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Introduction: Patients with mucosal cysts in the maxillary sinus require special consideration in patients who require implant therapy for the restoration when undergoing implant therapy for the restoration of the posterior maxillary dentition. Treatment strategies for these clinical situations remain controversial in the literature. Thus, this study seeks to describe a safe and effective therapeutic strategy for sinus augmentation in patients with pre-existing maxillary antral cysts., Methods: A total of 15 patients and 18 sinuses were consecutively enrolled in this cohort study and underwent maxillary antral cyst treatment by needle aspiration and simultaneous maxillary sinus augmentation (MSA). During surgical procedures, threeimplants (Zimmer Biomet, Indiana, USA) were positioned in 11 sinuses and two implants (Zimmer Biomet, Indiana, USA) were positioned in 5 sinuses., Results: Overall implant success and survival rates were 100% and 97.8%, respectively at 1 year and 5-year follow-ups. Crestal bone resorption averaged 0.3 ± 0.2 mm 5-year post-loading, showing bone stability. Implant survival rate at 5-year follow-up expressed predictability of the technique comparable to historical data when MSA was performed alone. Crestal bone resorption averaged 0.3 ± 0.2 mm 5 years post-loading and shows bone stability utilizing mucosal cyst aspiration with concomitant MSA procedures. Quality of life evaluation at 1-week post-op showed similar results to published historical data. In 81% (13 sinuses), the CBCT examination at 5-year follow-up showed no cyst reformation, in 19% (3 sinuses) cyst reformation was visible, but smaller in size when compared to the pre-op CBCT evaluation, and all the patients were asymptomatic., Conclusions: Maxillary sinus mucosal cyst aspiration with concomitant MSA, may be a viable option to treat maxillary sinus cyst., (© 2024 The Authors. Clinical Implant Dentistry and Related Research published by Wiley Periodicals LLC.)

Background: Full-arch IOS scan of edentulous areas rehabilitated with dental implants is nowadays still described as an unpredictable procedure. To improve the accuracy, a universal scan template (UST®) is proposed in this article. The clinician can easily assemble the template with a mechanical coupling, by matching the scan bodies with objects of known dimension characterized by specific markers. The UST® facilitates the scanning of an entire arch on scan bodies, reducing the learning curve, simplifying acquisition movements, shortening the scanning time, and drastically reducing the risk of distortions and aberrations of the scans., Materials and Methods: In a case series study on 12 patients, the improvement in the accuracy of the scans with UST® was validated by comparing the STL files derived from scans with and without the guide in place. A titanium bar was produced from each optical impression., Results: The bars obtained from the optical impressions taken without UST® were found to be nonpassive in the mouth in the majority of the cases. On the contrary with the use of UST® we obtained 12 passive prosthetic rehabilitations., Conclusions: The proposed solution may represent a valid method to improve the predictability of full arch optical impressions on implants., (© 2023 The Authors. Clinical Implant Dentistry and Related Research published by Wiley Periodicals LLC.)

Background: Many techniques have been proposed to address post-extraction ridge resorption, which often represents a concern, especially in the esthetic region., Purpose: The purpose of the present, prospective, multicenter, single cohort study was to investigate, up to 1 year of function, the effectiveness of a protocol for alveolar ridge preservation involving implants with laser-microgrooved surface immediately placed in fresh extraction sockets., Materials and Methods: Twenty eight patients candidate to tooth extraction in the esthetic zone (site 15-25 and 35-45) were treated by immediate placement of a single laser-microgrooved implants with the adjunct of a highly porous anorganic porcine bone mineral matrix and a collagen wound dressing. Peri-implant marginal bone level (MBL) was evaluated at time of loading, 3 and 12 months after loading. Gingival index, plaque index, probing depth, and bleeding on probing were measured at 3, 6, and 12 months after loading. Dimensional changes at implant sites were digitally evaluated using the best-fit superimposition of pre-and post-socket preservation models. Implant aesthetic score (IAS) as well as patients' post-operative quality of life were also evaluated at 12 months. Comparisons between data relative to thick and thin gingival phenotypes were made using Student's t-test or Mann-Whitney test, as appropriate. The significance level was set at p = 0.05., Results: No patient dropped out, and 28 implants were evaluated at 12 months post-loading. The overall MBL was found to be 0.92 ± 1.11 mm. Volumetric analysis of superimposed models showed an alveolar bone tissue displacement at the buccal aspect of -0.57 ± 0.52 mm in thin phenotypes and -0.46 ± 0.31 mm in thick phenotypes (p = 0.58, unpaired Student's t-test). No signs of soft tissue recession or esthetically unpleasant buccal gingiva were reported., Conclusions: The clinical protocol herein employed showed benefits in maintaining marginal bone levels and soft tissue contour around post-extraction implants in the esthetic zone., (© 2023 The Authors. Clinical Implant Dentistry and Related Research published by Wiley Periodicals LLC.)

