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Introduction. Full-arch, implant-supported hybrid restorations, employing tilted implants, can offer an efficient way of treating edentulous patients. Several factors, such as the timing of implant placement and the inclination of the fixture, can have a detrimental effect on their stability. This retrospective study is aimed at discerning the role played by those factors. Materials and Methods. Patients treated with full-arch, implant supported restorations were selected for this study; cone-beam computed tomography (CBCT) images, taken 3 months and 3 years after delivery of the final restoration, as well as peri-implant values, were obtained and compared; bone loss was measured on four sites for each implant and then averaged. These patients were recalled, and the OHIP-5 questionnaire was administered. Results. 21 patients, with a mean age of 53 years, were included in the present analysis. 108 implants were placed, and 25 Toronto prostheses were delivered. According to a mixed-model analysis, tilted implants (0.51, p < 0.001 ) had a higher rate of bone loss, while implants placed in a healed ridge suffered less bone loss than immediate implants (-0.21, p < 0.001 ). Patient-level variables have a significant effect on this variable, as implants coming from the same subject share a similar risk of bone loss. The mean response to the self-administered OHIP-5 questionnaire was 1.53 ± 0.29 ; other variables did not have a statistically significant effect on this outcome. Discussion/Conclusions. The results of the present study show that Toronto bridges prostheses are an efficient procedure for treating edentulous patients, as their oral-related quality of life is reported as satisfactory even 7 years after delivery of the restoration. Tilted and immediate implants are more at risk of bone loss. Implants coming from the same subject share a similar risk of bone loss.

Membrane exposure is a widely reported and relatively common complication in Guided Bone Regeneration (GBR) procedures. The introduction of micro-porous dPTFE barriers, which are impervious to bacterial cells, could reduce the technique sensitivity to membrane exposure, even if there are no studies investigating the potential passage of bacterial metabolites through the barrier. Aim of this study was the in vitro evaluation of the permeability of three different GBR membranes (dPTFE, native and cross-linked collagen membranes) to Porphyromonas gingivalis; in those cases, where bacterial penetration could not be observed, another purpose was the analysis of the viability and differentiation capability of an osteosarcoma (U2OS) cell line in presence of bacteria eluate obtained through membrane percolation. A system leading to the percolation of P. gingivalis broth culture through the experimental membranes was arranged to assess the permeability to bacteria after 24 and 72 h of incubation. The obtained solution was then added to U2OS cell cultures which underwent, after 10 days of incubation, MTT and red alizarin essays. The dPTFE membrane showed resistance to bacterial penetration, while both types of collagen membranes were crossed by P. gingivalis after 24 h. The bacteria eluate filtered through dPTFE membrane didn't show any toxicity on U2OS cells. Results of this study demonstrate that dPTFE membranes can contrast the penetration of both P. gingivalis and its metabolites toxic for osteoblast-like cells. The toxicity analysis was not possible for the collagen membranes, since permeability to bacterial cells was observed within the first period of incubation.

Edentulous patients’ quality of life can be greatly diminished by the use of a badly fitting removable prosthesis, as many aspects of social life become notably impaired. The object of this study was to evaluate if treating these patients with a two implants mandibular overdenture could improve their quality of life as measured with the Italian version of the OHIP-14 (Oral Health Impact Profile). Edentulous patients, in good clinical condition, were selected. Two implants were placed following the recommended guidelines and three months after new mandibular dentures were manufactured, implants were uncovered and connected to the prosthesis using LOCATOR abutments. OHIP-14 was measured at baseline, one month after delivery and one year after delivery. An improvement was observed even after one month (with a mean reduction of 17 points in OHIP) and that improvement appeared to be stable at the one-year follow-up. Mandibular overdentures can improve a patient’s quality of life when compared to a tissue-supported removable complete denture, as long as the patient is subjected to an appropriate follow-up as the retentive rings of the attachment can deteriorate even after two years and lose a great deal of retentive capabilities.

