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Objective: The aim of this non‐inferiority randomized clinical trial was to compare the surgical and healing complications, vertical bone gain, and volumetric bone changes after vertical ridge augmentation using two different approaches: customized Ti‐reinforced d‐PTFE mesh versus customized CAD/CAM Ti‐mesh. Materials and Methods: Fifty patients with vertical bone defects were randomly treated with Ti‐reinforced d‐PTFE mesh (control group) or CAD/CAM Ti‐mesh (test group) and a mix of autogenous bone and deproteinized bovine bone matrix. Surgical and healing complication rates (SCR‐HCR), vertical bone gain (VBG), regenerated bone volume (RBV), and regeneration rates (RR and ERR) were recorded and analysed [significance level (α) of 0.05]. Results: Of the 50 patients, 48 underwent bone augmentation surgery. SCR were 4% and 12% in PTFE and Ti‐mesh, whereas HCR were 12.5% and 8.3%. VBG were 5.79 ± 1.71 mm (range: 3.2–8.8 mm) in the PTFE group and 5.18 ± 1.61 mm (range: 3.1–8.0 mm) in the Ti‐mesh group (p =.233), whereas RBV were 1.46 ± 0.48 cc and 1.26 ± 0.55. RR was 99.5% and 87.0%, demonstrating a statistically significant difference (p =.013). Finally, the values related to pseudo‐periosteum, bone density, and implant stability were similar in the two study groups. Osseointegration rates were 98.2% and 98.3%. Conclusions: This study confirmed the non‐inferiority of customized CAD/CAM titanium meshes with respect to reinforced PTFE meshes in terms of surgical and healing complications. Although PTFE meshes showed higher vertical bone gain and regeneration rates than Ti‐meshes, no significant differences were found. [ABSTRACT FROM AUTHOR]

Objectives: To date, no studies have exploited micro‐CT in humans to evaluate bone morphology and structure after bone augmentation with CAD/CAM‐customized titanium mesh, in mandible and maxilla. The aim of this study was to assess the composition and microstructure of bone biopsy through micro‐CT analysis. Materials and Methods: Bone augmentation at both maxillary and mandible sites was performed on 30 patients randomly treated with customized mesh, either alone (M−) or covered with resorbable membrane (M+), in both cases filled 50:50 with autogenous bone and xenograft. After 6 months, biopsies were taken and micro‐CT was performed on consecutive 1‐mm‐thick VOIs from coronal to apical side, measuring tissue volumes, trabecular thickness, spacing, and number. Results: In both groups, irrespective of membrane use, bone tissue (M−: 29.76% vs. M+: 30.84%) and residual graft material (M−: 14.87% vs. M+: 13.11%) values were similar. Differences were site‐related (maxillary vs. mandibular) with higher percentage of bone tissue and trabecular density of low‐mineralized bone and overall bone in the mandible. Conclusions: The composition and structure of bone tissue, as assessed by micro‐CT after alveolar ridge augmentation using CAD/CAM‐customized titanium meshes, showed similar features regardless of whether a collagen membrane was applied. [ABSTRACT FROM AUTHOR]

This study evaluated the efficacy of buccal fat pad (BFP) as a natural barrier to cover nonresorbable devices for vertical ridge augmentation (VRA). Twelve consecutive patients with 14 vertical bone defects in need of bone augmentation for implantprosthetic rehabilitation were treated according to the described protocol. VRA was performed by means of customized titanium meshes, titanium-reinforced d-PTFE membranes, or resorbable membranes and titanium plates. After buccal flap release, the BFP was identified and isolated, then mesially and coronally advanced to cover the whole augmented area. BFP was used as a pedicle flap in 11 cases and as a free graft in 3 cases. The mean BFP surface area was 13.5 ± 5.5 cm2. Healing was uneventful in all 14 augmented sites. No patients reported healing complications or facial volumetric changes. The mean vertical bone gain (VBG) was 4.2 ± 1.8 mm. In this limited number of cases, using the BFP as a natural barrier has proven to be efficient in bone augmentation, as it improved the healing process while reducing the risk of complications. [ABSTRACT FROM AUTHOR]

