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Purpose: This study describes a new procedure for sinus elevation using computer-guided planning and guided surgical approach through the use of computer-aided design (CAD)/computer-aided manufacturing (CAM)-generated surgical template in combination with expander-condensing osteotomes thus providing a minimally invasive surgical technique. Materials and Methods: Sixty-six consecutive patients were treated with 136 implants placed by transcrestal-guided sinus floor elevation technique and the patients were followed for at least 3years in function. The drilling protocol is customized based on the bone density of each implant site to achieve an insertion torque ranging between 45 and 55Ncm. Titanium temporary abutments were connected to the implants with prosthetic screws tightened to 35Ncm and an acrylic resin provisional restoration was adapted and delivered immediately. Six months after initial loading, a definitive CAD/CAM-generated restoration was delivered. Outcome measurements assessed were implant and prosthesis survival rate, biological or biomechanical complications, marginal bone level changes, total alveolar ridge bone height before and after procedure, periodontal parameters measured as well as patient's perception of pain levels during recovery period. Results: Mean follow-up was 43.96 (range from 36 to 52) months. Cumulative implant survival rate was 98.53% at 3 years. No biological or mechanical complications were encountered and no prosthetic failures occurred during the entire follow-up period. Mean marginal bone loss (MBL) during the first year of function was 0.33±0.36mm, while at the 3-year follow-up, the mean MBL was 0.51±0.29mm. The mean residual bone height of the alveolar crest prior to grafting was of 6.7±1.6mm (range 5.1-9.2mm), while, the mean bone height gained was 6.4±1.6mm (range 3.2-8.1mm). All patients reported low levels of pain and found to have normal periodontal parameters. Conclusion: This proof-of-concept study suggests that the use of guided surgery to perform transcrestal maxillary sinus floor elevation for alveolar ridge height augmentation is a successful minimally invasive technique for the short- to medium-term follow-up, thus avoiding the extended treatment time and morbidities associated with maxillary sinus floor augmentation. © 2013 Wiley Periodicals, Inc.

PURPOSE: Radiation therapy influence on bone healing around 3 types of endosseous dental implants in dogs was evaluated. MATERIALS AND METHODS: Implants with 3 different surfaces (A = machined commercially pure titanium screws, B = commercially pure titanium plasma spray-coated cylinders, C = hydroxyapatite [HA] -ceramic coated cylinders) were first implanted unilaterally into the right posterior edentulous mandibles of 7 dogs as nonirradiated controls. After 12 weeks without functional loading and after sequential fluorochrome labeling these implants were retrieved by block dissection. In this same surgery, implants were placed on the contralateral side. Three weeks postimplantation the implant-containing hemimandibles were Cobalt 60 irradiated with the biologic equivalent of 5,000 cGy. Twelve weeks postimplantation and after labeling these irradiated implants were retrieved at sacrifice. On scanning electron, light, and fluorescence microscopic images of undecalcified longitudinal ground sections of the implants with surrounding tissues, percent bone-to-implant contact (% BIC), bone formation, and remodeling were histometrically and subjectively evaluated. RESULTS: Woven bone formation started 1 week after implantation at the implant interfaces on both the nonirradiated and the irradiated sides. Average BICs (total/cortical/spongious bone bed) of 26%/49%/36% for surface A, 46%/48%/64% for surface B, and 81%/83%/78% for surface C were observed. In the irradiated hemimandibles average BICs (total/cortical/spongious bone bed) were reduced to 11%/9%/4% for surface A, 43%/46%/43% for surface B, and 63%/85%/76% for surface C, with increased resorption of peri-implant bone and retarded bone formation after irradiation. DISCUSSION: Reductions of total % BIC in all irradiated implants, though not statistically significant, were significant (P < or = .05) on implant surfaces A and B in the spongious bone bed. CONCLUSION: Retarded bone formation on surfaces A and B in the spongious bone bed represented a more radiation-sensitive situation at the time of radiation onset compared to advanced bone formation and maturation at surface C. [ABSTRACT FROM AUTHOR]

