserted into the slits. Two experimental groups were established: (1) EMD-liquid + bone substitute (Osteon III®; biphasic calcium phosphate (BCP), β-TCP/HA = 40:60) and (2) saline + bone substitute (Osteon III®; BCP). The cylinders were filled with saturated graft materials and covered with polycarbonate caps. Micro-CT and histomorphometric evaluation were conducted., Results: In the histomorphometric analysis, new bone formation was significantly higher in the bone substitute (BS) + EMD-liquid group than in the BS only group at both 5 and 10 weeks (p < 0.01). There were statistically significant differences in the material area between the bone substitute and bone substitute + EMD-liquid groups at only 5 weeks (p < 0.05). The BS + EMD-liquid group demonstrated reduced material area to a greater extent. In micro-CT analysis, the BS + EMD-liquid group (27.04 ± 8.06 at 5 weeks, 28.49 ± 9.22 at 10 weeks) showed a significantly higher percentage of mineralized tissue volume at both 5 and 10 weeks (p < 0.05) than the BS only group., Conclusion: EMD-liquid enhances new bone formation when combined with BCP bone substitute in an animal model. Moreover, the EMD-liquid + BS has significantly lesser material area than BS alone, indicating accelerated graft degradation. Further studies on types of graft materials are required to verify the effect of EMD-liquid and to optimize its regenerative potential., Clinical Relevance: This study suggests that EMD-liquid may have beneficial effect on bone regeneration with synthetic bone substitute.

Xenograft bone substitutes are commonly used to increase bone volume and height in the deficient posterior maxilla. The addition of enamel matrix derivate (Emdogain) could increase the efficiency of the bone healing process. The aim of this prospective randomized, controlled split-mouth design study was to compare the percentage of newly formed bone in sinus floor augmentation with deproteinized bovine bone mineral with or without the addition of enamel matrix derivative after 6 months of healing. Sixteen bilateral sinus floor augmentation procedures were performed. Deproteinized bovine bone mineral combined with enamel matrix derivative (test) and deproteinized bovine bone mineral alone (control) groups were randomly allocated within each patient. Six months after augmentation and concurrent to implant placement, bone biopsies were taken for histomorphometric analysis. Additionally, implant survival and peri-implant bone levels were radiographically assessed at baseline and 24 months after functional loading. Histomorphometric analysis revealed a significantly higher amount of newly formed bone in the test group compared with the control group (22.6% and 15.5%, respectively; P = .033). No significant differences in the amount of remaining graft or connective tissue was found. Enamel matrix derivative added to deproteinized bovine bone mineral particles significantly increased new bone formation in sinus lift procedures in edentulous or partially edentulous patients with deficient bilateral posterior alveolar ridges requiring augmentation for implant placement.

Objective: To assess longitudinal peri-implant tissue evaluation in a plaque compromised ligature free dog model, clinically, radiographically, microbiologically and histologically., Materials and Methods: Six beagle mandibular premolars and first molars were extracted. Plaque accumulated for 16 weeks. Two implants were placed per hemi-mandible. For 17 weeks, control implants (CI) in one hemi-mandible were brushed daily; test implants (TI) in the other were not. These parameters were then assessed: clinically, probing depth (PD), bleeding-on-probing (BOP), presence of plaque (PP) and clinical attachment level (CAL); radiographically, marginal bone level; microbiologically, counts for Streptococcus spp., Fusobacterium spp., Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Prevotella intermedia and total bacterial load. At week 17, histomorphometric analysis was performed (MM-ISH (mucosal margin-implant shoulder); ISH-fBIC (implant shoulder-first bone-to-implant contact); MM-aJE (mucosal margin-apical area junctional epithelium); MM-aINF (mucosal margin-apical limit of the inflammatory infiltrate); %INF (percentage of inflammatory infiltrate))., Results: At week 17, TI had significant increased PD, BOP, PP and CAL versus baseline. All clinical variables presented intergroup differences. There was no intergroup difference for radiographic bone loss (p > 0.05). Total bacteria, Fusobacterium spp., A. actinomycetemcomitans and P. gingivalis had intergroup differences. There was no statistically significant intergroup difference for ISH-fBIC., Conclusions: Longitudinal microbiology evaluation detected a shift period. Final intergroup microbiological differences were the basis of W17 clinical intergroup differences, with higher values in TI. Microbiological and clinical changes detected in peri-implant tissues were compatible with onset of peri-implant disease. Despite histological inflammatory intergroup difference, no histological or radiographic intergroup bone loss was detected., Clinical Relevance: This study set-up describes a valuable method for generating "true" early peri-implant defects without mechanical trauma.

The aim of this case series was to assess, over a period of 24 months, the clinical and radiographic outcomes in partially edentulous patients receiving bone-level tapered implants. In total, 33 partially edentulous patients and 50 implants were evaluated. Patients received single or multiple implants in the posterior maxilla. Clinical and radiographic measurements of vertical bone levels were assessed at surgery, at loading, and 6, 12, and 24 months after surgery. The success and survival rates of the implants were also evaluated. Within the 24-month follow-up, only 1 implant failed (2.0%). Other biological or technical complications were not observed. The mean insertion torque was 34 ± 5.3 Ncm. Bone-level changes of 0.35 ± 0.23 mm were found between surgery and 12 months after surgery, and changes of 0.03 ± 0.05 mm were found between 12 months and 24 months after surgery. The overall change from surgery to 24 months after implant placement was 0.38 ± 0.24 mm. Most of the bone loss occurred between surgery and 3 months (0.28 ± 0.19 mm; P < .001); thereafter, the loss was minimal and statistically nonsignificant. Bone-level tapered implants yielded a high survival and success rate with minimal bone-level changes. Tapered implants could be considered as a predictable treatment option for partially edentulous patients with different types of bone qualities and loading protocols.