Background: Different biomaterials were suggested for sinus floor augmentation (SFA). Recently, new materials were launched showing true bone formation without remnants., Purpose: The aim of this prospective study was to evaluate an hydroxyapatite-based, sugar cross-linked collagen sponge (OSSIX™ Bone) in transcrestal SFA (t-SFA)., Materials and Methods: Twenty-four patients with edentulous posterior maxilla and residual bone height (RBH) >4 mm underwent t-SFA with OSSIX™ Bone as grafting material and simultaneous implant placement. The implant Stability Quotient (ISQ) was measured by resonance frequency analysis (RFA) directly after implant insertion and at 6 months. Differences in bone height (BH) and volume were determined in CBCT and x-rays at baseline versus 1 year of follow-up. Graft volume was evaluated by tridimensional reconstructions. Linear regression analysis was used to evaluate the effect of bucco-palatal sinus dimension, RBH, and length of the implant protruding (PIL) into the sinus, on the graft height (GH) changes up to 1 year, and on the graft volume at 1 year. Autocorrelation between time lag and augmented bone volume was evaluated through time series analysis correlograms. Health-related quality-of-life outcomes were captured., Results: Twenty-two patients completed the study. The mean RBH measured at baseline was 5.81 ± 2.2 mm. The mean graft volume was 1085.8 ± 733.4 mm 3 . The mean GH, measured in the immediate post-operative period, at 6 and 12 months respectively, was 7.24 mm ±1.94; 6.57 mm ± 2.30; 5.46 mm ± 2.04. The mean ISQ measured after the implant placement was 62.19 ± 8.09, and 6 months later was 76.91 ± 4.50. There was a significant correlation between buccolingual dimension and graft volume at 1 year. Neither buccolingual volume nor RBH had a significant effect on GH change, while the PIL showed a significant positive correlation (P = 0.02 and P = 0.03 at 6 and 12 months, respectively). The correlograms indicated no significant correlation, meaning that there is no tendency for graft volume to increase or decrease over time, therefore suggesting graft stability, at least up to one year of follow-up. 86% of patients had no chewing interference., Conclusion: Within the limitations of the study, OSSIX™ Bone could be considered a valid material for SFA due to its manageability and its positive results in promoting new bone formation with long-term stability. T-SFA is confirmed as a less invasive and less painful method., (© 2023 The Authors. Clinical Implant Dentistry and Related Research published by Wiley Periodicals LLC.)

Purpose: To compare clinical and radiographic outcomes of <7 mm short (SH) implants inserted in native bone vs longer (ST) implants placed in vertically augmented partially edentulous posterior jaws. A further aim was to evaluate if the residual bone dimension plays a role in the outcomes of SH and extra-SH implants., Materials and Methods: This review was registered with PROSPERO. An electronic literature search was performed on PubMed, Scopus and Web of Science. Randomized controlled trials (RCTs) with at least 1-year follow-up, comparing fixed prostheses supported by SH vs ST implants in augmented sites were included. Marginal bone level (MBL) changes, implant survival rate, and complications were evaluated through a meta-analysis. Subgroup analysis was performed dividing the SH implants according to length at each follow-up (1-, 3-, 5-year of function)., Results: Twenty-five articles fulfilled the inclusion criteria, featuring a total of 650 SH implants placed in 415 patients and 685 ST implants placed in 403 patients. There was a trend for a significantly lower MBL associated with SH implants respect to ST implants at each follow-up, whilst there was no evidence of a difference in failure rates between SH and ST implants, for any SH length considered and at any follow-up. There was evidence for a lower incidence of complications in favor of SH implants at both 1-year (P < .0001) and 3-year follow-up (P = .01), while at 5-year follow-up there was no evidence of a difference between SH and ST groups (P = .30)., Conclusion: SH implants supporting partial fixed rehabilitations represent a valuable alternative to augmentation procedures in the medium term. While the performance of implants at least 5-mm long is well documented, more studies with at least 5-year follow-up are needed to confirm the promising outcomes observed with <5 mm-long fixtures., (© 2020 Wiley Periodicals LLC.)

Background: Oral rehabilitation of patients after maxillofacial reconstructive surgery represents a challenge and stable prosthetic retention can be achieved with the use of dental implants., Purpose: This retrospective report aimed to evaluate implant-based oral rehabilitation following maxillofacial reconstruction with free fibula flaps., Materials and Methods: A total of 14 patients who had reconstruction with fibula flaps either by CAD/CAM or conventional surgery were included in this study. A total of 56 implants (40 in flaps, 16 in native bone) were evaluated. Follow-up after reconstructive surgery ranged between 3.25 and 6.3 years. Follow-up after implant surgery ranged between 1.5 and 3.8 years., Results: Overall survival rate was 85.7% in free fibula flaps and 85.6% in dental implants. Eight implants were lost in three patients and all of these failures were in dental implants inserted in free flaps. According to the results on patient basis, the implant survival was not influenced by any variable., Conclusions: The maxillofacial reconstruction with free fibula flap and oral rehabilitation with implant-supported prostheses after ablative surgery can be considered as an effective and safe procedure with successful aesthetic and functional outcomes., (© 2020 Wiley Periodicals LLC.)