PURPOSE: To guide treatment planning by analyzing the rates of dental implant failure to determine associated risk factors. MATERIALS AND METHODS: All consecutively treated patients from January 1982 until January 2003 were included in a retrospective cohort study, as defined in the hierarchy of evidence for dental implant literature. Data regarding gender, age, implant location, bone quality, bone volume, and medical history were recorded. Correlations between these data and implant survival were calculated to establish relative risk (RR) ratios. RESULTS: Increasing age was strongly associated with the risk of implant failure. Compared to patients younger than 40 years, patients in the 60-to-79 age group had a significantly higher risk of implant failure (RR = 2.24; P < .05). Gender, hypertension, coronary artery disease, pulmonary disease, steroid therapy, chemotherapy, and not being on hormone replacement therapy for postmenopausal women were not associated with a significant increase in implant failure. Smoking (RR = 1.56), diabetes (RR = 2.75), head and neck radiation (RR = 2.73), and postmenopausal estrogen therapy (RR = 2.55) were correlated with a significantly increased failure rate. Overall, implant failure was 8.16% in the maxilla and 4.93% in the mandible (P < .001). DISCUSSION: Patients who were over age 60, smoked, had a history of diabetes or head and neck radiation, or were postmenopausal and on hormone replacement therapy experienced significantly increased implant failure compared with healthy patients. CONCLUSION: Overall, dental implant failure is low and there are no absolute contraindications to implant placement. Conditions that were found to be correlated with an increased risk of failure should be considered during treatment planning and factored into the informed consent process. [ABSTRACT FROM AUTHOR]

Introduction: Bidirectional vertical ridge augmentation in the posterior maxilla is very challenging., Purpose: To evaluate the regenerative potential of micrografts, derived from periosteum or bone tissue, added to an anorganic xenograft in vertical reconstruction of the posterior maxilla, by a prospective, controlled study., Materials and Methods: After clinical selection and the analysis of CBCT scans, 24 posterior maxillary sites, in 19 patients, were treated by using Barbell Technique®. Sites requiring both inlay and onlay reconstruction were enrolled in the study. In the Control Group (CG, n = 8), a xenograft was used in the inlay site and for the onlay site, a 1:1 mix of xenograft and an autograft was used. In Test Group 1 (TG1, n = 8), both inlay and onlay sites were grafted with the xenograft associated with the micrografts derived from periosteum. In Test Group 2 (TG2, n = 8), both inlay and onlay sites were grafted with the xenograft associated with the micrografts derived from bone. Six months after the procedures, CBCT scans were obtained, and bone biopsy samples were harvested during implant placement surgery. The bone specimens were analyzed histomorphometrically, by measuring the percentages of vital mineralized tissue (VMT), non vital mineralized tissue (NVMT) and non mineralized tissue (NMT). Immunohistochemically, the levels of VEGF were categorized by a score approach., Results: Histomorphometric analysis revealed, for the inlay grafts, no significant difference among the groups for VMT, NVMT and NMT. However, for onlay grafts, CG achieved a higher amount of VMT in comparison with TG2, and the opposite occurred for NMT values. In this regard, no statistical difference was observed between CG and TG1. Concerning immunohistochemistry, the VEGF values for CG and TG1 were slightly higher than those obtained by TG2 for both inlay and onlay grafts, but without statistical significance. CBCT analysis showed a similar level of gain for all groups, for both inlay and onlay bone augmentation sites. Clinically, one implant (in CG) within a total of 50 implants installed, had early failure and was replaced after 3 months. All patients received implant supported prosthesis., Conclusion: This study indicated that the clinical use of micrograft derived from periosteum may have some potential to increase bone formation in onlay reconstructions, unlike the micrograft derived from bone tissue., (© 2024 Wiley Periodicals LLC.)

