Search

Objective: The aim of this study was to analyze the effects of periodontal treatment on markers of atherosclerotic coronary artery disease and circulating levels of periostin. Background: Periostin is necessary for periodontal stability, but it is highly present in atherosclerotic plaques. Treatment of periodontal disease, with low levels of local periostin, is thought to reduce systemic levels of periostin. Thus, this may contribute to cardiovascular health. Methods: A pilot randomized controlled clinical trial was designed to include patients with severe periodontal disease and history of atherosclerotic coronary artery disease. Samples of gingival crevicular fluid (GCF) and serum were collected before and after periodontal treatment by periodontal surgery or non‐surgical therapy. The levels of several markers of inflammation and cardiovascular damage were evaluated including CRP, IFN‐γ, IL‐1ß, IL‐10, MIP‐1α, periostin, and TNF‐α in GCF and CRP, Fibrinogen, IFN‐γ, IL‐1ß, IL‐6, IL‐10, L‐Selectin, MIP‐1α, Periostin, TNF‐α, and vWF in serum. Results: A total of 22 patients with an average of 56 years old were recruited for participating in this study. Twenty of them were male. Most of them (82%) had suffered an acute myocardial event and underwent surgery for placing 1, 2, or 3 stents in the coronary arteries more than 6 months ago but less than 1 year. The treatment of periodontal disease resulted in an overall improvement of all periodontal parameters. Regarding the evaluation of GCF and serum, a significant increase of periostin in the GCF was observed after periodontal surgery. In contrast, although other markers in GCF and serum improved, no significant correlations were found. Conclusion: Treatment of periodontal disease through periodontal surgery induces a local and transient increase in the levels of periostin in the gingival crevicular fluid. The effects on systemic markers of inflammation and cardiovascular function have not been confirmed. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to detect and compare the tissular expression of neutrophil extracellular traps (NETs) in peri‐implant and periodontal samples of patients with peri‐implantitis, periodontitis, and controls. Materials and Methods: An observational study was performed on patients with peri‐implantitis, periodontitis, and controls. Peri‐implant and/or periodontal clinical examinations were performed on each participant. Tissue samples were collected during tooth/implant extraction for clinical reasons. Electron microscopy analysis, Picro‐Sirius red staining, immunohistochemical (CD15), and immunofluorescence (citrullinated H3 and myeloperoxidase) techniques were performed to detect NET‐related structures and the degree of connective tissue destruction, between the study groups. Results: Sixty‐four patients were included in the study: 28 peri‐implantitis, 26 periodontitis, and 10 controls, with a total of 51 implants, 26 periodontal teeth, and 10 control teeth. Neutrophil release of nuclear content was observed in transmission electron microscopy. Immunohistochemical analysis showed a greater CD15 expression in both peri‐implantitis and periodontitis compared to controls (p < 0.001), and peri‐implantitis presented lower levels of connective tissue and collagen compared to both periodontitis (p = 0.044; p < 0.001) and controls (p < 0.001). Immunofluorescence showed greater citH3 expression in peri‐implantitis than the one found in both periodontitis (p = 0.003) and controls (p = 0.048). Conclusions: A greater presence and involvement of neutrophils, as well as a greater connective tissue destruction were observed in cases of peri‐implantitis. A higher expression of NET‐related markers was found in mucosal samples of peri‐implantitis compared to periodontitis and controls. [ABSTRACT FROM AUTHOR]

Implant dentistry has evolved to the point that standard implant osseointegration is predictable. This is attributed in part to the advancements in material sciences that have led toward improvements in implant surface technology and characteristics. Nonetheless, there remain several cases where implant therapy fails (specifically at early time points), most commonly attributed to factors affecting bone metabolism. Among these patients, smokers are known to have impaired bone metabolism and thus be subject to higher risks of early implant failure and/or late complications related to the stability of the peri‐implant bone and mucosal tissues. Notably, however, emerging data have unveiled other critical factors affecting osseointegration, namely, those related to the metabolism of bone tissues. The aim of this review is to shed light on the effects of implant‐related factors, like implant surface or titanium particle release; surgical‐related factors, like osseodensification or implanted biomaterials; various drugs, like selective serotonin reuptake inhibitors, proton pump inhibitors, anti‐hypertensives, nonsteroidal anti‐inflammatory medication, and statins, and host‐related factors, like smoking, diet, and metabolic syndrome on bone metabolism, and aseptic peri‐implant bone loss. Despite the infectious nature of peri‐implant biological complications, these factors must be surveyed for the effective prevention and management of peri‐implantitis. [ABSTRACT FROM AUTHOR]

Background: Inflammasome components NLRP3 and AIM2 contribute to inflammation development by the activation of caspase‐1 and IL‐1β. They have not been yet evaluated in samples from patients with active peri‐implantitis. Thus, the aim of the present study is to analyze the expression of inflammasomes NLRP3 and AIM2 and subsequent caspase 1 and IL‐1β assessing the microenvironment of leukocyte subsets in samples from patients with active peri‐implantitis. Methods: Biopsies were collected from 33 implants in 21 patients being treated for peri‐implantitis. Biopsies from gingival tissues from 15 patients with healthy periodontium were also collected for control. These tissues were evaluated through conventional histological stainings. Then, immunohistochemical detection was performed to analyze NLRP3, AIM2, caspase‐1, and IL‐1β and markers of different leukocyte subsets. PCR for inflammasomes and related genes was also done. Results: This manuscript reveals a high immunohistochemical and mRNA expression of NLRP3 and AIM2 inflammasomes, caspase‐1, and IL‐1β in biopsies collected from human peri‐implantitis. The expression of the tested markers was significantly correlated with the increase in inflammatory infiltrate, probing depth, presence of biofilm, and bleeding on probing. In these peri‐implantitis lesions, the area of biopsy tissue occupied by inflammatory infiltrate was intense while the area occupied by collagen was significantly lower. In comparison with periodontal healthy tissues, the inflammatory infiltrate was statistically significantly higher in the peri‐implantitis biopsies and was mainly composed of plasma cells, followed by T and B lymphocytes. Conclusion: In human peri‐implantitis, chronic inflammation can be explained in part by the action of IL‐1β/caspase 1 induced through NLRP3 and AIM2 inflammasome activation. [ABSTRACT FROM AUTHOR]

Rehabilitation of the edentulous maxilla with implant‐supported fixed dental prostheses can represent a significant clinical challenge due to limited bone availability and surgical access, among other factors. This review addresses several treatment options to replace missing teeth in posterior maxillary segments, namely the placement of standard implants in conjunction with maxillary sinus floor augmentation, short implants, tilted implants, and distal cantilever extensions. Pertinent technical information and a concise summary of relevant evidence on the reported outcomes of these different therapeutic approaches are presented, along with a set of clinical guidelines to facilitate decision‐making processes and optimize the outcomes of therapy. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the clinical and radiographic outcomes of single‐tooth implant restorations using one‐piece, internally connected, screw‐retained, computer‐aided design and computer‐aided manufactured monolithic zirconia restorations fabricated on regular diameter implants. Material and methods: Following a 2‐stage surgical procedure, 22 implants placed in anterior and posterior areas in 21 partially edentulous patients (mean age of 55 years; 9 males/12 females) were evaluated in terms of plaque index, pocket probing depth, bleeding on probing, level of oral hygiene (OH), signs of mucositis/peri‐implantitis, esthetic score (ES), gingival zenith position (GZP), papilla index score, the thickness of peri‐implant gingiva, radiographic marginal bone loss, and technical complications. Implants and restorations were prospectively followed from the insertion of the restoration (baseline), up to 12‐months post‐loading. Results: A 100% implant survival rate resulted after loading; one implant was lost before loading. Clinically, patients performed an adequate OH, and tissues were kept healthy. Probing depth showed a slightly lower value at baseline compared to any follow‐up examination (2.26 [0.94] at baseline vs. 2.53 [0.66] mm at 12 months). ES, GZP, and the thickness of the peri‐implant gingiva improved throughout the course of the study. Radiographically, average marginal bone level (MBL) was 0.40 (0.40) mm after 1‐year follow‐up with no differences in average MBL at all time points. Technically, after 1 year of clinical function, neither abutment fracture nor any other serious complications occurred. Hence, prosthetic reconstruction survival rate was 100%. Conclusions: Clinical outcomes of single‐tooth implant restorations using internally connected, screw‐retained, computer‐aided design and computer‐aided manufacturing monolithic zirconia abutments can be considered a reliable treatment alternative after 1‐year clinical observation. [ABSTRACT FROM AUTHOR]