Background: Zygomatic implant surgery is considered as a safe and successful alternative to the conventional implant surgery with bone grafts for patients with severe atrophic maxilla., Purpose: The aim of this retrospective clinical case series was to report clinical outcome of zygomatic implants with a follow-up between 6 months and 7 years., Materials and Methods: A total of 110 patients with 302 zygomatic implants were included in this study. The intra and postoperative complications and survival rate of zygomatic implants were evaluated., Results: The study included 110 consecutively treated patients with an age range of 21 to 76 years (mean 57.35 years, SD 10.42). The overall zygomatic implant survival rate was 98.34%. There were five implant failures in four patients. One intraoperative and 17 postoperative complications developed in 18 patients. There were no dropouts and the median follow-up of the patients was 41.75 months (with a range of 6-89 months)., Conclusions: According to the results, in cases of severely atrophic posterior maxilla, zygomatic implant surgery can be considered as an effective and safe alternative to conventional implants and bone grafting procedures., (© 2020 Wiley Periodicals LLC.)

Background: The achievement and preservation of an adequate amount of soft tissue around implants is a critical factor for the prognosis of the treatment., Purpose: To evaluate the effectiveness of a porcine dermal matrix applied during second stage implant surgery for horizontal soft tissue augmentation and preservation of dimensional stability., Materials and Methods: Twenty patients (mean age 50.2 ± 11.9 [SD] years) candidate to implant therapy and requiring soft tissue augmentation were recruited in four centers. Augmentation was performed in 24 cases. A porcine dermal matrix was placed into a buccal split-thickness pouch during uncovering surgery. Silicone impressions were taken before surgery (T0), 2 weeks later at suture removal (T2), 6 months (T3), and 24 months (T4) post augmentation. Dimensional changes of soft tissue were evaluated using superimposition of digitalized study casts., Results: Nineteen patients (23 implants) could be evaluated at 6 months and 13 patients (17 implants) at 24 months. After 6-month follow-up, there was a significant dimensional gain respect to baseline, averaging 0.83 ± 0.64 mm (P < .01). This did not change significantly at 24 months (0.77 ± 0.65 mm, P = .19). The gain was >0.5 mm in 65.2% and 64.7% of the cases, respectively. Soft tissue shrinkage averaged 34.2% ± 77.0% from T2 to T3 (P < .01) and did not change thereafter (P = .39). Shrinkage was more consistent in the posterior mandible than in the maxilla, but not significantly (P = .23 at 6-month and .36 at 24-month). No adverse events occurred., Conclusion: Within the limitations of this prospective case series, the use of a porcine dermal matrix may provide consistent soft tissue augmentation that maintains up to 24-month follow-up, although graft shrinkage may occur in the first 6 months, depending on the location of surgery., (© 2019 Wiley Periodicals, Inc.)

Background: Lateral approach to maxillary sinus floor elevation (LSFE) with autologous bone grafts and simultaneous implant insertion is a widespread technique for prosthetic rehabilitation of the atrophic maxilla., Purpose: To analyze implant survival and autologous bone graft resorption after LSFE, in patients with at least 5 years follow-up., Materials and Methods: Thirty-three patients (mean age 56 years, range 46-68 years) who had undergone LSFE with intraoral autologous bone graft from mandibular ramus and simultaneous implant insertion were included. A minimum of 5 years of follow-up was required. The total peri-implant bone height was measured at mesial and distal aspects of the implants immediately after surgery (T0) and after a period ranging from 5 to 11.5 years after surgery (mean 7.65 ± 1.80 years) (T1) on digital panoramic and periapical radiographs. Wilcoxon matched-pairs signed rank test was used to compare bone graft height at T0 and T1. The influence of patient-, surgery-, and implant-related factors on the outcomes was investigated., Results: Of the 58 implants placed, no one was lost. All prostheses were in function, and no biological or mechanical complications occurred. The residual ridge height at the involved sites averaged 6.48 ± 1.72 mm. The mean bone height at grafted regions was 12.05 ± 2.47 mm at T0 and 12.13 ± 2.39 mm at T1 (not statistically significant). Marginal bone level change at T1 averaged -1.22 ± 1.60 mm. None of the evaluated factors significantly affected the results., Conclusion: Autologous bone grafts from intraoral donor sites display excellent volume stability over time that may contribute to optimal outcomes of the procedure., (© 2018 Wiley Periodicals, Inc.)