Objective: Semaphorin 4D (Sema4D) is a coupling factor expressed on osteoclasts that may hinder osteoblast differentiation. Since the leukocyte platelet-rich fibrin (L-PRF) membrane promotes growth factor concentration, this study aims to quantify the amount of Sema4D in L-PRF membranes, and analyze the impact of Sema4D on osteoblast cell function in vitro., Design: Enzyme-linked immunosorbent assay (ELISA) was used to quantify the levels of Sema4D in both L-PRF and whole blood (serum). To analyze the impairment of Sema4D on osteoblasts, MC3T3-E1 cells were induced to osteogenic differentiation and exposed to Sema4D ranging from 10 to 500 ng/ml concentrations. The following parameters were assayed: 1) cell viability by MTT assay after 24, 48, and 72 h; 2) matrix mineralization by Alizarin Red staining after 14 days, 3) Runt-related transcription factor 2 (RUNX-2), osteocalcin (OCN), osteonectin (ONC), bone sialoprotein (BSP) and alkaline phosphatase (ALP) gene expression by qPCR. For all data, the significance level was set at 5%., Results: The amount of Sema4D in the whole blood (serum) was higher than in L-PRF. Osteoblasts exposed to Sema4D at all tested concentrations exhibited a decrease in matrix mineralization formation as well in RUNX-2, OCN, ONC, BSP, and ALP gene expression (p < 0.05)., Conclusion: The presence of Sema4D, a molecule known for suppressing osteoblast activity, diminishes within L-PRF, enhancing its ability to facilitate bone regeneration., Competing Interests: Declaration of Competing Interest We wish to confirm that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome. We confirm that the manuscript has been read and approved by all named authors and that there are no other persons who satisfied the criteria for authorship but are not listed. We further confirm that the order of authors listed in the manuscript has been approved by all of us. We confirm that we have given due consideration to the protection of intellectual property associated with this work and that there are no impediments to publication, including the timing of publication, with respect to intellectual property. In so doing we confirm that we have followed the regulations of our institutions concerning intellectual property. We further confirm that any aspect of the work covered in this manuscript that has involved either experimental animals has been conducted with the ethical approval of all relevant bodies and that such approvals are acknowledged within the manuscript., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Horizontal bone augmentation is a common surgical procedure used in implant therapy to achieve adequate bone volume to permit dental implant placement. However, most current techniques are focused on unidirectional bone reconstruction (grafting only on the buccal side). This study was carried out to validate a new device that will permit bidirectional bone augmentation. Ten patients of both sexes (7 women and 3 men), with ages ranging from 29 to 62 years, who needed a bidirectional horizontal bone augmentation in maxilla were separated in accordance with the horizontal alveolar change (HAC) classification published by Pelegrine et al (2018). The patients classified as HAC 3 (ie, containing remaining cancellous bone at the recipient bed) received the Barbell device with xenogeneic biomaterial and a collagen membrane, whereas HAC 4 patients (ie, with no remaining cancellous bone at the recipient bed) received the Barbell device with a mixture of autogenous bone chips and xenogeneic biomaterial covered by a collagen membrane. For each patient, two computerized tomography scans were performed (T0 at baseline and T1 at 6 months postoperative examinations). Mean bone thickness (T0) in the studied sites were 3.25 ± 0.35 in HAC 3 and 1.98 ± 0.5 in HAC 4 patients. The mean bone thickness achieved after 6 months was 7.70 ± 0.89 mm and 8.62 ± 0.89 in HAC 3 and 4, respectively. All grafted sites were able to receive dental implants in adequate prosthetic positions. Based on these results, the use of this novel device permits bidirectional horizontal bone augmentation.

Background: It is known that a large number of mediators involved in osteogenesis can influence bone development and repair; however, whether these mediators could be used as markers of bone maturity has yet to be determined., Aim: To evaluate the expression of osteocalcin (OC) and Runt-related transcription factor 2 (Runx2) in bone biopsies obtained during the reconstruction of atrophic anterior maxillae using particulate bone xenografts with or without association of autogenous bone marrow aspirate concentrate (BMAC)., Materials and Methods: Ten patients were distributed into two groups ( n = 5), according to the type of grafting material used: Control group (CG), particulate bone xenograft alone, and test group (TG), particulate bone xenograft combined with BMAC. A bone specimen was removed from the graft area 4 months after grafting, before implant placement. The specimens were processed and submitted to immunohistochemical analysis for detection of OC and Runx2. Histomorphometry was used to ascertain the percentage of stained areas in both groups. The Wilcoxon Mann-Whitney U -Test was used in the statistical analysis ( P < 0.05)., Results: The immunohistochemical analysis revealed a significantly higher OC expression in the TG than in the CG, namely 27.40 ± 1.34% and 11.40 ± 2.70%, respectively ( P < 0.05), and a significantly higher Runx2 expression in the TG than in the CG, namely 2.80 ± 0.84% and 0.40 ± 0.55%, respectively ( P < 0.05)., Conclusion: The OC and Runx2 expression levels were higher when BMAC was associated with the bone xenograft than when it was not., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Contemporary Clinical Dentistry.)