Background: Due to the clinical challenges involved in successfully treating peri‐implantitis, it is imperative to identify patient‐ and implant‐level risk factors for its prevention. The main goal of this retrospective longitudinal radiographic and clinical study was to investigate whether interproximal radiographic implant thread exposure after physiological bone remodeling may be a risk factor for peri‐implantitis. The secondary goal was to evaluate several other potential risk indicators. Methods: Of 4325 active dental school patients having implants placed, 165 partially edentulous adults (77 men, 88 women) aged 30–91 with ≥2 years of follow‐up upon implant restoration were included. Implants with ≥1 interproximal thread exposed (no bone‐to‐implant contact) (n = 98, 35%) constituted the test group and those without exposed threads (n = 182, 65%) the control group. Descriptive, binary, and multivariate regression analyses were evaluated for goodness of fit. Wald tests were used to evaluate for significance set at 0.05. Results: Of the 280 implants (98 test, 182 control), 8 (2.9%) failed over a mean follow‐up period of 7.67 (±2.63) years, and 27 implants (19 test, 8 control) developed peri‐implantitis, with the exposed group having eight‐fold (7.82 times) adjusted greater odds than the non‐exposed. The risk increased four‐fold (3.77 times) with each thread exposed. No other patient‐ or implant‐related potentially confounding risk factors were identified. Conclusions: Exposed interproximal implant threads after physiologic bone remodeling may be an independent risk indicator for incident peri‐implantitis. Hence, clinicians should closely monitor patients with implant threads that have no bone‐to‐implant contact for incident peri‐implantitis. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the present review and meta‐analysis was to evaluate the influence of soft tissue thickness on initial bone remodeling after implant installation. Materials and Methods: A literature search was conducted by two independent reviewers on electronic databases up to May 2022. Randomized controlled trials (RCTs) and controlled clinical trials (CCTs) performed on human subjects were included. The risk of bias was evaluated using Cochrane Collaboration's tool. Meta‐analysis and Trial Sequential Analysis (TSA) were performed on the selected articles. The primary outcome was marginal bone loss. Results: After screening, 6 studies were included in the final analysis, with a total of 354 implants, and a follow‐up from 10 to 14 months. 194 implants were placed in a ≥ 2 mm soft tissue thickness, while 160 had <2 mm soft tissue thickness before implant placement. The included studies had a high level of heterogeneity (I2 > 50%). The meta‐analysis indicated a statistically significant difference between the two groups (0.54; p =.027) and the TSA analysis confirmed the results, despite the limited number of dental implants. Additional analysis showed that age and follow‐up parameters were not statistically significant factors influencing the bone loss (p =.22 and p =.16, respectively). Conclusions: Based on the available RCTS and CCTs, initial soft tissue thickness seems to influence marginal bone loss after a short follow‐up period. Based on TSA analysis, further studies are needed to assess the influence of the soft tissue thickness on marginal bone loss. PROSPERO registration number: CRD42021235324. [ABSTRACT FROM AUTHOR]

Aim: This study was primarily aimed at assessing the effect that specific periodontal phenotypical characteristics have on alveolar ridge remodelling after tooth extraction. Materials and Methods: Patients in need of extraction of a non‐molar maxillary tooth were enrolled. Baseline phenotypical characteristics (i.e., mid‐facial and mid‐palatal soft tissue and bone thickness, and supracrestal soft tissue height [STH]) were recorded upon extraction. A set of clinical, digital imaging (linear and volumetric), and patient‐reported outcomes were assessed over a 14‐week healing period. Results: A total of 78 subjects were screened. Forty‐two subjects completed the study. Linear and volumetric bone changes, as well as vertical linear soft tissue and alveolar ridge volume (soft tissue contour) variations, were indicative of a marked dimensional reduction of the alveolar ridge over time. Horizontal facial and palatal soft tissue thickness gain was observed. Thin facial bone (≤1 mm) upon extraction, compared with thick facial bone (>1 mm), was associated with greater linear horizontal (−4.57 ± 2.31 mm vs. –2.17 ± 1.65 mm, p =.003) and vertical mid‐facial (−0.95 ± 0.67 mm vs. –4.08 ± 3.52 mm, p < 0.001) and mid‐palatal (−2.03 ± 2.08 mm vs. –1.12 ± 0.99 mm, p = 0.027) bone loss, as well as greater total (−34% ± 10% vs. 15% ± 6%, p < 0.001), facial (−51% ± 19% vs. 28% ± 18%, p = 0.040), and palatal bone volume reduction (−26% ± 14% vs. –8% ± 10%, p < 0.001). Aside from alveolar bone thickness, STH was also found to be a predictor of alveolar ridge resorption since this variable was directly correlated with bone volume reduction. Patient‐reported discomfort scores progressively decreased over time, and the mean satisfaction upon study completion was 94.5 ± 0.83 out of 100. Conclusions: Alveolar ridge remodelling is a physiological phenomenon that occurs after tooth extraction. Post‐extraction alveolar ridge atrophy is more marked on the facio‐coronal aspect. These dimensional changes are more pronounced in sites exhibiting a thin facial bone phenotype (Clinicaltrials.gov NCT02668289). [ABSTRACT FROM AUTHOR]

Background: Anorganic bovine bone has been deeply studied for bone regeneration in the oral cavity. Different manufacturing processes can modify the final composition of the biomaterial and the responses that induce. Aim: To evaluate the physico‐chemical characteristics of a bovine bone mineral matrix and the clinical, radiographical, histological, and mRNA results after using it for maxillary sinus floor augmentation in humans. Materials and Methods: First, the physical–chemical characteristics of the biomaterial were evaluated by X‐ray powder diffraction, X‐ray fluorescence, and electron microscopy. A frequently used biomaterial with the same animal origin was used as comparator. Then, a clinical study was designed for evaluating clinical, radiographical, histological, and mRNA outcomes. Patients in need of two‐stage maxillary sinus floor augmentation were included in the study. Six months after the grafting procedure, a bone biopsy was collected for evaluation. Results: In terms of physico‐chemical characteristics, no differences were found between both biomaterials. Clinically, 10 patients were included in the study. After 6 months, clinical and radiographical data showed adequate outcomes for allowing implant placement. Histological, immunohistochemical and mRNA analyses showed that the biomaterial in use provides biological support to induce responses similar to those of other commonly used biomaterials. Conclusion: Bovine bone mineral matrix (Creos™ Xenogain) used as a single material for maxillary sinus floor augmentation shows adequate biological, clinical, and radiological outcomes. In fact, the results from this study are similar to those reported in the literature for another bovine bone‐derived biomaterial with whom it shares composition and micro‐ and nanoscale characteristics. [ABSTRACT FROM AUTHOR]

Background: There is limited information on the need for bone augmentation in the context of delayed implant placement whether alveolar ridge preservation (ARP) is previously performed or not. The primary aim of this retrospective cohort study was to evaluate the efficacy of ARP therapy after tooth extraction compared with unassisted socket healing (USH) in reducing the need for ancillary bone augmentation before or at the time of implant placement.Methods: Adult subjects that underwent non-molar single tooth extraction with or without simultaneous ARP therapy were included in this study. Cone beam computed tomography scans obtained before tooth extraction and after a variable healing period were used to record the baseline facial bone thickness and to virtually plan implant placement according to a standard method. A logistic regression model was used to evaluate the effect of facial alveolar bone thickness upon tooth extraction and baseline therapy (USH or ARP) on the need for additional bone augmentation, adjusting for several covariates (i.e., age, sex, baseline KMW, and tooth type).Results: One hundred and forty subjects that were equally distributed between both baseline therapy groups constituted the study population. Implant placement was deemed virtually feasible in all study sites. Simultaneous bone augmentation was considered necessary in 60% and 11.4% of the sites in the USH and ARP group, respectively. Most of these sites (64.2% in the USH group and 87.5% in the ARP group) exhibited a thin facial bone phenotype (<1 mm) at baseline. Logistic regression revealed that the odds of not needing ancillary bone augmentation were 17.8 times higher in sites that received ARP therapy. Furthermore, the need for additional bone augmentation was reduced 7.7 times for every 1 mm increase in facial bone thickness, regardless of baseline therapy.Conclusions: Based on a digital analysis, ARP therapy, compared with USH, and thick facial alveolar bone largely reduce the need for ancillary bone augmentation at the time of implant placement in non-molar sites. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the healing outcomes in non‐molar post‐extraction sockets filled with deproteinized bovine bone mineral with collagen (DBBM‐C) as a function of time. Materials and Methods: Patients in need of non‐molar tooth extraction were randomly allocated into one of three groups according to the total healing time (A—3 months; B—6 months; C—9 months). The effect of alveolar ridge preservation (ARP) therapy via socket filling using DBBM‐C and socket sealing with a porcine collagen matrix (CM) was assessed based on a panel of clinical, digital, histomorphometric, implant‐related, and patient‐reported outcomes. Results: A total of 42 patients completed the study (n = 14 in each group). Histomorphometric analysis of bone core biopsies obtained at the time of implant placement showed a continuous increase in the proportion of mineralized tissue with respect to non‐mineralized tissue, and a decrease in the proportion of remaining xenograft material over time. All volumetric bone and soft tissue contour assessments revealed a dimensional reduction of the alveolar ridge overtime affecting mainly the facial aspect. Linear regression analyses indicated that baseline buccal bone thickness is a strong predictor of bone and soft tissue modelling. Ancillary bone augmentation at the time of implant placement was needed in 16.7% of the sites (A:2; B:1; C:4). Patient‐reported discomfort and wound healing index scores progressively decreased over time and was similar across groups. Conclusions: Healing time influences the proportion of tissue compartments in non‐molar post‐extraction sites filled with DBBM‐C and sealed with a CM. A variable degree of alveolar ridge atrophy, affecting mainly the facial aspect, occurs even after performing ARP therapy. These changes are more pronounced in sites exhibiting thin facial bone (≤1 mm) at baseline (Clinicaltrials.gov NCT03659617). [ABSTRACT FROM AUTHOR]