High levels of cholesterol and triglycerides may have a negative effect on the immune system and bone health, leading to lower bone mineral density, an increased risk of osteoporosis, and bone fractures, and could therefore also be related to a significant worsening of peri-implant health. The purpose of the following study was to evaluate whether the altered lipid profile in patients who undergo implant insertion surgery represents a prognostic factor capable of influencing clinical outcomes. This prospective observational study was conducted on 93 subjects; patients were required to have taken blood tests to obtain triglycerides (TG), total cholesterol, low-density lipoprotein (LDL), and high-density lipoprotein (HDL) levels prior to the surgical procedure to classify them according to current American Heart Association guidelines. The outcomes considered were marginal bone loss (MBL) 3 years after implant placement, full-mouth plaque score (FMPS), and full-mouth bleeding score (FMBS) 3 years after surgery. A statistically significant correlation was found between hypertriglyceridemia and MBL as well as between total cholesterol and MBL. There is no statistically significant correlation between the variables analyzed and the secondary outcomes 3 years after implant placement. Peri-implant marginal bone loss may be influenced by hyperlipidemia. However, further studies are needed, with larger samples and more extensive follow-ups, to confirm these results.

To evaluate a novel proof-of-principle technique of simultaneous bone regeneration and implant placement in severely damaged sockets.This study consisted of patients who required a single implant and presented with severe facial bone loss. Individuals were randomly assigned to either the immediate or delayed implant placement protocol. Socket reconstruction and simultaneous implant placement were performed through periosteal-guided bone regeneration. Implants were encased in a customized shield of autogenous cortical bone harvested from an adjacent site. Re-entry surgery was performed at 12 to 18 weeks. Peri-implant tissues and pink esthetics were assessed following established success criteria.Of the 34 patients treated, 28 patients-consisting of 15 women and 13 men with an average age of 50.8 ± 4.5 years-continued to the final follow-up. All individuals showed new facial cortical bone regeneration at second-stage implant surgery after an average healing time of 14.9 ± 2.2 weeks (range: 12 to 18 weeks). Implants remained stable after loading. Success rates were 100% at 12 months. Mean pink esthetic score (PES) was 7.8 ± 1.2 (range: 6 to 9 on a scale of 0 to 10). Linear regression analysis showed that provisionalization and attachment loss are independent risk factors affecting pink esthetics (P.01). Mild and moderate/severe attachment loss decrease pink esthetic scores by 0.9 and 1.7 points, respectively (95% CI: 0.2-1.5; P.01). The use of provisional restorations improves pink esthetic scores by 1.6 points (95% CI: 0.8-2.4; P.001). A PES7 was four and five times more likely to be expected for delay and immediate implants, respectively, if the implant had a provisional restoration delivered post-second-stage (RR = 4 to 5; 95% CI: 1-31; P = .07; P = .02). Cramér's V test showed a strong association between lack of implant provisionals and low pink esthetic scores (≤ 7, value = 0.7; P = .02). Facial implant transparency at follow-up was absent, and all implants had a band of keratinized tissue2 mm.Facial bone regeneration and simultaneous implant placement is feasible in severely damaged sockets through periosteal-guided bone regeneration after a short healing period following immediate or delayed protocols. The assisted regenerated intrasocket bone allows for functional implant stability. Adjacent tooth attachment loss and lack of implant provisionalization negatively impacts pink esthetics. The proposed approach decreases costs, morbidity, and treatment duration and eliminates the need for multi-stage approaches.

PURPOSE This is a systematic review and meta-analysis to estimate the overall prevalence of proximal contact loss (PCL) and determine the distribution and clinical features of PCL. METHODS This systematic review was conducted following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. As this was a systematic review of prevalence, the condition, context, and population framework was followed. The focus question was: What is the prevalence and distribution of PCL in implant-supported restorations? Two investigators independently examined the literature in four databases (Medline, Scopus, Web of Science, and Cochrane) for suitable articles published before November 11, 2020, with no start-date restriction; an additional search was conducted by hand. A standardized data extraction chart was utilized to extract the relevant information from the selected studies. RESULTS Fifteen studies met the inclusion criteria. A total of 11,699 restorations were evaluated in the final sample. The overall prevalence was 20% at the implant restoration level (among 4984 implants) and 26.6% at the contact point level (among 2603 contact points). The frequency of PCL was higher on the mesial side, both at the implant restoration level (13.8%) and at the contact point level (21.9%), than on the distal side, where the prevalence was 3.3% and 11.0%, respectively. The event rate in the maxilla and in the mandible at the contact level was 21.4% and 21.9%, respectively. CONCLUSIONS PCL is a frequent complication. Approximately 29% of contact points develop this condition, which may cause food impaction and damage to the interproximal tissues.