Ten years have passed since Hürzeler and coworkers first introduced the socket-shield technique. Much has developed and evolved with regard to partial extraction therapy, a collective concept of utilizing the patient's own tooth root to preserve the periodontium and peri-implant tissue. The specifications, steps, instrumentation, and procedures discussed in this article are the result of extensive experience in refining the socket-shield technique as we know it today. A repeatable, predictable protocol is requisite to providing tooth replacement in esthetic dentistry. Moreover, a standardized protocol provides a better framework for clinicians to report data relating to the technique with procedural consistency. This article aims to illustrate a reproducible, step-by-step protocol for the socket-shield technique at immediate implant placement and provisionalization for single-rooted teeth.

Background: A dentition with adequate function and esthetics is essential for the well-being and quality of life. A full implant-retained fixed prosthetics is an ideal solution for fully edentulous arch, however requires complex planning, surgical, and prosthetic procedure. With the help of digital workflow, it becomes a predictable and fast solution for the dentists and the patients. This retrospective study analyzed the most advanced surgical approach in full-arch rehabilitation with dental implants and immediate loading using digital workflow., Methods: Patient records of fully edentulous jaws treated in four clinical centers in Warsaw, Poland, were evaluated. Computer-assisted planning and surgical template fabrication were done using the planning software coDiagnostiX™, based on a pre-op cone beam computed tomography (CBCT) and scanned data of a plaster model. A post-op CBCT was acquired after the placement of four to six implants by the guided system. The influence of different surgical variables on the discrepancy between planning and execution was analyzed, together with the biomechanical indices., Results: A total of nine patient records were selected of 12 edentulous jaws treated with 62 implants. The overall mean three-dimensional (3D) offset at the implant base was 1.60 mm, at the tip 1.86 mm. The mean angle of deviation was 4.89°, the mean implant stability quotient (ISQ) 70.42, and the insertion torque 35.58 Ncm. The 3D offsets were influenced by the gender of the patient, treated jaw, the diameter, and length of the implant. The angle of deviation was affected only by the treated jaw. Insertion torque was influenced by the treated jaw, the age of the patient, the length of the implant, tooth type, and the side of the jaw., Discussion: Bone quality of the patient and implant preparation procedure influenced the discrepancy between the planning and the execution of the digitally guided implant placement. Dense bone-mandible, posterior area, young age, and man-and multiple preparations of the implant bed-wider and longer implant-could be suggested as risk factors., Conclusion: Digital workflow successfully enabled the immediate full-arch rehabilitation with a predictable outcome by different surgeons in multiple centers.

Purpose: Only limited information on the effect of implant surface hydrophilicity in conjunction with simultaneous bone augmentation is available. In this study, new bone growth around implants with a superhydrophilic modSLA (SLActive) and hydrophobic SLA (SLA) surface were compared in circumferential defects when grafted in conjunction with mineralized cancellous bone allograft (MCBA, maxgraft) or sintered bovine bone mineral (SBBM, cerabone)., Materials and Methods: The osseointegration and bone formation in circumferential defects in minipig mandibles around Straumann Roxolid, Ø 3.3 mm, length 8 mm; either SLA or SLActive, were evaluated. Following implant placement, the 2-mm circumferential defects around the implants were filled with MCBA or SBBM. Distance from implant shoulder to first bone-to-implant contact (f-BIC), percentage of bone-to-implant contact (BIC), and bone aggregate percentage (amount of new bone and remaining graft) within the defect area were evaluated after 8 weeks of healing., Results: In the SBBM group, lingual fBIC and buccal BIC were significantly lower for SLA (mean -0.404 ± 0.579 mm for modSLA versus -1.191 ± 0.814 mm for SLA, P = .021 and mean 62.61% ± 9.49% for modSLA versus 34.67% ± 24.41% for SLA, P = .047, respectively). Bone aggregate percentage was significantly higher for modSLA versus SLA implants in SBBM (77.84% ± 6.93% versus 64.49% ± 13.12%; P = .045). The differences between implant surfaces in MCBA showed a similar trend but were less pronounced than in the SBBM group and did not reach a statistically significant level., Conclusion: The results suggest that implants with a superhydrophilic modSLA surface are more conducive to faster osseointegration even in conjunction with simultaneous bone grafting procedures.

Bone is a composite material composed of collagen and calcium phosphate (CaP) mineral. The collagen gives bone its flexibility while the inorganic material gives bone its resilience. The CaP in bone is similar in composition and structure to the mineral hydroxyapatite (HA) and is bioactive, osteoinductive and osteoconductive. Therefore synthetic versions of bone apatite (BA) have been developed to address the demand for autologous bone graft substitutes. Synthetic HA (s-HA) are stiff and strong, but brittle. These lack of physical attributes limit the use of synthetic apatites in situations where no physical loading of the apatite occurs. s-HA chemical properties differ from BA and thus change the physical and mechanical properties of the material. Consequently, s-HA is more chemically stable than BA and thus its resorption rate is slower than the rate of bone regeneration. One solution to this problem is to introduce a faster resorbing CaP, such as β-tricalcium phosphate (β-TCP), when synthesizing the material creating a biphasic (s-HA and β-TCP) formulation of calcium phosphate (BCP). The focus of this review is to introduce the major differences between BCP and biological apatites and how material scientists have overcome the inadequacies of the synthetic counterparts. Examples of BCP performance in vitro and in vivo following structural and chemical modifications are provided as well as novel ultrastructural data. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 2493-2512, 2018., (© 2017 Wiley Periodicals, Inc.)