Background: Several treatment options exist for the implant-supported rehabilitation of edentulous posterior maxilla., Purpose: To compare maxillary sinus floor augmentation associated to standard length implants, with direct placement of implants of reduced length in the available residual bone., Materials and Methods: Patients with edentulous posterior maxilla and a residual height of 4-7 mm were randomly allocated to the test (short implants [SIs], 6.5 to 8.5mm long) or the control (sinus augmentation [SA] and implants ≥10mm long) group. Anorganic bovine bone was the grafting material for the control group. In both groups pure platelet-rich plasma was used to bioactivate implant surface prior to insertion. Implant and prosthesis survival, clinical variables, radiographic bone level change, quality of life, and patient satisfaction were assessed., Results: Twenty-five patients were treated in the control group (58 standard length implants) and 27 in the test group (42 SIs). After 3 years of follow-up no implant failure and biological or mechanical complications were recorded. Marginal bone loss, soft tissue, and oral hygiene parameters were similar in the 2 groups at both 1 and 3 years' follow-up. Postoperative pain, swelling and other symptoms and daily activities were better in the SIs group than in the SA group, while patients' satisfaction after 1 year was similar., Conclusions: In spite of comparable medium-term clinical and radiographic outcomes, when the residual ridge height is sufficient for a safe placement, SIs may be preferred due to simplified protocol, less invasiveness, shorter treatment time, and reduced postoperative discomfort as compared to SA., (© 2017 Wiley Periodicals, Inc.)

Purpose: The aim of this study was to assess whether immediate implant placement into post-extraction sites presenting a chronic infection poses a greater risk of implant failure than immediate placement in non-infected sites., Materials and Methods: Records of patients who underwent extraction and immediate implant placement into both infected and non-infected sites from January 1998 to September 2014 at 5 different dental centers were considered for inclusion. Included records were subjected to statistical analysis of survival rates, along with a number of other patient-, implant-, surgery-, and prosthesis-related variables., Results: The inclusion criteria were met by 369 patients who received a total of 527 implants. The follow-up averaged 53.2 months (range 0.9-158.3) for implants placed into non-infected sockets (N = 334) and 50.1 months (range 1.6-146.1) for those placed into infected sites (N = 193). Seven implants failed in non-infected sites and 3 in infected ones. All failures occurred within 1 year of placement. Cumulative implant survival rate for non-infected and infected sites was, respectively, 97.9% ± 0.8% and 98.4% ± 0.9%, being not significantly different (P = .66). None of the investigated variables affected the outcome., Conclusions: Placement of implants into periodontally or endodontically infected sites immediately after tooth extraction is a safe option, even when the implants are loaded immediately or early., (© 2017 Wiley Periodicals, Inc.)

Objectives: The study aims to test the hypothesis of no differences in temperature variation by using a single bur for implant site preparation as compared with conventional drilling sequence using multiple burs with incremental diameter., Materials and Methods: Synthetic blocks of bone (type I density) were used for drilling procedures., Three Groups Were Evaluated: Group 1 and Group 2 - drilling with three consecutive burs for a 4.1 mm cylindrical implant and for a 4.3 mm conical implant, respectively; Group 3 - drilling with a single bur for a 4.2 mm conical implant. For each group, 20 drilling procedures were performed without irrigation and 20 with external irrigation. The temperature in the cortical bone during osteotomy for implant site preparation was measured through a thermocouple., Results: The mean temperatures and standard deviations for the drilling without irrigation were: 25.5 ± 1.24°C for Group 1; 28.1 ± 1.76°C for Group 2; 26.5 ± 1.79°C for Group 3. Considering the drilling with irrigation, the mean values and standard deviations were: 20.4 ± 1.17°C for Group 1; 22.2 ± 1.38°C for Group 2; 20.2 ± 0.83°C for Group 3. Groups 1 and 3 yielded similar results, while Group 2 displayed significantly higher temperature increase than the other two groups., Conclusions: The single bur drilling protocol did not produce greater bone heating than the conventional protocol and may be considered a safe procedure., (© 2013 Wiley Periodicals, Inc.)

Purpose: The control of postoperative discomfort may improve the patient's quality of life as well as treatment acceptance. The aim of the present preliminary report was to assess if the use of autologous platelet concentrate during maxillary sinus augmentation may have a favorable impact on pain and other factors related to patient's quality of life in the first week after surgery., Materials and Methods: This is an interim report of a randomized single-blind study. Fifteen patients with atrophic edentulous posterior maxilla underwent maxillary sinus augmentation using deproteinized bovine bone matrix (DBBM) as the grafting material (control group). In other 15 patients (test group), autologous plasma rich in growth factors (P-PRP) was added to DBBM, then a P-PRP clot was applied to covering the graft before suturing and finally P-PRP was placed over the suture in liquid form. During the first week postsurgery, all patients filled in a questionnaire for evaluation of main symptoms and daily activities. The outcomes of the questionnaires of the two groups were statistically compared., Results: In the first days postsurgery, the group using P-PRP reported significantly less pain, swelling, and hematoma, and improved functional activities with respect to the control group., Conclusions: The adjunct of P-PRP to the maxillary sinus augmentation procedure produced a beneficial effect to patients' quality of life in the early postsurgical phase., (© 2013 Wiley Periodicals, Inc.)

