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BackgroundThe present study aimed to evaluate hard and soft tissue parameters around implants placed in augmented posterior mandible, comparing Ti-reinforced d-PTFE membranes with Ti-meshes covered with collagen membranes, after 3 years of follow-up. Materials and MethodsForty eligible patients were randomly assigned to group A (Ti-reinforced d-PTFE membrane) or group B (mesh covered with collagen membrane) for vertical ridge augmentation (VRA) and simultaneous implants. Implants were evaluated using specific peri-implant parameters for bone and soft tissues: probing pocket depth (PPD), modified plaque index (mPI), bleeding on probing (BoP), modified gingival index (mGI), thickness of keratinized tissue (tKT), width of keratinized tissue (wKT), fornix depth (FD), peri-implant bone level (PBL), interproximal bone peaks (IBP), marginal bone loss (MBL), interproximal bone loss (IBL). ResultsA total of 28 patients with 79 implants were evaluated after 3 years of follow-up. The mean value of MBL was 0.70 mm (group A = 0.73 mm; group B = 0.71 mm), while mean IBL was 0.54 mm (group A = 0.64 mm; group B = 0.40 mm). The treatment with meshes resulted not inferior to PTFE and their clinical results appeared similar. A strong correlation between PBL and IBP was confirmed. Both study groups showed an increase of tKT and wKT values. ConclusionIn the posterior mandible, VRA using both techniques provides stable PBLs up to 3 years. A correct soft tissue management and a strict professional oral hygiene protocol play a crucial role on peri-implant health over time.

In recent years the interest towards flood forecasting in urban areas has increased significantly: urban areas and the people living in there are generally very exposed to floods; also, this problem may worsen in the future due to climate and land-use change.Empirical rainfall thresholds could represent a useful tool especially for those river basins where applying hydrological models is difficult. Such an approach can potentially be used for every river cross section whenever enough rainfall-discharge data are collected.In this study, we developed some empirical rainfall threshold with the aim of validating and enhancing the Regional Civil Protection warning system operating in the Lombardy Region.Rainfall data were collected from a total of 92 stations taken from the official regional Environmental Protection Agency of the Lombardy Region (ARPA-Lombardia) and from the network of a citizens science association “Meteonetwork”. Data on hydrometric levels and discharge were obtained entirely through the regional Environmental Protection Agency of the Lombardy Region.The study focused on the small and well urbanized river basins which drain their water towards the city of Milan (mainly Seveso, Olona and Lambro River basins). Simple rainfall-runoff methods and decision theory, as indicated on the local civil protection directory, were used to validate the results obtained.Preliminary results given by this methodology have shown that it could be a helpful tool for local civil protection authorities to take preventive actions for the population, as well as to validate the existing warning systems based on rainfall thresholds.

Objectives: The aim was to evaluate the role of resorbable membranes applied over customized titanium meshes related to soft tissue healing and bone regeneration after vertical/horizontal bone augmentation. Materials and Methods: Thirty patients with partial edentulism of the maxilla/mandible, with vertical/horizontal reabsorption of the alveolar bone, and needing implant-supported restorations, were randomly divided into two groups: Group A was treated using only custom-made meshes (Mesh-) and Group B using custom-made meshes with cross-linked collagen membranes (Mesh+). Data collection included surgical/technical and healing complications, “pseudo-periosteum” thickness, bone density, planned bone volume (PBV), regenerated bone volume (RBV), regeneration rate (RR), vertical bone gain (VBG), and implant survival in regenerated areas. Statistical analysis was performed between the two study groups using a significance level of α=.05. Results: Regarding the healing complications, the noninferiority analysis proved to be inconclusive, despite the better results of group Mesh+ (13%) compared to group Mesh- (33%): estimated value −1.13 CI-95% from −0.44 to 0.17. Superiority approach confirmed the absence of significant differences (p=.39). RBV was 803.27mm3 and 843.13mm3, respectively, and higher RR was observed in group Mesh+ (82.3%) compared to Mesh- (74.3%), although this value did not reach a statistical significance (p=.44). All 30 patients completed the study, receiving 71 implants; 68 out of them were clinically stable and in function. Conclusion: The results showed that customized meshes alone do not appear to be inferior to customized meshes covered by cross-linked collagen membranes in terms of healing complication rates and regeneration rates, although superior results were observed in group Mesh+compared to group Mesh- for all variables.

ObjectivesOral surgery morbidity is highly variable based on patients’ characteristics and kind of surgical intervention. However, poor data are available in the literature regarding patient outcomes after oral surgery. The aim of this retrospective study was to evaluate patient-reported outcome and complication rates after maxillary sinus floor elevation.Materials and methodsData from the records of patients undergoing maxillary sinus elevation have been collected from a private dental office. Patient-reported outcome has been assessed using a 100-mm visual analog scale to evaluate the post-operative pain (VASpain) experienced in the first week following surgery and visual rating scales to evaluate discomfort level (VRSdiscomfort: 0 to 4) and willingness to repeat the same surgical procedure (VRSwillingness: 0 to 3). Analgesics intake, swelling onset and duration, and ecchymosis have been also recorded.ResultsVASpainshowed moderate values in the first 2 days (discomfort) after surgery was low (median: 1; IR: 1–0), while willingness to undergo the same surgical procedure was very high (77.63% of patients). Swelling and ecchymosis were experienced by 97.36% and 51.32% of patients, respectively, with a mean duration of 4.09 ± 1.43 and 2.21 ± 2.31 days, respectively. Membrane perforation occurred in 4 cases. Other post-operative complications were not observed.ConclusionsMaxillary sinus grafting is a safe procedure, with a low complication rate and moderate morbidity that is well tolerated by patients. Particular attention is needed in case selection, surgical planning and operator expertise.Clinical relevanceThe analysis of patient-reported outcomes can be of great help in surgical planning and in providing correct and adequate treatment.

