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The ability for clinicians to adequately obtain primary stability in host bone is critical to the success of dental implants. Numerous conditions require dentists to perform multistage approaches to rebuild deficient bone volume prior to surgically placing implants. In many instances, implant placement cannot be achieved due to a lack of primary implant stability. Recently, a novel mineralorganic resorbable bone adhesive (MORBA) has demonstrated promising results in animal studies. MORBA is a synthetic, injectable, self-setting, load-bearing adhesive biomaterial that exhibits osteopromotive properties and bonds bone to bone and metal within 10 minutes and can fully resorb in 30 weeks. Its unique novel formulation was developed from biomimetic proteins found in marine animal creatures that possess distinct adhesive properties underwater. Excellent long-term results have shown its potential use for achieving primary stability in immediate implants. The present case report demonstrates the first use of MORBA in a human patient, utilized on a nonrestorable mandibular first molar. MORBA was utilized after placement of a mobile 5.8-mm implant to achieve stabilization. At 3 months postsurgery, both clinical and CBCT evaluations showed maintained implant stability. One year after implant placement, radiographic bone was seen on the buccal surface of the implant with continued long-term stabilization. This case report extends to 3 years whereby the use of MORBA, in an initially unstable situation, demonstrated an excellent long-term follow-up. MORBA provided immediate implant stability with resorbable characteristics, leading to successful longterm clinical outcomes up to 3 years. This innovative biomaterial offers a more efficient solution to a critical problem in implant dentistry, allowing optimal primary stability during immediate implant placement, thus reducing treatment times and costs. [ABSTRACT FROM AUTHOR]

Over the past two decades, the Khoury plate technique has been widely utilized with much success to facilitate bone augmentation in critically deficient bone areas. Simply, the technique includes harvesting autogenous bone plates and utilizing them with external screw fixation. The rigidity of the bone plates enclosing the bony defect on both the buccal and lingual surfaces allows for tension-free bone remodeling to occur, favoring an ideal bone-forming environment. Following, a 4- to 6-month healing period, a flap is raised, screws may be removed, and implants are placed. With advancements made in tissue engineering, a novel mineral-organic resorbable bone adhesive (MORBA) formulated from underwater biomimetic marine proteins has recently been utilized for immediate bone-to-bone or bone-to-metal fixation. MORBA is a synthetic, injectable, self-setting, and resorbable load-bearing adhesive biomaterial that exhibits over 300 pounds of fixation strength. The unique adhesive properties of MORBA enable it to immediately stabilize dental implants into host bone. The present article describes a novel modification of the Khoury plate technique that utilizes MORBA as a substitute for screws during bone plate fixation. A step-by-step protocol is described that utilizes this novel biomaterial, favoring a more biologic approach to this conventional technique. This novel modification is surgically easier to conduct and is a more biocompatible option that avoids screw fixation and removal. [ABSTRACT FROM AUTHOR]

Platelet‐rich fibrin (PRF) has been characterized as a regenerative biomaterial that is fully resorbed within a typical 2–3 week period. Very recently, however, a novel heating process was shown to extend the working properties of PRP/PRF from a standard 2–3 week period toward a duration of 4–6 months. Numerous clinicians have now utilized this extended‐PRF (e‐PRF) membrane as a substitute for collagen barrier membranes in various clinical applications, such as guided tissue/bone regeneration. This review article summarizes the scientific work to date on this novel technology, including its current and future applications in periodontology, implant dentistry, orthopedics and facial aesthetics. A systematic review was conducted investigating key terms including "Bio‐Heat," "albumin gel," "albumin‐PRF," "Alb‐PRF," "extended‐PRF," "e‐PRF," "activated plasma albumin gel," and "APAG" by searching databases such as MEDLINE, EMBASE and PubMed. Findings from preclinical studies demonstrate that following a simple 10‐min heating process, the transformation of the liquid plasma albumin layer into a gel‐like injectable albumin gel extends the resorption properties to at least 4 months according to ISO standard 10 993 (subcutaneous animal model). Several clinical studies have now demonstrated the use of e‐PRF membranes as a replacement for collagen membranes in GTR/GBR procedures, closing lateral windows in sinus grafting procedures, for extraction site management, and as a stable biological membrane during recession coverage procedures. Furthermore, Alb‐PRF may also be injected as a regenerative biological filler that lasts extended periods with advantages in joint injections, osteoarthritis and in the field of facial aesthetics. This article highlights the marked improvement in the stability and degradation properties of the novel Alb‐PRF/e‐PRF technology with its widespread future potential use as a potential replacement for collagen membranes with indications including extraction site management, GBR procedures, lateral sinus window closure, recession coverage among others, and further highlights its use as a biological regenerative filler for joint injections and facial aesthetics. It is hoped that this review will pioneer future opportunities and research development in the field, leading to further progression toward more natural and less costly biomaterials for use in medicine and dentistry. [ABSTRACT FROM AUTHOR]