Purpose: The purpose of this retrospective investigation was to present the incidence of biological and technical complications in patients treated with implant-supported, immediately loaded full-arch restorations., Materials and Methods: Clinical data of all patients treated with full-arch, immediately loaded rehabilitations supported by a combination of upright and tilted implants were screened. Data on both technical and biological complications (such as peri-implant mucositis and peri-implantitis) and their onset and frequency of occurrence were recorded and analyzed., Results: The clinical records of 86 patients (95 prosthetic rehabilitations) were included in this study. There were 61 mandibular rehabilitations and 34 maxillary ones, all of them immediately loaded within 8 to 48 hours of the surgical intervention. The follow-up time varied from 16.3 to 112 months of function (mean 65.36 months). The most common biological complications were hygiene-related (n = 81; 30.2% of patients displayed peri-implant mucositis and 10.4% peri-implantitis). Among all prosthetic complications, the detachment of an element of the definitive prosthesis was the most frequent event (n = 20; 23.2% of patients). The total number of prosthetic complications was 42. Most complications were reversible and did not affect the overall implant/prosthesis survival rate., Conclusions: The occurrence in well-maintained patients of technical and biological complications in full-arch rehabilitations supported by a combination of tilted and upright implants in the medium to long term is lower than previously reported by the pertinent literature. Further studies are needed to confirm this result., (© 2013 Wiley Periodicals, Inc.)

Purpose: The aim of the present systematic review was to estimate the implant survival rate in different types of techniques for the rehabilitation of posterior atrophic maxilla, after at least 3 years of follow-up., Materials and Methods: MEDLINE database was searched using a combination of specific terms. A hand searching of the relevant journals and of the reference lists of systematic reviews was also performed. All retrospective and prospective studies evaluating short implants in posterior maxilla, osteotome sinus floor elevation and lateral approach sinus floor elevation, and having a follow-up of at least 3 years, were included., Results: Forty-four articles were included in the review. In four studies reporting on a total of 901 short implants, the implant survival rate varied from 86.5% to 98.2% with up to 5 years follow-up. For the osteotome technique, 1,208 implants in eight studies were considered, showing a survival rate varying from 95.4% to 100% after 3-year follow-up. Twenty-nine studies, accounting for 6,940 implants placed in 2,707 sinuses augmented through lateral technique were considered. Implant survival rate varied from 75.57% to 100%. Only three comparative studies were found that showed no significant difference in clinical outcomes between lateral approach and osteotome technique., Conclusions: Sinus floor elevation with the lateral approach and with the osteotome technique is an effective and well-documented therapeutic option for the rehabilitation of atrophic posterior maxilla. The use of short implants is promising but needs further investigation to be considered as effective as the other techniques in the long term. However, the indication for the three different techniques is not perfectly equivalent and the treatment choice should be based on a careful evaluation of the individual case, in particular on the available residual bone., (© 2013 Wiley Periodicals, Inc.)

Background: Implant site preparation usually consists of several consecutive drilling steps, performed using different burs with increasing diameter., Purpose: The purpose of the present study was to report the clinical outcomes of edentulous patients that underwent implant treatment, in which a special bur that allows preparation of the implant site in a single drilling step was used., Material and Methods: One hundred forty-nine patients (79 males, 70 females, mean age 51.8 ± 12.2 [SD] years, range 20-80 years) have been rehabilitated using different oral surgery procedures. A total of 350 implants were inserted (171 in the maxilla and 179 in the mandible). A barrier membrane was used for covering a total of 126 implants. Fifteen implants were placed by using the osteotome technique and 52 by using the lateral sinus lift procedure. Eighty-nine implants were placed in postextraction sockets. Thirty-six implants underwent immediate loading. Implant survival, peri-implant bone level change, and patients' satisfaction were the main variables assessed., Results: No patient dropout occurred. The mean follow-up on a patient basis was 21.5 ± 3.1 months (range 12-27 months). A total of seven implant failures were recorded in six patients, leading to a mean implant survival of 98.0% (96.0% on a patient basis). The mean peri-implant bone loss after 1 year was 0.58 ± 0.44 mm (n = 282). Apart from implant failures, no biological nor mechanical complications occurred. All patients demonstrated full satisfaction., Conclusions: The use of a single bur for implant site preparation allows the reduction of the time needed for the surgical procedure, without compromising the clinical outcomes. Further, long-term comparative studies are needed to confirm the results of this study., (© 2013 Wiley Periodicals, Inc.)