Dental implant placement is a predictable therapy for replacing teeth. Nevertheless, mechanical, biological, and aesthetic complications frequently occur. The aim of this study was to compare the clinical outcomes of a xenogeneic collagen matrix (XCM) used at the time of implant placement as an alternative to a subepithelial connective tissue graft (SCTG), for soft tissue augmentation. This was a prospective clinical trial with 12 months of follow-up. In the control group, soft tissue augmentation at the time of implant placement was performed with a SCTG, while in the test group, a XCM was employed. At 12 months postoperative, all xenografts showed no postoperative complications. In both groups, a significantly greater thickness was observed on the buccal and occlusal sides from preoperative to 3 months postoperative (P

Objective: The purpose of the present study was to analyze the management of dental extractions in patients affected by coagulation disorders in order to prevent bleeding intraoperative and postoperative complications. Subjects and Methods: This study included 17 patients with a diagnosis of a coagulation disorder, who had been subjected to a single or multiple dental extraction. Recombinant activated Factor VII was administered in those patients who were affected by a deficit of factor VII ranged between 10,5% and 21%. The other patients were treated locally with tranexamic acid. Results: A total of 50 teeth were extracted, 7 by surgical extraction and 43 by simple extraction. Of the 17 patients included 9 of them suffering from factor VII deficiency, 5 from factor V deficiency, 1 from Glanzmann's thrombasthenia and 2 from Haemophilia A. Pretreatment with recombinant activated factor VII was performed on a total of 8 patients with factor VII deficiency; the remaining 9 patients underwent tranexamic acid treatment. 1 hemorragic postoperative complication was observed. Conclusions: Surgical and no surgical extractions appear to be a safe procedure for patients affected by coagulation disorders when appropriate prophylaxis is adopted.

Objective This study aimed to analyze the effectiveness of root‐shape inserts mounted on a reciprocating handpiece during the procedure of root surface debridement (RSD) on extracted teeth. Three different approaches were compared: ultrasonic scaling, employment of root‐shape inserts mounted on a reciprocating handpiece, and a combination of both. Materials and Methods A total of 51 extracted teeth were divided into three groups. The first group was instrumented with an ultrasonic scaler, the second group with flexible root‐shape inserts mounted on a reciprocating handpiece (grain size 40, 15, and 4 μm), whereas the final group underwent a combination of both approaches. The time required for the instrumentation was taken. The specimens were subjected to optical and scanning electron microscopy (SEM), and the photographs were evaluated by three examiners who were blinded to the study. The parameters included were: SEM roughness index (SRI) for the roughness calculation, remaining calculus Index (RCI) to evaluate the residual calculus deposits, and loss of tooth substance index (LTSI) to evaluate the loss of tooth substance caused by instrumentation. Result The results revealed that the time taken for the instrumentation was on average longer when the root‐shape inserts were employed alone, meanwhile the combined approach did not show significant difference in comparison with the ultrasonic scaling. The lower average RCI was obtained with a combined approach. The use of root‐shape inserts seems to cause a moderate increase in LTSI, especially in a combined approach, whereas it resulted in a better average SRI. Conclusion The employment of root‐shape inserts seems to be effective in the RSD for its ability to obtain a smooth and calculus‐free instrumented surface, especially when used in combination with an ultrasonic scaler, and their use can so represent a valid approach to be tested in further in vivo studies.

The novel Coronavirus pandemic defines a new risk for all dental practitioners, hygienists, and dental assistants. As an increasing number of dentists are now developing this disease, we wanted to provide some measures to manage this risk in the dental practice, by undergoing a review of the current literature. This minireview searches the literature for articles that both defined the infection risk in the dental practice and provided evidence on the efficacy of some procedures on reducing the infection risk. Several articles have already pointed out some necessary measures: fewer patients have to be admitted to the practice, a short triage should be carried out, and the appropriate measures of protection have to be used. On the basis of the literature collected, a short questionnaire and a flowchart is proposed to define the risk that each patient carries, and to appropriately adapt each procedure based on the patient’s risk. The literature is still limited on this subject, but on the basis of what is available, dental practices have to adapt to the situation in order to protect dental health professionals. Impact statement Dentists have always been taught how to protect themselves and their patients from potential blood-borne pathogens, but the Coronavirus pandemic has brought a new unprecedented challenge to the world of dentistry; we therefore reviewed the literature to provide suggestions on how to accordingly change dental practice prevention.