Purpose: The aim of the present study was to evaluate the 5‐year results in terms of marginal bone level (MBL) around implants supporting fixed full‐arch metal‐ceramic restorations in a series of cases of patients who had lost their teeth in that dental arch because of severe periodontal disease. Material and Methods: A retrospective cohort study was designed to evaluate the 5‐year MBL results of OsseoSpeed™ Astra Tech TX implants with internal tapered conical connection. Age, gender, bone substratum, smoking habits, history of periodontitis, and prosthetic features were recorded. Mixed linear model was used to determine the influence of the different variables on MBL. Results: In this series, a total of 160 implants placed in 19 patients were evaluated. No implant failure was reported during the 5 years of follow‐up. Only 14 (8.75%) implants had more than 2 mm of MBL. Abutment height, F(3,142) = 6.917, p <.001, and implant diameter, F(1,141) = 15.059, p <.001, were determined to be statistically associated with MBL. No other effect was significant. Pairwise comparisons showed that MBL was larger for abutment height = 1 (MBL = −0.987, SE = 0.186) compared with the remaining heights [−0.335 (0.171), −0.169 (0.192) and −0.247 (0.267), 2, 4 and 6 mm, respectively]. MBL was larger for narrow (−0.510, SE = 0.169) than for wide implants (−0.364, SE = 0.190). Conclusion: The current study demonstrates that the vast majority of internal conical connection implants supporting fixed full‐arch metal‐ceramic restorations do not suffer from relevant MBL after 5 years in function. Particularly, those implants with transmucosal abutments longer than 2 mm show less than 0.5 mm from the implant shoulder to the marginal bone. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to establish an objective criterion in terms of marginal bone level (MBL) to know the prognosis of an implant. Materials and Methods: A group of 176 patients in whom 590 implants were placed were included in this retrospective study. Patients older than 18 years, presenting either Kennedy class I or II edentulous section, or totally edentulous at least in one of the dental arches were included in this study. Those with any type of disturbance able to alter bone metabolism or with nontreated periodontal disease were excluded. Data on radiographic MBL at loading, 6 and 18 months later, age, gender, smoking habits, history of periodontitis, bone substratum, implant, and prosthetic features were recorded. Nonparametric receiver operating curves (ROC) were constructed for the MBL at 18 months in order to establish a distinction among high bone loser (HBL) and low bone loser (LBL) implants. Differences as a function of main variables were also determined, particularly abutment height and periodontal disease. Results: HBL implants lost at least 0.48 mm of MBL 6 months after loading; they reached at least 2 mm of MBL 18 months after loading. MBL rate followed a nonlinear trend, except in implants restored over long prosthetic abutments and in patients with history of severe periodontitis; in whom the rate of MBL over the time was nearly zero. Conclusion: Implants that lose more than 0.5 mm of marginal bone 6 months after loading are at great risk of not being radiographically successful anymore. Therefore, 0.5 mm of MBL is proposed as a distinctive and objective criterion of success in Implant Dentistry within a 6‐month follow‐up period. A prosthetic abutment height ≥2 mm resulted the most protective factor in the peri‐implant bone maintenance. [ABSTRACT FROM AUTHOR]

Introduction: Ageing leads to physiological cognitive decline that it is worsened in people with neurodegenerative diseases such as Alzheimer's disease. Despite the ongoing search for a solution to this cognitive decline, no effective remedies have been established. It has been determined that modifiable external factors, such as oral health and occlusal function, prevent cognitive decline.Objective: To analyse the primary interactions between occlusal function and cognitive functions.Main Findings: Masticatory function is related to cognitive functions. In particular, current evidence, from both animal and human studies, suggests that the activation of masticatory muscles and proper mastication, with natural teeth or dental prosthesis, induces the release of several mediators and the activation of specific brain areas. Together, they result in higher neuronal activity, neurotrophic support, blood flow and the prevention of amyloid-beta plaque formation. Thus, all the components of the masticatory system must work together in order to preserve cognitive function.Conclusions: Available evidence suggests that oral and cognitive health are more interconnected than previously thought. Therefore, maintenance and adequate restoration of the whole masticatory system are important for the prevention of cognitive decline. In summary, oral and chewing health lead to healthy cognitive ageing. [ABSTRACT FROM AUTHOR]

Purpose: To review the most up to date scientific evidence concerning the technical implications, soft tissue biocompatibility, and clinical applications derived from the use of titanium nitride hard thin film coatings on titanium alloy implant abutments. Materials and Methods: A review was performed to answer the following focused question: "What is the clinical reliability of nitride coated titanium alloy abutments?". A MEDLINE search between 1980 and 2021 was performed for investigations pertaining to the clinical use of nitride coated titanium alloy implant abutments (TiN) in case reports, case series, and short‐ and long‐term non/randomized controlled clinical trials. Literature analysis led to addition evaluation of research related to the technical and biological aspects, as well as the physicochemical characteristics of TiN hard thin film coatings and their impact on titanium abutment biocompatibility, mechanical properties, macroscopic surface topography, and optical properties. Therefore, preclinical data from biomechanical and in vitro investigations were also considered as inclusion criteria. Results: The limited number of clinical investigations published made a systematic review and meta‐analysis not possible, therefore a narrative review was conducted. TiN coatings have been applied to dental materials and instruments to improve their clinical longevity. Implant abutments are coated with titanium nitride to mask the titanium oxide surface and enhance its surface characteristics providing the TiN abutment surface with a low friction coefficient and a very high chemical inertness. TiN coating is suggested to reduce early bacterial colonization and biofilm formation and enhance fibroblast cell proliferation, attachment and adhesion when compared to Ti controls. Additionally, studies indicate that hard thin film coatings enhance the mechanical properties (hardness and wear resistance) of titanium alloy and appears as a yellow color when deposited on the titanium alloy substrate. To date, clinical investigations show that nitride coated titanium abutments provide promising short‐term clinical outcomes. Conclusions: Published research on nitride‐coated abutments is still limited, however, the available biomedical research, mechanical engineering tests, in vitro investigations, and short‐term clinical trials have, to date, reported promising mechanical, biological, and esthetic outcomes. [ABSTRACT FROM AUTHOR]

Background: The 2017 World Workshop classified peri-implant diseases into health, peri-implant mucositis, and peri-implantitis. The aim of this article is to build upon this recent classification and propose a framework for the diagnosis of peri-implant status after surgical treatment for peri-implantitis.Methods: A literature review was conducted to discuss the relevant diagnostic, clinical, and radiographic parameters, including probing depth, bleeding on probing, visual inspection, and radiographic bone loss. Case definitions of possible treatment outcomes were discussed, and a flowchart was constructed to guide post-treatment diagnosis according to the possible clinical scenarios which can be encountered in daily practice.Results: Three possible treatment outcomes were identified after resective treatment of peri-implantitis: 1) peri-implant health with a reduced support, 2) peri-implant mucositis with a reduced support, and 3) recurrent/refractory peri-implantitis. After regenerative treatment for peri-implantitis, the peri-implant condition was classified according to the same diagnoses with the addition of peri-implant health or peri-implant mucositis after complete regeneration for cases where complete regeneration was attained. Criteria for successful treatment of peri-implantitis were proposed. After resective therapy, a successful treatment outcome was defined as peri-implant health with a reduced support, whereas, after regenerative therapy, a successful outcome was described as either peri-implant health after complete regeneration or peri-implant health with a reduced support.Conclusions: The proposed classification system of peri-implant status after surgical treatment for peri-implantitis provides a framework for diagnosing the various forms of peri-implant stability or disease to guide clinical decision-making post-treatment. [ABSTRACT FROM AUTHOR]

