Search

Objective: Mucogingival surgery involving tissue grafts is commonly employed for cosmetic procedures like root coverage, and is increasingly applied in implant therapy to modulate peri-implant soft tissues and enhance implant survival. These procedures involve harvesting autologous connective or epithelial connective tissue, often from the palate or tuber maxillae. However, this can cause patient morbidity due to postoperative pain. Substitute materials, including animal-derived and xenografts, have been developed but lack qualities of autologous grafts. Method and materials: To address postoperative discomfort, a novel technique, named "palatal shield," using composite resin stabilized on adjacent teeth's palatal surface is proposed as an aid to donor site healing after mucogingival procedures. Two cases are reported where this technique was successfully applied. The first case involves a 53-year-old woman undergoing free gingival graft surgery for peri-implant treatment. The second case features a 58-year-old man receiving subepithelial connective tissue graft surgery for root sensitivity. Results: Ten days post surgery, both patients reported excellent postoperative comfort. The technique's effectiveness is highlighted in these cases, demonstrating its applicability in various surgical cases involving free gingival graft or connective tissue graft harvesting. Conclusion: The proposed "palatal shield" technique offers several advantages, including enhanced patient comfort, ease of application, and cost-effectiveness, making it a promising addition to mucogingival surgical procedures. [ABSTRACT FROM AUTHOR]

The primary aim of this study was to assess the histomorphometric outcomes of extraction sockets grafted with freeze-dried bone allograft (FDBA) and sealed with a collagen membrane after 3 months of healing in specific region of interest (ROI) areas. The secondary aims were to analyze the biomaterial resorption rate, the bone-to-biomaterial contact (BBC), and the area and perimeter of grafted particles compared with commercially available FDBA particles. Fifteen patients underwent tooth extractions and ridge preservation procedures performed with FDBA and a collagen membrane. Bone biopsy samples were harvested after 3 months at the time of implant placement for histologic and histomorphometric analysis. Two areas of concern (ROI1 and ROI2) with different histologic features were identified within the biopsy samples; ROI1, ROI2, and commercially available particles were analyzed and compared. The following parameters were analyzed: newly formed bone, marrow space, residual graft particles, perimeter and area of FDBA particles, and BBC. The histomorphometric analysis showed 35.22% ± 10.79% newly formed bone, 52.55% ± 16.06% marrow spaces, and 12.41% ± 7.87% residual graft particles. Moreover, the histologic data from ROI1 and ROI2 showed that (1) the mean percentage of BBC was 64.61% ± 27.14%; (2) the newly formed bone was significantly higher in ROI1 than in ROI2; (3) the marrow space was significantly lower in ROI1 than in ROI2; and (4) the FDBA particles in ROI1 sites showed significantly lower area and perimeter when compared to commercially available FDBA particles. This latter data led to the hypothesis that FDBA particles embedded in newly formed bone undergo a resorption/remodeling process. [ABSTRACT FROM AUTHOR]

Aim Materials and Methods Results Conclusions To evaluate the changes in periodontal parameters (reduction in probing pocket depth [PPD], gain in clinical attachment level [CAL] and reduction in full‐mouth bleeding on probing [BoP]) after subgingival instrumentation of periodontal pockets at different time points in systemically healthy patients suffering from periodontitis.Four databases were searched for RCTs that carried out subgingival instrumentation in periodontal pockets and evaluated PPD at a minimum of two consecutive time points other than baseline. The analysis was conducted for both all pocket depths and stratified for initially shallow (4–5 mm) and deep (≥6 mm) pockets and data were extracted for various time points, 1–2, 3–4 and 5–6 months. Weighted mean effects (WMEs) were calculated with 95% confidence interval (CI) and predictive intervals were calculated.Twenty‐nine RCTs were identified, and all of them were included in the meta‐analysis. The results showed that for both shallow and deep pockets there was a small though clinically meaningful change between 1‐ to 2‐month and 3‐ to 4‐month time points and between these and 5–6 months.In systemically healthy patients, the greater part of reduction in PPD and gain in CAL occurs within the first 1–2 months after subgingival instrumentation. However, additional benefits in terms of pocket depth reduction occur beyond these early time points. [ABSTRACT FROM AUTHOR]