Objective: To compare two pulp harvesting methods for stem cell expansion, namely, conservative pulpotomy and pulpectomy from exodontia., Method: Ten freshly extracted sound third molars from five patients were selected. Five were used in the control group, where pulp harvesting was performed by exodontia and the remaining teeth were used in the test group, where the pulp was harvested by conservative pulpotomy (preserving the tooth). This was a split-mouth design study, where a third molar from one side was randomly allocated into the test group and the contralateral tooth in the control group. After pulp harvesting, the following evaluations were performed: cell morphology, sterility test, immunophenotyping, differentiation assays, first pass live cell counts, time to cryopreservation, and total number of expanded cells at the end of the fourth pass., Results: Regarding morphology, the cells from both groups presented a fibroblastic phenotype. All samples were sterile. Immunophenotyping demonstrated a positive expression for CD105, CD90, and CD73 and negative expression for CD45 in both groups. Differentiation assays were positive for osteogenic and chondrogenic differentiation in both groups. Regarding live cell counts in the first passage, the control group had 95.8% live cells in the total count and the test group 91.2% ( p < 0.05). The time required for cryopreservation was equivalent in both groups 51.6 days and 52.6 days, respectively ( p > 0.05). The total number of cells at the end of the fourth passage was 5,286,782 and 5,736,862, respectively ( p > 0.05)., Conclusion: These results suggest that adult stem cell harvesting from conservative pulpotomy is as effective as the traditional exodontia-based method., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2021 Victor Okada Vendramini et al.)

Purpose: The objective of this study was to quantify the probability of implant failure over time from intrinsic patient factors using a population of patients from multiple private practices., Materials and Methods: The records for this retrospective, multicenter cohort study were randomly selected from eight private practices. The primary outcome variable was time to event (implant failure or last known follow-up). The included independent variables were age, sex, diabetes status, smoking status, and arch location. Analyses were performed with Cox proportional hazards on three models: univariate, full multivariate, and systemic factor multivariate. The probability of implant survival at 1, 5, and 10 years was calculated using univariate time-to-event modeling on log-normal distribution with 95% CIs and Cox proportional hazard tests for significance. The Kaplan-Meier survival curve was calculated for patients < 71 years of age., Results: Eight hundred thirty-five implant-level records from 378 patients were collected for analyses. The mean patient age was 60 years, and 48% were men, 15% reported a history of smoking, and 16% reported having diabetes. The follow-up time was as long as 17 years, with a mean of 23.1 months, and a median of 7 months. The hazard ratio (HR) for implant failure due to sex (HR = 1.18; 95% CI: 0.52 to 2.66), smoking (HR = 1.30; 95% CI: 0.49 to 3.46), diabetes (HR = 1.17; 95% CI: 0.35 to 3.86), and arch location (HR = 2.13 to 3.39) failed to reach the threshold within any Cox proportional hazards model (P > .05)., Conclusion: The implant survival probability for patients ≤ 70 years of age is 86.4% at 10 years in the course of routine private practice by experienced providers. Cautious interpretation of these results is critical, as the effects of known systemic risk factors are likely tempered by effective modifications in clinical decisions and protocols with short- and long-term follow-up maintenance.