Purpose: The increasing prevalence of obesity or metabolic syndrome (O/MS) and type 2 diabetes mellitus (DM) remains a global health concern. Clinically relevant and practical translational models mimicking human characteristics of these conditions are lacking. This study aimed to demonstrate proof of concept of the induction of stable O/MS and type 2 DM in a Göttingen minipig model and validate both of these disease-adjusted Göttingen minipig models as impaired healing models for the testing of dental implants., Materials and Methods: Nine minipigs were split into 3 groups-control (normal diet), obese (cafeteria diet), and diabetic (cafeteria diet plus low-dosage streptozotocin)-followed by placement of dental implants. Inflammatory markers including tumor necrosis factor α, C-reactive protein, and cortisol were recorded for each study group. Removal torque was measured, and histomorphometric analysis (bone-to-implant contact and bone area fraction occupancy) was performed., Results: O/MS pigs showed, on average, a 2-fold increase in plasma C-reactive protein (P < .05) and cortisol (P < .09) concentrations compared with controls; DM pigs showed, on average approximately, a 40-fold increase in plasma tumor necrosis factor α levels (P < .05) and a 2-fold increase in cortisol concentrations (P < .05) compared with controls. The impact of O/MS and DM on implants was determined. The torque to interface failure was highest in the control group (200 N-cm) and significantly lower in the O/MS (90 N-cm) and DM (60 N-cm) groups (P < .01). Bone formation around implants was significantly greater in the control group than in the O/MS and DM groups (P < .02)., Conclusions: Both O/MS and DM minipigs express a human-like disease phenotype, and both presented bone-healing impairment around dental implants. Our finding of no significant difference between type 2 DM and O/MS in bone formation around implants provides evidence that further investigation of the impact of O/MS is warranted., (Copyright © 2018 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Amelogenin (AMG) is a cell adhesion molecule that has an important role in the mineralization of enamel and regulates events during dental development and root formation. The purpose of the present study was to investigate the effects of recombinant human AMG (rhAMG) on mineralized tissue-associated genes in cementoblasts. Immortalized mouse cementoblasts (OCCM-30) were treated with different concentrations (0.1, 1, 10, 100, 1000, 10,000, 100,000 ng · mL -1 ) of recombinant human AMG (rhAMG) and analyzed for proliferation, mineralization and mRNA expression of bone sialoprotein (BSP), osteocalcin (OCN), collagen type I (COL I), osteopontin (OPN), runt-related transcription factor 2 (Runx2), cementum attachment protein (CAP), and alkaline phosphatase (ALP) genes using quantitative RT-PCR. The dose response of rhAMG was evaluated using a real-time cell analyzer. Total RNA was isolated on day 3, and cell mineralization was assessed using von Kossa staining on day 8. COL I, OPN and lysosomal-associated membrane protein-1 (LAMP-1), which is a cell surface binding site for amelogenin, were evaluated using immunocytochemistry. F-actin bundles were imaged using confocal microscopy. rhAMG at a concentration of 100,000 ng · mL -1 increased cell proliferation after 72 h compared to the other concentrations and the untreated control group. rhAMG (100,000 ng · mL -1 ) upregulated BSP and OCN mRNA expression levels eightfold and fivefold, respectively. rhAMG at a concentration of 100,000 ng · mL -1 remarkably enhanced LAMP-1 staining in cementoblasts. Increased numbers of mineralized nodules were observed at concentrations of 10,000 and 100,000 ng · mL -1 rhAMG. The present data suggest that rhAMG is a potent regulator of gene expression in cementoblasts and support the potential application of rhAMG in therapies aimed at fast regeneration of damaged periodontal tissue.

Objectives: The aim of the present study was to review the current literature relating to the impact of dental implants on oral health-related quality of life (OHRQoL) in edentulous or partially dentate patients., Data/sources: Systematic literature searches were performed in the PubMed, EMBASE, and Cochrane Library databases, using high level MeSH terms. The searches were limited to studies published in English from 1960 to June 11, 2017, reporting OHRQoL outcomes using validated instruments, and having enrolled at least 50 patients., Study Selection: After removal of duplicates, a total of 2827 unique hits were identified. After title, abstract, and full text screening, 63 articles were included in the review presenting findings of 55 individual studies. The provision of implant-supported dentures was associated with a significant increase in OHRQoL in partially dentate and in edentulous patients, with the magnitude of achieved improvement typically being greater for implant-supported dentures than with conventional ones. Furthermore, OHRQoL impairment prior to treatment was strongly associated with OHRQoL improvement., Conclusion: For partially dentate patients, there is not enough evidence that implant-supported FDP are superior in terms of OHRQoL than conventional FDP, but moderate evidence suggests that implant-supported FDP perform better than conventional RDP. In edentulous patients, evidence suggests that only if OHRQoL at baseline is highly impaired and patients request implant treatment, IOD are superior than CD in terms of treatment-induced OHRQoL improvement., Clinical Significance: Patients can be informed that implant treatment is usually related to a significant improvement in OHRQoL. However, improvement is not necessarily higher than for conventional prosthodontic treatments but depends on patient's clinical and psychosocial characteristics., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Objectives: Titanium-zirconium (TiZr) has been proposed as a mechanically stronger alternative to commercially pure titanium for oral and orthopaedic implants. However, not much is known on the osseointegration kinetics of TiZr surfaces. In this study, we aimed to identify the genetic response of bone around TiZr implants compared to pure Ti., Material and Methods: Microtextured and hydrophilic TiZr implants (tests) and cpTi implants grade IV (controls) were placed in the tibia of 30 New Zealand white rabbits. At 2, 4 and 12 weeks, the implants were subjected to removal torque test (RTQ). The expression of a panel of genes involved in the process of osseointegration was measured in the bone around the test and control implants by means of quantitative real-time polymerase chain reaction (PCR) and compared to the control samples., Results: The controls yielded statistically significant higher RTQ at 4 weeks, but the RTQ of the tests had a larger increase between 4 and 12 weeks, when both groups reached similar values. The gene expression analysis showed that all selected markers for bone formation, bone remodelling and cytokines were significantly upregulated around TiZr implants after 2 weeks. After 4 weeks of healing, two bone formation markers were significantly more expressed in the test samples, while at 12 weeks, the expression of all genes was similar in the two groups., Conclusions: TiZr implants showed comparable biomechanical outcomes to cpTi up to 12 weeks of healing. However, at early healing stages, they showed a significant upregulation of osteogenesis and osteoclastogenesis markers., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Angiogenesis play a crucial role in the regeneration of hard and soft tissue around dental titanium (Ti) implant. Enamel matrix derivative (EMD) promotes tissue regeneration and stimulates angiogenesis but its effect on the angiogenesis on Ti surfaces was never investigated. The effect of EMD on the angiogenic activity of endothelial cells cultured on pre-treated smooth Ti (PT), acidetched (A), coarse-grit blasted and acid-etched (SLA) surfaces and tissue culture plastic (TCP) in the presence or absence of EMD was investigated. EMD inhibited the proliferation/viability of human umbilical vein endothelial cells (HUVECs) growing on A and SLA Ti surfaces. EMD induced an increase in the expression of all these genes in HUVECs grown on SLA surface but not on other surfaces. Summarizing, our data show that EMD influences proliferation and expression of angiogenesis associated gene in HUVECs grown on moderately rough SLA surfaces, suggesting that EMD might promote angiogenesis following implantation.

