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ObjectivesTo measure the lateral surface area of microgrooved zirconia implants, to evaluate the cell geometry and cell density of human fetal osteoblasts seeded on zirconia microgrooved implants, to describe the surface roughness and chemistry, and to evaluate the activity of human fetal osteoblasts seeded on zirconia microgrooved disks. Materials and methodsThis experimental in vitro study used 62 zirconia implants and 130 zirconia disks. Two experimental groups were created for the implants: 31 non-microgrooved implants (Control) and 31 microgrooved implants (Test); two experimental groups were created for the disks: 65 non-microgrooved disks (Control) and 65 microgrooved disks (Test). The following evaluations of the implants were made: lateral surface area (LSA), cell morphology, and density of human fetal osteoblasts seeded on implant surfaces. On the disks, surface parameters (roughness and chemistry) and cell activity (alkaline phosphatase - ALP and alizarin red - ALZ) were evaluated at 7 and 15days. ResultsLSA was lower for control implants (62.8mm) compared with test implants (128.74mm) (P lt 0.05). Cell bodies on control surfaces were flattened and disorganized, while in the test group, they were aligned inside the microgrooves. Control group cells showed few lamellipodia, which were attached mainly inside topographical accidents (surface cracks, valleys, and pits). Test group implants presented cells rich in lamellipodia prolongations, attached to the inner walls or to the borders of the microgrooves and in the flat areas between the microgrooves. Cell density was higher in the test group compared with controls (P lt 0.05) Surface roughness and oxygen content increased in test disks samples compared with controls (P lt 0.05). Carbon and aluminum were reduced in disks test samples compared with controls (P lt 0.05), and ALP and ALZ levels were significantly increased on test surfaces (P lt 0.05) at both study times. ConclusionsWithin the limitations of th

PurposeTo describe contact, thickness, density, and orientation of connective tissue fibers around healing abutments of different geometries by means of a new method using coordinates. Materials and MethodsFollowing the bilateral extraction of mandibular premolars (P2, P3, and P4) from six fox hound dogs and a 2-month healing period, 36 titanium implants were inserted, onto which two groups of healing abutments of different geometry were screwed: Group A (concave abutments) and Group B (wider healing abutment). After 3 months the animals were sacrificed and samples extracted containing each implant and surrounding soft and hard tissues. Histological analysis was performed without decalcifying the samples by means of circularly polarized light under optical microscope and a system of vertical and horizontal coordinates across all the connective tissue in an area delimited by the implant/abutment, epithelium, and bone tissue. ResultsIn no case had the connective tissue formed a connection to the healing abutment/implant in the internal zone; a space of 3510m separated the connective tissue fibers from the healing abutment surface. The total thickness of connective tissue in the horizontal direction was significantly greater in the medial zone in Group B than in Group A (p lt .05). The orientation of the fibers varied according to the coordinate area so that internal coordinates showed a higher percentage of parallel fibers in Group A (p lt .05) and a higher percentage of oblique fibers in Group B (p lt .05); medial coordinates showed more oblique fibers (p lt .05); and the area of external coordinates showed the highest percentage of perpendicular fibers (p lt .05). The fiber density was higher in the basal and medial areas (p lt .05). ConclusionsAbutment geometry influences the orientation of collagen fibers; therefore, an abutment with a profile wider than the implant platform favors oblique and perpendicular orientation of collagen fibers and greater connective tis