Aim: To compare the effectiveness of two xenografts for maxillary sinus floor augmentation in terms of clinical, radiographical, histologic, and molecular outcomes. Materials and methods: A split‐mouth randomized clinical trial was conducted at the University of Granada. Ten consecutive patients in need of bilateral two‐staged maxillary sinus floor augmentation were included. Each patient received both biomaterials (porcine bone mineral and anorganic bovine bone), which were randomly assigned for bilateral sinus augmentation. The maxillary autogenous bone scraped from the sinus access window was mixed with each xenograft at a 20:80 ratio. After a healing period of 6 months, bone biopsies were collected with a trephine during the implant placement in the regenerated area. Histologic, histomorphometrical, immunohistochemical, and molecular outcomes were analyzed. Clinical and radiographical data throughout the treatment phases were also evaluated. Results: The resulting anatomic features were similar between both groups. After six months of graft consolidation, the graft resorption rates were similar between both biomaterials. The histologic, histomorphometrical, and immunohistochemical results showed no statistical differences between groups. Conclusion: Anorganic bovine bone and porcine bone mineral combined with maxillary autogenous cortical bone show similar biologic and radiologic features in terms of biomaterial resorption, osteoconduction, and osteogenesis when used for maxillary sinus floor augmentation. [ABSTRACT FROM AUTHOR]

Background: The treatment of the peri‐implantitis remains complex and challenging with no consensus on which is the best treatment approach. Purpose To examine the key local and systemic factors associated with implant loss, disease progression, or favorable outcomes after surgical peri‐implantitis therapy. Materials and Methods: Records of patients treated for peri‐implantitis were screened. Patient‐, implant‐ and surgery‐related variables on and prior to the day of the surgery were collected (T0: time of peri‐implantitis treatment). If the treated implant was still in function when the data was collected, the patient invited to participate for a recall study visit (T1, longest follow‐up after treatment). Impacts of the variables on the implant survival, success, and peri‐implant bone change after treatment were investigated. Results: Eighty patients with 121 implants with a mean follow‐up of 42.6 ± 26.3 months were included. A total of 22 implants (18.2%) were removed during the follow‐up period. When relative bone loss (%) was in range 25%–50%, risk for implant removal increased 15 times compared to lower bone loss <25% (OR = 15.2; CI: 2.06–112.7; p = 0.008). Similarly, relative bone loss of >50% increased 20 times the risk of implant failure compared to the <25% (OR = 20.2; CI: 2.42–169.6; p = 0.006). For post‐treatment success rate, history of periodontitis significantly increased the risk of unsuccess treatment (OR = 3.07; p = 0.04) after resective surgery). Conclusion: Severe bone loss (>50%) poses significantly higher risk of treatment failure. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate alveolar ridge dimensional changes of different alveolar ridge preservation techniques after 3 months of tooth extraction and to compare the efficacy of autologous plasma rich in growth factor (PRGF) to the bone substitutes in alveolar ridge preservation and sites left to heal spontaneously. Materials and Methods: Forty patients requiring tooth extraction in the anterior maxilla were randomly allocated to the four following treatment modalities: spontaneous healing (control), natural bovine bone mineral covered with resorbable native collagen membrane (BBM/CM), freeze‐dried bone allograft covered with resorbable native collagen membrane (FDBA/CM) and PRGF alone. Cone beam computed tomography (CBCT) scans were taken after surgery and 3 months later. The measurements of height and width (at 1, 3, and 5 mm below the crest) were performed after superimposing the 2 consecutive CBCT scans. Results: The greatest horizontal alveolar bone resorption at 1 mm below bone crest was observed in the control group (−1.61 ± 1.76 mm, P =.037), whereas the least reduction in width was found in the BBM/CM group (−0.68 ± 0.67 mm, P =.037). The most pronounced alveolar height reduction was observed in the control group (−0.86 ± 0.43 mm), whereas alveolar ridge preservation with BBMC/CM (−0.26 ± 0.91 mm) and PRGF (−0.54 ± 0.86 mm) successfully reduced the alveolar height reduction as compared to the control group. Conclusions: Alveolar ridge preservation technique in the esthetic zone using BBM/CM or using PRGF is beneficial to reduce horizontal and vertical bone changes. [ABSTRACT FROM AUTHOR]

Aim: To compare the influence of the abutment height and its insertion timing on the marginal bone change (MBC) variation of implants placed at posterior mandibular partial edentulous areas in a medium follow‐up period. Material and methods: This randomized clinical trial (RCT) comprised a sample of patients with posterior mandibular edentulous areas, treated with at least two implants and distributed into three groups: implants connected to a 2 mm height abutment during the surgical stage (Group A); implants connected to a 1 mm height abutment during the surgical stage (Group B); and implants connected to a 2 mm height abutment after 2 months (Group C). Clinical and radiographic measurements were performed during a 36‐month period (T4). The MBC was set as the main variable in study. Statistical significance was set at 0.05. Results: A total of 29 subjects and 59 implants were enrolled in this study. A mean MBC of 0.35 ± 0.46 mm, 0.60 ± 0.81 mm, and 0.71 ± 0.90 mm was computed for groups A, B and C, respectively, at T4. Significant differences were found between groups A and C in terms of MBC variation after 3 years of treatment (p =.048). Multiple linear regression analysis showed a significant influence of the first‐year MBC and the abutment insertion timing has independent predictor variables for the MBC assessed at T4. Conclusion: The installation of 2‐mm prosthetic abutments, at the time of implant placement, in areas with limited keratinized mucosa presents as a favorable treatment option in terms of periimplant marginal bone maintenance. [ABSTRACT FROM AUTHOR]

The present investigation is aimed at systematically analyzing the recent literature about the innovative scaffold involved in the reconstructive surgeries by applying growth factors and tissue engineering. An extensive review of the contemporary literature was conducted according to the PRISMA guidelines by accessing the PubMed, Embase, and Scopus Elsevier databases. Authors performed the English language manuscript research published from 2003 to 2020. A total of 13 relevant studies were included in the present review. The present systematic review included only papers with significant results about correlation between scaffold, molecular features of growth factor, and reconstructive surgeries in oral maxillofacial district. The initial research with filters recorded about 1023 published papers. Beyond reading and considering of suitability, only 42 and then 36 full-text papers were recorded for the revision. All the researches recorded the possibility of using growth factors on rebuilding atrophic jaws. Different growth factors like morphogenetic factors, cytokines, and inflammatory ones and their application over different scaffold materials were recorded. Further investigations should be required in order to state scientific evidence about a clear advantage of applying tissue engineering for therapeutic purpose. [ABSTRACT FROM AUTHOR]

Objectives: To compare the marginal bone level around implants with a thin multi‐phosphonate coated surface after either an early or conventional loading protocol. Material and methods: A randomized pilot clinical trial was conducted. Dental impressions were obtained after either 4 (test) or 8 weeks (control) and single crowns screwed‐in 2 weeks later. Several variables were evaluated including radiographical marginal bone level (MBL), patient's level variables, and those related to the restoration and surrounding tissues. These data were obtained at several time points up to a 1‐year follow‐up. Results: Thirty‐four patients were included in the study, 18 assigned to the test group. No differences at implant placement were detected for tissue thickness, keratinized mucosa, nor any other clinical or radiological variable. At the time of impressions, tissue was thinner in the test group (2.30 (0.46) versus 2.78 (0.66) mm, test versus control, respectively; p =.012) so shorter abutments were used in this group. Regardless, no significant changes in marginal bone level were detected neither within group along time nor between groups. The average MBL at the 1‐year follow‐up was −0.15 (0.32) versus −0.22 (0.37) (p =.443) (test versus control, respectively). None of the clinical or radiological variables evaluated had a determinant influence on the MBL at any visit nor group. Conclusion: The use of implants with a multi‐phosphonate coated surface for early loading offers successful radiographical outcomes 1 year after loading. MBL over time was not affected by taking the impressions 4 or 8 weeks after implant placement and loading them 2 weeks later. [ABSTRACT FROM AUTHOR]

Objectives: To analyze a modified biphasic phycogenic biomaterial in comparison with anorganic bovine bone in maxillary sinus floor elevation in humans. Material and methods: Eight male patients in need of bilateral two‐stage sinus floor elevation were consecutively recruited for this randomized split‐mouth study. A combination of autogenous cortical bone (ACB, 20%) and anorganic bovine bone (ABB, 80%) (ACB + ABB group) or ACB (20%) and modified biphasic phycogenic material (BP, 80%) (ACB + BP group) were randomly assigned to graft each sinus. Patients were followed up for 6 months post‐surgery when bone samples were collected for analysis. Results: Radiographically, bone height gain was statistically higher in the ACB + ABB versus the ACB + BP group. While the analysis of the biological compartments showed differences in non‐mineralized tissue (39.15 ± 20.97% vs. 65.87 ± 28.59%, ACB + ABB vs. ACB + BP respectively; p =.018) and remnant biomaterial particles (22.62 ± 17.01% vs. 7.96 ± 8.57%, respectively; p =.028), the percentage of mineralized tissue (38.23 ± 17.55% vs. 24.14 ± 24.66%, respectively; p =.398) showed no statistically significant difference. In contrast, ACB + ABB biopsies showed higher Musashi‐1‐positive cells per mm2 compared to ACB + BP biopsies (811.49 ± 875.30 vs. 236.90 ± 280.81; p <.018), where the fusiform cells corresponded mainly with fibroblasts, as demonstrated by ultrastructural analysis. Conclusion: Both combinations of materials exhibited bone formation after 6 months of healing in the maxillary sinus cavity. However, the combination with biphasic phycogenic biomaterial induced a higher radiographical vertical resorption and graft collapse in comparison with the combination with anorganic bovine bone, possibly due to a higher remodeling of the graft. [ABSTRACT FROM AUTHOR]