Purpose: The placement of immediate implants has become a routine treatment modality for the replacement of missing teeth. The aim of the present study was to evaluate dimensional changes of hard tissues following tooth extraction, implant bed preparation, and the subsequent integration of titanium implants placed immediately or following an 8-week healing period., Materials and Methods: All mandibular premolars were extracted and used as experimental sites in five beagle dogs. The left quadrant was used to compare the healing of alveolar bone following regular tooth extraction or surgical implant bed preparation. The right quadrant was used to compare immediate with delayed implant placement (3.3 mm, Bone Level SLActive, Roxolid, Straumann) after an 8-week healing period. All samples were assessed histologically for new bone area/total area (BATA), bone-to-implant contact (BIC), and bone height changes from the buccal and lingual midlines., Results: Implant bed preparation led to significantly lower BATA values and bone height loss compared with regular extraction sockets (-2.46 mm vs -1.44 mm, respectively; P = .0007). Placement of immediate implants demonstrated buccal and lingual bone height loss of 1.51 mm and 0.91 mm, respectively, whereas only 0.12 mm and 0.12 mm of bone height loss was observed during delayed implant placement. A significantly higher BIC was observed for implants placed immediately compared with delayed placement (52% vs 35%, P < .05)., Conclusion: Implant bed preparation further increased dimensional changes when compared with routine extraction sockets. Although immediate implant placement produced better BIC than did delayed placement, a significantly higher bone height loss at both the buccal and lingual midlines was reported. Further investigation is underway to minimize dimensional changes following immediate implant placement.

Purpose: Implant-supported prosthetic rehabilitations are in constant augmentation in everyday dental practice. This is largely due to increasing demand from patients for fixed or implant-stabilized prosthesis, although they are frequently reticent to complex preimplant bone augmentation surgeries, whenever bone volume is lacking. Narrow-diameter implants (NDI; ≤3.5 mm) have been developed to offer relatively simple implant solutions in challenging bone-deficient sites. However, concerns regarding their mechanical properties have been raised. Special titanium-zirconium material (Ti-Zr), with superior mechanical resistance, compared with pure titanium alloys has been introduced into the market. The purpose of this systematic review was to determine the available data on clinical performance of Ti-Zr NDI., Materials and Methods: A literature search of all available clinical articles dealing with Ti-Zr NDI has been carried out. After including only prospective clinical trials, 14 papers were retrieved for thorough reviewing., Conclusion: Short-term results from preliminary clinical reports are quite promising, although the number of published studies and the follow-up periods are still insufficient to determine the real benefit of this hybrid material compared with titanium, especially when using NDI.

DICER is the central enzyme that cleaves precursor microRNAs (miRNAs) into 21-25 nucleotide duplex in cell lineage differentiation, identity, and survival. In the current study, we characterized the specific bone metabolism genes and corresponding miRNAs and found that DICER and Runt-related transcription factor 2 (Runx2) expressions increased simultaneously during osteogenic differentiation. Luciferase assay showed that Runx2 significantly increased the expression levels of DICER luciferase promoter reporter. Our analysis also revealed weaker DICER expression in embryos of Runx2 knock out mice (Runx2 -/-) compared with that of Runx2 +/- and Runx2 +/+ mice. We further established the calvarial bone critical-size defect (CSD) mouse model. The bone marrow stromal cells (BMSCs) transfected with siRNA targeting DICER were combined with silk scaffolds and transplanted into calvarial bone CSDs. Five weeks post-surgery, micro-CT analysis revealed impaired bone formation, and repairing in calvarial defects with the siRNA targeting DICER group. In conclusion, our results suggest that DICER is specifically regulated by osteogenic master gene Runx2 that binds to the DICER promoter. Consequently, DICER cleaves precursors of miR-335-5p and miR-17-92 cluster to form mature miRNAs, which target and decrease the Dickkopf-related protein 1 (DKK1), and proapoptotic factor BIM levels, respectively, leading to an enhanced Wnt/β-catenin signaling pathway. These intriguing results reveal a central mechanism underlying lineage-specific regulation by a Runx2/DICER/miRNAs cascade during osteogenic differentiation and bone development. Our study, also suggests a potential application of modulating DICER expression for bone tissue repair and regeneration. J. Cell. Physiol. 232: 182-191, 2017. © 2016 Wiley Periodicals, Inc., (© 2016 Wiley Periodicals, Inc.)

Objectives: The aim of this study was to test the following hypothesis: (1) Aging would adversely affect bone integration of implants; (2) Titanium-zirconium-SLActive (TiZr-SLActive) implant might perform better in osseointegration than Ti-SLA implant in aged group., Materials and Methods: Thirteen miniature pigs (six of them were young adult minipigs, with other seven being aged ones.) were enrolled in this study. The right mandibular premolars (P1, P2, P3) and the first molar (M1) were extracted in all animals. Three months later, one TiZr-SLActive and one Ti-SLA implants were inserted into the endentulous area in mandible of each animal. The animals were sacrificed 8 weeks after placement of implants. Implants in the mandibles were used for removal torque (RT) tests, while vertebra and femur being retrieved for bone mineral density (BMD) tests., Results: Implant success rate in the young group was significantly higher than that in the aged group. Higher survival rate of implants was also observed in younger group than that in the aged group but without significant difference. Within the young group, mean value for peak RT of Ti-SLA implants was higher than that of TiZr-SLActive implants without significant difference. In the aged group, the TiZr-SLActive implants showed a higher mean value for peak RT than Ti-SLA implants. No significant difference was found in the mean BMD in both vertebra and femur between different age groups., Conclusions: Within the limits of this study, aging could negatively affect osseointegration of dental implants. TiZr-SLActive implants might to some degree compensate for the compromise in osseointegration brought by aging., (© 2016 Wiley Periodicals, Inc.)