Implant surface characteristics, as well as physical and mechanical properties, are responsible for the positive interaction between the dental implant, the bone and the surrounding soft tissues. Unfortunately, the dental implant surface does not remain unaltered and changes over time during the life of the implant. If changes occur at the implant surface, mucositis and peri-implantitis processes could be initiated; implant osseointegration might be disrupted and bone resorption phenomena (osteolysis) may lead to implant loss. This systematic review compiled the information related to the potential sources of titanium particle and ions in implant dentistry. Research questions were structured in the Population, Intervention, Comparison, Outcome (PICO) framework. PICO questionnaires were developed and an exhaustive search was performed for all the relevant studies published between 1980 and 2018 involving titanium particles and ions related to implant dentistry procedures. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed for the selection and inclusion of the manuscripts in this review. Titanium particle and ions are released during the implant bed preparation, during the implant insertion and during the implant decontamination. In addition, the implant surfaces and restorations are exposed to the saliva, bacteria and chemicals that can potentially dissolve the titanium oxide layer and, therefore, corrosion cycles can be initiated. Mechanical factors, the micro-gap and fluorides can also influence the proportion of metal particles and ions released from implants and restorations.

Background/Aim. The modification of implant surfaces could affect mechanical implant stability as well as dynamics and quality of peri-implant bone healing. The aim of this 3-month experimental study in dogs was to investigate implant stability, marginal bone levels and bone tissue response to zirconia dental implants with two laser-micro-grooved intraosseous surfaces in comparison with nongrooved sandblasted zirconia and sandblasted, high-temperature etched titanium implants. Methods. Implant surface characterization was performed using optical interferometric profilometry and energy dispersive X-ray spectroscopy. A total of 96 implants (4 mm in diameter and 10 mm in length) were inserted randomly in both sides of the lower jaw of 12 Fox Hound dogs divided into groups of 24 each: the control (titanium), the group A (sandblasted zirconia), the group B (sandblasted zirconia plus microgrooved neck) and the group C (sandblasted zirconia plus all microgrooved). All the implants were immediately loaded. Insertion torque, periotest values, radiographic crestal bone level and removal torque were recorded during the 3-month follow-up. Qualitative scanning electon microscope (SEM) analysis of the bone-implant interfaces of each group was performed. Results. Insertion torque values were higher in the group C and control implants (p lt 0.05). Periotest values increased in all the periods in proportion to the extent of microgrooving as follows: the group C > the control > the group B > the group A (p lt 0.05). Radiographic measurements showed minimal crestal bone loss at 3 months for microgrooved zirconia implants (groups C and B) and control implants compared with the group A implants (p lt 0.05). The removal torque values increased with time for all the groups as follows: the group C > the control > the group B > the group A (p lt 0.05). SEM showed that implant surfaces of the groups B and C had an extra bone growth inside the microgrooves that corresponded to the shape and d, Uvod/Cilj. Modifikacija površine implantata može uticati na njegovu mehaničku stabilnost kao i na dinamiku i kvalitet periimplantatnog koštanog zarastanja. Cilj ove tromesečne eksperimentalne studije na psima bio je da se ispita stabilnost implantata, nivo marginalne kosti i odgovor koštanog tkiva na cirkonijum endoosealne implantate sa dve intraosealne površine mikrostrukturirane laserom u poređenju sa peskiranim cirkonijum implantatima čija površina nije mikrostrukturirana kao i sa titanijum implantatima čije su površine peskirane i nagrižene visokom temperaturom. Metode. Karakterizacija površine implantata učinjena je optičkom interferometrijskom profilometrijom i analizom energetskog spektra pri difrakciji X-zračenja. Ukupno 96 implantata (prečnika 4 mm i dužine 10 mm) ugrađeno je nasumično i obostrano u donju vilicu kod 12 pasa (lisičara) i podeljeno u četiri grupe po 24: kontrolna (titanijum implantati); grupa A (peskirani cirkonijum implantati); grupa B (peskirani cirkonijum implantati sa mikrokanalima u koronarnoj trećini); grupa C (peskirani cirkonijum implantati sa mikrokanalima duž cele površine). Svi implantati su odmah opterećeni. Meren je obrtni momenat pri ugradnji implantata, vrednosti periotesta, radiografski nivo marginalne kosti i obrtni moment za uklanjanje implantata tokom tromesečnog perioda praćenja. Međuspoj kosti i implantata iz svake grupe ispitivan je kvalitativnom skenirajućom elektronskom mikroskopijom (SEM). Rezultati. Veći obrtni momenat zabeležen je pri ugradnji implantata kod grupe C i kontrolne grupe (p lt 0,05). U ispitivanom vremenskom periodu, vrednosti periotesta uvećavale su se srazmerno obimu mikrostrukturiranja površine i to: grupa C > kontrolna grupa > grupa B > grupa A (p lt 0,05). Radiografskom analizom utvrđen je minimalni gubitak marginalne kosti u trećem mesecu praćenja oko cirkonijum implantata sa mikrokanalima (grupa B i C) i kontrola u poređenju sa implantatima grupe A (p lt 0,05). Vrednosti obrtnog momenta za uklanj