Introduction: The primary aim of this systematic review was to investigate and compare the outcomes of different vertical ridge augmentation (VRA) techniques in relation to peri‐implant bone loss (PBL), after at least 12 months of functional loading. Material and methods: The search was conducted to find all the studies about VRA and measurements of PBL with at least 12 months follow‐up. Three pairwise meta‐analysis (MA) was performed to completely evaluate the outcomes. Results: A total of 42 studies were included, of which 11 were randomized clinical trials (RCTs). RCTs were available only for guided bone regeneration (GBR), onlay, and inlay techniques. The weighted mean estimate (WME) of PBL value was found to be 1.38 mm (95% confidence interval [95% CI]: 1.10–1.66) after a mean follow‐up of 41.0 ± 27.8 months. GBR, Inlay, Onlay, osteodistraction, and SBB represented in weight 32.9%, 30.6%, 25.0%, 7.6%, and 3.9%, respectively; and their WME (95% CI) were 1.06 (0.87–1.26) mm, 1.72 (1.00–2.43) mm, 1.31 (0.87–1.75) mm, 1.81 (0.87–1.75) mm, and 0.66 (0.55–0.77) mm, respectively. Among the secondary outcomes, the analysis was conducted for vertical bone gain, healing complication rate, surgical complication rate, implant survival, and success rate. Conclusions: The primary findings of the meta‐analysis, based on the changes between final and baseline values, showed that the peri‐implant bone loss could be influenced by the type of intervention but there is a need to evaluate in RCTs the behavior of the peri‐implant bone levels after long‐term follow‐up for all techniques. [ABSTRACT FROM AUTHOR]

Objectives: To date, no clinical studies have investigated the effect of using resorbable collagen membrane in conjunction with customized titanium mesh to promote bone formation in guided bone regeneration. Therefore, a non‐inferiority analysis (one‐sided 95% CI approach) was designed to compare the augmented bone gained using meshes with and without collagen membranes, through histological and histomorphometric investigations. Materials and Methods: Thirty patients undergoing bone augmentation procedures at both maxillary and mandible sites were randomly treated with customized titanium meshes alone (M−, n = 15) or covered with resorbable membrane (M+, n = 15), in both cases filled with autogenous bone and xenograft. After 6 months of healing, bone tissue biopsies were taken from the augmented region. The bone tissue (B.Ar), grafting material (G.Ar), and non‐mineralized tissue (NMT.Ar) areas were quantified through histomorphometric analysis, as were the osteoid area (O.Ar) and its width. Results: Collagen membrane did not appear to significantly influence the investigated parameters: B.Ar, G.Ar, NMT.Ar, and O.Ar were similar between Group M− (34.3%, 11.5%, 54.1%, 1.95 μm2, respectively) and Group M+ (35.3%, 14.6%, 50.2%, and 1.75 μm2, respectively). Considering the overall population, significantly higher rates of newly formed bone were obtained in mandibular sites, while non‐mineralized and dense connective tissue rates were higher in the maxilla (p <.05). Conclusions: The application of collagen membrane over titanium mesh did not lead to significant results. Bone formation appeared significantly different in the maxilla compared with the mandible. Additional studies are required to further investigate the issues observed. [ABSTRACT FROM AUTHOR]

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 tissue < 1 mm); Type 2 (regular tissue between 1 and 2 mm); and Type 3 (irregular tissue or tissue > 2 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. [ABSTRACT FROM AUTHOR]