Background: Vertical bone augmentation (VBA) remains unpredictable and challenging for most clinicians. This study aims to compare hard tissue outcomes of VBA, with and without recombinant human bone morphogenetic protein (rhBMP)-2, under space-making titanium mesh in a canine model.Methods: Eleven male beagle dogs were used in the study. Experimental ridge defects were created to form atrophic ridges. VBA was performed via guided bone regeneration using titanium mesh and allografts. In experimental hemimandibles, rhBMP-2/absorbable collagen sponge was well mixed with allografts prior to procedures, whereas a control buffer was applied within controls. Dogs were euthanized after a 4-month healing period. Clinical and radiographic examinations were performed to assess ridge dimensional changes. In addition, specimens were used for microcomputed tomography (micro-CT) assessment and histologic analysis.Results: Membrane exposure was found on five of 11 (45.5%) rhBMP-2-treated sites, whereas it was found on nine of 11 (81.8%) non-rhBMP-2-treated sites. Within 4 months of healing, rhBMP-2-treated sites showed better radiographic bone density, greater defect fill, and significantly more bone gain in ridge height (P <0.05) than controls. Experimental hemimandibles exhibited lower rates of membrane exposure and a noteworthy, ectopic bone formation above the mesh in 72% of sites. Results from micro-CT also suggested a trend of less vertical bone gain and bone mineral density in controls (P >0.05). Under light microscope, predominant lamellar patterns were found in the specimen obtained from rhBMP-2 sites.Conclusion: With inherent limitations of the canine model and the concern of such a demanding surgical technique, current findings suggest that the presence of rhBMP-2 in a composite graft allows an increase of vertical gain, with formation of ectopic bone over the titanium mesh in comparison with non-rhBMP-2 sites. [ABSTRACT FROM AUTHOR]

Background: Poly (lactic‐co‐glycolic acid) (PLGA) is widely used for the development of delivery systems for drugs and therapeutic biomolecules in tissue engineering applications. Particles of biphasic calcium phosphate can be covered by PLGA to change their manipulating characteristics. Purpose: Aim of this study was to investigate the radiological and histomorphometric results of the use of PLGA‐coated biphasic calcium phosphate granules in sinus floor elevation and to analyze the underlying molecular processes by immunohistochemical staining. Materials and Methods: A randomized clinical study was designed to include patients in need of sinus floor elevation. Patients were assigned to receive either PLGA‐coated biphasic calcium phosphate particles (group I) or the equivalent but noncoated particles (group II). Cone beam computed tomography (CBCT) scans were performed before and 6 months after the procedure to assess the bone height gain. At the time of implant placement, bone core biopsies were obtained at the site of implant placement. Histological sections were subjected to histomorphometric and immunohistochemical evaluation of differentiation markers (Musashi‐1 [MSI1]). Results: No statistically significant differences were observed between groups for the radiologic parameters. No differences were observed histologically or histomorphometrically. However, PLGA‐coated particles (group I) were more colonized by MSI1‐positive osteoblast precursors (P = 0.0001, chi‐squared test) and were penetrated by more CD34‐positive vascular structures (P = 0.001, chi‐squared test) than noncoated particles (group II). Conclusions: PLGA‐coated particles are associated with more MSI11‐positive cells and more extensive microvascularization than noncoated particles. [ABSTRACT FROM AUTHOR]

Background and Aims: To describe the biology of alveolar bone regeneration. Material and Methods: Four comprehensive reviews were performed on (a) mesenchymal cells and differentiation factors leading to bone formation; (b) the critical interplay between bone resorbing and formative cells; (c) the role of osteoimmunology in the formation and maintenance of alveolar bone; and (d) the self‐regenerative capacity following bone injury or tooth extraction were prepared prior to the workshop. Results and Conclusions: This summary information adds to the fuller understanding of the alveolar bone regenerative response with implications to reconstructive procedures for patient oral rehabilitation. The group collectively formulated and addressed critical questions based on each of the reviews in this consensus report to advance the field. The report concludes with identified areas of future research. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to evaluate and compare the morphometric components and the histological properties of pristine bone and bone grafted with a biphasic ß‐tricalcium phosphate in humans using the maxillary sinus model. Reparative mesenchymal stem cells in the pristine bone and graft were also evaluated. Materials and Methods: For this prospective case series, sinus augmentation was performed using a biphasic ß‐tricalcium phosphate. After 6 months of healing, a core of remnant native alveolar bone and grafted bone was collected with a trephine. Histological, histomorphometrical, and immunohistochemical techniques were performed. Radiological analysis through cone beam computerized tomography was also conducted. Results: A total of 10 patients were enrolled in this study. Radiologically, patients showed an average increase of crestal bone of 8.03 ± 1.72 mm. Morphologically, the grafted area was composed by 34.93 ± 14.68% of new mineralized tissue, 9.82 ± 11.42% of remnant biomaterial particles, and 55.23 ± 11.03% non‐mineralized tissue. Histologically, we found no differences in the number of osteocytes per mm2 (p = 0.674), osteoblasts (p = 0.893), and blood vessels (p = 0.894) in the grafted area compared to the pristine bone. Differences were found on the number of osteoclasts (15.57 ± 27.50 vs. 5.37 ± 16.12, p = 0.027). The number of Musashi‐1 positive mesenchymal cells (239.61 ± 177.4 vs. 42.11 ± 52.82, p = 0.027) was also significantly higher in the grafted area than in the pristine bone. Conclusion: Biphasic ß‐tricalcium phosphate is a suitable biomaterial to be used in the formation of new bone in sinus floor elevation procedures in humans, not only from the histomorphometrical point of view, but also regarding the cellular and vascular quality of the regenerated bone. [ABSTRACT FROM AUTHOR]

Background: Multiple variables have been shown to affect early marginal bone loss (MBL). Among them, the location of the microgap with respect to the alveolar bone crest, occlusion, and use of a polished collar have traditionally been investigated as major contributory factors for this early remodeling. Recently, soft tissue thickness has also been investigated as a possible factor influencing this phenomenon. Hence, this study aims to further evaluate the influence of soft tissue thickness on early MBL around dental implants.Methods: Electronic and manual literature searches were performed by two independent reviewers in several databases, including Medline, EMBASE, and Cochrane Oral Health Group Trials Register, for articles up to May 2015 reporting soft tissue thickness at time of implant placement and MBL with ≥12-month follow-up. In addition, random effects meta-analyses of selected studies were applied to analyze the weighted mean difference (WMD) of MBL between groups of thick and thin peri-implant soft tissue. Metaregression was conducted to investigate any potential influences of confounding factors, i.e., platform switching design, cement-/screw-retained restoration, and flapped/flapless surgical techniques.Results: Eight articles were included in the systematic review, and five were included in the quantitative synthesis and meta-analyzed to examine the influence of tissue thickness on early MBL. Meta-analysis for the comparison of MBL among selected studies showed a WMD of -0.80 mm (95% confidence interval -1.18 to -0.42 mm) (P <0.0001), favoring the thick tissue group. Metaregression of the selected studies failed to demonstrate an association among MBL and confounding factors.Conclusion: The current study demonstrates that implants placed with an initially thicker peri-implant soft tissue have less radiographic MBL in the short term. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to compare the influence of the abutment height and insertion timing on early marginal bone loss (MBL) in posterior mandibular partial implant‐supported restorations. Material and methods: The study was planned as a prospective, randomized, controlled parallel group including subjects in need of at least two implants for the restoration of an edentulous posterior mandibular area. The patients were allocated into Groups A (implants immediately connected to 2‐mm height abutments), B (immediately connected 1‐mm height abutments), and C (2‐mm abutments were inserted in a second‐stage surgery). Each subject was placed in a 1‐year follow‐up program, including examination assessment of various soft tissue and bone‐level parameters. Results: A total of thirty‐three patients, including sixty‐eight implants, were enrolled in this study. One implant was lost on group C after the first month of healing. A mean MBL change of 0.719 ± 0.361, 0.651 ± 0.379, and 0.754 ± 0.672 mm was computed for groups A, B, and C, respectively, with no significant differences found. The early MBL at T1 was an independent predictor variable for the marginal bone alterations that were assessed at T3 (p < 0.001). Conclusion: The first‐month MBL variation is a predictor factor of the bone alterations that might occur after 1 year of treatment. The early connection of final prosthetic abutments with distinct heights does not seem to reduce the 1‐year MBL rate when compared with traditional treatment protocols. [ABSTRACT FROM AUTHOR]