Background: The aim of the study was to evaluate whether early loading of implants with a chemically modified sandblasted, large-grit, acid-etched (SLA) (SLActive®) surface was non-inferior to conventional loading in terms of change in crestal bone level., Methods: This was a randomized, controlled, multicenter study. Patients requiring single-tooth rehabilitation in the posterior maxilla or mandible received implants and were randomized to receive a provisional restoration in occlusal load after 25 ± 3 days (early loading) or after 13 ± 1 weeks (conventional loading). The primary endpoint was change in crestal bone level between implant placement (baseline) and 6 months. Secondary endpoints included change in crestal bone level between baseline and 12 months, implant survival and success rates, and patient satisfaction., Results: Of the 84 patients enrolled, 78 received implants and were randomized onto the early loading (41 patients) and conventional loading (37 patients) groups. The mean change in crestal bone level between baseline and 6 months was 0.56 ± 0.58 and 0.51 ± 0.62 mm for early and conventional loading, respectively; at 12 months, the mean change was 0.76 ± 0.60 and 0.73 ± 0.77 mm, respectively. Implant survival and success at 12 months were 100 % for both groups. Patient satisfaction was similar between the groups, except that more patients in the early loading group were satisfied or highly satisfied with the time taken for fitting., Conclusion: The study demonstrated that early implant loading was non-inferior to conventional implant loading in terms of crestal bone level change in a Japanese patient population in short follow-up period and single tooth gaps in molar regions.

Objectives: Guided bone regeneration (GBR) aims to predictably restore missing bone that has been lost due to trauma, periodontal disease or a variety of systemic conditions. Critical to this procedure is the ability of a bone grafting material to predictably serve as a 3-dimensional scaffold capable of inducing cell and bone tissue in-growth at the material surface. Although all bone grafts are osteoconductive to bone-forming osteoblasts, only a small number of commercially available bone grafts with FDA approval are osteoinductive including demineralized freeze-dried bone allographs (DFDBA) and scaffolds containing bone morphogenetic proteins (BMPs). Recently, a class of synthetic bone grafts fabricated from biphasic calcium phosphate (BCP) sintered at a low temperature have been shown to form ectopic bone formation in non-skeletal sites without the use of growth factors. Therefore, the present study aimed to compare the osteoinductive potential of this group of synthetic BCP alloplasts with autografts, allografts and xenografts., Materials and Methods: In the present study, 4 types of bone grafting materials including autogenous bone harvested with a bone mill, DFDBA (LifeNet, USA), a xenograft derived from bovine bone mineral (NBM, BioOss, Geistlich, Switzerland) and a novel synthetic biphasic calcium phosphate (BCP, Straumman, Switzerland) were implanted into intramuscular pouches of 24 rats and analysed histologically for their ability to form ectopic bone formation around grafting particles. A semi-quantitative osteoinductive score was used to quantify the osteoinductive ability of each bone graft., Results: The results from the present study reveal that (1) autogenous bone resorbed rapidly in vivo, (2) the xenograft showed no potential to form ectopic bone formation and (3) both DFDBA and BCP were able to stimulate ectopic bone formation., Conclusion: These studies demonstrate that these newly developed synthetic bone grafts have potential for inducing ectopic bone formation similar to DFDBA. Future clinical testing is necessary to reveal their bone-inducing properties in clinical scenarios including GBR procedures and in combination with implant dentistry., Clinical Relevance: Novel BCP scaffolds are able to induce ectopic bone formation without the use of osteoinductive growth factors such as BMP2 and thus demonstrate a large clinical possibility to further enhance bone formation for a variety of clinical procedures.

Purpose: Tapered implants are thought to result in equivalent long-term stability and marginal peri-implant bone height in comparison to cylindrical implants. The goal of this study was to compare the primary stability and osseointegration of a novel bone-level tapered-wall implant to a control bone-level cylindrical implant with exactly the same surface characteristics, in a direct side-by-side comparison in an animal model., Materials and Methods: Mandibular premolars and first molars were extracted in 11 G.ttingen minipigs, and healing was allowed for 3 months. Six implants were placed with a 4-week surgical lag time between hemimandibles (three per side), and either immediately loaded (first implantation time point) or submerged (second implantation time point). Eight-mm-long × 4.1-mm-diameter titanium screw-type bone-level implants with tapered (two per side) and cylindrical bodies (one per side) were used (Institut Straumann); insertion torque and implant stability were measured, and the soft tissue was closed. Standardized radiographs were taken at implant placement and at sacrifice. Following a healing period of 1 month from the last surgical intervention (8 weeks total healing time for loaded implants; 4 weeks total healing time for nonloaded implants), the animals were sacrificed and mandibular blocks were harvested for nondecalcified histologic and histomorphometric analysis., Results: All implants were integrated radiographically and osseointegrated histologically. Maximum insertion torque measurements and implant stability quotient values showed no significant difference between tapered and cylindrical implants. Histomorphometric analysis also resulted in comparable bone-to-implant contact values between the implant types and similarly limited marginal peri-implant bone resorption; no significant differences were observed regarding all the evaluated parameters between the groups, regardless of the loading regime., Conclusion: In a direct side-by-side comparison, in an intraoral minipig model, a novel bone-level tapered screw implant with an SLActive surface showed comparable clinical and histologic outcomes to a parallel-walled bone-level screw implant with an SLActive surface.