Purpose: The purpose of the present systematic review was to estimate the survival rate of implants placed in fresh extraction sockets and immediately restored. Secondary aims were to compare it with the survival rate of implants placed in healed ridges and of implants restored according to a delayed protocol as well as to assess the influence of several other confounding factors on the clinical outcomes., Methods: An electronic search was performed on MEDLINE, EMBASE, and CENTRAL databases in order to identify prospective clinical studies published from 1990 to October 2012. A hand search was also done. Studies were selected according to specific inclusion criteria. The effect of the following parameters on 1-year implant survival (IS) was statistically evaluated: study design, risk of bias, prosthesis type, type of loading (occlusal or nonocclusal), type of incision (flap or flapless), presence of infection, and grafting material. A meta-analysis of studies comparing immediately restored implants placed in fresh postextraction sockets versus healed ridges was conducted., Results: Seven randomized trials, three controlled trials, and 35 case series were included, accounting for 1170 patients and 1974 postextraction implants immediately restored. Twenty-eight studies had a low risk of bias. The overall 1-year IS was 97.6%. All failures occurred within 1 year of function. Meta-analysis showed a significant better outcome for implants placed in healed ridge (IS = 99.4%) as compared with postextraction implants (IS = 95.6%). No other parameter had a significant effect on clinical outcomes. Most variables, among which the esthetic aspect, could not be assessed as they were not systematically reported., Conclusion: Though the conventional protocol still represents the gold standard, immediate restoration of implants placed in fresh extraction sites displayed an excellent implant prognosis. Such clinical approach can be successfully adopted in order to minimize the treatment time with a relevant impact on patient's satisfaction., (© 2013 Wiley Periodicals, Inc.)

Objective: To evaluate the efficacy of the topical administration of bisphosphonates in implant therapy., Materials and Methods: Thirty-nine consecutive patients were selected for a split-mouth study. Inclusion criteria were: presence of a bilateral or total edentulism, ability to tolerate conventional implant procedures, older than 18 years. Ten patients were smokers. Ten patients were fully edentulous in both maxilla and mandible, 12 patients had fully edentulous maxilla or mandible, and 17 were bilaterally partially edentulous (9 in the mandible and 8 in the maxilla). A one-stage procedure was adopted in all cases. The prosthetic phase started 10 weeks after implant insertion. Each patient received implants on the control side and the test side, with insertion performed in the conventional way on the control side; on the test side, a 3% clodronate solution mixed with a surfactant (Tween-20) at a 1:3 ratio was topically administered both at the implant surface and at the implant site., Results: One hundred fifty-five implants were inserted. The test and control groups included 75 and 80 implants, respectively. The implant insertion torque was no less than 30 Ncm. A total of 7 implants failed in the control group (6 before loading and one after 12 months of loading). No failure occurred on the test side. By the 5-year follow-up, no further implant failure had been recorded. Overall, implant survival rates at 5 years for the test and control groups were, respectively, 100% and 91.3%, the difference being significant (p < .01). Mean marginal bone loss was 0.85 ± 0.71 mm in the test group and 1.12 ± 0.85 mm in the control group after 1 year of loading and stable thereafter. The difference was not significant., Conclusions: The topical administration of bisphosphonates may positively affect implant survival in the preloading and postloading phases in partially and fully edentulous patients. However, a larger study population is needed to verify these promising clinical results., (© 2013 Wiley Periodicals, Inc.)

Purpose: This retrospective study deals with the issue of how to realize the transition from a failing dentition to an implant-supported prosthesis. The main aim was to assess the reliability of immediate implant and immediate loading (IL) protocols in the edentulous jaws. A further aim was to investigate the role of patient-related, implant-related, and surgery-related secondary variables in the occurrence of implant failure., Materials and Methods: Patients with at least a 4-year post-loading follow-up undergoing the transition from a failing dentition to an implant-supported prosthesis were retrospectively investigated. Primary variables of implant failure were immediate placement and IL. Secondary variables were categorized as demographic, anatomic, site, and prosthetically related. Cumulative survival rates (CSRs) were compared using the Kaplan-Meier survival estimate method. Predictors of failure were included in a multivariate Cox regression model to evaluate the simultaneous effects of multiple covariates and control for correlated observation. Crestal bone loss was also measured at the delayed and the immediately loaded implants., Results: Five hundred nineteen implants rehabilitating 91 jaws in 80 patients were followed. The Kaplan-Meier survival estimate method showed that immediate implant and IL decreased the CSR significantly in the maxilla but not in the mandible. Some secondary variables were found to affect the CSR: maxillary location, age over 70 years, prostheses supported by only immediate implants or a majority of them, temporary cementation, implant diameter, and length. Crestal bone loss was not significantly related to the outcomes., Conclusions: The present data may provide clinical recommendations to the practitioner treating the transitional patient. In the mandible, the use of immediate implants and IL does not increase the failure rate. In the maxilla however, combining immediate placement and IL may significantly increase the failure rate., (© 2013 Wiley Periodicals, Inc.)