Objective: To compare the clinical and histologic outcomes of two different grafting materials (allograft and xenograft) when combined with autogenous bone and covered with a collagen membrane for sinus augmentation. Material and Methods: A parallel case series of fourteen patients in need of a unilateral sinus augmentation was evaluated in this study. Seven patients received a graft composed by autologous cortical bone (ACB) and anorganic bovine bone in a ratio of 1:1; the other seven patients received ACB mixed with an allograft in the same ratio. Bone biopsies were obtained 6 months after sinus augmentation at the time of implant placement. Comparative histomorphometrical, histopathological, and immunohistochemical analyses were conducted and statistically analyzed. Results: After 12 months of functional loading, all implants in both groups were clinical and radiographically successful. Histomorphometrically, although the initial bone formation was not significantly different between groups (new mineralized tissue: 41.03(12.87)% vs. 34.50(13.18)%, p = .620; allograft vs. xenograft groups), the graft resorbed faster in the allograft group (remnant graft particles: 9.83[7.77]% vs. 21.71[17.88]%; p = .026; allograft vs. xenograft groups). Non‐mineralized tissue did not statistically differ either (49.00[14.32]% vs. 43.79[19.90]%; p = .710; allograft vs. xenograft groups). The histologic analyses revealed higher cellular content, four times more osteoid lines, and higher vascularization in the xenograft group. Musashi‐1 (mesenchymal stromal cell marker) was also more intensively expressed in the xenograft group (p = .019). Conclusions: Both composite grafts generate adequate substratum to receive dental implants after healing. Compared with the xenograft composite, allograft composite shows faster turnover and a quicker decrease in biological action after 6 months. [ABSTRACT FROM AUTHOR]

Objective This study was initiated to evaluate the 5-year implant survival rate and marginal bone levels around a 3.0-mm implant when replacing a single tooth in the anterior region. Materials and methods The study was designed as a prospective, single-arm, multicenter clinical study. Patients missing 12, 22, 32, 31, 41 or 42 teeth were included, and implants of 3.0 mm diameter and different lengths were placed by a one-stage surgery protocol. Definitive cemented crowns were placed 6-10 weeks later. Clinical and radiographic measurements were taken at implant installation, at loading and at the 6-, 12-, 24-, 36-, 48- and 60-month follow-up visits. Results Sixty-nine patients with 97 implants were included in this study. Four implants were lost before loading (4.12% failure rate). Implant marginal bone levels did not differ statistically after the 1-year follow-up visit. After 5 years, no bone loss was observed for 50.60% of the implants and only 8.43% of them lost more than 1 mm. Similarly, probing pocket depths and gingival zenith scores did not change significantly. Conclusions The use of the two-piece narrow 3.0-mm titanium dental implant for the restoration of upper lateral or lower incisors is safe and results in stable marginal bone levels and probing pocket depths after 5 years of function. [ABSTRACT FROM AUTHOR]

Objective: To investigate how the distance between narrow implants and adjacent teeth influences the marginal bone levels (MBL) up to 3 years after placement. Material and Methods: A prospective, single-arm, multicenter clinical study was designed to include patients missing 12, 22, 32, 31, 41 or 42 teeth. Implants of 3.0 mm diameter and different lengths were used in the study. One-stage surgery was performed and healing abutments placed during the 6–10 weeks healing period. Clinical and radiographic evaluation was performed at implant installation, loading, and at the 6, 12, 24 and 36-months follow-up visits. Results: Eighty-three implants were placed in 59 patients. A total of 48 implants were placed in narrow implant-to-tooth spaces (percentile 25, 0.83(0.25) mm), 80 in regular spaces (percentile 25 < x < 75, 1.59(0.26) mm) and 47 in wide spaces (percentile 75, 2.61(0.51) mm). Implant MBL change from restoration delivery to 36 months was of 0.50(0.79), 0.50(0.98) and 0.00(0.55) mm in the narrow, regular and wide distance groups (P = 0.005, Mann–Whitney U-test). Changes in MBL on the adjacent teeth were not significant. Conclusion: The distance between narrow-diameter implants and the adjacent teeth does not influence the marginal bone levels neither at the implant or the tooth side. In this study, less marginal bone loss occurred in the narrower spaces. [ABSTRACT FROM AUTHOR]

Objectives To systematically review changes in mucosal soft tissue thickness and keratinised mucosa width after soft tissue grafting around dental implants. Materials and Methods An electronic literature search was conducted of the MEDLINE database published between 2009 and 2014. Sequential screenings at the title, abstract, and full-text levels were performed. Clinical human studies in the English language that had reported changes in soft tissue thickness or keratinised mucosa width after soft tissue grafting at implant placement or around a present implant at 6-month follow-up or longer were included. Results The search resulted in fourteen articles meeting the inclusion criteria: Six of them reported connective tissue grafting around present dental implants, compared to eight at the time of implant placement. Better long-term soft tissue thickness outcomes were reported for soft tissue augmentation around dental implants (0.8-1.4 mm), compared with augmentation at implant placement (−0.25-1.43 mm). Both techniques were effective in increasing keratinised tissue width: at implant placement (2.5 mm) or around present dental implants (2.33-2.57 mm). Conclusions The present systematic review discovered that connective tissue grafts enhanced keratinised mucosa width and soft tissue thickness for an observation period of up to 48 months. However, some shrinkage may occur, resulting in decreases in soft tissue, mostly for the first three months. Further investigations using accurate evaluation methods need to be done to evaluate the appropriate time for grafting. [ABSTRACT FROM AUTHOR]

Purpose To compare the immediate implant success rates between sites with chronic apical lesions and healthy sites in the same patients 1 year postdelayed loading. Materials and Methods One hundred sixty-eight immediate implants were placed in sixty patients at upper incisor, canine, and premolar sites. A split-mouth design was used, placing a minimum of two implants, one in a fresh socket associated with chronic periapical disease, the average lesion size was larger than 4 mm and less than 8 mm (test group), and the other(s) in a healthy fresh socket (control group). Implant survival rate at 1 year postloading delayed was compared between the groups. Results The implant survival rate was 98.2% for the total sample ( n = 168); out of the three implants lost, two were from the test group, and one was from the control group (in the same patient as one of the former). Among the surviving implants, five were also considered failures due to excessive bone loss ( n = 3) and also because of the recurrence of the periapical lesions ( n = 2). Survival rates were significantly lower in the test than control sites at 12 months postloading. Conclusions Implant survival rates were significantly lower after the immediate implantation in postextraction sockets associated with chronic periapical disease (90.8%) than in healthy postextraction sockets (98.1%). [ABSTRACT FROM AUTHOR]

Introduction The study of classic papers permits analysis of the past, present, and future of a specific area of knowledge. This type of analysis is becoming more frequent and more sophisticated. Our objective was to use the H-classics method, based on the h-index, to analyze classic papers in Implant Dentistry, Periodontics, and Oral Surgery ( ID, P, and OS). Material and methods First, an electronic search of documents related to ID, P, and OS was conducted in journals indexed in Journal Citation Reports ( JCR) 2014 within the category 'Dentistry, Oral Surgery & Medicine'. Second, Web of Knowledge databases were searched using Mesh terms related to ID, P, and OS. Finally, the H-classics method was applied to select the classic articles in these disciplines, collecting data on associated research areas, document type, country, institutions, and authors. Results Of 267,611 documents related to ID, P, and OS retrieved from JCR journals (2014), 248 were selected as H-classics. They were published in 35 journals between 1953 and 2009, most frequently in the Journal of Clinical Periodontology (18.95%), the Journal of Periodontology (18.54%), International Journal of Oral and Maxillofacial Implants (9.27%), and Clinical Oral Implant Research (6.04%). These classic articles derived from the USA in 49.59% of cases and from Europe in 47.58%, while the most frequent host institution was the University of Gothenburg (17.74%) and the most frequent authors were J. Lindhe (10.48%) and S. Socransky (8.06%). Conclusion The H-classics approach offers an objective method to identify core knowledge in clinical disciplines such as ID, P, and OS. [ABSTRACT FROM AUTHOR]

Background Bone morphogenetic proteins ( BMPs) are members of the transforming growth factor- β ( TGFβ) protein superfamily and are known to be involved in bone and cartilage formation. Within this family, BMP-4 is one of the most studied members. It has been shown to induce osteogenic differentiation of osteoblasts and osteoprogenitor cells in vitro, but the intimate processes in which this protein promotes and regulates osseous repair still remains unclear. Purpose To assess whether the native cellular immunohistochemical expression of BMP-4 correlates with the maturation of bone samples obtained at 6 months after maxillary sinus augmentation. Materials and Methods Histopathological and histomorphometrical analyses were performed in all the samples, which were obtained from a total of 58 patients. Immunohistochemical expression of BMP-4 was analyzed in 30 core biopsies obtained from maxillary sinuses grafted with a combination of anorganic bovine bone and autogenous cortical bone [1:1] ( AB-group), and 18 biopsies from maxillary sinuses grafted solely with a cortico-cancellous particulate allograft ( M-group), all of them after a 6-month healing period. Also, 10 biopsies of native pristine bone were obtained and used as control group ( C-group). Results Mild to moderate immunohistochemical expression of native granular BMP-4 was present in 56.8% (31.0% AB-group, 22.4% M-group, and 3.4% C-group) ( p = 0.000, chi-square) of the specimens analyzed. BMP-4 expression was primarily located in the cytoplasm of osteoblasts, osteoclasts, and epithelial cells of the schneiderian membrane. Whereas significant differences were observed in the proportion of mineralized tissue and cellularity between sinuses grafted with anorganic bovine bone, allograft, or nongrafted sinuses, there were no statistically significant differences in the cellular expression of BMP-4 among groups. Conclusion Our findings suggest that the native expression of BMP-4 appears to be associated with normal bone homeostasis and reparation in grafted and nongrafted maxillary sites. [ABSTRACT FROM AUTHOR]