Background and Aim: It is unclear if fibrous dysplasia (FD) represents a contraindication for implant borne rehabilitation, and only two successful cases are reported in the literature with a 4–2‐year follow‐up. The present paper discusses this issue reporting a full‐arch maxillary rehabilitation with a >5‐year follow‐up. Materials and Methods: A 79‐year‐old woman complained of a progressive asymmetry of the medial facial third with inter‐arch occlusal alterations, reduced mandibular movements, upper right dental dislocation and mobility and toothache in the upper posterior jaw. The X‐ray supported monostotic FD diagnosis was followed by a remodelling intervention in general anaesthesia, with the extraction of the hopeless teeth. After that and the failed rehabilitation with a removable prosthetic device, the patient underwent implant placement procedure for a fixed 'Toronto‐bridge' prosthesis. Results: After 6 years from implant loading, a posterior vestibular swelling of the affected maxilla was recorded, and one implant in 1.1 position had to be removed for peri‐implantitis, without compromising the rehabilitation. Conclusions: The acceptable results obtained in this case should promote the dental implantology practice in FD affected jaws, evaluating the proper clinical situations and the more adequate technological solutions. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the clinical, radiographic and patient-related outcomes of a novel technique for digitalisation and customisation of reinforced polytetrafluoroethylene meshes in vertical ridge augmentation surgery. Materials and methods: A total of 10 patients (five men and five women, mean age 54 years) with vertical defects were included in the study. Prior to surgery, digital planning of bone augmentation, manufacturing of 3D printed models and replicas of the meshes and modelling of a customised reinforced polytetrafluoroethylene mesh were carried out. All patients were treated using a 50:50 mixture of xenogeneic and autogenous bone, customised reinforced polytetrafluoroethylene mesh and collagen membrane. After 6 to 9 months, computer-guided surgery was planned, the reinforced polytetrafluoroethylene mesh was removed and implants were placed in augmented sites using a fully guided surgical template. Patient-related outcomes, intraoperative timing, surgical and healing complications, vertical bone gain, bone density, pseudoperiosteum type and number and stability of implants were recorded. Results: All 10 patients were treated without surgical complications. Healing was largely uneventful, with the exception of one case of abscess formation without mesh exposure (exposure rate 0%). The mean duration of digital planning was 17.0 minutes, reinforced polytetrafluoroethylene mesh customisation took 9.0 minutes, and the total intraoperative time was 91.3 minutes. The mean planned bone volume was 1.52 cc, vertical bone defect depth was 6.0 ± 1.7 mm and vertical bone gain was 5.5 ± 1.9 mm; most sites showed medium bone density and a Type 1 pseudoperiosteum. All patient-related outcomes were favourable. Conclusions: The preliminary results of this pilot study demonstrated the feasibility and reliability of a fully digital workflow for the customisation of reinforced polytetrafluoroethylene mesh in vertical ridge augmentation. [ABSTRACT FROM AUTHOR]

A sample of 24 patients with varied morphologic defects were treated with 34 titanium meshes and particulate bone and rehabilitated at least 8 to 9 months thereafter with the placement of 88 implants. Of the 34 meshes, 4 had to be removed before implant placement (11.76% total failure) and 20 were exposed due to soft tissue dehiscence (58.82% of complications): 4 (11.77%) prematurely (within 4 to 6 weeks) and 16 (47.05%) delayed (after 4 to 6 weeks), with no compromise in implant placement. None of the 88 implants was lost (100% implant survival), and 15 demonstrated increased bone loss, yielding a cumulative implant success rate of 82.9%. This technique appears useful in treating extended and morphologically varied alveolar defects. [ABSTRACT FROM AUTHOR]