Purpose: To establish consensus-driven guidelines that could support the clinical decision-making process for implant-supported rehabilitation of the posterior atrophic maxilla and ultimately improve long-term treatment outcomes and patient satisfaction. Materials and methods: A total of 33 participants were enrolled (18 active members of the Italian Academy of Osseointegration and 15 international experts). Based on the available evidence, the development group discussed and proposed an initial list of 20 statements, which were later evaluated by all participants. After the forms were completed, the responses were sent for blinded analysis. In most cases, when a consensus was not reached, the statements were rephrased and sent to the participants for another round of evaluation. Three rounds were planned. Results: After the first round of voting, participants came close to reaching a consensus on six statements, but no consensus was achieved for the other fourteen. Following this, nineteen statements were rephrased and sent to participants again for the second round of voting, after which a consensus was reached for six statements and almost reached for three statements, but no consensus was achieved for the other ten. All 13 statements upon which no consensus was reached were rephrased and included in the third round. After this round, a consensus was achieved for an additional nine statements and almost achieved for three statements, but no consensus was reached for the remaining statement. Conclusion: This Delphi consensus highlights the importance of accurate preoperative planning, taking into consideration the maxillomandibular relationship to meet the functional and aesthetic requirements of the final restoration. Emphasis is placed on the role played by the sinus bony walls and floor in providing essential elements for bone formation, and on evaluation of buccopalatal sinus width for choosing between lateral and transcrestal sinus floor elevation. Tilted and trans-sinus implants are considered viable options, whereas caution is advised when placing pterygoid implants. Zygomatic implants are seen as a potential option in specific cases, such as for completely edentulous elderly or oncological patients, for whom conventional alternatives are unsuitable. [ABSTRACT FROM AUTHOR]

Purpose: This cross-sectional study aimed to identify and characterize the pathway for appropriate placement of four zygomatic implants in the severely atrophic maxilla and to group the anatomical variations of the osteotomy trajectory for anterior zygomatic implants. Materials and Methods: CBCT images of patients presenting indications for the use of four zygomatic implants to withstand a maxillary rehabilitation were reviewed. Cross-sectional planes corresponding to the implant trajectories, designed according to a zygoma anatomy-guided approach for implants placed in the anterior and posterior maxilla, were assessed separately. The relationship of the implant osteotomy trajectory with the correlated residual alveolar bone, nasal and sinus cavities, maxillary wall, and zygomatic bone anatomies was established. Results: The study population included 122 globally recruited patients, with 488 zygomatic implants, 244 of which had their starting point on the anterior incisor-canine area and 244 on the posterior premolar-molar area. The anatomy of the osteotomy path designed for the anterior implants ("A") was named and grouped into five assemblies from zygomatic anatomy-guided ZAGA A-0 to A-4, representing 2.9%, 4.5%, 19.7%, 55.7%, and 17.2% of the studied sites. Percentages for posterior implant ("P") trajectories of the osteotomy were grouped and named as ZAGA P-0 to P-4, representing 5.7%, 10.2%, 8.2%, 18.4%, and 57.4% of the sites, respectively. Approximately 70% of the population presented anatomical intra-individual differences. Conclusion: The trajectory of the zygomatic implant followed different anatomical pathways depending on its coronal point being anteriorly or posteriorly located, which justifies a new zygoma anatomy-guided approach classification for anteriorly placed zygomatic implants. Topographic characteristics of the anatomical structures that are cut by an anterior oblique plane joining the lateral incisor-canine area to the zygomatic bone, representing the planned anterior osteotomy path in a quadruple-zygoma indication, have not been previously reported. Adaptation of surgical procedures and implant sections/designs to individual patients' anatomical characteristics is essential to reduce early and long-term complications. [ABSTRACT FROM AUTHOR]