Diabetes is a chronic disease that occurs when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin that it produces. The number of people with diabetes is increasing. These trends highlight the urgency for a better understanding of diabetes as well as for improving the dental care of patients with diabetes. Patients with diabetes have increased frequency of periodontitis, tooth loss, and xerostomia, and diabetes has been considered a risk condition for oral surgery and dental implants with the fact that it is associated with delayed wound healing, prevalence of microvascular disease, and impaired response to infection. (article extract)

Purpose: To evaluate stability and success rate of hydrophilic nanostructured implants placed via osteotome sinus floor elevation (OSFE) without grafting material or using beta-tricalcium phosphate (beta-TCP), deproteinized bovine bone (DBB), or their combination, and also to assess three-dimensional volumetric stability of endo-sinus bone gained in the aforementioned conditions. Materials and Methods: OSFE with simultaneous implant placement (10-mm long SLActive-BL (R), Straumann, Basel, Switzerland) was performed. Grafting materials were randomly allocated to implant sites, whereas one site was left without graft. Implant stability was measured by resonance frequency analysis over 6 months. Implant success was evaluated after 2 years of loading. Volume of new endo-sinus bone was calculated from CBCT images using 3D Slicer (R) software. Results: A total of 180 implants were inserted into posterior maxilla of 45 patients with 6.59 +/- 0.45 mm of residual bone height, and all remained successful after 2 years. Implant stability steadily increased during healing, without significant difference between groups (p =.658). After 2 years, endo-sinus bone significantly shrank (p lt .001) in all groups (DBB: 66.34%; beta-TCP: 61.44%; new bone formed from coagulum: 53.02%; beta-TCP + DBB: 33.47%). Conclusions: Endo-sinus bone gained after OSFE inevitably and significantly shrinks regardless of whether grafting material is applied or not. Grafting material offers no significant advantage to stability nor clinical success of hydrophilic and nanostructured implants placed simultaneously with OSFE.

Objectives: The aim of this study was to evaluate the incidence of bleeding complications after dental implant placement in patients in treatment by the anticoagulant oral rivaroxaban without interrupting its administration or modifying dosage. Materials and methods: About 57 patients were divided into two groups: 18 had been in treatment by rivaroxaban for over 6 month before implant surgery and a control group consisted of 39 healthy subjects. All subjects received dental implants in different positions, without interrupting or modifying rivaroxaban dosage. Patients were treated in an outpatient setting. Non-absorbable sutures were used, and all patients were given gauze impregnated with tranexamic acid 5%, to bite on for 30 60 min. Results: One rivaroxaban patient presented moderate bleeding the day after surgery, and two control patients presented moderate bleeding the day after and on the second day. Bleeding was managed with gauzes impregnated with tranexamic acid. No statistically significant differences (P 0.688) were found in relation to bleeding episodes between the groups, with a relative risk 0.919 based on the pooled groups and 95% confidence interval of 0.078 10.844. Conclusions: Dental implant surgery in patients taking the anticoagulant oral rivaroxaban can be performed safely in outpatients departments applying local hemostatic measures without the need to modify or interrupt anticoagulant medication.