Objectives: The aim of this study was to evaluate hard and soft tissues around implants placed in posterior mandible 1year after vertical ridge augmentation (VRA). Materials and Methods: 40 patients with vertical defects were enrolled and treated according to the study protocol. Patients were randomly divided into two study groups: reinforced PTFE membranes (group A) and titanium meshes plus collagen membranes (group B). All patients received simultaneous implants which were evaluated after prosthetic restoration at baseline and after 1year, using the following parameters: peri-implant bone levels (PBLs), interproximal bone peaks (IBPs), pocket probing depth (PPD), bleeding on probing (BoP), plaque index (mPI), gingival index (mGI), keratinized tissue thickness/width (tKT and wKT), and fornix depth (FD). Statistical analysis was performed to investigate any statistically significant differences and/or correlations (p=.05). Results: 30 patients were completely followed up according to the study protocol. After 1year, implants showed a change in PBL from 0.12 to 0.76mm, with marginal bone loss of 0.67 and 0.61mm for group A and group B, respectively, without significant differences (p>.9337). The estimated difference between treatments for the change from baseline in PBL was −0.05 (95% CI −0.27 to 0.16). Statistical analysis revealed strong correlations between PBL and IBP (p.05). Conclusion: The results indicate that GBR treatment with titanium meshes plus collagen membranes (Group B) compared to reinforced PTFE membranes does not appear to be inferior or superior in terms of PBL change. In both groups, hard and soft tissues were stable after 1year of follow-up, with a peri-implant bone loss less than 1.0mm in the first year (study registered at ClinicalTrials.gov NCT04332679).

The use of short implants has been suggested in recent years as an option for facilitating prosthetic restoration in resorbed jawbones. The aim of the present study was to determine how implant success rate is affected in the long term when ultra-short implants are rehabilitated with fixed restorations, resulting in a crown to implant (C/I) ratio of more than 3:1. The study was conducted as an analysis on all patients operated from December 2005 to November 2007 with ultra-short dental implants. All implants were sintered porous-surfaced (SPS) with a length of 5 mm and a diameter of 5 mm (5 × 5 mm) and were restored with a single crown or a fixed dental prosthesis (FDP). Data collected included implant positioning site, crestal bone levels (CBL), and clinical and anatomical C/I ratios, and pre-established success criteria were used to evaluate the success rate of the implants. Statistical analysis was used to determine any significant differences or correlations (p = 0.05). Forty-one patients completed the follow-up and were eligible for this retrospective study on a total of 50 ultra-short SPS implants. The mean follow-up was 9.5 years (range 8.3 to 10.2 years). Three of the 50 implants failed because they were lost due to peri-implantitis, while all the other 47 met the pre-established success criteria giving an overall implant success rate of 94%. During the follow-up period, the mean peri-implant bone loss (PBL) was 0.41 + 0.36 mm. This study shows that ultra-short SPS implants can prove a reliable solution for prosthetic restoration in patients with severe alveolar bone atrophy. In selected patients with a sufficient bone width, ultra-short implants with a resulting C/I ratio of more than 3:1 presented no contraindications. In selected cases, ultra-short implants may represent an alternative to bone augmentation procedures and a long-term predictable solution.

The aim of this study was to evaluate the efficacy of buccal fat pads (BFP) as a natural barrier to cover nonresorbable devices for vertical ridge augmentation (VRA). A total of 12 consecutive patients with 14 vertical bone defects in need of bone augmentation for implant-prosthetic rehabilitation were treated according to the described protocol. VRA was performed by means of (1) customized titanium meshes, (2) titanium-reinforced PTFE membranes, or (3) resorbable membranes plus titanium plates. After buccal flap release, the BFP was identified, isolated, then mesially and coronally advanced to cover the whole augmented area. BFP was used as a pedicle flap in 11 cases and as free graft in 3 cases. The mean surface of the BFP obtained was 13.5 ± 5.5 cm

International audience; We introduce and study a diffuse interface model describing cell motility. We provide a detailed rigorous analysis of the model in dimension 1 and formally derive the sharp interface limit in any dimension. The model integrates the most important physical processes involved in cell motility, such as incompressibility, internal stresses exerted by the cytoskeleton seen as an active gel, and dynamic contact lines. The resulting nonlinear system couples a degenerate fourth order parabolic equation of Cahn-Hilliard type for the phase variable with a convection-reaction-diffusion equation for the active potential. The sharp interface limit leads to a Hele-Shaw type free boundary problem which includes the effects of surface tension and an additional destabilizing term at the free boundary. This additional term can be seen as a nonlinear Robin type boundary condition with the "wrong" sign. Such a boundary condition reflects the active nature of the cell, e.g., protrusion formation. We rigorously investigate the properties of this model in one dimension and prove the appearance of nontrivial traveling wave solutions for the limit problem when the key physical parameter exceeds a certain critical value. Although minimal, this new Hele-Shaw model, with Robin's unconventional boundary condition, is rich enough to describe the universal property of migrating cells that has been recently described by various theoretical biophysical models.

The aim of this cohort study was to investigate the relationship between crestal bone levels and crown-to-implant ratio of ultra-short implants, after functional loading. Sixty patients with single or partial edentulism and alveolar bone atrophy were enrolled and treated between December 2009 and January 2016. Without using bone-grafting procedures, patients were rehabilitated with ultra-short implants characterized by a microrough surface and a 6-mm length. Clinical and anatomical crown-to-implant (C/I) ratios and crestal bone levels (CBL) were measured after a follow-up period ranging from 12 to 72 months; all peri-implant and prosthetic parameters were recorded. The data collected were statistically analyzed (P = .05). A total of 47 patients with 66 ultra-short implants were completely followed up according to described protocol. The mean follow-up was 48.5 ± 19.1 months. The mean anatomical C/I ratio was 2.2, while the mean clinical C/I ratio was 2.6 ± 0.6 at baseline and 2.8 ± 0.6 at the last follow-up appointment. Mean CBL as calculated at the baseline was 0.7 ± 0.5 mm, while at the last appointment it measured 1.0 ± 0.5 mm. The overall implant-based success rate was 96.9%, and the mean peri-implant bone loss (PBL) was 0.3 ± 0.3 mm. No statistically significant relationship was found between anatomical or clinical C/I ratio and PBL. Ultra-short implants appear to offer a predictable solution for implant-prosthetic rehabilitation in patients with edentulism and bone atrophy. A high percentage of implants were successful, with minimal crestal bone loss. The high C/I ratio did not appear to influence either peri-implant bone loss or prosthetic complication rates.