Purpose: To assess longitudinal volumetric changes during immediate implant placement with simultaneous intentional retention of the buccal aspect of the root. Materials and Methods: This study assessed 10 cases drawn from a previously reported cohort that had study casts available pretreatment and at least 2 years after periodontal ligament (PDL)-mediated immediate implant placement. Gypsum casts were scanned using a laser scanner and converted into digital three-dimensional rendered files. The digital casts were superimposed, and semi-automated subtractive assessment was performed via specialized software. Results: Data from 10 patients with a minimum of 3 years follow-up (median follow-up time: 42 months) were analyzed. Each person contributed one implant site in this study. All implants successfully maintained osseointegration during the follow-up period and demonstrated optimal soft tissue stability. Changes during the observation period ranged from 0.19 mm (95% confidence interval [95% CI]: 0.10 to 0.28) in the midfacial region 6 mm apical to the mucosal zenith to -0.06 mm (95% CI: -0.14 to 0.02) at 5 mm apical to the base of the distal papilla. All changes were noninferior to pre-extraction baseline measurements based on a 0.5-mm noninferiority margin. Conclusion: The intentional retention of the buccal aspect of the root with its periodontal apparatus during immediate implant placement led to optimal soft tissue dimensional stability in the esthetic zone. This technique holds promise for clinical application, and further controlled clinical studies are warranted to determine the comparative clinical benefit from the use of this procedure. [ABSTRACT FROM AUTHOR]

Introduction: Immediate implant placement in conjunction with partial extraction therapy has been shown to result in functional osseo‐ and dento‐integration with partial preservation of the periodontal ligament (PDL) in humans. Strategic buccal root retention for PDL preservation is a biologically driven procedure that maintains alveolar ridge dimensions and esthetics, while allowing for implant placement. The aim of this study was to conduct a systematic review of longitudinal clinical outcomes of PDL‐mediated ridge preservation in conjunction with implant placement in adults, compared with conventional immediate implant placement with total extractions. The primary outcome for this study was marginal bone level (MBL) changes after strategic buccal root retention implant placement techniques. Materials and Methods: To address a predefined PICOS question, a systematic search of randomized clinical trials and cohort studies with at least 10 participants per group and a minimum 12‐month follow‐up was conducted. A two‐phase systematic selection strategy, data extraction, and risk of bias assessment, was performed independently and in duplicate. Randomized trials were quantitatively analyzed in a meta‐analysis. Results: Ten human studies fulfilled the predefined criteria and were included; three clinical trials and seven cohort studies, for a total of 506 patients and 587 implants. PDL‐mediated implant placement of single‐rooted periodontally healthy teeth was found to reduce marginal peri‐implant bone loss and buccal plate changes as compared to conventional immediate implants across studies, while implant survival and success rates were comparable between the two procedures. A meta‐analysis found that bone changes were significantly less when retention of the buccal root section was performed as compared to total extractions (standardized mean difference: [−4.53, −0.11]); the three clinical trials were, however, largely heterogeneous (I2: 93.1%; Q = 28.98, p < 0.001). Conclusion: Strategic retention of the buccal root section has a benefit in terms of dimensional ridge stability over conventional immediate implantation when implemented in carefully selected cases of single‐rooted teeth. [ABSTRACT FROM AUTHOR]