To develop an Italian version of the Orofacial Esthetic Scale (OES-I), validated in a prosthodontic and non-prosthodontic patients' cohort, for clinicians and researchers to use in their practice.The OES-I was obtained with a process of translation and back translation from the English version of the questionnaire (OES-E). The psychometric properties of the obtained version were then observed in a group of 70 prosthodontic and 70 non-prosthodontic patients. Validity (discriminative and convergent) and reliability (internal and external) were measured. Also, CFA (confirmatory factor analysis) was run, and several models were obtained.The OES-I scores were much higher for patients who were not scheduled for an esthetic prosthodontic treatment (p 0.05); similarly, the same analysis conducted by a clinicians provided similar results (Pearson's coefficient = 0.93, p 0.05). Reliability results show that the different items of the questionnaire are consistent within the test (Cronbach alpha = 0.93) and that the obtained results are stable within a reasonable time period (test-retest reliability = 0.98). The Final CFA model showed that OES score can properly characterize orofacial esthetic.The OES-I is a reliable means both for clinicians and researchers to assess patients' self-perceived esthetic.The OES-I can be used effectively for measuring the self-perceived esthetic appearance in all areas of dental practice and research.

(1) Background: Ankyloglossia, or tongue-tie is a condition, in which the tip of tongue cannot protrude beyond the lower incisor teeth because of short frenulum linguae, often containing scar tissue. Limitations of movement are the most important clinical symptoms of this condition, together with feeding, speech, and mechanical problems. (2) Methods: the present study included two groups of patients (group A and group B) including, respectively, 29 and 32 patients (61 patients total), aged from 8 to 12 and presenting ankyloglossia classified according to the Kotlow’s classification. The patients in group A underwent a common surgical procedure. For the patients of group B, a diode laser device (K2 mobile laser, Dentium, Korea) with a micro-pulsed wavelength of 980 ± 10 nm and power of 1.2 watts was used. The post-surgical discomfort of the patients (recording the pain perceived immediately after the end of the anesthesia and during the following week, using the Numeric Rating Scale (NRS) system) and healing characteristics (recorded using the Early Wound Healing Score or EHS) were evaluated. (3) Results: The results shows that the pain in the patients who underwent laser-assisted frenectomy is significantly reduced (p < 0.001) when compared to those who underwent conventional surgical frenectomy, both immediately after surgery (with a reduction in the average NRS of 80.6%) and after the first week (with a reduction in the average NRS of 86.58%). Additionally, in the same patients, an augmentation in the average value of the EHS of 45% was recorded, highlighting significantly (p < 0.001) better quality in the healing of the wound within the 24 h after surgery. Moreover, other advantages observed in the use of laser assisted-frenectomy are the absence of bleeding and, consequently, a clear operative field; no need to use sutures; no need to take painkillers or antibiotics after surgery; and having a faster recovery and less time needed to perform the operation. (4) Conclusions: within the limits of the present study, it seems possible to assert that the laser frenectomy performed using the v-shape technique presents a series of advantages if compared to the conventional surgical method.

Diet and nutrition are generally categorized as modifiable lifestyle risk factors for the development of periodontal disease because diet may influence a person’s inflammatory status. This study aimed to evaluate the efficacy of the application of a diet plan focused on reducing inflammation and oxidative stress in treating periodontitis. Subjects suffering from periodontitis were divided into two groups. Both groups underwent non-surgical periodontal therapy, and in the optimized diet (OD) group, this treatment was associated with a diet plan. The sample consisted of 60 subjects; 32 (53%) were treated in the non-optimized diet group (ND group) and 28 (47%) in the OD group. In both groups, the periodontal treatment significantly improved the recorded periodontal outcomes between T0 and T1 (FMPS, FMBS, CAL, PPD). Inter-group differences were not statistically significant (p < 0.05). The linear regression models showed that the optimized diet was associated with a higher reduction in PPD and FMBS after the treatment, while patients who had higher LDL levels (over 100 mg/mL) had a less favorable improvement of PPD. The application of an improved diet plan can increase the reduction in PPD and FMBS after non-surgical periodontal therapy when compared with periodontal treatment alone.