Guided bone regeneration is a frequently used surgical procedure for hard tissue reconstruction when horizontal and or/vertical augmentation are needed. The treatment concept is based on the application of occlusive membranes like non-resorbable membranes or titanium mesh plus resorbable membranes. However, there are no studies comparing the microcomputed tomography results for bone obtained using these two procedures, and this was the purpose of the present study.A total of 40 patients with vertical posterior bone mandibular atrophy were randomly assigned to group A (guided bone regeneration with titanium-reinforced polytetrafluoroethylene membrane and simultaneous implant placement) or group B (guided bone regeneration with titanium mesh and collagen membrane and simultaneous implant placement). Tissue biopsy specimens were obtained from augmented sites after 9 months for microcomputed tomography analysis of volume of interest. Bone volume (BV/TV), biomaterial volume (MatV/TV), soft tissue volume (StV/TV), trabecular thickness (TbTh), trabecular number (TbN) and trabecular separation (TbSp) were measured. The correlation between regenerated bone and native bone was also evaluated. STATA software (StataCorp, College Station, TX, USA) was utilised for statistical analysis (significance α = 0.05).In group A, the values of BV/TV, MatV/TV and StV/TV in regenerated bone were 28.8%, 8.9% and 62.4%, respectively. In group B, the values of BV/TV, MatV/TV and StV/TV were 30.0%, 11.0% and 59.0%, respectively. No statistical differences were found between the two groups for any of the variables (P0.05). In both groups, considerable differences were noted between regenerated and native bone (P0.05), with a slight correlation between the microcomputed tomography parameters that suggests that native bone influences the quality of regenerated bone.Based on microcomputed tomography analysis, both surgical approaches facilitated the obtention of approximately 30% of newly formed bone with the same microarchitecture. Native bone influences the quality and microarchitecture of the obtained bone, irrespective of the technique used.

The purpose of this article is to present the preliminary clinical results obtained with a novel hybrid digital-analog technique, the solid index impression protocol (SIIP), which uses a solid index to capture accurate impressions of multiple implants for the fabrication of implant-supported fixed full arches (FFAs).This pilot study was based on five patients, each treated with a FFA supported by four implants. Three months after implant placement, impressions were taken for all patients with an intraoral scanner (IOS) (direct digital impression) and with the SIIP, using a custom tray consisting of four hollow cylinders connected with a bar. This index was linked to the implant transfers and transferred to the laboratory, and the definitive FFAs were fabricated based on it. The outcomes of the study were the passive fit of implant superstructures and the accuracy of the models generated by the SIIP, inspected using a coordinate measuring machine (CMM) and reverse engineering software, and compared with the accuracy of direct digital impressions.Excellent clinical precision and passive fit were obtained in all five implant-supported FFAs fabricated with the SIIP. One year after delivery, all FFAs were functional without any complication. Differences in accuracy were found between the SIIP and direct intraoral scanning.The SIIP seems to represent a viable option for capturing accurate impressions for the fabrication of clinically precise implant-supported FFAs with a hybrid digital-analog workflow. Further studies are needed to confirm these results.

In this paper, we prove the existence of traveling wave solutions for an incompressible Darcy's free boundary problem recently introduced in [6] to describe cell motility. This free boundary problem involves a nonlinear destabilizing term in the boundary condition which describes the active character of the cell cytoskeleton. By using two different methods, a constructive method via a graph analysis and a local bifurcation method, we prove that traveling wave solutions exist when the destabilizing term is strong enough.

Introduction Extremely atrophic maxillae can be considered the most important indication for three-dimensional maxillary reconstruction. Different bone-augmentation techniques have been suggested to accomplish this. This article illustrates a minimally invasive approach to rehabilitation of the extremely atrophic maxilla. Material and methods A 63-year-old male patient was referred for restoration of his totally edentulous maxilla with a fixed full-arch implant-prosthetic rehabilitation. Four short implants in the premaxillary region and 2 longer implants in the pterygomaxillary regions were inserted with piezoelectric implant site preparation. Discussion At the 1-year follow-up appointment, no clinical or radiographic changes in the soft-tissue contours or crestal bone levels were observed. Conclusion This surgical approach, based on the combination of short implants in the premaxillary regions and pterygoid implants in the pterygomaxillary regions, represents a way to shorten treatment timing, minimize the risk of surgical complications, and reduce patient discomfort and costs.

Cell migration is a complex phenomenon that plays an important role in many biological processes. Our aim here is to build and study models of reduced complexity to describe some aspects of cell motility in tissues. Precisely, we study the impact of some biochemical and mechanical cues on the cell dynamics in a 2D framework. For that purpose, we model the cell as an active particle with a velocity solution to a particular Stochastic Differential Equation that describes the intracellular dynamics as well as the presence of some biochemical cues. In the 1D case, an asymptotic analysis puts to light a transition between migration dominated by the cell’s internal activity and migration dominated by an external signal. In a second step, we use the contact algorithm introduced in [15,18] to describe the cell dynamics in an environment with obstacles. In the 2D case, we study how a cell submitted to a constant directional force that mimics the action of chemoattractant, behaves in the presence of obstacles. We numerically observe the existence of a velocity value that the cell can not exceed even if the directional force intensity increases. We find that this threshold value depends on the number of obstacles. Our result confirms a result that was already observed in a discrete framework in [3,4].

Background One of the most recent innovations in bone augmentation surgery is represented by computer-aided-design/computer-aided-manufacturing (CAD/CAM) customized titanium meshes, which can be used to restore vertical bone defects before implant-prosthetic rehabilitations. The aim of this study was to evaluate the effectiveness/reliability of this technique in a consecutive series of cases. Methods Ten patients in need of bone augmentation before implant therapy were treated using CAD/CAM customized titanium meshes. A digital workflow was adopted to design virtual meshes on 3D bone models. Then, Direct Metal Laser Sintering (DMLS) technology was used to produce the titanium meshes, and vertical ridge augmentation was performed according to an established surgical protocol. Surgical complications, healing complications, vertical bone gain (VBG), planned bone volume (PBV), lacking bone volume (LBV), regenerated bone volume (RBV), average regeneration rate (RR) and implant success rate were evaluated. Results All augmented sites were successfully restored with definitive implant-supported fixed partial dentures. Measurements showed an average VBG of 4.5 ± 1.8 mm at surgical re-entry. Surgical and healing complications occurred in 30% and 10% of cases, respectively. Mean values of PBV, LBV, and RBV were 984, 92, and 892 mm3, respectively. The average RR achieved was 89%. All 26 implants were successfully in function after 1 year of follow-up. Conclusions The results of this study suggest that the bone augmentation by means of DMLS custom-made titanium meshes can be considered a reliable and effective technique in restoring vertical bone defects.