Aim: The aim of this pilot study was to describe an in vitro model of peri-implantitis microcosm for contamination of titanium surfaces and an in vivo model for evaluating different disinfection strategies of titanium surfaces., Materials and Methods: Biofilms were grown in vitro for 30 days on sandblasted large-grit acid-etched (SLA) Ti discs (n = 69) in a constant depth film fermentor (CDFF) associated with peri-implantitis conditions. Four Swedish loop rabbits were randomly allocated in three test groups (T 1 , T 2 , T 3 ) and one control group (C). In group C, two sterile SLA Ti discs were implanted/fixed in each tibia. In the test groups (to evaluate the potential of different surface disinfection techniques), one sterile and three previously disinfected SLA Ti discs were placed following different disinfection protocols: group T 1 : the discs were treated with a titanium brush - TiB; group T 2 : the discs were treated with the combination of TiB and photodynamic therapy; and group T 3 : the discs were treated with TiB and 1%NaOCl plus 0.2%CHX. Tensile strength test and qualitative histological analysis were performed on all 16 discs after 4 weeks of healing., Results: Thirty days following CDFF emulating peri-implantitis microcosm, all SLA Ti discs had a mean total viable aerobes and facultative anaerobes count of 8.06 log 10  CFU/biofilm and anaerobes 8.32 log 10  CFU/biofilm. Before implantation/fixation on the tibia, differences of log 10  CFU/biofilm counts between control and test groups after post hoc adjustment were highly significant (P < 0.001). In the in vivo analysis, group C exhibited the highest tensile strength (67.60 N [25.64-127.02]) and the histological sections revealed the presence of dense mature bone in direct contact with the disc surface. The analysis at the test groups showed that T 2 presented with the highest tensile strength in comparison with the other two test groups., Conclusions: The in vitro model used in this study provides a valuable and reproducible tool for evaluating the in vitro dynamics of the peri-implantitis microcosm biofilm and for contaminating in a reproducible manner titanium surfaces. At the same time, the in vivo model used in this study provides a standardised mode of evaluating disinfection modalities of previously infected titanium surfaces., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: The aim of the present study was to evaluate the effect of a titanium brush and chemical agents following surgical treatment of experimental peri-implantitis., Material and Methods: Six implants were installed in the mandible of eight beagle dogs (unit of analysis) 3 months after tooth extraction. Experimental peri-implantitis was induced 3 months later. The defects were randomly allocated in three treatment groups: (a) TiBrush(™)  + sodium hypochlorite + chlorhexidine (TBH), (b) TiBrush(™)  + chlorhexidine (TB), (c) an ultrasonic device + chlorhexidine (US). The distal implant in each hemimandible was used as control, and no treatment was done. Clinical and histological measurements were performed after 3 months of healing., Results: All treatment procedures resulted in statistically significant improvements of all clinical parameters. Histomorphometrical analysis revealed no statistically significant differences between treatment groups in terms of woven bone height (primary outcome). However, there were differences between test and control groups in terms of inflammation, bone defect depth and bone refill without differences between TBH and TB groups., Conclusions: Resolution of peri-implantitis after access surgery and decontamination of peri-implant surfaces with TiBrush(™) with or without sodium hypochlorite is possible. However, the concomitant use of sodium hypochlorite has minor effect on treatment outcomes., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Bacground: On June 5th, 2015 at Europerio 8, a group of leading experts were gathered to discuss what has now been 20 years of documented evidence supporting the clinical use of enamel matrix derivative (EMD). Original experiments led by Lars Hammarström demonstrated that enamel matrix proteins could serve as key regenerative proteins capable of promoting periodontal regeneration including new cementum, with functionally oriented inserting new periodontal ligament fibres, and new alveolar bone formation. This pioneering work and vision by Lars Hammarström has paved the way to an enormous amount of publications related to its biological basis and clinical use. Twenty years later, it is clear that all these studies have greatly contributed to our understanding of how biologics can act as mediators for periodontal regeneration and have provided additional clinical means to support tissue regeneration of the periodontium., Aims: This review article aims to: (1) provide the biological background necessary to understand the rational for the use of EMD for periodontal regeneration, (2) present animal and human histological evidence of periodontal regeneration following EMD application, (3) provide clinically relevant indications for the use of EMD and (4) discuss future avenues of research including key early findings leading to the development of Osteogain, a new carrier system for EMD specifically developed with better protein adsorption to bone grafting materials., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

This paper describes a novel suturing approach that achieves harmonious and atraumatic soft tissue displacement in periodontal plastic surgery and soft tissue management around implants. The technique relies on a combination of horizontal and vertical mattress that are anchored at the splinted incisal contact points.