Purpose: The purpose of this prospective study was to investigate the clinical success of a treatment protocol for the rehabilitation of edentulous posterior maxilla consisting of the positioning of short implants in combination with transcrestal sinus lifting, with the adjunct of pure (leukocyte-free) platelet-rich plasma, in order to reducing the risk of membrane perforation and other surgical complications., Materials and Methods: A total of 25 patients (65 implants) were treated. Pure platelet-rich plasma was used in the sinus membrane lifting procedure. Implants of 8.5 mm length or shorter were splinted through the prosthetic rehabilitation with one or more implants longer than 10 mm., Results: After a follow-up period ranging from 12 to 19 months (mean 14.4 months) after prosthetic loading, 23 patients (60 implants) were evaluated. Overall implant success and survival rates were 100% at 1 year follow-up visit. All prosthetic rehabilitations were successful and in function. After 1 year of loading, peri-implant bone loss averaged 0.34 ± 0.21 mm for 8.5 mm or shorter implants (n = 25) and 0.36 ± 0.30 mm for longer implants (n = 35) (overall mean 0.35 ± 0.25 mm) without significant difference between the two groups (p = 0.23)., Conclusions: The proposed treatment protocol is a viable option for the rehabilitation of edentulous posterior atrophic maxilla., (© 2012 Wiley Periodicals, Inc.)

Purpose: The aim of this prospective study was to assess long-term clinical outcomes and peri-implant bone level changes around oxidized implants supporting partial fixed rehabilitations., Materials and Methods: Twenty-two partially edentulous patients were included in the study. A total of 33 fixed rehabilitations were placed, supported by 54 titanium implants with oxidized microtextured surface. Prostheses were delivered after 3 and 6 months of implant placement in the mandible and maxilla, respectively. Patients were scheduled for follow-up at 6 and 12 months and then yearly. At each follow-up, plaque level and bleeding scores were assessed and periapical radiographs were taken. The main outcomes were prosthesis success, implant survival, implant success, and marginal bone level change., Results: Three patients were excluded from the study because they did not attend the 1-year follow-up. Nineteen patients, accounting for 49 implants, were followed for at least 6 years after prosthesis delivery. The mean follow-up duration was 81.8 months (range 75-96 months). One mandibular single-tooth implant failed after 1 year in a smoker woman. Cumulative implant survival and success at 6 years were 98.0% and 95.9%, respectively. Prosthesis success was 96.7%. The mean peri-implant bone loss at 6 years was 0.76 ± 0.47 mm. Not significantly (p = .75) greater bone loss was found in the maxilla (0.78 ± 0.14 mm, n = 19) as compared with the mandible (0.74 ± 0.59 mm, n = 30). In the maxilla, bone loss was significantly greater around implants supporting partial prostheses as compared with single-tooth implants (p = .03). Full patient satisfaction was reported., Conclusion: Implants with oxidized microtextured surface may achieve excellent long-term clinical outcomes in the rehabilitation of partial edentulism., (© 2012 Wiley Periodicals, Inc.)

Purpose: The aim of the present study was to systematically evaluate the effect of autogenous platelet concentrates on the clinical and histomorphometric outcomes of maxillary sinus augmentation., Materials and Methods: MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials were searched using a combination of specific search terms. Furthermore, a hand searching of the relevant journals and of the bibliographies of reviews was performed. Prospective comparative clinical studies were included. Implant survival and histomorphometric outcomes were evaluated., Results: Twelve studies were included. Four hundred forty-five sinus floor augmentation procedures were considered. No difference in implant survival was reported between test and control groups. Six studies reported a beneficial effect of platelet concentrates based on histomorphometric outcomes, while another six studies found no significant effect. A large heterogeneity was found regarding study design, surgical techniques, graft materials, clinical and histomorphometric outcome variables, and methods for preparing platelet concentrates. Favorable effects on soft tissue healing and postoperative discomfort reduction were often reported but not quantified., Conclusions: A clear advantage of platelet concentrates could not be evidenced. Standardization in the experimental design is needed in order to detect the true effect of platelet concentrates in maxillary sinus augmentation procedure, especially regarding postoperative quality of life., (© 2011 Wiley Periodicals, Inc.)