After guided bone regeneration (GBR) with different devices, a layer of connective tissue called pseudo-periosteum can be observed above the newly formed bone. The aim of this study is to evaluate the clinical and histologic features and to suggest a classification of this connective tissue after GBR with nonresorbable membranes or titanium (Ti)-mesh plus resorbable membranes. Forty patients with partial edentulism in the posterior mandible were randomized into two groups: 20 patients were treated by means of Ti-reinforced dense polytetrafluoroethylene (d-PTFE) membrane (group A), while the other 20 patients were treated with Ti-mesh and a cross-linked collagen membrane (group B). After 9 months and during re-opening surgery, bone density and pseudo-periosteum type were recorded. Pseudo-periosteum was classified into Type 1 (no tissue or tissue1 mm); Type 2 (regular tissue between 1 and 2 mm); and Type 3 (irregular tissue or tissue2 mm). Histologic analyses were performed to identify the features of pseudo-periosteum. Out of 40 patients, 36 (n = 19 in Group A; n = 17 in Group B) with 99 implants were analyzed after GBR and according to the study protocol. The vertical bone gain was 4.2 ± 1.0 mm in Group A and 4.1 ± 1.0 mm in Group B. Group A had a higher bone density and greater amounts of type 1 periosteum than Group B (P = .01 for both). The preliminary results of this study show that both d-PTFE membranes and Ti-mesh plus collagen membranes are two valid options for bone augmentation in the mandible. However, nonresorbable membranes achieve higher bone density and a thinner pseudo-periosteum layer above the newly formed bone.

Purpose: The aim of this prospective study was to establish if ultrashort implants are a reliable therapeutic solution by evaluating their effect on mean crestal bone loss and assessing their survival and success rates. Materials and Methods: Patients were treated using 6-, 9-, and 11-mm-long implants with sandblasted and acid-etched surfaces and fitted with fixed partial prostheses. Clinical and radiographic examinations were scheduled yearly. Data collected included the implant positioning site, implant length and diameter, peri-implant bone loss (PBL), and clinical and anatomical C/I ratios. Results: One hundred eleven implants (6-mm-long, 30.6%) were positioned; two implants were lost before loading. During the 36-month followup, no other implants were lost (98.2% survival rate, 100% from loading), but four implants did not meet the criteria for success, due to excessive crestal bone loss, resulting in a 94.6% success rate, 96.3% from loading. Success rates and peri-implant bone loss were not significantly different among implants with different lengths. No correlation was observed between implant length and bone resorption. Conclusion: Six-millimeter-long implants did not show different results in comparison with 9- and 11-mm-long implants. They can be considered a reliable solution for implant prosthetic rehabilitation and a dependable and minimally invasive therapeutic option in areas showing severe bone resorption.

The aim of this multicentre prospective study was to evaluate the efficacy and safety of a surgical approach based on a novel osteotome technique, in order to obtain both alveolar ridge expansion and sinus floor elevation. Partially edentulous patients requiring an implant-prosthetic rehabilitation with a fixed prosthesis in the posterior maxilla were included in this study according to pre-established inclusion and exclusion criteria. All implants were placed after site preparation with the ‘Alternating Osteotome Technique’, which consists of the use of alternating concave and convex osteotomes. After a 4 to 6-month healing period, all implants were restored with a definitive fixed prosthesis. Clinical and radiographic examinations were scheduled over a 36-month follow-up of functional loading according to a well-established protocol. Statistical analysis was used to detect any significant differences or correlations (P = 0.05). Seventy-six patients were consecutively treated with a total of 120 implants in three different centres. The mean ridge expansion and sinus floor elevation were 1.8 ± 0.3 and 2.5 ± 0.7, respectively. After three years of functioning, the implant success rate was 99.1% since one implant had failed and the mean marginal bone loss was 0.6 ± 0.3 mm. No complications occurred during the intraoperative and postoperative periods. All parameters analysed were stable and steady throughout the three-year follow-up. The ‘Alternating Osteotome Technique’ enables the dental surgeon to achieve an adequate implant osteotomy with limited ridge expansion and sinus floor elevation, increasing modestly the vertical and horizontal dimensions of the alveolar crest but reducing significantly the risk of surgical complications.

Introduction The aim of this report was to show results of post-extraction implants placed to rehabilitate an atrophic mandible using a protocol based on CTX records and PRGF application in order to prevent MRONJ. Case Presentation A 65-year-old male affected by rheumatoid arthritis who was a chronic consumer of bisphosphonates and methylprednisolone was referred to the authors seeking restoration of his mandible with a full-arch prosthesis. Bisphosphonates were suspended, and the marker for bone turnover (CTX) was recorded every 3 months until it exceeded 200 pg/mL. During surgery, PRGF was applied to all the implant sites and the alveolar ridge before suturing. No complications occurred during the healing period, and no signs or symptoms of MRONJ were detected throughout the 1-year follow-up. Conclusions The protocol described in this report can be a viable solution for preventing MRONJ in a patient who is consuming bisphosphonates and corticosteroids and undergoes implant surgery. Its purpose is to reduce the risk of infection and hasten the healing of bone and soft tissue.

Background Guided bone regeneration (GBR) allows to achieve vertical ridge augmentation whether with nonresorbable membranes or resorbable membranes with Ti-mesh, but till now no studies are published comparing histological and histomorphometrical outcomes of these two procedures. Materials and methods Forty partially edentulous patients required vertical bone regeneration to place implants in the posterior mandible: 20 patients were randomly assigned to group A (Ti-PTFE); while 20 patients to group B (Collagen plus Ti-mesh). For both groups, graft material was a 50:50 mixture of autogenous bone and bone allograft. After 9 months, tissue biopsies were taken from augmented sites (regenerated bone ROI-1; native bone ROI-2) and undergone to histological and histomorphometric analysis. Percentages of bone tissue (B.Ar), biomaterial (Mat. Ar), and soft tissue (St.Ar) were measured; measurements of perimeters were calculated too. ROI-1 values were also compared to ROI-2 in both groups. Results Twenty-five samples were collected and analyzed consecutively: 13 in group A and 12 in group B. The mean B.Ar, Mat.Ar, and St.Ar were 39.7%, 8.6%, and 52.1% in group A; similar results were obtained in group B, with mean values of 42.1%, 9.6%, and 48.3%, respectively. No significant statistically differences were observed. Differences were observed between ROI-1 and ROI-2 in both group. Finally, bone structure index of ROI-1 and ROI-2 showed statistical differences. Conclusions The preliminary results of this study suggest that GBR using nonresorbable membranes and Ti-mesh with resorbable membranes in combination with autogenous bone and bone allograft provide similar histological and histomorphometric results.