The aim of the present study was to generate an international and multidisciplinary consensus on the clinical management of implant protrusion into the maxillary sinuses and nasal fossae. A total of 31 experts participated, 23 of whom were experts in implantology (periodontologists, maxillofacial surgeons and implantologists), 6 were otolaryngologists and 2 were radiologists. All the participants were informed of the current scientific knowledge on the topic based on a systematic search of the literature. A list of statements was created and divided into three surveys: one for all participants, one for implant providers and radiologists and one for otolaryngologists and radiologists. A consensus was reached on 15 out of 17 statements. According to the participants, osseointegrated implants protruding radiographically into the maxillary sinus or nasal fossae require as much monitoring and maintenance as implants fully covered by bone. In the event of symptoms of sinusitis, collaboration between implant providers and otolaryngologists is required. Implant removal should be considered only after pharmacological and surgical management of sinusitis have failed. [ABSTRACT FROM AUTHOR]

Objective: The purpose of the present study was to review indexed literature and provide an update on the effectiveness of high-frequency radio waves (HRW) application in modern general dentistry procedures. Data Sources: Indexed databases were searched to identify articles that assessed the efficacy of radio waves in dental procedures. Results: Radiosurgery is a refined form of electrosurgery that uses waves of electrons at a radiofrequency ranging between 2 and 4 MHz. Radio waves have also been reported to cause much less thermal damage to peripheral tissues compared with electrosurgery or carbon dioxide laser-assisted surgery. Formation of reparative dentin in direct pulp capping procedures is also significantly higher when HRW are used to achieve hemostasis in teeth with minimally exposed dental pulps compared with traditional techniques for achieving hemostasis. A few case reports have reported that radiosurgery is useful for procedures such as gingivectomy and gingivoplasty, stage-two surgery for implant exposure, operculectomy, oral biopsy, and frenectomy. Radiosurgery is a relatively modern therapeutic methodology for the treatment of trigeminal neuralgia; however, its long-term efficacy is unclear. Radio waves can also be used for periodontal procedures, such as gingivectomies, coronal flap advancement, harvesting palatal grafts for periodontal soft tissue grafting, and crown lengthening. Conclusion: Although there are a limited number of studies in indexed literature regarding the efficacy of radio waves in modern dentistry, the available evidence shows that use of radio waves is a modernization in clinical dentistry that might be a contemporary substitute for traditional clinical dental procedures. [ABSTRACT FROM AUTHOR]