Purpose The purpose was to radiographically analyze and compare the marginal bone loss ( MBL) between implants with different mismatching distance and to study the influence of the prosthetic abutment height on the MBL in association with the related mismatching distances. Material and methods This retrospective study included 108 patients in whom 228 implants were placed, 180 with diameter of 4.5 mm and 48 with diameter of 5 mm. All patients received OsseoSpeed™ implants with internal tapered conical connection (Denstply Implants). Different mismatching distances were obtained, given that all implants were loaded with the same uni-abutment type (Lilac; Denstply Implants). Data were gathered on age, gender, bone substratum, smoking habits, previous history of periodontitis, and prosthetic features. MBL was analyzed radiographically at 6 and 18 months post-loading. Results Mixed linear analysis of mesial and distal MBL values yielded significant effects of abutment, implant diameter, follow-up period, bone substratum, smoking, and abutment × time interaction. MBL was greater at 18 vs. 6 months, for short vs. long abutments, for grafted vs. pristine bone, for a heavier smoking habit, and for implants with a diameter of 5.0 vs. 4.5 mm. Conclusion Greater mismatching does not minimize the MBL; abutment height, smoking habit, and bone substratum may play a role in the MBL over the short- and medium term. [ABSTRACT FROM AUTHOR]

Objective A systematic review and meta-analysis are carried out to assess the scientific evidence that bisphosphonate therapy can decrease the success rate of dental implants. Material and methods The Pub Med ( Medline) database was used to search for articles published up until February 22, 2014. The meta-analysis was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-analysis ( PRISMA). The Newcastle- Ottawa scale ( NOS) was used to assess study quality. Results The combinations of search terms resulted in a list of 256 titles. Fourteen finally met the inclusion criteria and were thus selected for inclusion in the systematic review. Eight studies (six retrospective and two prospective) were included in the meta-analysis, with a total of 1288 patients (386 cases and 902 controls) and 4562 dental implants (1090 dental implants in cases and 3472 in controls). The summary odds ratio ( OR = 1.43, P = 0.156) indicates that there is not enough evidence that bisphosphonates have a negative impact upon implant survival. According to the number need to harm ( NNH), over 500 dental implants are required in patients receiving bisphosphonate treatment to produce a single implant failure. Conclusion Our results show that dental implant placement in patients receiving bisphosphonates does not reduce the dental implant success rate. On the other hand, such patients are not without complications, and risk evaluation therefore must be established on an individualized basis, as one of the most serious though infrequent complications of bisphosphonate therapy is bisphosphonate-related osteonecrosis of the jaws. Given the few studies included in our meta-analysis, further prospective studies involving larger sample sizes and longer durations of follow-up are required to confirm the results obtained. [ABSTRACT FROM AUTHOR]

Objective Cone-beam computed tomography ( CBCT) and radiographic outcomes of crestal sinus elevation, performed using mineralized human bone allograft, were analyzed to correlate results with maxillary sinus size. Material and methods A total of 60 sinus augmentations in 60 patients, with initial bone ≤5 mm, were performed. Digital radiographs were taken at surgical implant placement time up to post-prosthetic loading follow-up (12-72 months), when CBCT evaluation was carried out. Marginal bone loss ( MBL) was radiographically analyzed at 6 months and follow-up time post-loading. Sinus size ( BPD), implant distance from palatal ( PID) and buccal wall ( BID), and absence of bone coverage of implant (intra-sinus bone loss - IBL) were evaluated and statistically evaluated by ANOVA and linear regression analyses. Results MBL increased as a function of time. MBL at final follow-up was statistically associated with MBL at 6 months. A statistically significant correlation of IBL with wall distance and of IBL/mm with time was identified with greater values in wide sinuses ( WS ≥ 13.27 mm) than in narrow sinuses ( NS < 13.27 mm). Conclusions This study is the first quantitative and statistically significant confirmation that crestal technique with residual ridge height <5 mm is more appropriate and predictable, in terms of intra-sinus bone coverage, in narrow than in WS. [ABSTRACT FROM AUTHOR]

Background: There is a need for studying bone characteristics systematically for a better understanding of planning (i.e., timing of placement and loading) and outcomes of implant therapy. Therefore, the aim of the present review is to evaluate alveolar bone microarchitecture and its modifiers.Methods: Two independent reviewers conducted electronic and manual literature searches in several databases, including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Oral Health Group Trials Register, for articles published up to February 2015 reporting alveolar bone microstructure. The random-effect model was applied to calculate the weighted mean (WM) of total bone volume (TBV), which has a range from 0 to 1. TBV was stratified by anatomic locations, atrophic status, and types of specimens. Correlations between TBV and other bone-related parameters were also analyzed.Results: A total of 800 articles were initially identified. After abstract/full-text review, 24 articles were included in the systematic review, of which 23 were also included in the quantitative analysis. The WM TBV was 0.365 (95% confidence interval = 0.278 to 0.452), higher in the maxillary/mandibular anterior sites than the maxillary/mandibular posterior sites. However, great variations existed within each anatomic location. Additionally, WM TBV was lower in atrophic sites than non-atrophic sites. TBV was correlated negatively with trabecular spacing (R(2) = 0.11).Conclusions: The present systematic review suggests that the TBV might not be different between the defined anatomic locations. However, the atrophy status might influence TBV. [ABSTRACT FROM AUTHOR]

Poly-lactic-co-glycolic acid (PLGA) is one of the most widely used synthetic polymers for development of delivery systems for drugs and therapeutic biomolecules and as component of tissue engineering applications. Its properties and versatility allow it to be a reference polymer in manufacturing of nano- and microparticles to encapsulate and deliver a wide variety of hydrophobic and hydrophilic molecules. It additionally facilitates and extends its use to encapsulate biomolecules such as proteins or nucleic acids that can be released in a controlled way. This review focuses on the use of nano/microparticles of PLGA as a delivery system of one of the most commonly used growth factors in bone tissue engineering, the bone morphogenetic protein 2 (BMP2). Thus, all the needed requirements to reach a controlled delivery of BMP2 using PLGA particles as a main component have been examined. The problems and solutions for the adequate development of this system with a great potential in cell differentiation and proliferation processes under a bone regenerative point of view are discussed. [ABSTRACT FROM AUTHOR]

Background The aim of this study was to assess the influence of ridge morphology on the amount of horizontal bone augmentation achieved with the sandwich bone augmentation ( SBA) technique in the reconstruction of buccal dehiscence defects on dental implants. Methods Cone beam computed tomography ( CBCT) was used to assess bone width changes in 26 patients who participated in a randomized controlled trial conducted in 2008 to 2011. The amount of horizontal bone gain was evaluated at four different levels (3, 6, 9, and 12 mm apical to the alveolar crest) and three different time points ( T1: baseline, T2: at time of graft placement, and T3: 6 months later). Different morphological characteristics of the alveolar ridge were also evaluated to determine their influence on horizontal bone augmentation. A total of 78 CBCT scans were assessed. Results Comparison of the changes in ridge morphology at all measurement locations showed an overall ridge width gain of 2.30 ± 2.20 mm after 6 months. The use of membranes and the angulation of the concavity played a role in influencing the outcomes of the SBA technique. Critical crest angulation ( CA) is 150° for bone gain at 9 mm apical to the crest. When CA is smaller than 150°, the horizontal bone gain was 4.3 ± 2.2 mm; if CA is greater than 150°, the gain was significantly lower at 1.3 ± 1.7 mm ( p = .001). Conclusions SBA is a reliable and predictable technique to gain horizontal ridge width with simultaneous implant placement. Crest ridge angulation can be used as a tool to predict bone gain at 9 mm apical to the bone crest. [ABSTRACT FROM AUTHOR]