The aim of this prospective study was to compare implant success rate and crestal bone loss around tilted and straight implants supporting immediate-loading full-arch rehabilitations. Twenty consecutive patients with edentulous jaws treated between June 2013 and July 2015 who satisfied all inclusion and exclusion criteria were included in the study. All patients were rehabilitated through a full-arch restoration supported by 4 or 6 immediately loaded implants. Clinical and radiographic examinations were scheduled every 12 months to evaluate implant success rates and crestal bone levels. Significant differences in crestal bone levels and success rates between straight and tilted implants were investigated by means of independent statistical analysis; differences were regarded as significant if P < .05. Seventy straight and 50 tilted implants were placed to rehabilitate 14 mandibles and 12 maxillae in 20 patients. After a follow-up of 12 to 36 months, survival rate was 97.1% for straight implants and 96.0% for tilted implants; while success rates were 94.3% and 94.0%, respectively. Success and survival rates were not significantly different (P > .05). Change in crestal bone level was 0.5 ± 0.4 mm for straight implants and 0.6 ± 0.4 mm for tilted implants (P > .05). Straight and tilted implants seemed to have similar behavior after immediate loading rehabilitations. After functional loading, straight and tilted implants did not differ significantly in clinical outcome.

Background Bromelain belongs to a group of protein-digesting enzymes obtained commercially from the fruit or stem of pineapple. Several studies demonstrated that bromelain exhibits various fibrinolytic, anti-edematous, antithrombotic, and anti-inflammatory activities supporting its application for many therapeutic benefits. The aim of this study was to analyze the effects of bromelain on the pro-wound healing activities and the regenerative properties of mesenchymal stem cells. Methods Mesenchymal stem cells were treated in vitro with bromelain alone or combined with dexamethasone sodium phosphate. Real-time polymerase chain reaction was performed to profile the expression of extracellular matrix components and remodeling enzymes, and cytokines. Results The combination of bromelain and dexamethasone sodium phosphate induced a great activation of mesenchymal stem cells with an increase in hyaluronan and collagen production and anti-inflammatory cytokines release. Conclusion Based on the results of this in vitro study, the combined use of bromelain and dexamethasone sodium phosphate stimulated the pro-wound healing activities and the regenerative properties of mesenchymal stem cells better than bromelain and dexamethasone alone.

In this clinical case was investigated the basic principles of digital workflow and the surgical steps of a novel type of custom-made titanium mesh (Ti-mesh), validated this surgical approach for bone augmentation in an edentulous atrophic maxilla, and analyzed the stability of the augmented bone after 1 year of follow-up

PURPOSE The primary prevention of peri-implantitis onset is a key factor in long-term implant success, and the evaluation of the antibacterial efficacy of different implant surfaces is fundamental in this way. The aim of this study was to assess if implants with collars coated with anatase were less subjected to bacterial colonization than implants with noncoated collars, and to investigate how implant bacterial colonization varies over time. MATERIALS AND METHODS Eighteen patients in need of implant-supported rehabilitation were selected to have two adjacent implants placed, one with an anatase-coated collar and one with the collar uncoated. Biofilm samples were collected at four sites around each implant at four different time points. Samples were analyzed through polymerase chain reaction (PCR) to detect and calculate the colonization rate of Aggregactibacter actinomycetemcomitans, Porphyromonas gingivalis, Treponema denticola, Tannerella forsythia, and Prevotella intermedia. RESULTS Due to one patient dropout and two nonosseointegrated implants, 32 out of 36 placed implants were followed up for 12 months, and 128 samples for each time point were collected: in total, 512 biofilm samples were analyzed. The type and rate of bacterial colonization were not significantly different between the two groups at all the intervals. However, the anatase-coated collar showed no proliferation of T forsythia. A significant difference in marginal bone level could be observed at the 12-month follow-up only. No significant difference in the other clinical and radiographic indexes was observed. CONCLUSION In this study, anatase-coated collar implants did not seem to provide significantly different microbiologic outcomes than uncoated collar implants. However, the absence of colonization of the species T forsythia and the slightly smaller peri-implant bone loss at the 12-month follow-up suggest that further investigations on anatase coating are needed. Nevertheless, data on bacterial colonization and crestal bone levels need further investigations to draw meaningful conclusions, due to the statistical power of this pilot study.

Objectives: The specific aim of this study was to assess sintered porous-surfaced (SPS) implant system from a biological point of view, through a prospective study of the health status and the evolution of the peri-implant tissues over time and analysis of the changes observed in the various peri-implant parameters. Material and Methods: Hundred and fifty-one patients were treated consecutively from 2005 to 2007 using 280 SPS implants, which were restored with a single crown or a partial fixed denture. To accurately monitor the health and biological evolution of peri-implant soft and hard tissues, a number of clinical parameters were adopted, such as the modified Plaque Index (mPI), the modified sulcus Bleeding Index (mBI), Peri-implant Probing Depth (PPD), and Crestal Bone Level (CBL). Clinical and radiographic examinations were scheduled over a 36-month follow-up of functional loading according to a well-established protocol generally applied to determine implant success rates and Peri-implant Bone Loss (PBL). Statistical analysis was used to determine any significant differences or correlations (P = 0.05). Results: A total of 259 SPS implants in 136 patients were followed up for 36 months. According to Buser’s success criteria, the overall implant-based success rate was 98.1% and the mean PBL was 0.48 0.29 mm. MBI and mPI mean values showed statistically significant differences between baseline and follow-up analyses (P < 0.001). No statistically significant differences in mean PPD values were found between baseline and control analyses (P = 0.060). Conclusion: This prospective cohort study revealed that the biological behavior of SPS implant system was characterized by high tissue stability during the observation period, both as regards soft and hard tissues. In particular, the crestal bone remodeling pattern was very similar to that reported in other studies, confirming that the bone loss around SPS implants, at least at 36 months, seems to be predictable.