Purpose: To systematically review the literature comparing marginal bone loss (MBL) and pink esthetic scores of implants with convergent or concave transmucosal profiles vs divergent or parallel profiles.Materials and Methods: A PICO question was defined, and an electronic search was carried out in the MEDLINE/PubMed and Cochrane Oral Health Group databases. Studies documenting type of transmucosal profile (either tissue-level profiles or abutments) and soft and/or hard tissue outcomes of implants were considered eligible. Studies were selected on the basis of the inclusion criteria and quality assessments. A meta-analysis with subgroup analyses was performed.Results: Five papers fulfilled the inclusion criteria, and four were eligible for meta-analysis. Significantly less MBL was found in concave/convergent groups, with a mean difference of 0.772 (95% confidence interval [CI]: 0.450 to 1.095; P < .001). In the subgroup analyses for platform-switching and platform-matching connections, a significant effect in favor of concave/convergent was detected, with a standardized difference in means of 1.135 (95% CI: 0.688 to 1.583, P < .001) when platform switching was considered. No significant effects were found for platform-matching connections.Conclusion: Within the limitations of this review, it is suggested that concave/convergent implant transmucosal profiles result in less MBL. No statistically significant results were obtained for soft tissue-related outcomes or for the platform-matching connection subgroup. [ABSTRACT FROM AUTHOR]

Purpose: This study was conducted to compare the bone cutting performance of the piezoelectric device with traditional drills in terms of cut execution time, environmental noise produced, surface morphology characteristics, and residual cell vitality of the bone samples. Materials and Methods: Two fresh pig jaws were obtained from a local slaughterhouse, and nine bone samples with a standard size (1 cm3) were harvested from each jaw: three using piezosurgery, three with a multiblade bur mounted on a surgical handpiece, and three with a diamond bur mounted on a high-speed handpiece, for a total of 18 samples. Two samples for each harvesting method were examined by scanning electron microscope (SEM), observing four surfaces per sample. For each surface observed, a count of the intertrabecular spaces was performed, and each space was evaluated as completely, partially, or unfilled by debris. Four samples per sampling method were examined by cell culture to evaluate residual cell vitality after cutting. The execution time of each osteotomy was measured with a stopwatch. The environmental noise was measured, at two different distances, with a phonometer. Results: At SEM analysis, piezosurgery osteotomies showed 66% of totally free intertrabecular spaces on the cutting surface, statistically significantly higher than those on the multiblade bur (33%) and diamond bur (12%) cutting surfaces (P < .0005). Bone samples harvested with piezosurgery also demonstrated faster cell proliferation. Finally, piezosurgery generated less environmental noise, though it required longer cutting time. Conclusion: Piezoelectric technology is a valid alternative to rotating burs for osteotomy, demonstrating higher bone cell viability and a precise and silent, though slower, cut. [ABSTRACT FROM AUTHOR]

The aim of this study was to examine 10 different shades of pink ceramic to determine which one best matches the mean color of human gingiva. Barshaped zirconia samples were fabricated and veneered with 1 of 10 pink zirconia veneering ceramics. The color of the gingiva at the central maxillary incisors of 20 healthy volunteers was compared to the pink veneering ceramics using a spectrophotometer (Spectroshade, MHT). The obtained color parameters L*, a*, and b* (CIELAB) of the gingiva and the ceramics were used to calculate the color difference (ΔE). Mean ΔE values were descriptively analyzed and compared to the threshold value for visibility of color differences of gingiva (ΔE = 3.1). The lowest pink ceramic ΔE value obtained (closest to the mean ΔE of all the volunteers' gingiva) was 6.2. All the tested ceramics exhibited a color difference above the threshold value for visibility. [ABSTRACT FROM AUTHOR]