The present study investigated clinical and histomorphometric data after sinus lift procedures performed with and without mesenchymal stem cells (MSCs) added to a graft. Twenty-four patients underwent maxillary sinus lift for implant placement. Twelve patients each were assigned to control (Group 1) and test (Group 2) groups. An MSC suspension was added to the graft used in patients of Group 2. Five of 12 patients in both groups underwent crestal-approach sinus lift with immediate implant placement, while seven patients received a lateral-approach sinus lift. The MSC suspension was obtained using the Rigenera protocol. Samples from the grafted site were evaluated, processed, and stained using three staining techniques 90 days after surgery. Histomorphometric analysis was performed using an imaging software (ImageJ). Two types of tissues were defined: Type 1 'mature bone' and Type 2 'osteoid tissue'. The mean Type 1 tissue percentage was 27.24% in Group 1 and 44.45% in Group 2 (P0.05). The mean Type 2 tissue percentage was 10.86% and 7.04% in Groups 1 and 2, respectively. The mean Type 1 tissue percentages for the crestal approach were 24.52% for Group 1 and 50.78% for Group 2, while the mean Type 1 tissue percentages for the lateral approach were 29.18% for Group 1 and 39.92% for Group 2. Patients treated with grafts containing MSCs showed 63.18% increased bone formation compared to those treated with grafts not containing MSCs (P0.05). Although our data showed a positive trend in patients treated with MSCs, differences between subgroups were not significant (P0.05).

Angulated screw channels (ASC) allow the clinician to reposition the access hole of screw-retained restorations, improving the design of the rehabilitation and the esthetic outcome. Few clinical studies are available on the efficacy of these restorations, especially at longer follow-ups and with a large number of subjects. The objective of this study was therefore to retrospectively evaluate patients rehabilitated with screw-retained restorations using ASC. The time of delivery and their adherence to the maintenance program was obtained, as well as the characteristics of the restoration and of the patient’s occlusion, a Kaplan–Meier survival curve was then built to investigate the success rate of these restorations and the effects of several variables were evaluated with a Cox model. A total of 105 subjects and 162 implants were enrolled in this study, after 42 months a success rate (92%) similar to what is reported for conventional screw-retained restorations was encountered. Monolithic zirconia restorations (n = 52) had a higher success rate (95%) when compared to partially veneered restorations (n = 53), which suffered a higher number of complications (90%). The other variables had no statistically significant effect. Implant supported prostheses adopting ASC provide a favorable outcome both in the posterior and anterior regions and can therefore be adopted to treat cases where the implant angulation is unfavorable for a conventional screw-retained prosthesis.

PURPOSE This study was conducted to compare the bone cutting performance of the piezoelectric device with traditional drills in terms of cut execution time, environmental noise produced, surface morphology characteristics, and residual cell vitality of the bone samples. MATERIALS AND METHODS Two fresh pig jaws were obtained from a local slaughterhouse, and nine bone samples with a standard size (1 cm3) were harvested from each jaw: three using piezosurgery, three with a multiblade bur mounted on a surgical handpiece, and three with a diamond bur mounted on a high-speed handpiece, for a total of 18 samples. Two samples for each harvesting method were examined by scanning electron microscope (SEM), observing four surfaces per sample. For each surface observed, a count of the intertrabecular spaces was performed, and each space was evaluated as completely, partially, or unfilled by debris. Four samples per sampling method were examined by cell culture to evaluate residual cell vitality after cutting. The execution time of each osteotomy was measured with a stopwatch. The environmental noise was measured, at two different distances, with a phonometer. RESULTS At SEM analysis, piezosurgery osteotomies showed 66% of totally free intertrabecular spaces on the cutting surface, statistically significantly higher than those on the multiblade bur (33%) and diamond bur (12%) cutting surfaces (P < .0005). Bone samples harvested with piezosurgery also demonstrated faster cell proliferation. Finally, piezosurgery generated less environmental noise, though it required longer cutting time. CONCLUSION Piezoelectric technology is a valid alternative to rotating burs for osteotomy, demonstrating higher bone cell viability and a precise and silent, though slower, cut.