Background The loss of one or more teeth has always been a reason for bone resorption and it can lead to a condition of “alveolar atrophy” that could make implant rehabilitation difficult. Purpose The aim of this prospective study was to observe crestal bone loss and implant success of short implants with oxidized surfaces in patients with partially edentulous jaws after a 3- to 5-year follow-up. Materials and Methods Forty-six patients with single or partial edentulism were treated consecutively from 2006 to 2008 using 107 short implants with oxidized surfaces, which were restored with a single crown or a partial fixed denture. Clinical and radiographic examinations were scheduled after functional loading of implants according to a well-established protocol generally applied to determine implant success rates and crestal bone levels. Statistical analysis was used to determine significant differences or correlations between variables (p = .05). Results After a 3- to 5-year follow-up, 44 patients with 102 implants were still followed up according to previously established study protocol, because two patients with five implants dropped out. Ninety-eight out of 102 implants are still functioning: four implants have been lost, with a survival rate of 96.1%. Moreover, a total of seven implants failed to meet the success criteria, resulting in a success rate of 93.1%. The mean bone loss was 0.9 ± 0.6 mm. Conclusions Many authors had recently demonstrated the predictability of short implants in different clinical conditions after a short-term follow-up. After 3 to 5 years of functional loading, short implants used to restore posterior teeth seems to be a viable solution in order to simplify and shorten the treatment of patients with partial edentulous jaws. Long-term follow-up is recommended to definitively establish the predictability and efficiency of this kind of implant-supported rehabilitation.

Purpose. To evaluate the survival, success, and complication rates of tapered double-lead threads single implants, placed in fresh extraction sockets and healed sites of the posterior jaws. Methods. The enrolled patients were randomly divided into 2 groups: in the test group (TG), all implants were inserted at the time of tooth extraction; in the control group (CG), all implants were placed 3 months after extraction. The implants were followed for a period of 1 to 3 years after loading. The main outcomes were implant survival, complications, and implant-crown success. Results. Ninety-two patients had 97 installed implants (49 in the TG, 48 in the CG). Only two implants failed, in the TG; the survival rates were therefore 95.9% (47/49) and 100% (48/48) for TG and CG, respectively. In the surviving implants, no complications were reported, for an implant-crown success of 100%. Conclusions. Although a significant difference was found in the levels of primary stability between TG and CG, single implants placed in fresh extraction sockets and healed sites of the posterior jaws had similar survival and complication rates. Crestal bone levels and peri-implant bone resorption showed similar values. A longer follow-up period is however required, to confirm these positive outcomes.

Objectives To evaluate and compare clinical and histological changes after ridge preservation procedures with those of spontaneous healing. Materials_and_Methods Ninety patients were enrolled in the present randomized controlled clinical trial and underwent single-tooth extraction in the premolar/molar areas. Thirty sites were grafted with collagenated cortico-cancellous (coll), 30 sites with cortical (cort) porcine bone and 30 sites underwent natural healing. Primary (vertical and horizontal bone changes after 3-month) and secondary outcomes (histomorphometric after 3 months) were evaluated at implant placement. Results The vertical bone changes at the grafted sockets were significantly (Ps< 0.0001) lower (0.30mm for cort- and 0.57mm for coll-group) when compared to non-grafted sockets (2.10mm for nat-group). Moreover, the width reduction of the coll (0.93mm) and cort (1.33mm) groups was significantly lower (P

Title (100): EVALUATION OF SOFT TISSUES AND PERI-IMPLANT PARAMETERS AFTER GBR IN POSTERIOR MANDIBLE. Authors: Alessandro Cucchi, Carla Cinquegarna, Elisa Rocchi, Giuseppe Corinaldesi, Claudio Marchetti Background (500): Guided Bone Regeneration (GBR) has proven to be a successful and predictable technique for vertical and horizontal ridge augmentation in short- and long-term studies. However, the newly-formed bone could have a significant resorption and the implant survival and success rate could be minor than implant placed in native bone. The soft tissues can have a key role in the prognosis of implants in augmented bone. Aim (300): The aim of the study was to evaluate soft tissues and peri-implant parameters after Guided Bone Regeneration (GBR) with non-resorbable membranes versus resorbable membranes in atrophic posterior mandible. Material and methods (1000): All patients were randomized in 2 groups: Group A treated by means of d-PTFE Ti-reinforced membranes; Group B treated by means of Ti-meshes and cross-linked collagen membranes. Implants were placed simultaneously during bone augmentation surgery (T0). Reopening was performed after 9 months (T1). All implants were restored with fixed prosthesis(T2). Connective tissue grafts (CTG) or free gingival grafts (FGG) were performed during T1 or after T2 in order to increase keratinized tissue (KT). The following parameters were evaluated: modified plaque index (mPI), modified gingival inflammation (mGI), probing depth (PD), recession and papilla deficit of adjacent teeth, crestal bone levels (CBL), bleeding on probing (BOP) and keratinized tissue (KT) of implants, depth of vestibular fornix (VF), soft tissue thickness, and pink esthetic score (PES). Sampling and measurements were performed at baseline and after 12 month after loading. Each variable was evaluated by two different observers. Results (1000): All 40 patients underwent to implant and bone augmentation surgery (T0). Considering dropped-out patients and GBR failure, 35 out of 40 patients (n=18 Group A and N=17 Group B) had entirely completed the study protocol with definitive restoration of implants (T2). 25 out of 35 patients were evaluated according to above-described protocol. 98% of adjacent teeth showed no gingival recession or reduction of interproximal papillae; 97% of implant showed negative BOP and 91% of implants had PPD less or equal to 4 mm. All parameters related to KT, VF, and PES were analyzed considering the muco-gingival approach (CTG, FGG, no treatment). Conclusions and clinical implications (500): The preliminary result of this RCT showed that GBR surgery allows to achieve a health of peri-implant tissue and stability of crestal bone levels. CTG seems to increase soft tissue thickness but not keratinized tissue; while FGG increase the amount of KT. Vestibular fornix had an increase after bone augmentation. No correlations were observed with mucogingival approaches.