Purpose: This retrospective study evaluated the use of a composite graft of recombinant human bone morphogenetic protein-2 (rhBMP-2) and particulate mineralized bone allograft protected by a titanium mesh for vertical bone augmentation. Materials and Methods: A review of data on patients from four oral and maxillofacial surgery practices in the United States who required vertical augmentation prior to implant treatment was conducted. Vertical augmentation was accomplished with rhBMP-2 in an absorbable collagen sponge (ACS) carrier and particulate allograft. Cone beam computed tomography was used to measure vertical bone gains using this technique. Results: Sixteen vertical ridge augmentation procedures were performed in 15 patients. The maximum vertical bone gains ranged from 4.4 to 16.3 mm. The average maximum vertical bone gain was 8.53 mm. The procedure allowed implant placement in all patients. Forty implants were inserted into the grafted ridges after a minimum of 6 months of healing. All implants integrated and were used for prosthetic support. Conclusion: This study suggests that rhBMP-2/ACS and particulate mineralized bone allograft protected by a titanium mesh offers favorable vertical bone gains to allow dental implant placement. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the cytocompatibility of an herbal extract compound oral rinse [StellaLife VEGA (SLife)] against relevant human cellular models of oral surgical wound healing. SL was compared to the gold standard for peri-/post-operative oral surgical use, i.e., Chlorhexidine (CHX) and to a commonly utilized essential-oil (EO) based antiseptic rinse. Fibroblasts and primary oral stem cells of the apical papilla (SCAPs) were employed to assess its comparative cytotoxicity to the active comparator antiseptic rinses and its effects on wound healing in vitro. In cytotoxicity assays, multiple timepoints were tested ranging from clinically relevant of 60-s rinsing to protracted challenge of up to 5 min, to determine dose-dependent toxicity. The SLife group consistently demonstrated minimal cytotoxicity as compared to active comparators across experimental timepoints and different cells lines. At concentrations up to 20% v/v SLife-challenged fibroblasts and SCAPs demonstrated no significant toxicity as compared to unstimulated controls (p > 0.05). When assessing wound healing, a scratch wound assay revealed significantly accelerated cell migration for SLife as compared to CHX (p < 0.05). Notably, all active comparator antiseptic rinses affected wound healing responses by significantly reducing total collagen deposition after intermittent "rinsing" intervals that simulated post-surgical oral rinsing. Nonetheless, intermittent as well as continuous challenge of cells with SLife had a positive effect in functional collagen assays. An herbal extract compound-based oral rinse was found to be cytocompatible to cells critical to oral wound healing and to promote fibroblast migration and differentiation, contrary to existing antiseptic rinses that lack selective cytotoxicity. [ABSTRACT FROM AUTHOR]

As highlighted in part 1 of this two-part article, primary mechanical stability in implant dentistry is considered a prerequisite for successful osseointegration. While many surgical techniques have been conceptualized with the goal of improving implant stability, osseodensification (OD) represents a novel method utilizing the accumulation of autogenous bone within the implant site via the compaction of cancellous bone, which has good viscoelastic and plastic deformation characteristics. The philosophy of this technique runs counter to that of conventional bone drilling in that healthy bone is maintained within the implant osteotomy, especially in regions where bone density is already compromised. This article focuses on the clinical indications of OD. Three cases are presented and include a lateral sinus augmentation procedure, a crestal sinus augmentation in combination with use of a synthetic bone putty, and a socket-shield technique in the esthetic zone. The aim of this article is to provide clinicians a better understanding of OD and methods to optimize the technique. It also highlights favorable clinical outcomes in cases where initial bone density has been compromised. [ABSTRACT FROM AUTHOR]

Objectives: Platelet-rich fibrin (PRF) has been utilized in regenerative dentistry as a supra-physiological concentrate of autologous growth factors capable of stimulating tissue regeneration. Due to the variability in the macroscopic morphology/size of PRF membranes observed between patients, we were interested in studying the effects of patient age, gender, and time between blood draw and the start of centrifugation on the size outcomes of PRF membranes. Despite PRF therapy being increasingly more popular in private practice, to date, no study has investigated the effects of the delay between blood draw and the start of centrifugation in a clinical setting. Materials and methods: A total of 60 patients enrolled in this study were divided into 6 groups of 10 patients each, including male and female patients categorized into age groups 21–40, 41–60, and 61–80 years. From each patient, a total of five PRF membranes were fabricated from 10-mL tubes following centrifugation starting after 0, 30, 60, 90, and 120 s. In total, 300 PRF membranes were produced in this study to investigate the effects of patient age, gender, and time on the size outcomes of PRF membranes. Results: A longer delay by the clinician before starting centrifugation following blood draw led to a smaller final size of PRF membranes. At 90 s following blood draw, a significant (13%) reduction in PRF membrane size was observed. After 120 s, a significant (23%) reduction was observed. Additionally, female patients had on average 17% larger membranes compared to men (p < 0.05, 300 samples). Lastly, the size outcomes of the PRF membranes was largest in patients aged 61–80, followed by those aged 41–60 and 21–40. However, no statistically significant differences in PRF membrane sizes were reported between age groups. Conclusions: The time at which a centrifugation procedure begins following blood draw is critical to optimize the size outcomes of PRF membranes. In general, approximately 15 s is required per tube to harvest 9–10 cc of blood. Therefore, a 60- to 90-s interval between blood draw and the start of centrifugation should be a parameter that is respected by clinicians to avoid significant changes in the macroscopic morphology/size of fabricated PRF membranes. Furthermore, females and older patients produced larger membranes, likely due to lower red blood cell counts derived from their peripheral blood. Clinical relevance: The findings from the present study demonstrate that on average, a clinician has approximately 60–90 s between blood draw and the start of the centrifugation cycle to produce standard-sized PRF membranes. Shortly thereafter, a significant reduction in size is observed. Additionally, females and older patients were found to produce larger PRF membranes. Centrifugation protocols may therefore be adapted accordingly. [ABSTRACT FROM AUTHOR]