PurposeThe study aims to assess the total soft tissue (ST) width, crestal bone level (CBL), bone-to-implant contact (BIC), and bone density (BD) for zirconia implants textured with microgrooved surfaces and immediately loaded. Materials and MethodsThis study included 51 implants; one implant from each study group was retained for surface characterization. The 48 remaining implants were inserted randomly in premolar areas of both sides of the healed edentulous lower jaws of foxhound dogs. They were divided into three groups of 16: control (titanium); test A (zirconia), and test B (microgrooved zirconia). The implants were splinted and covered with an acrylic bridge. A split-mouth design was used and immediate occlusal loading was applied on one side, while the other side did not have occlusal contact. ST, CBL, BIC, and BD were evaluated after 3 months. The effects of immediate loading on these parameters were analyzed. ResultsAll the implants were osseointegrated. ST was established at 3 months with mean values of 2.90.4mm for all groups. No differences were appreciated between loaded and unloaded sides regarding ST (p>.05). CBL showed a mean of 1.2 +/- 0.3mm for all groups without differences between loaded and unloaded sides (p>.05). BIC percentages were significantly higher for loaded all-microgrooved implants (p<.05). BD percentages were higher in areas close to all-microgrooved implants (p<.05) and significantly higher for loaded implants than unloaded. ConclusionsWithin the limitations of the present study, it may be concluded that for zirconia dental implants with microgrooved surfaces and immediate loading, the thickness of STs remains stable resulting in 3mm mean biologic width, that crestal bone preservation is related to insertion depth, and that higher BIC percentages and increased BD around implants microgrooved over the entire intraosseous area may be expected at 3 months following implant insertion and immediate loading.

PurposeThe study aims to assess the total soft tissue (ST) width, crestal bone level (CBL), bone-to-implant contact (BIC), and bone density (BD) for zirconia implants textured with microgrooved surfaces and immediately loaded. Materials and MethodsThis study included 51 implants; one implant from each study group was retained for surface characterization. The 48 remaining implants were inserted randomly in premolar areas of both sides of the healed edentulous lower jaws of foxhound dogs. They were divided into three groups of 16: control (titanium); test A (zirconia), and test B (microgrooved zirconia). The implants were splinted and covered with an acrylic bridge. A split-mouth design was used and immediate occlusal loading was applied on one side, while the other side did not have occlusal contact. ST, CBL, BIC, and BD were evaluated after 3 months. The effects of immediate loading on these parameters were analyzed. ResultsAll the implants were osseointegrated. ST was established at 3 months with mean values of 2.90.4mm for all groups. No differences were appreciated between loaded and unloaded sides regarding ST (p>.05). CBL showed a mean of 1.2 +/- 0.3mm for all groups without differences between loaded and unloaded sides (p>.05). BIC percentages were significantly higher for loaded all-microgrooved implants (p<.05). BD percentages were higher in areas close to all-microgrooved implants (p<.05) and significantly higher for loaded implants than unloaded. ConclusionsWithin the limitations of the present study, it may be concluded that for zirconia dental implants with microgrooved surfaces and immediate loading, the thickness of STs remains stable resulting in 3mm mean biologic width, that crestal bone preservation is related to insertion depth, and that higher BIC percentages and increased BD around implants microgrooved over the entire intraosseous area may be expected at 3 months following implant insertion and immediate loading.