Objective: The aim of this research was to evaluate the primary stability, the marginal bone loss, the survival, and the success criteria, of 4-mm-length implants compared with implants of conventional length supporting fixed prostheses., Materials and Methods: Ten patients were selected for treatment of their atrophic edentulous jaws. Each patient received the following treatment: six dental implants were inserted, two anterior implants of conventional length (10-mm) in the interforaminal area and four posterior short implants of 4-mm length (Standard Plus, Roxolid, SLActive, Institut Straumann AG). The implants supported screw-retained fixed complete dentures. Examinations were conducted at day 0, three, six, and twelve months after surgery for the evaluation of the implant primary stability, secondary stability, crestal bone loss and survival by clinical evaluations, insertion torque values, resonance frequency analysis (RFA), and periapical radiography, respectively., Results: Sixty implants were inserted in ten patients. Mean insertion torque was slightly lower for 4-mm implants than 10-mm implants (38.1 Ncm vs. 42.2 Ncm) but without statistically significant difference. Implant stability was similar for extrashort and conventional implants. Marginal bone loss was similar for both groups for all the time periods. One short implant was lost before loading. The survival rates twelve months after implant placement were of 97.5% and 100% for short and conventional implants, respectively. Similarly, implant stability as measured by RFA was nonsignificantly lower for the 4-mm implants compared to the 10-mm implants. The marginal bone loss was lower for short implants three, six, and twelve months after the surgery without statistical significant difference., Conclusions: Within the limitations of this study, we conclude that short dental implants (8 mm or less in length) supporting single crowns or fixed bridges are a feasible treatment option with radiographic and clinical success rates similar to longer implants for patients with compromised ridges. Long-term data with larger number of implants and subjects are needed to confirm these preliminary results., (© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: The aim of this study was to investigate clinical and soft/hard tissues histomorphological outcomes of a ceramic implant comparatively to a titanium implant in a minipig model., Material and Methods: Eighteen soft tissue level implants (9 Ceramic with ZLA(®) surface as test, and 9 titanium SLActive(®) as control, Institut Straumann, Basel, Switzerland) were randomly placed into the mandible of 6 minipigs (n = 6). Two months later, animals were sacrificed and block biopsies were obtained to assess histomorphological outcomes. Unadjusted paired comparisons, of both groups were performed using the Wilcoxon signed rank test. The Dunnett-Hsu test was used to adjust for multiple comparisons., Results: All implants showed excellent integration into bone and soft tissue. The fBIC (distance implant shoulder to most coronal implant contact) and BIC% (percentage bone-to-implant contact) were for both groups; test: 3.95 mm and 85.4%; control 3.97 mm and 84.3% respectively. No difference in peri-implant mucosa height was found, however, the sulcular epithelium was significantly shorter for the ZrO2 (mean: 0.76, 95%CI: 0.46-1.06) than for the Ti (mean: 1.40, 95%CI: 1.10-1.70) (p = 0.0090)., Conclusions: Within the limits of this pilot study, no difference was found between the ceramic implant with ZLA(®) surface and a titanium implant in terms of bone tissue integration. Furthermore, the epithelial attachment favoured this ceramic implant over titanium., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: It has recently been shown that enamel matrix derivative (EMD) components (Fraction C, containing <6 kDa peptides (mainly a 5.3 kDa tyrosine-rich amelogenin peptide (TRAP)), and Fraction A, containing a mixture of >6 kDa peptides (including a leucine-rich amelogenin peptide (LRAP))) differentially regulate osteogenic differentiation of periodontal ligament (PDL) cells. The present study examined whether EMD and the EMD Fractions (i) bind and internalize into PDL cells and (ii) precipitate and form insoluble complexes on PDL cells., Materials and Methods: Biotin-labelled EMD/EMD Fractions were incubated with PDL cells under various different culture conditions and confocal and electron microscopies were carried out to examine the binding and intracellular trafficking of these proteins., Results: The results reported here show, for the first time, that at least some components in Fraction A and the TRAP peptide in Fraction C can bind and be internalized by human PDL cells via receptor-mediated endocytosis. In addition, Fraction A was found to form insoluble aggregate-like structures on PDL cells, whereas Fraction C was soluble in culture media., Conclusion: Soluble amelogenin isoform TRAP appears to be internalizing into a subset of PDL cells. Moreover, TRAP uptake is most likely controlled by receptor-mediated endocytosis., Clinical Relevance: Information on interaction between PDL cells and EMD/TRAP might prove useful in designing targeted interventions (i.e. use of chemically prepared soluble amelogenin peptides) to repair/regenerate periodontal tissues. Such interventions can also (i) avoid the use of rather crude animal-derived enamel matrix protein (EMP)/EMD preparation and (ii) preparation of cost-effective and more controlled chemically synthesized amelogenin peptides for the clinical use.

Background: Clinically, there is a demand for mechanically stronger alloyed implants; however, not much evidence exists with regard to these materials., Purpose: To test the osseointegration property of TiZr1317 implants in a rabbit model., Materials and Methods: Hydrophilic titanium-zirconium alloy (TiZr1317) implants with sand-blasted and acid-etched surface (test) and hydrophilic cpTi implants with the same treatment (control) were placed pairwise in the hind limbs (two in each tibia and one in each femur) of 36 Swedish lop-eared rabbits. After 2, 4, and 12 weeks (n = 12/time point), the bone samples were subjected to removal torque (RTQ, proximal tibia and femur) and histologic/histomorphometric (distal tibia) testings., Results: The control presented significantly higher RTQ than the test at 2 weeks (55 vs 36 Ncm). No differences were observed for other time points. The test presented higher mean BIC than the control (19.25 vs 13.89 %) at 4 weeks; however, there were no statistical differences for the following time point tested in vivo.The new bone area was significantly higher for the test at 4 weeks in the marrow areas., Conclusion: The TiZr1317 implants presented comparable biologic outcomes to that of the cpTi implants through a 12-week evaluation period., (© 2015 Wiley Periodicals, Inc.)