Purpose: The aim of this prospective study was to assess clinical outcomes and peri-implant bone level changes around tilted and axial implants supporting full-arch fixed immediate rehabilitations up to 60 months of loading., Material and Methods: Forty-seven patients (22 women and 25 men) were included in the study. Each patient received a full-arch fixed bridge supported by two axial and two distal tilted implants. Loading was applied within 48 hours of surgery. Patients were scheduled for follow-up at 6, 12, 18, 24 months, and annually up to 5 years. At each follow-up, plaque level and bleeding scores were assessed and radiographic evaluation of marginal bone level change was performed. Periapical radiographs were taken using a paralleling technique, and subsequently scanned at 600 dpi. An image analysis software was used to assess bone level., Results: A total of 33 mandibles and 16 maxillae were rehabilitated (two patients received a fixed prosthesis in both arches). One hundred ninety-six Nobel Biocare implants of 4 mm diameter were placed. The mean follow-up duration was 52.8 months (range 30-66 months) in the mandible, and 33.8 months (range 22-40 months) in the maxilla. All subjects attended the scheduled follow-up visits. No implant was lost. No significant difference in marginal bone loss was found between axial and tilted implants in both jaws, at each follow-up. No significant difference in bone loss was found between mandible and maxilla, for both axial and tilted implants at each comparable time frame, although slightly higher mean values were always found for the mandible., Conclusion: The use of tilted implants in the immediate rehabilitation of fully edentulous jaws is safe and is not associated to a higher marginal bone loss as compared to axially placed implants., (© 2010 Wiley Periodicals, Inc.)

Purpose: The aim of this review was to evaluate the survival rate of upright and tilted implants supporting fixed prosthetic reconstructions for the immediate rehabilitation of partially and fully edentulous jaws, after at least 1 year of function., Materials and Methods: An electronic search of databases plus a hand search on the most relevant journals up to December 2009 was performed. The articles were selected using specific inclusion criteria, independent of the study design., Results: The literature search yielded 347 articles. A first screening based on the title and abstract identified 25 eligible studies. After full-text review of these studies, 10 articles were selected for analysis. Seven were prospective single-cohort studies and three had a retrospective design. A total of 462 patients have been rehabilitated with 470 immediately loaded prostheses (257 in the maxilla, 213 in the mandible), supported by a total of 1,992 implants (1,026 upright and 966 tilted). Twenty-five implants (1.25%) failed in 20 patients within the first year. All failures except one occurred in the maxilla. No significant difference in failure rate was found between tilted and upright implants, nor between maxillary and mandibular implants. No prosthesis failure was reported. Limited peri-implant bone loss was reported with no difference between upright and tilted implants. Full patients' satisfaction for function, phonetics, and esthetics was reported in three studies, based on questionnaires., Conclusions: The use of tilted implants to support immediately loaded fixed prostheses for the rehabilitation of edentulous jaws can be considered a predictable technique, with an excellent prognosis in the short-medium term. However, randomized long-term trials are needed to determine the efficacy of this surgical approach., (© 2010 Wiley Periodicals, Inc.)

Purpose: The aim of the present study was to systematically evaluate the implant survival rate after osteotome-mediated maxillary sinus augmentation with or without using grafting materials., Materials and Methods: MEDLINE database was searched using a combination of specific search terms. Furthermore, a hand searching of the relevant journals and of the bibliographies of reviews was performed. Prospective and retrospective clinical studies with at least 20 patients treated by osteotome-mediated sinus floor elevation were included., Results: Nineteen studies were selected for data analysis. A total of 1,822 patients, accounting for 3,131 implants were considered. Mean weighted cumulative implant survival at 1, 2, 3, and 5 years was estimated as 98.12%, 97.40%, 96.75%, and 95.81%, respectively. No significant difference was found in relation to the use of grafting material nor in relation to implant length. Overall implant survival was 92.7% for 331 implants placed in <5 mm ridge height and 96.9% for 2,525 implants inserted in ≥ 5 mm ridge height. The difference was significant (p = .0003)., Conclusions: The transalveolar sinus augmentation technique could be a viable treatment in case of localized atrophy in the posterior maxilla even in case of minimal residual bone height. The prognosis can be more favorable when the residual ridge is at least 5 mm high., (© 2011 Wiley Periodicals, Inc.)

Purpose: The aims of this prospective study were to assess the treatment outcome of immediately loaded full-arch fixed bridges anchored to both tilted and axially placed implants for the rehabilitation of the mandible and to compare the outcome of axial versus tilted implants., Materials and Methods: Sixty-two patients (34 women and 28 men) were included in the study. Each patient received a full-arch fixed bridge supported by two axial implants and two distal tilted implants (All-on-Four, Nobel Biocare AB, Göteborg, Sweden). Loading was applied within 48 hours of surgery. Patients were scheduled for follow-up at 6, 12, 18, and 24 months, and annually up to 5 years. At each follow-up, plaque level and bleeding scores were assessed; moreover, patient's satisfaction for aesthetics and function was evaluated by a questionnaire. Radiographic evaluation of marginal bone level change was performed at 1 year., Results: The overall follow-up range was 6 to 43 months (mean 22.4 months). Forty-four patients were followed for a minimum of 1 year. No implant failures were recorded to date, leading to a cumulative implant survival and prosthesis success rate of 100%. Plaque level and bleeding scores showed progressive decrease over time, parallel to increase of satisfaction for both aesthetics and function. No significant difference in marginal bone loss was found between tilted and axial implants at 1-year evaluation., Conclusion: The present preliminary data suggest that immediate loading associated with tilted implants could be considered a viable treatment modality for the mandible.