Purpose The extraction of a tooth is followed by hard and soft tissue changes that can compromise implant placement. The aim of the present retrospective study was to compare the clinical and radiographic outcomes of different ridge preservation procedures based on the use of leukocyte and platelet-rich fibrin (L-PRF). Materials and Methods The study population consisted of all patients who had undergone surgery from January 1, 2017 to January 1, 2018 for alveolar ridge preservation on single posterior teeth using 3 clinical protocols: L-PRF alone, L-PRF mixed with a bone xenograft, and bone xenograft alone. Clinical and radiographic measures were recorded preoperatively and at 6 months postoperatively to determine the horizontal and vertical ridge resorption. Results A total of 45 patients were included in the present study. All the surgeries were performed successfully, and no intraoperative complications developed. The L-PRF group experienced significantly greater horizontal and vertical bone resorption. The L-PRF plus bone xenograft group had less vertical and horizontal bone resorption than the bone xenograft alone group. Statistically significant differences in postoperative pain and wound healing were observed, with the bone xenograft alone group, in particular, having higher values for pain and experiencing delayed wound healing. Conclusions Within the limitations of the present retrospective study, the use of a bone xenograft alone or L-PRF combined with a bone xenograft to perform alveolar ridge preservation procedures significantly limited bone resorption.

The purpose of this study was to compare the envelope flap and triangular flap for impacted lower third molar (M3) extraction and their effects on the periodontal health of adjacent second molars (M2). A population of 60 patients undergoing M3 extraction with the envelope flap (Group A) or triangular flap (Group B) was analyzed, comparing probing pocket depth (PPD), clinical attachment level (CAL), and gingival recession (REC) recorded at six sites (disto-lingual, mid-lingual, mesio-lingual, disto-vestibular, mid-vestibular, and mesio-vestibular) before (T0) and 6 months after extraction (T1). There was a statistically significant mean difference in PPD and CAL at two sites, disto-vestibular (dv) and disto-lingual (dl), between values recorded before and 6 months after surgery for either Group A or Group B. Furthermore, for the same periodontal records, at 6 months after surgery, a statistically significant difference was recorded between younger and older patients, implying that the healing process was more beneficial for younger patients. No significant differences were found between the two groups (A and B) in PPDdl, PPDdv, CALdl, and CALdv, confirming that the mucoperiosteal flap design does not influence the periodontal healing process of second molars.

Restoring the proximal contacts is important for a restoration's long-term success. A frequently observed late complication of implant restoration is proximal contact loss. At present, there is a lack of sufficient research for determining the prevalence of proximal contact loss and for identifying the causative factors. The purpose of this clinical retrospective study was to evaluate the prevalence of proximal contact loss between implant restorations and adjacent teeth and to identify the causative factors. Partially edentulous patients who had received single crowns or fixed dental prostheses on implants were selected; the rehabilitations were metal-ceramic or all-ceramic, screw- or cement-retained. The primary study outcome was clinical evaluation of mesial and distal proximal contact tightness. The secondary outcome was evaluation of patient awareness of proximal contact loss, food impaction, and occurrence of biologic complications. In total, 237 single crowns and 83 fixed partial dentures were assessed. A multivariate logistic regression model was adopted. The overall prevalence of proximal contact loss was 51%. Among the patients with proximal contact loss, 107 (65%) were aware of its presence, while 58 (35%) reported food impaction. Within the limits of the present study, proximal contact loss between implant prostheses and adjacent teeth can be considered a frequent event, even at a 10-year follow-up, that should be carefully considered and monitored by patients and operators.

Background Nowadays, due to the esthetic and social demands of patients, conventional staged protocols seem to be increasingly replaced by faster, one-step protocols. The purpose of the present systematic review is to assess the peri-implant soft tissue changes after immediate implant placement and provisionalization (IIPP) comparing patients treated with or without a sub-epithelial connective tissue graft (SCTG) when replacing a single tooth in the esthetic region. Methods The present systematic review was written following the PRISMA checklist. Immediate implants placed with a connective tissue graft and without one were compared. The researched primary outcomes were the mid-buccal mucosa level (MBML) facial soft tissue thickness (FSTT) and marginal bone loss (MBL). The weighted mean differences (WMD) were estimated for all three outcomes. Results The change in the mid-buccal mucosa level in the intervention group was significantly higher (WMD 0.54; 95% CI 0.33–0.75), with no indication of heterogeneity (I2 = 16%). The facial soft tissue thickness increased significantly in the intervention group (WMD 0.79; 95% CI 0.37–1.22). The marginal bone loss was significantly higher in the control group (WMD 0.13; 95% CI 0.07–0.18), with no indication of heterogeneity (I2 = 0%). Conclusions The results of the meta-analyses showed a statistically significant reduced change of the marginal bone loss and vestibular recession, as well as higher soft tissue thickness, when a graft was used. The included studies had a short observation time; therefore, studies with longer follow-ups are needed to confirm these findings.

