Search

Background. Different factors may affect new bone formation following maxillary sinus floor augmentation for the rehabilitation of posterior edentulous maxilla. The purpose of this study was to determine the influence of residual bone height (RBH) on new bone formation after lateral sinus augmentation utilizing different biomaterials, through a network meta-analysis (NMA). Methods. PUBMED, Scopus, and Web of Science electronic databases were searched until 31 December 2022 to obtain relevant articles. A hand search was also conducted. Randomised controlled studies on maxillary sinus augmentation comparing different grafting materials in patients with atrophic posterior maxilla, in need of prosthetic rehabilitation, were included. The risk of bias was assessed following the guidelines of the Cochrane Collaboration. The primary outcome was new bone formation (NBF), assessed histomorphometrically. The statistical analysis was performed by splitting the data according to RBH (<4 mm and ≥4 mm). Results. A total of 67 studies were eligible for conducting NMA. Overall, in the included studies, 1955 patients were treated and 2405 sinus augmentation procedures were performed. The biomaterials used were grouped into: autogenous bone (Auto), xenografts (XG), allografts (AG), alloplasts (AP), bioactive agents (Bio), hyaluronic acid (HA), and combinations of these. An inconsistency factor (IF) seen in the entire loop of the XG, AP, and Bio+AP was found to be statistically significant. The highest-ranked biomaterials for the <4 mm RBH outcome were XG+AG, XG+AP, and Auto. Similarly, the surface under the cumulative ranking curve (SUCRA) of biomaterials for ≥4 mm RBH was Auto, Bio+XG, and XG+Auto. Conclusion. There is no grafting biomaterial that is consistently performing better than others. The performance of the materials in terms of NBF may depend on the RBH. While choosing a biomaterial, practitioners should consider both patient-specific aspects and sinus clinical characteristics. [ABSTRACT FROM AUTHOR]

ABSTRACT 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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Purpose: To retrospectively assess clinical and radiographic outcomes of immediately loaded full‐arch fixed prostheses supported by axial and tilted implants up to 15 years of function. Materials and Methods: Patients with one completely edentulous arch received an immediate full‐arch fixed prosthesis supported by two anterior axial and two posterior tilted implants. Definitive prosthesis consisting of a CAD‐CAM titanium framework and acrylic teeth was delivered 6 months later. Patients were regularly followed to assess clinical parameters and marginal bone level (MBL) change. Multilevel regression analysis was performed to investigate factors affecting implant failure and MBL. Results: Six hundred ninety‐two implants were placed in 72 maxillae and 101 mandibles. Seven maxillary implants (5 axial and 2 tilted) in 6 patients and 12 mandibular implants (6 axial and 6 tilted) in 5 patients failed. 15‐year cumulative implant survival was 97.51% and 96.91% in maxilla and mandible, respectively (p =.64). After 10 years, the difference in MBL between axial and tilted implants was not significant in the maxilla (p =.47, 65 patients), while it was in the mandible (p <.001, 80 patients). Significant higher bone loss was reported in the mandible at both 5‐ and 10‐year follow‐up (p <.001 and p =.004, respectively). Mixed‐effect multilevel linear regression evidenced a correlation between arch and bone loss at 5‐ and 10‐year follow‐up, while no correlation was found with age, gender, smoking, diabetes, and history of periodontal disease. Conclusion: This long‐term study suggests that the present technique can be considered a viable treatment modality for the immediate rehabilitation of both maxilla and mandible. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

This case report describes the management of a lesion involving the Canalis Sinuosus (CS), that is a bone channel originating from the infraorbital canal below the orbital margin and posterior to the infraorbital foramen and coursing in an anterolateral direction to the anterior wall of the nasal cavity. A female patient, 62y, ASA 1, wearing full mobile dentures, came to our clinic asking for upper jaw rehabilitation. Due to a severe bone atrophy, a graft procedure was performed and the placement of eight implants was planned. One week after implants were positioned, the patient referred pain in the upper right central incisor region, that was compatible with a normal post‐operative healing. After 15 days, since the symptoms worsened and became localized and persistent, a more detailed CBCT analysis was carried out. The images demonstrated that a CS on the right side was compressed by the apex of the implant in position #11. The implant was replaced with a shorter one and adequate pharmacological therapy was prescribed. All the symptoms completely disappeared after 30 days. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

ABSTRACT 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. [ABSTRACT FROM AUTHOR]