In implant dentistry, primary mechanical stability is considered a prerequisite for successful osseointegration. That is, the alveolar bone architecture of the implant drilling site is critical in dictating the success rate of the implant. Immediately after implant placement, a series of cellular and molecular events occur directly on the implant surface (apposition), whereby host tissues biologically integrate the "foreign" biomaterial into the native bone structure. While cortical bone is responsible for providing the function of withstanding torsional loading and enabling high initial implant stability, cancellous bone is richer in cellular content and is vasculature and, therefore, capable of supplying progenitor cells more rapidly to the implant surface. This article provides an overview of the basic biological remodeling events that take place following implant placement and outlines surgical methods used over the years to increase primary implant stability. Thereafter, implant loading protocols utilizing low, high, and excessive torque are discussed. Finally, the authors introduce the biological rationale supporting the concept of osseodensification of osteotomy sites, which have been heavily utilized in modern implant dentistry. [ABSTRACT FROM AUTHOR]

Regenerative therapies with platelets have been widely used in medicine over the past two decades as a means to speed revascularization to damaged/defective tissues. Within the oral cavity, the sinus is one of the least vascularized areas with healing times typically increased to augment lost or missing bone. As a result, attempts have been proposed to combine platelet concentrates with various biomaterials to accelerate new blood flow to these tissues and ultimately facilitate new bone regeneration. While platelet-rich plasma (PRP) was introduced as a first-generation platelet concentrate, more recently platelet-rich fibrin (PRF) has been developed with anticoagulant removal from centrifugation protocols. Unlike PRP, PRF forms a fibrin clot that may further be utilized as a 3-dimensional scaffold containing a concentrated pool of autologous growth factors for tissue regeneration. Over the past decade, PRF has been used both as a sole grafting material and in combination with a bone graft for sinus augmentation procedures. This article highlights the biological and clinical advantages of using PRF with or without a bone grafting material for sinus augmentation procedures and provides guidelines detailing when, where, and why to use PRF alone versus in combination with a bone graft. Furthermore, the use of PRF for the repair of Schneiderian membrane perforations and as a barrier membrane for lateral window closure is discussed. [ABSTRACT FROM AUTHOR]

The article presents answers to a question on vertical augmentation procedures in anterior and posterior regions.

The cover image is based on the Original Article Clinical outcomes of retention of the buccal root section combined with immediate implant placement: A systematic review of longitudinal studies by Georgios A. Kotsakis DMD, MS et al., https://doi.org/10.1111/cid.13150. [ABSTRACT FROM AUTHOR]

This article reviews the rationale, techniques, and advantages of a guided full-arch immediate function implant treatment modality that includes placement of a prefabricated, bar-supported, monolithic polymethyl methacrylate acrylic (PMMA) prosthesis for edentulous and terminal dentition patients. A case presentation depicting the protocol shows it to be an effective and predictable approach to providing fullarch immediate fixed teeth, particularly when compared to conventional denture conversion techniques. [ABSTRACT FROM AUTHOR]