Objective. The introduction of CAD/CAM and the development of zirconia-based restorations have allowed clinicians to use less expensive materials and faster manufacturing procedures. The purpose of the study was to analyze the differences, in terms of mechanical and biological complication, in multiunit zirconia fixed dental prosthesis (FPDs) on posterior implants produced using a digital workflow. Method and Materials. This study was a retrospective investigation, and patients treated with screw-retained monolithic or partial veneer FPDs on dental implants were selected. Periapical radiographs were taken at baseline and at the 3-year follow-up. Complications were recorded and classified as technical and biological ones. Results. The study population included 25 patients. The occlusal and interproximal corrections were not clinically significant. In the study sample, the survival rate and success rate of the FPDs after 3 years were 100% and 96%, respectively. One implant failed immediately after placement. Conclusion. Monolithic zirconia FPDs and partial veneer FPDs showed a 100% survival rate, presenting an interesting alternative to metal ceramic restorations. The partial veneer FPDs had a higher technical complication rate than the monolithic FPDs; however, no statistically significant difference was found.

Most studies indicate that the mechanical removal of the bacterial biofilm from the implant surface is the central goal of peri-implantitis therapy. However, controversial results in the treatment of peri-implantitis have led to the consideration of additional strategies that include surgical approaches and chemical adjuvants. Local/topical antibiotics, such as minocycline, azithromycin, tetracycline, amoxicillin, doxycycline, and metronidazole, may improve the efficacy of the definitive treatment of the disease, but the lack of conclusive findings prevents their use in clinical practice. This systematic review aimed to evaluate the effect of local/topical antibiotics for peri-implantitis treatment. Randomised controlled studies (RCT) on patients with peri-implantitis and comparing the efficacy of local/topical antibiotics vs. placebo or mechanical debridement were included. A systematic search strategy was carried out using three registered databases (PubMed, Web of Science, and Scopus). RoB2 was used to assess risk of bias. Five RCTs were identified (n = 250 patients and 333 implants). Contrast results emerged among the included studies, and a high heterogeneity level was observed. Risk of bias revealed some concerns for three studies out of five, while one study was judged at high risk. Only one study analysed the limitations of its findings. Overall, local antibiotic use can be considered a valid approach in the treatment of peri-implantitis. Therefore, future long-term clinical trials with standardised protocols and antibiotics with similar biological activity profiles should be tested to achieve a valid and definitive conclusion.

Diabetes represents a challenge in implant therapy because hyperglycemia may negatively affect bone regeneration, directly compromising clinical outcomes and increasing clinical failures. The aim of this retrospective study is to analyse the prognostic significance of HbA1c levels in patients undergoing implant placement associated with horizontal guided bone regeneration. Thirty-four patients were divided into 3 groups according to their HbA1c levels: nondiabetic normoglycemic patients ( HbA 1 c < 5.7 % ), nondiabetic hyperglycemic patients ( HbA 1 c < 6.5 % ), and controlled diabetic patients ( HbA 1 c < 7 % ). Primary outcomes were dimensional changes in height (VDH) and width (DW) of the peri-implant defect. Secondary outcomes were evaluations of periodontal parameters of adjacent tooth sites, wound healing, marginal bone loss (MBL), and survival and success rates. At T 1 (6 months), mean VDH values in groups 1, 2, and 3 were, respectively, 0.07, 0.5, and 0.25 mm. Mean DW values in those same groups were, respectively, 0.07, 0.38, and 0.33 mm. HbA1c levels were not statistically related to VDH and DW values at T 1 . No statistically significant differences were observed in MBL between groups ( p = 0.230 ). Implant survival and success rates were, respectively, 98% and 96%. Simultaneous guided bone regeneration is a feasible procedure for the treatment of horizontal bone deficiencies in controlled diabetic patients.