The esthetic success of a case requiring implant therapy mainly depends on both the correct planning and the surgical-prosthetic execution. However, planning and surgical implementation according to prosthetically guided criteria are not always possible due to contingent anatomical limitations. When this is further complicated by the presence of mucogin- gival deficiencies in a highly visible esthetic area, the management of the case can become very complex. The present case report describes the presurgical and surgical management of a case of maxillary lateral incisor agenesis in the absence of sufficient vertical space. Through orthodontic therapy, the opening of the deep overbite and the alignment of the maxillary and mandibular arches were obtained, allowing for an implant positioning without compromises dictated by anatomical limitations. Finally, through mucogingival surgery and careful management of the provisional prosthetic phase, an optimal esthetic profile was achieved. (Int J Esthet Dent 2022;17:42-56) [ABSTRACT FROM AUTHOR]

Background: Lateral maxillary sinus augmentation (MSA) is a predictable bone regeneration technique in case of atrophy of the posterior‐upper maxilla. Aimed at obtaining quantity and quality of bone suitable for receiving osseointegrated implants, its success is largely due to the skill of the surgeon, but also to the characteristics of the biomaterial used. Methods: Twenty‐four patients needing MSA were included in the study. The patients were randomly allocated to three different groups: anorganic bovine bone mineral as control, tricalcium phosphate with or without hyaluronic acid (HA) as test groups. Nine months after MSA, bone biopsies were harvested for the histomorphometric analysis. Secondary outcomes were mean bone gain, intraoperative and postoperative complications, implant insertion torque, implant failure, and patient‐reported outcome measures. Results: Although the percentage of new bone was not statistically different between the three groups (P =.191), the percentages of residual biomaterial was significantly higher (P <.000) and nonmineralized tissue significantly lower (P <.000) in the control than in the test groups. Test groups did not differ significantly from each other for all histomorphometric parameters. The implant insertion torque was significantly higher in the control group (P <.0005). The rest of the secondary outcomes were not significantly different between the groups. Conclusion: MSA is a safe and predictable procedure in terms of histological, clinical, and PROAMs, regardless of the biomaterial used. The addition of HA did not influence the outcomes. [ABSTRACT FROM AUTHOR]

What happens to implants after we introduce them into the oral environment? Do they keep their sterility, or are they colonized by bacteria? How fast is the surface of the implants colonized by the bacteria, and which bacteria will colonize it? Do healthy implants have the same microbial populations as diseased implants? What's the role of the remaining teeth in the contamination of the dental implants? This short review of the literature will give a general overview of critical concepts in terms of peri-implant microbiology, based on the most important evidence in the literature. [ABSTRACT FROM AUTHOR]

Peri-implantitis is a long-term complication that frequently occurs after implant surgery. Several treatment methods have been proposed that are aimed at arresting the disease and potentially regenerating bone defects related to it. The use of a combination of proposed decontaminative treatments could possibly improve outcomes. In this case report the authors describe a combined mixed protocol, in which chemical decontamination and a laser-assisted decontamination technique are used in a surgical regenerative approach to successfully manage and treat a case of peri-implantitis. The combined surgical and antimicrobial protocol described can be a suitable treatment option in cases in which implants show severe bone resorption as a result of peri-implant disease. [ABSTRACT FROM AUTHOR]