Purpose: The aim of this study was to investigate the relationship between surgical techniques and implant macro-design (self-tapping/non-self-tapping) for the optimization of implant stability in the low-density bone present in the posterior maxilla using resonance frequency analysis (RFA). Materials and Methods: A total of 102 implants were studied. Fifty-six self-tapping BlueSkyBredent (R) (Bredent GmbH &, Senden, Germany) and 56 non-self-tapping Standard Plus Straumann (R) (Institut Straumann AG (R), Waldenburg, Switzerland) were placed in the posterior segment of the maxilla. Implants of both types were placed in sites prepared with either lateral bone-condensing or with bone-drilling techniques. Implant stability measurements were performed using RFA immediately after implant placement and weekly during a 12-week follow-up period. Results: Both types of implants placed after bone condensing achieved significantly higher stability immediately after surgery, as well as during the entire 12-week observation period compared with those placed following bone drilling. After bone condensation, there were no significant differences in primary stability or in implant stability after the first week between both implant types. From 2 to 12 postoperative weeks, significantly higher stability was shown by self-tapping implants. After bone drilling, self-tapping implants achieved significantly higher stability than non-self-tapping implants during the entire follow-up period. Conclusions: The outcomes of the present study indicate that bone drilling is not an effective technique for improving implant stability and, following this technique, the use of self-tapping implants is highly recommended. Implant stability optimization in the soft bone can be achieved by lateral bone-condensing technique, regardless of implant macro-design.

Purpose: The aim of this study was to investigate the relationship between surgical techniques and implant macro-design (self-tapping/non-self-tapping) for the optimization of implant stability in the low-density bone present in the posterior maxilla using resonance frequency analysis (RFA). Materials and Methods: A total of 102 implants were studied. Fifty-six self-tapping BlueSkyBredent (R) (Bredent GmbH &, Senden, Germany) and 56 non-self-tapping Standard Plus Straumann (R) (Institut Straumann AG (R), Waldenburg, Switzerland) were placed in the posterior segment of the maxilla. Implants of both types were placed in sites prepared with either lateral bone-condensing or with bone-drilling techniques. Implant stability measurements were performed using RFA immediately after implant placement and weekly during a 12-week follow-up period. Results: Both types of implants placed after bone condensing achieved significantly higher stability immediately after surgery, as well as during the entire 12-week observation period compared with those placed following bone drilling. After bone condensation, there were no significant differences in primary stability or in implant stability after the first week between both implant types. From 2 to 12 postoperative weeks, significantly higher stability was shown by self-tapping implants. After bone drilling, self-tapping implants achieved significantly higher stability than non-self-tapping implants during the entire follow-up period. Conclusions: The outcomes of the present study indicate that bone drilling is not an effective technique for improving implant stability and, following this technique, the use of self-tapping implants is highly recommended. Implant stability optimization in the soft bone can be achieved by lateral bone-condensing technique, regardless of implant macro-design.

Aim: The aim of this 1-year prospective cohort study was to evaluate the outcomes and complications of immediately loaded mini dental implants used for stabilizing mandibular overdentures in edentulous patients wearing conventional complete dentures. Materials and methods: Thirty patients received mandibular conventional complete dentures that were subsequently retained by 4 immediately loaded mini dental implants placed in the interforaminal region. Overdenture success, implant success and biological and prosthetic complications were evaluated after the first year of service. Quality of life using the Oral Heath Impact Profile (OHIP)-EDENT test, satisfaction with dental prosthesis and chewing efficiency using questionnaires and a Visual Analogue Scale (VAS) were evaluated twice: after they had received mandibular complete dentures, and again after they had received mandibular overdentures. Results: After 1 year, no overdenture failed and 2 implants did not osseointegrate, resulting in a 98.3% success rate for loaded implants and 95.9% for total implants used (3 out of 123 were not loaded due to fracture). A flap surgical approach was performed in 7 patients, 3 implants fractured during insertion, 3 overdentures fractured, occlusion balancing was necessary for 11 dentures and relining for 8. Implant rehabilitation provided significant improvement in quality of life, stability, comfort, chewing and speaking ability while no significant differences were found in quality of maintenance of hygiene and for aesthetics. Conclusions: Mini dental implant retained overdentures can be a successful therapeutic procedure for treating mandibular edentulism that improves quality of life, patient satisfaction and chewing ability in patients wearing maxillary dentures. Longer follow-ups are needed to validate this therapy in the medium and long-term.