Purpose: To retrospectively compare short implants (6 to 8 mm) (short group) to standard-length implants (= 11 mm) inserted in combination with a lateral sinus elevation procedure (sinus group), supporting partial fixed prostheses in the atrophic posterior maxilla. Materials and Methods: Records of 118 patients treated with fluoride-modified implants in the atrophic posterior maxilla between January 2009 and December 2011 were screened in two private practices. Two to four implants were placed in each patient and loaded after 5 to 6 months with partial fixed prostheses. Patients were followed for at least 3 years after implant placement. Patients were contacted and invited for clinical and radiologic follow-up examinations. Outcome measures were implant failures, complications, soft tissue parameters, and marginal bone levels. Fisher exact and unpaired t tests were used to compare proportions and means at the .05 level of significance. Results: A total of 101 patients attended the examination: 53 (112 implants) in the sinus group and 48 (109 implants) in the short group. The mean observation period was 47.03 ± 7.46 months for the sinus group and 44.18 ± 6.42 months for the short group. Ten surgical complications occurred in nine patients of the sinus group versus only one complication in the short group; the difference was statistically significant (P = .01). Six implants failed in five patients of the sinus group versus two implants in two patients of the short group. At follow-up, mean marginal bone loss was 0.64 ± 0.58 mm in the sinus group vs 0.48 ± 0.5 mm in the short group. No significant difference was observed in terms of implant failures, prosthetic complications, soft tissue parameters, or marginal bone loss between the two groups. Conclusion: Within the limitations of this study, both techniques showed similar medium-term outcomes, but short implants provided advantages in terms of a reduced number of surgical complications. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the three-dimensional (3D) reconstruction of atrophic alveolar ridges using titanium mesh (Ti-mesh) and its correlation with the extent and timing of mesh exposure and amount of reconstruction planned. Materials and Methods: This study retrospectively evaluated 12 patients (mean age, 49.1 years) with 15 alveolar defects treated with Ti-mesh and particulate grafts (70/30 autogenous bone/anorganic bovine bone) followed by implant placement 8 to 9 months later. For each site, computed tomography images were analyzed using software designed to measure 3D volumes. The lacking bone volume (LBV) was calculated by subtracting the reconstructed bone volume at reentry from the planned bone volume (PBV). In all cases, the meshes were modeled preoperatively on a stereolithographic model. LBV was correlated with the extent and time of mesh exposure and PBV. Results: The mean LBV (0.45 cm3) was 30.2% (range, 6% to 74%) of the mean PBV (1.49 cm3). The mean extent and timing of mesh exposure, which occurred at 80% of augmented sites (12/15), were 0.73 cm2 (range, 0.09 to 3.45 cm2) and 2.17 months (range, 1 to 8 months), respectively. LBV was significantly positively correlated with the area of mesh exposed, with 16.3% LBV for every cm2 of mesh exposed; there were positive correlations between LBV and early exposure and PBV. Conclusion: On average, there was 30.2% less bone than planned preoperatively; there was a significant negative correlation between the amount of reconstructed bone and area of mesh exposed. [ABSTRACT FROM AUTHOR]

Fifty patients underwent single-tooth replacement in the maxillary and mandibular incisor area using two-piece 3.0-mm-diameter implants. Clinical and radiographic measurements of soft and hard tissue levels and esthetic parameters (pink esthetic score/white esthetic score [PES/WES]) were assessed at 3 years. No implant failed (success rate: 100%), and facial soft tissues and marginal bone levels remained stable throughout the study period. The mean total PES/WES was high (14.1 ± 1.75), and only one implant demonstrated an unfavorable esthetic outcome (PES/WES = 10). The use of 3.0-mm-diameter implants appears to be a viable treatment procedure in the medium term for single-tooth anterior restorations with limited dimensions. [ABSTRACT FROM AUTHOR]

Purpose: 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. Materials and methods: 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 p = 0.05). Results: 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 (P < 0.05). In both groups, considerable differences were noted between regenerated and native bone (P > 0.05), with a slight correlation between the microcomputed tomography parameters that suggests that native bone influences the quality of regenerated bone. Conclusions: 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. Conflict-of-interest statement: The authors declare there are no conflicts of interest relating to this study. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to evaluate hard and soft tissues around implants placed in posterior mandible 1 year 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 1 year, 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 1 year, implants showed a change in PBL from 0.12 to 0.76 mm, with marginal bone loss of 0.67 and 0.61 mm 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 <.0001). However, no significant differences were observed for PPD, mPI, mGI, tKT, wKT, and FD (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 1 year of follow‐up, with a peri‐implant bone loss less than 1.0 mm in the first year (study registered at ClinicalTrials.gov NCT04332679). [ABSTRACT FROM AUTHOR]