Purpose: This randomized clinical trial aimed to investigate the relationships between insertion torque, implant stability quotient (ISQ), and crestal bone loss (CBL) of implants placed in fresh or 12-week healed extraction sites. Materials and Methods: Forty patients were randomly assigned to one of two groups and had one implant placed immediately (test group, n = 20) or 12 weeks after extraction (control group, n = 20) at premolar or molar sites. For all implants, insertion torque and ISQ scores at insertion and loading were recorded. Patients were followed for up to 12 months. Results: Implant success was 100% in both groups. No differences were observed concerning both ISQ at insertion and ISQ at loading. A stronger correlation was detected between ISQ at insertion and insertion torque in the postextractive group (R = 0.83), than in the delayed group (R = 0.39), while ISQ at loading and insertion torque showed no correlation. CBL at 12 months was significantly different between test (0.68 ± 0.43 mm) and control (0.40 ± 0.26 mm, P = .02) groups. Conclusion: Implant placement timing (immediate or delayed) may affect correlation between insertion torque and ISQ at insertion with ISQ at loading. While insertion torque influences ISQ at insertion, it does not affect ISQ at loading because of successful osseointegration. Postextraction and delayed implants seem to have similar ISQ at insertion and at loading, but different CBL after 12 months of follow-up because of postextraction bone remodeling.

The purpose of this prospective randomized controlled clinical trial was to evaluate the effect of oral administration of bromelain on discomfort after mandibular third molar surgery.Eighty-four consecutive patients requiring surgical removal of a single mandibular impacted third molar under local anesthesia were randomly assigned to receiving no drug (control group, Group A), postoperative 40 mg bromelain every 6 hours for 6 days (Group B), preoperative 4 mg dexamethasone sodium phosphate as a submucosal injection (Group C), and preoperative 4 mg dexamethasone sodium phosphate as a submucosal injection plus postoperative 40 mg bromelain every 6 hours for 6 days (Group D). Standardized surgical and analgesic protocols were adopted. Maximum interincisal distance and facial contours were measured at baseline and on postoperative days 2 and 7. Pain was measured objectively by counting the number of analgesic tablets required. Patient perception of the severity of symptoms was assessed with a follow-up questionnaire (PoSSe scale).On postoperative day 2, there was a statistically significant reduction in facial edema in both Groups C and D compared with the control group, but no statistically significant differences were observed between Group B and the control group. At evaluation on postoperative day 7, Group D showed a statistically significant reduction in postoperative swelling compared with the control group. The combined use of bromelain and dexamethasone (Group D) induced a statistically significant reduction in the total number of analgesic tablets taken after surgery compared with the control group. The treatment groups had a limited, nonsignificant effect on trismus when compared with the control group.Bromelain used singly showed moderate anti-inflammatory efficacy, reducing postoperative swelling, albeit not to any significant extent compared with no drug administration. The combined use of bromelain and dexamethasone sodium phosphate yielded the best results in terms of control of postoperative discomfort.

Trauma of maxillary teeth is a common accident. In most cases, the result is a root or crown fracture requiring tooth extraction and implant placement. Immediate postextraction implants are considered an effective option for restoring missing teeth in order to achieve successful aesthetic and functional outcomes. The aim of this article is to describe a clinical case in which a fractured maxillary canine was replaced by an osseointegrated implant using a simplified technique in a patient who was a smoker and presented poor oral hygiene. The technique adopted permits a reduction of the number of implant components and consequently a lower cost of treatment, while at the same time maintaining acceptable aesthetic and functional outcomes.

Introduction: Edentulism causes progressive bone resorption of the maxillae, which can lead to altered maxillo-mandibular relationships. The aim of the study was to evaluate the applicability of guided bone regeneration (GBR) to Le Fort I osteotomies with interpositional bone grafts for treatment of patients with severe maxillary atrophy. Materials and methods: Twenty consecutive patients characterized by severely atrophic maxillae were treated from January 2003 to January 2006 in order to resolve maxillary edentulism. All patients underwent pre-prosthetic surgery, including a Le Fort I osteotomy associated with autologous interpositional bone grafts to move the alveolar arch forward and to resolve the maxillary atrophy. Barrier membranes were also used to cover the bone grafts and the osteotomy line, favoring the healing process according to GBR principles. Maxilla advancement and alveolar crest augmentation were measured to assess the degree of reconstruction. A total of 154 implants were inserted in reconstructed maxillae 4 months after surgery and were restored with fixed full-arch dentures after another 4 months. Surgical and prosthetic complications were recorded and previously established implant success criteria were used to assess the success of this treatment protocol. Results: The outcome of pre-prosthetic surgery and implant-supported rehabilitation was prospectively evaluated every year. All Le Fort I osteotomies were successfully carried out, with a mean maxilla advancement of 4.2 cm (range: 3.1–5 cm), which appeared to be stable during the follow-up. After a mean follow-up of 66.4±18.4 months, only four implants failed according to the success criteria, yielding a cumulative success rate of 95.8%. Discussion and conclusions: Le Fort I osteotomies with the use of barrier membranes to cover the interpositional bone grafts can be a predictable treatment for edentulous patients with severely resorbed maxillae. The study data suggest that this approach makes it possible to compensate for both sagittal and vertical discrepancies due to maxilla atrophy, with a minimum resorption of advanced maxillae and grafted bone. A GBR-based protocol seems to lead to high implant success rates, although further randomized controlled studies are needed to demonstrate the usefulness and advantageousness of GBR. To cite this article: De Santis D, Trevisiol L, D'Agostino A, Cucchi A, De Gemmis A, Nocini PF. Guided bone regeneration with autogenous block grafts applied to Le Fort I osteotomy for treatment of severely resorbed maxillae: a 4- to 6-year prospective study. Clin. Oral Impl. Res. 23, 2012; 60–69. doi: 10.1111/j.1600-0501.2011.02181.x

Guarnelli ME, Farina R, Cucchi A, Trombelli L. Clinical and microbiological effects of mechanical instrumentation and local antimicrobials during periodontal supportive therapy in aggressive periodontitis patients: smoker versus non-smoker patients. J Clin Periodontol 2010; 37: 998–1004. doi: 10.1111/j.1600-051X.2010.01623.x. Abstract Aim: To compare the clinical and microbiological effects of ultrasonic mechanical instrumentation (UMI) associated to home-care use of amine fluoride/stannous fluoride (AmF/SnF2)-containing mouthrinse and toothpaste in smoker and non-smoker patients affected by generalized aggressive periodontitis (G-AgP) during a recall session of supportive periodontal therapy (SPT). Material and Methods: Thirteen smokers and 25 non-smokers G-AgP patients enrolled in an SPT programme received a single session of UMI associated with home-care use of AmF/SnF2-containing mouthrinse and toothpaste. Clinical and microbiological parameters were assessed pre-treatment, at 6 and 12 weeks post-treatment. Results: In both groups, UMI plus AmF/SnF2-implemented oral hygiene use determined a significant decrease of total bacterial counts, with non-smokers exhibiting a lower count compared with smokers at 12 weeks. No significant differences were observed between smokers and non-smokers in the counts of total pathogens and red complex species at each observation interval. Clinically, a significant reduction of supragingival plaque, gingival inflammation and probing pocket depth was similarly observed in both groups. Conclusions: A combined mechanical/chemical plaque control approach based on UMI and the use of AmF/SnF2 agents resulted in the reduction of supragingival plaque deposits, gingival inflammation and subgingival periodontal pathogens in G-AgP patients during SPT, with no substantial difference between smokers and non-smokers.