The digital workflow and the application of Computer-Aided Manufacturing (CAM) to prosthodontics present the clinician with the possibility of adopting new materials that confer several advantages. Especially in the case of zirconia, these innovations have profoundly changed daily practice. This paper compares the satisfaction and perception of patients who received implant-supported single crowns (SC) and fixed partial dentures (FPD) made from zirconia, either monolithic or partially veneered, after 3 years of follow-up; the success and survival rate of these restorations were also measured. Forty patients, who had been previously treated with implant-supported SC or FPD, either monolithic or partially veneered, and submitted to a yearly maintenance program, were recalled 3 years after their treatment and requested to complete an 8-question questionnaire regarding their perceptions of the treatment. Any mechanical or biological complication that had occurred from the time of delivery was also recorded. Patients that experienced ≥1 complication were less likely to be prone to repeat the treatment. The 3-year success rate was 92.6% for monolithic restoration and 92.3% for partially veneered restoration, while the survival rate was 100% for both restorations. The 3-year follow-up found that monolithic and partially veneered zirconia restorations are both well-accepted treatment options, and patients preferred the veneered restorations (0.76, p < 0.05 ) from an aesthetic point of view. According to our results, monolithic and veneered zirconia restorations are both reliable treatment options and are both equally accepted by patients.

The purpose of this clinical research was to evaluate peri-implant marginal changes around immediate implants placed either with the application of SCTG or XCM or without soft tissue grafting. A total of 48 patients requiring a single implant-supported restoration in the anterior jaw were selected for inclusion. Three surgical procedures were performed, as follows: type 1 implant with subepithelial connective tissue graft (SCTG), type 1 implant with xenogenic collagen matrix (XCM), and type 1 implant without soft tissue augmentation (NG) (control group). The marginal change of peri-implant soft tissue, facial soft tissue thickness (FSTT), peri-implant health status, esthetics, and patient satisfaction were assessed at one year after surgery. All of the placed implants showed a survival rate of 100%. No significant differences in FSTT were recorded between the SCTG group and the XCM group after treatment ( P > 0.05 ), while the NG group presented a significant difference ( P < 0.05 ). Patients in the NG group lost significantly more in the buccal marginal level than did patients in the SCTG group and those in the XCM group ( P < 0.05 ). The favourable success rate recorded in all groups confirmed immediate tooth replacement as a choice of treatment for a missing anterior single tooth. The NG group presented significant changes of FSTT and buccal marginal level, while XCM constituted a viable alternative to SCTG.

Statement of problem The technology behind optical scanners has greatly improved recently, making their dental application advantageous. While their accuracy is now comparable with that of conventional impression materials, whether these techniques have other advantages is unclear. Purpose The purpose of this systematic review and meta-analysis was to determine whether digital scanning for implant-supported restorations is more time-efficient and convenient for the patient. Material and methods The study was conducted on September 23, 2020 using 4 different databases (Medline, Cochrane, Web of Science, Scopus) searching for clinical studies that compared the time needed and/or patient perceptions between those who had undergone the digital scanning procedure and those who had undergone conventional impression making. Results Twelve studies met the inclusion criteria for qualitative and quantitative analysis. Outcome variables were measured as standard mean differences (SMDs) by following a fixed-effects model or random-effects model (in the case of high heterogeneity). Digital scanning was more time-efficient and was preferred by patients for all 4 analyzed outcomes (comfort, anxiety, nausea, time perception). Conclusions Digital scanning was found to be more time-efficient and convenient than conventional impression making for implant-supported restorations. Additional randomized controlled trials are needed to confirm the findings of this review.

Background: Scientific information about the effects of implant therapy following a precise workflow and patient and operators&rsquo, preferences should be considered to choose which implant treatment protocol to use, and to achieve patient&rsquo, s satisfaction and functional results. The aim of this study was to analyze implant rehabilitations with a fully digital workflow and compare this approach with a conventional one. Methods: This study comprises 64 patients treated with a fully digital approach and 58 patients treated using a conventional protocol. Patient and operator centered outcomes were assessed through two visual analogue scale (VAS) questionnaires. Results: The VAS questionnaire demonstrated better results for the digital workflow concerning anxiety, convenience, taste, nausea sensation, pain and breathing difficulties (p &lt, 0.0001). The VAS questionnaire administered to the operators showed better scores for the digital approach in relation to anxiety, convenience, difficulties of the impression procedure and the workflow (p &lt, 0.0001). A significant reduced mean time for the digital workflow as well as a reduced number of required visits were recorded. Conclusion: The analysis of a fully digital and a conventional protocol showed better results according to patient and operators&rsquo, preferences when a fully digital approach was used.