Background The alveolar antral artery ( AAA) is a vascular structure that often passes through the area of lateral window opening during sinus augmentation and can reach dimensions that, if the vessel is severed, can represent a serious complication of the surgical procedure. Purpose With this narrative review, we aimed at summarizing the results obtained from all the studies that analyzed the variability in anatomical position and dimension of the AAA in order to give the clinician a reference when planning for a sinus augmentation surgery. Materials and Methods A search of available literature was conducted using electronic databases ( Pub Med and Medline) and manual searching. Results Detection rate of AAA on cone beam computerized tomography ( CBCT) is variable and may depend upon the experience of the clinician. The course of the vessel is most frequently intraosseous, and its diameter, despite being smaller than 1 mm in most of the cases, can have a high incidence of diameters between 1 mm and 2 mm. Mean distances of the AAA from alveolar crest and sinus floor range from 11.25 mm to 26.90 mm and 5.80 mm to 10.40 mm. Conclusions Anatomical variants of the AAA that may increase the risk of severe intraoperatory bleeding are frequent and must be detected by the clinician implementing the use of the CBCT. [ABSTRACT FROM AUTHOR]

Dental implants are being increasingly used in dentistry. Millions of implants are being placed on a yearly basis around the world by dental surgeons. These implants support restorations ranging from a single crown to a denture. There are significant costs associated with implant supported restorations. The advent of peri-implant diseases threatens the survival and maintenance of implant supported restorations leading to significant impact on the sustainability of such restorations while affecting the patient's functionality. This review article discusses the current concepts, as well as the etiopathological and treatment considerations related to peri-implant diseases. [ABSTRACT FROM AUTHOR]

Tooth extractions can result in alveolar bone dimensional changes, necessitating additional bone grafting for implant placement. Alveolar ridge preservation (ARP) aims to counteract postextraction changes. This case series evaluates the bone regenerative properties of a freeze-dried bone allograft (FDBA) and the clinical outcomes of implants in grafted extraction sites. A total of 33 patients were enrolled, undergoing single/multiple tooth extractions followed by ARP. Biopsy samples were harvested during implant placement for histologic and histomorphometric analysis. Clinical outcomes included marginal bone loss and pink esthetic score (PES). Twenty-five patients completed the study. FDBA-augmented sockets exhibited new bone formation adjacent to graft particles. Implants (n = 25) showed 100% survival and success rates at 1 and 2 years. PES improved significantly over time (P < .001), while marginal bone loss did not significantly differ at 1 and 2 years (P = .096). Specimens showed trabecular bone, residual FDBA particles, and marrow spaces. High magnification revealed immature bone and woven bone bridges around graft particles. No inflammatory cells were observed. This case series provides valuable insights into ARP performed with FDBA (as implants were placed after 3 months of healing without any additional bone augmentation), the histologic outcomes were favorable, and implants were successful after a 2-year follow-up period.

Purpose: The present systematic review and meta-analysis aimed to investigate the available evidence in the literature to answer the following focused question: In partially edentulous arches with reduced bone width, do implants placed after horizontal bone augmentation exhibit differences in survival and success rate compared to narrow-diameter implants placed in native bone?, Materials and Methods: A population, intervention, comparison and outcome question was defined and an electronic search was conducted using the MEDLINE (via PubMed) and Cochrane Oral Health Group databases to identify all studies analysing the use of standard-diameter implants inserted in regenerated bone or narrow-diameter implants for the rehabilitation of partially or completely edentulous atrophic maxillae and mandibles. Inclusion criteria and quality assessments were established, and studies were selected on this basis., Results: Twenty-four studies met the inclusion criteria and were analysed cumulatively. A comparative meta-analysis was not possible due to the lack of studies directly comparing the two rehabilitation methods in question. A cumulative implant survival rate of 97.80% (1246/1274; pooled proportion 0.984, 95% confidence interval 0.977-0.991) was reported for the narrow implants placed in atrophic ridges, while similar results were obtained for the standard-diameter implants placed in regenerated bone, with a cumulative implant survival rate of 97.94% (1332/1360; pooled proportion 0.983, 95% confidence interval 0.976-0.990)., Conclusions: The present systematic review found high and comparable survival rates between narrow- and standard-diameter implants placed in regenerated bone; however, well-designed randomised controlled trials are required to support the hypothesis that both treatment strategies are successful in comparable circumstances.