Bone regeneration is often needed prior to dental implant treatment due to the lack of adequate quantity and quality of the bone after infectious diseases, trauma, tumor, or congenital conditions. In these situations, cell transplantation technologies may help to overcome the limitations of autografts, xenografts, allografts, and alloplastic materials. A database search was conducted to include human clinical trials (randomized or controlled) and case reports/series describing the clinical use of mesenchymal stem cells (MSCs) in the oral cavity for bone regeneration only specifically excluding periodontal regeneration. Additionally, novel advances in related technologies are also described. 190 records were identified. 51 articles were selected for full-text assessment, and only 28 met the inclusion criteria: 9 case series, 10 case reports, and 9 randomized controlled clinical trials. Collectively, they evaluate the use of MSCs in a total of 290 patients in 342 interventions. The current published literature is very diverse in methodology and measurement of outcomes. Moreover, the clinical significance is limited. Therefore, the use of these techniques should be further studied in more challenging clinical scenarios with well-designed and standardized RCTs, potentially in combination with new scaffolding techniques and bioactive molecules to improve the final outcomes. [ABSTRACT FROM AUTHOR]

Background. Collagen-induced arthritis (CIA), a murine experimental disease model induced by immunization with type II collagen (CII), is used to evaluate novel therapeutic strategies for rheumatoid arthritis. Adult stem cell marker Musashi-1 (Msi1) plays an important role in regulating the maintenance and differentiation of stem/precursor cells. The objectives of this investigation were to perform a morphological study of the experimental CIA model, evaluate the effect of TNFα-blocker (etanercept) treatment, and determine the immunohistochemical expression of Msi1 protein. Methods. CIA was induced in 50 male DBA1/J mice for analyses of tissue and serum cytokine; clinical and morphological lesions in limbs; and immunohistochemical expression of Msi1. Results. Clinically, TNFα-blocker treatment attenuated CIA on day 32 after immunization (P<0.001). Msi1 protein expression was significantly higher in joints damaged by CIA than in those with no lesions (P<0.0001) and was related to the severity of the lesions (Spearman’s rho = 0.775, P=0.0001). Conclusions. Treatment with etanercept attenuates osteoarticular lesions in the murine CIA model. Osteoarticular expression of Msi1 protein is increased in joints with CIA-induced lesion and absent in nonlesioned joints, suggesting that this protein is expressed when the lesion is produced in order to favor tissue repair. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to analyze marginal bone loss ( MBL) rates around implants to establish the difference between physiological bone loss and bone loss due to peri-implantitis. Materials and methods Five hundred and eight implants were placed in the posterior maxilla in 208 patients. Data were gathered on age, gender, bone substratum (grafted or pristine), prosthetic connection, smoking and alcohol habits, and previous periodontitis. MBL was radiographically analyzed in three time frames (5 months post-surgery and at 6 and 18 months post-loading). Nonparametric receiver operating curve ( ROC) analysis and mixed linear model analysis were used to determine whether implants could be classified as high or low bone loser type ( BLT) and to establish the influence of this factor on MBL rates. Results Marginal bone loss rates were significantly affected by BLT, connection type, bone substratum, and smoking. Bone loss rates at 18 months were associated with initial bone loss rates: 96% of implants with an MBL of >2 mm at 18 months had lost 0.44 mm or more at 6 months post-loading. Conclusion Implants with increased MBL rates at early stages (healing and immediate post-loading periods) are likely to reach MBL values that compromise their final outcome. Initial (healing, immediate post-loading) MBL rates around an implant of more than 0.44 mm/year are an indication of peri-implant bone loss progression. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this study is to evaluate the vertical and horizontal graft bone resorption ( GR) in grafted maxillary sinuses and the marginal bone loss ( MBL) around implants placed in the sinuses with different prosthetic connections and to determine the effect of other clinical factors on these tissue responses at 6 and 18 months postloading. Material and Method A total of 254 implants were placed in 150 grafted maxillary sinuses of 101 patients (51.5% female) with mean age of 52.2 years (range, 32-82 years). GR and MBL measurements were made in implants placed with two different prosthetic connections (internal and external) at 6 and 18 months postloading. The complex samples general linear model was used to analyze the influence of patient age, gender, smoking habit, history of periodontal disease, implantation timing (simultaneous vs deferred), and prosthetic abutment length on radiographic GR and MBL values. Results At 18 months postloading, the MBL ranged from 0 mm to 5.89 mm; less than 1 mm was lost around 49.0% (mesial) and 44.3% (distal) of the implants, while no bone was lost around 32.9% (mesial) and 26.7% (distal). The GR was significantly affected by smoking, remnant alveolar bone height, graft length, graft height, gender, and age, and it significantly decreased over time. The MBL was influenced by the type of connection, implantation timing, and prosthetic abutment length. The MBL was greater with longer postloading interval and higher patient age and in smokers. Conclusion Resorption of grafts that combine autogenous cortical bone with anorganic bovine bone is dependent on the anatomic features of the sinus and is not affected by the time elapsed after the first 6 months. The MBL in implants placed in these grafted areas is time dependent and mainly related to potentially modifiable clinical decisions and patient habits. [ABSTRACT FROM AUTHOR]

Purpose There is limited evidence available on the influence of residual ridge height ( RH) on bone density. Therefore, this study aimed to investigate the correlation between the atrophic posterior RH in the maxilla and its bone density as determined by microcomputed tomography (μ- CT). Material and Methods Thirty-two subjects with atrophic posterior maxilla of residual RH <8 mm were included in this study. A preoperative cone beam CT scan with a radiographic stent was taken for each patient. A bone core biopsy was thus obtained from the predetermined surgical site. Out of 32 biopsies, 27 were intact and sent for μ- CT analysis. Results A statistically significant positive correlation between bone volumetric fraction ( BV/ TV) and RH was identified ( r = 0.417, p = .03). A statistically significant negative correlation between trabecular pattern factor and RH was also found ( r = −0.415, p = .03). The rest of the morphometric parameters analyzed did not have any significant correlation to RH. Conclusion BV/ TV is potentially influenced by the residual bone height at the posterior maxilla. The lesser the RH, the lower the bone quantity and quality present. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the clinical reliability of narrow implants placed in a one-stage procedure and early loaded in the upper and lower incisor region. Material and methods: This is a prospective, single-arm, multicenter study in which patients with missing natural dentition in upper lateral and lower incisor positions were enrolled. Eligible implants (OsseoSpeed™ TX 3.0S, DENTSPLY Implants) were of three different lengths and of 3.0 mm in diameter. One-stage surgery was performed and healing abutment connection took place. Placement of the permanent single crown took place after a 6-10 weeks healing period. Clinical and radiographic checks were performed at implant placement, loading, and at the 6, 12, 24, and 36 months follow-up visits. Results: A total of 69 subjects with 97 implants have been included in this study. From surgery to 36 months follow-up, 5.6% of the implants showed bone loss of more than 1 mm, while no bone loss at all were observed for 57.3% of the implants. The mean marginal bone level change from surgery to the 6, 12, and 36 months follow-up visits was -0.27, -0.11, and -0.09 mm, respectively. The total survival rate after 3 years is 95.5%. Conclusions: The data presented show stable marginal bone levels as well as healthy soft tissue around OsseoSpeed™ TX 3.0S implants, after 3 years of function. An interesting finding from this investigation was that a longer healing period before crown placement and loading contributed to statistically significant less marginal bone loss between loading and the 1-year follow-up visit (Galindo-Moreno et al. 2012). This finding, associated with a stable probing pocket depth and a stable crown-gingiva distance, using a one-stage surgical procedure helps to maintain the integrity of the peri-implant soft tissues. Narrow implants can be considered as a valid solution in the treatment of the localized narrow bony defects in the anterior area with reduced spaces between the natural teeth. [ABSTRACT FROM AUTHOR]

Background: The purpose of this case-control study is to investigate the association between stress and periodontitis by determining stress biomarkers in saliva and urine and to determine whether oral hygiene, gingival inflammation, and tooth loss are correlated with stress biomarkers in patients with periodontitis. Methods: A total of 77 patients (41 cases [with periodontitis] and 36 controls) participated in this study. Periodontal examination findings included probing depth, clinical attachment loss, bleeding on probing (BOP), plaque index (PI), and tooth loss. Secretory immunoglobulin (slg)A and cortisol were determined in saliva. Cortisol, creatinine-adjusted cortisol, metanephrine, normetanephrine, and total metanephrines were measured in urine. Results: Urinary metanephrine (P = 0.013) and total metanephrine (P= 0.023) levels were higher in the case group. In cases, salivary cortisol was correlated with PI (r= 0.464, P<0.01), BOP (r= 0.401, P<0.05), and tooth loss (r= 0.245, P<0.05). Urinary metanephrine levels above the median were associated with a 3.4-fold higher risk of periodontitis (95% confidence interval [Cl] = 1.1 to 10.2; P= 0.029), with an 82% increase in risk for each increment of 0.05 pg/24 hours. Urinary total metanephrine levels above the median were associated with a five-fold higher risk of periodontitis (95% Cl = 1.6 to 15.7; P= 0.006). Conclusions: The present results offer new evidence of the association between urinary concentrations of catecholamine metabolites (metanephrine and total metanephrines) and chronic periodontitis. Salivary IgA level showed no statistical difference between the cases and controls. Salivary cortisol levels in the patients with periodontitis were correlated with worse PI, higher gingival inflammation, and greater tooth loss. [ABSTRACT FROM AUTHOR]