This report describes the possibility of treating a patient affected by unilateral cleft palate and an extremely atrophied edentulous maxilla using zygomatic implants inserted in a conventional manner and maxillary implants inserted by means of a computer-assisted surgery. A cross-arch prosthesis supported by 4 maxillary and 2 zygomatic implants may be an ideal mode of prosthetic rehabilitation for these kinds of patients. The use of zygomatic implants is essential to optimize load distribution and to increase prosthesis stability, whereas the use of computer-assisted surgery facilitates surgical procedures and makes it possible to improve patient satisfaction.

Introduction: This study explores the patient opinions about the helpfulness of the External Rehabilitative Activities (ERA) delivered in two residential facilities for psychiatric rehabilitation. Methods: We administered a Questionnaire developed to assess general helpfulness, helpfulness of specific therapeutic processes and satisfaction with the ERA to a sample of 46 psychiatric patients participating in at least three external activities. Results: The External Rehabilitative Activities, tested by the ERA-Questionnaire, were considered helpful or very helpful by most of the patients. The therapeutic process with the highest score was “relaxation”, followed by “general helpfulness”, “socialization”, “knowledge of social context”, “community integration”. The least-valued process was “autonomy”. Conclusion: This pilot study has shown that psychiatric patients consider ERA helpful and rate more helpful the specific therapeutic processes, such as relaxation and socialization, that assure symptomatic relief and interaction with the outside world.

Computer-assisted surgery is based on computerized tomography (CT) scan technology to plan the placement of dental implants and a computer-aided design/computer-aided manufacturing (CAD-CAM) technology to create a custom surgical template. It provides guidance for insertion implants after analysis of existing alveolar bone and planning of implant position, which can be immediately loaded, therefore achieving esthetic and functional results in a surgical stage. The absence of guidelines to treat dentulous areas is often due to a lack of computer-assisted surgery. The authors have attempted to use this surgical methodology to replace residual teeth with an immediate implantoprosthetic restoration. The aim of this case report is to show the possibility of treating a dentulous patient by applying a computer-assisted surgical protocol associated with the use of a double surgical template: one before extraction and a second one after extraction of selected teeth.

Purpose: Concerns have been expressed about the possibility of high insertion torque (IT) causing necrosis, impaired osseointegration, and crestal bone loss over time. The present study investigated the relationship between primary stability and implant success, including early and late maintenance of crestal bone levels. Materials and Methods: Implants were placed in patients at three study centers. Every effort was made to achieve the highest possible primary stability, which was measured with IT and implant stability quotient (ISQ). The IT and ISQ at insertion and reopening (3 to 4 months), as well as bone levels at several points in time, were recorded. The correlations between IT, ISQ, and immediate and 3-year crestal bone loss were investigated through linear regression analyses. Results: Average IT was 76.1 ± 20.8 Ncm, while the average ISQ score was 80.4 ± 8.4. The implant success rate at 36 months was 98.6%. The crestal bone loss around most implants (41.0%) ranged from 0.05 to 0.5 mm. None of the osseointegrated implants had crestal bone loss greater than 2.5 mm. The linear regression analysis showed no correlation among early or 3-year crestal bone loss and IT, ISQ at surgery, and ISQ at reopening. Conclusion: The implants studied avoided any negative effects deriving from the high IT values (> 50 Ncm) applied during 3 years of follow-up.

This is the peer reviewed version of the following article: Barone A, Toti P, Quaranta A, Alfonsi F, Cucchi A, Calvo- Guirado JL, Negri B, Di Felice R, Covani U. Volumetric analysis of remodelling pattern after ridge preservation comparing use of two types of xenografts. A multicentre randomized clinical trial. Clin. Oral Impl. Res. 27, 2016, e105–e115], which has been published in final form at 10.1111/clr.12572. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. Objectives: The aim of this randomized clinical trial was to analyse and compare the volumetric changes after ridge preservation procedures using two different biomaterials and to evaluate associations between outcome variables and pristine three-dimensional aspects of the ridges. Materials and Methods: Twenty-eight patients subjected to single-tooth alveolar ridge preservation were enrolled in the present multicentre, single-blind, prospective and randomized clinical trial. Fourteen sites were randomly allocated to each experimental group. The experimental sites were grafted with pre-hydrated collagenated cortico-cancellous porcine bone (coll group) or with a cortical porcine bone (cort group) and a collagen membrane; a secondary soft tissue healing was obtained for all experimental sites. Plaster casts were scanned (preoperative, at 1 and 3 months postoperative). Analysis of volumes and areas was performed, and all measured variables were statistically compared. Results: Intragroup analyses at 3 months revealed that when examining changes related to three- dimensional features of remodelling patterns (volume, surfaces, height and shape), the two biomaterials showed similar behaviours with a minor loss in volume and ridge surface. Intergroup analysis at 3-month survey revealed that volume resorption of the coll group (244 mm3) was significantly lower (P = 0.0140) than that of the cort group (349 mm3). The reduction for basal surface appeared significantly different between the two groups at 1-month survey only (P = 0.0137), while the final basal surface reduction was 4.9 and 12.2 mm2 for coll and cort group, respectively. The superior surface reduction was 40.8 mm2 for coll and 50.7 mm2 for cort group, with no significant difference between the two groups. Conclusion: At the 3rd month analysis, coll group showed a significantly lower reduction of ridge volume and a significantly smaller shrinkage of the basal area when compared to the cort group; moreover, the coll group experienced a smaller superior surface shrinkage when compared to the cort group, even though no significance was evaluated. Odontología