Objectives: To investigate soft tissue histomorphology and quality around implants with a modified transgingival collar surface comparatively to a machined., Material and Methods: Twenty-seven Straumann Standard Tissue Level implants belonging to the following groups (nine of each group): Ti modSLA with machined collar (Ti-M), Ti modSLA with machined, acid-etched surface collar (Ti-modMA), and TiZr modSLA with machined, acid-etched surface collar (TiZr-modMA) were placed in the mandible of six minipigs. After 8 weeks of healing, buccal sections were obtained and processed for histological evaluation., Results: Histometric soft tissue outcomes were similar for the three types of implants. The percentage of connective tissue attached to implant surface and its length was longer at TiZr-modMA with respect to Ti-M implants. The number of inflammatory cells was slightly higher at the TiZr-modMA with respect to Ti-M implant. The percentage of area occupied by perpendicular collagen fibers was slightly higher for the modified surfaces in comparison with the machined., Conclusions: Modified implant collar surfaces at Ti and TiZr implants showed a soft tissue interface similar to machined. A tendency of increasing number of perpendicular collagen fibers and improved connective tissue contact was found at the modified implant surfaces., (© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Alveolar bone regeneration associated with the local release of osteogenic protein-1 (OP-1) from a polyethylene glycol (PEG) scaffold was evaluated in 14 mini-pigs. Following extraction of mandibular teeth and 26-weeks of healing time, standardized bone defects were created bilaterally in the posterior mandibles (3 sites for each hemimandible) that were randomly assigned to treatment groups. Seven treatments groups were compared: 4 different concentrations of the PEG/OP-1 test system (n = 14 for each), a positive control (collagen/OP-1, n = 14), a negative control (PEG only, n = 7) and nontreated defects (n = 7). Each animal provided all test and control groups. The animals were sacrificed after 3 weeks of healing and samples were processed for histology and histomorphometry. Three weeks after implantation, there were positive clinical responses for all test groups. Earlier bone maturation was observed in the test groups that had higher concentrations of OP-1 (0.25, 0.5, or 1 mg/mL) compared to the negative control group (PEG alone), the low concentration group (0.1 mg/mL), and the positive control group (collagen/OP-1). However, histomorphometric quantitative analyses did not reveal any statistical difference between any of the groups. No residual PEG biomaterial or inflammatory responses to the biomaterial or growth factor were observed. This study confirmed the safe local delivery of OP-1 from PEG hydrogel. Alveolar bone regeneration was not statistically different between tests groups, negative control (PEG alone) or commercial positive control (collagen/OP-1). The semi-quantitative analysis, however, showed a trend in favor of the higher concentrations of OP-1 to induce faster bone maturation.

Biphasic calcium phosphates (BCPs), consisting of hydroxyapatite (HA) and β-tricalcium phosphate (β-TCP), exhibit good biocompatibility and osteoconductivity, maintaining a balance between resorption of the biomaterial and formation of new bone. We tested whether the chemical composition and/or the microstructure of BCPs affect osteoclasts (OCs) differentiation and/or their ability to crosstalk with osteoblasts (OBs). To this aim, OCs were cultured on BCPs with HA content of 5, 20 or 60% and their differentiation and activity were assessed. We found that OC differentiation is partially impaired by increased HA content, but not by the presence of micropores within BCP scaffolds, as indicated by TRAP staining and gene profile expression. We then investigated whether the biomaterial-induced changes in OC differentiation also affect their ability to crosstalk with OBs and regulate OB function. We found that BCPs with low percentage of HA favored the expression of positive coupling factors, including sphingosine-kinase 1 (SPHK1) and collagen triple helix repeat containing 1 (Cthrc1). In turn, the increase of these secreted coupling factors promotes OB differentiation and function. All together our studies suggest that the chemical composition of biomaterials affects not only the differentiation and activity of OCs but also their potential to locally regulate bone formation.

Objectives: The aim of this study was to investigate bone regeneration following application of a novel biphasic calcium phosphate (BCP I) composed of microstructured granules of 90% β-tricalcium phosphate (β-TCP)/10% hydroxyapatite (HA) compared to BCP non-microstructured biphasic calcium phosphate with a composite of 60% hydroxyapatite/40% β-TCP (BCP II) and a deproteinized bovine bone mineral (DBBM) at surgically created defects in the mandible of minipigs in a combined approach with guided bone regeneration (GBR)., Material and Methods: Sixteen minipigs were used for the study. Lower premolars P2, P3, P4 and first molar M1 were extracted. Following 3 months of healing, two defects with a width and depth of 7 mm were created bilaterally in the mandible. The different grafting materials were randomly placed in the created defects and covered by means of a collagen membrane. After 3 and 8 weeks, biopsies were sampled. All specimens were evaluated with descriptive histology and histomorphometric evaluations complemented by micro-CT scan analysis., Results: All three biomaterials presented with higher bone volume at 8 weeks compared to 3 weeks (P < 0.0442). BCP I and DBBM demonstrated a significant higher amount of bone formation compared to BCP II at 8 weeks (P < 0.0328). BCP I also demonstrated a significant higher percentage of remaining graft volume compared to the other test groups both at 3 and 8 weeks (P < 0.0001 to P < 0.0003). Congruently, defects containing BCP I showed a significant higher amount of mineralized tissue compared to the other groups., Conclusions: All the three test materials performed well with regard to bone formation at 8 weeks. BCP I showed significant higher amounts of newly formed bone despite a higher remaining graft volume compared to the other groups. With regard to the regenerative outcome, all the three materials can be recommended for clinical use., (© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: Enamel matrix derivative (EMD) is an effective biomaterial for periodontal tissue regeneration and might stimulate angiogenesis. In order to clarify mechanisms underlying its biological activity, we separated two EMD fractions with different molecular weight protein components and investigated their effects on human umbilical vein endothelial cells (HUVECs) in vitro., Methods: Fraction Low-Molecular Weight (LMW) included proteins with a molecular weight (M.W.)<8kDa. Fraction LMW-depleted included proteins with M.W.>8kDa and lower than approximately 55kDa. The effect of EMD fractions on proliferation/viability, apoptosis, migration and expression of angiopoetin-2 (ang-2), von Willebrand factor (vWF), E-selectin, intracellular adhesion molecules 1 (ICAM-1), vascular endothelial growth factor (VEGF) receptors Flt-1 and KDR was investigated., Results: The proliferation/viability of HUVECs was inhibited by both LMW and LMW-depleted at concentrations 100μg/ml, whereas EMD slightly increased cell proliferation/viability. The expression of all investigated proteins was up-regulated by EMD. However, differences in the effect of EMD fractions on the protein expression were observed. The effect of LMW-depleted on the expression of ICAM-1 and E-selectin was markedly higher compared to LMW. In contrast, the expression of vWF and VEGF receptors Flt-1 and KDR was primarily affected LMW than by LMW depleted. The expression of ang-2 was not influenced by LMW and LMW-depleted. HUVECs migration was stimulated more strongly by LMW than by EMD and LMW-depleted., Conclusion: Our in vitro study shows that the proteins composing EMD have different and specific biological activities and consequently have the ability to cover different aspects of EMD's biological and clinical effects., (Copyright © 2015 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.)