The aim of this study was to evaluate the level of mineralized tissue and expression of bone markers in sockets grafted with platelet-rich fibrin and bone marrow aspirate concentrate (BMAC). Patients requiring extraction of one maxillary anterior tooth were randomized into three groups. After tooth extraction, the sockets in the control group (CG) were permitted to fill with blood clot. In the platelet-rich fibrin group (PRFG), after blood processing, the sockets were grafted with PRF plug. In the bone marrow aspirate concentrate combined with platelet-rich fibrin group (BM/PG), after blood and bone marrow processing, the sockets were grafted with a mixture of PRF plug and BMAC. After 6 months, the sites were reopened and bone cores were harvested and prepared for histomorphometric and immunohistochemical evaluation. The following levels were measured: mineralized tissue, expression of RUNX-2, and osteocalcin. Fifteen patients were included in this study. The histomorphometric analysis showed a more pronounced level of mineralized tissue in PRFG and BM/PG (54.20 ± 4.31% and 64.70 ± 6.74%, respectively) when compared with CG (40.60 ± 5.98%) (p = 0.0283 and p = 0.0090, respectively). The expression of RUNX-2 was very low in BM/PG (0.80 ± 0.84%) and absent in CG and PRFG (p = 0.0528). Osteocalcin expression was higher for BM/PG (23.40 ± 1.52%) when compared with CG and PRFG (18.40 ± 2.07% and 16.20 ± 1.92%, respectively) (p = 0.0117 and p = 0.0088, respectively). This preliminary study indicates that clinical use of bone marrow aspirate concentrate, when combined with platelet-rich fibrin as a carrier, might have some potential to increase mineralization in fresh extraction sockets., Competing Interests: Declaration of competing interest There is no conflicts of interest., (Copyright © 2020 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Purpose: The purpose of this study was to determine the minimum torque required to attach the transducer to the implant to measure the implant stability quotient (ISQ) with two different devices and to estimate if finger-generated torque would be reliable for this purpose., Materials and Methods: One hundred implants were inserted into a uniform polyurethane block. The implants were distributed into 10 groups, with 10 implants each. The transducers were manually attached by a female operator (G female) and by a male operator (G male) using the standard connector provided by the manufacturers. For the remaining groups, the transducers were placed using a connector adapted to a digital torque wrench with different torque settings: 3 Ncm (G 3Ncm), 4 Ncm (G 4Ncm), 5 Ncm (G 5Ncm), 6 Ncm (G 6Ncm), 10 Ncm (G 10Ncm), 13 Ncm (G 13Ncm), 17 Ncm (G 17Ncm), and 20 Ncm (G 20Ncm). The stability was measured for all groups using both the Osstell and the Penguin resonance frequency analyzers. The minimum, medium, and maximum finger grip torque were accessed on 100 volunteers., Results: For Osstell, the conjugated confidence intervals were homogenous for four groups (G 10Ncm, G 13Ncm, G 17Ncm, and G 20Ncm), and for Penguin, they were homogenous for six groups (G 5Ncm, G 6Ncm, G 10Ncm, G 13Ncm, G 17Ncm, and G 20Ncm). The minimum finger-generated force was 2.18 ± 1.05 Ncm, the medium force was 4.25 ± 1.57 Ncm, and the maximum force was 7.51 ± 2.52 Ncm, measuring with a digital torque meter., Conclusion: For an accurate measurement of ISQ, the minimum torque necessary to insert the transducer into the implant for Osstell was 10 Ncm, while for Penguin, it was 5 Ncm. Therefore, when using Osstell to assess implant stability, the authors suggest the use of a torque wrench to ensure 10 Ncm of force is applied when tightening the transducer into the implant to obtain accurate stability measurements. When using Penguin, the maximum finger-generated tightening force is enough.

Horizontal bone reconstruction is a common augmentation procedure used in implant dentistry to achieve adequate 3-dimensional ridge reconstruction to permit proper dental implant positioning. However, most available techniques are focused on unidirectional bone reconstruction (grafting only on the buccal side). This study was carried out to validate an innovative device that is indicated for bidirectional bone augmentation. The study consisted of 4 patients who required bidirectional horizontal bone augmentation of the upper jaw. Two computerized tomographies were performed (T0 at baseline and T1 at 6 months postoperative examinations). Mean bone thickness in the studied sites at T0 was 2.30 ± 0.65 and mean bone thickness achieved was 9.11 ± 1.08 mm at T1, with an overall bone gain of 6.81 ± 1.33 mm. Concerning the specific gains in direction, buccal and palatal bone augmentations were 4.89 ± 0.94 and 1.92 ± 0.42 mm, respectively. Based on these results, it can be concluded that the use of this novel device allows for the achievement of bidirectional horizontal bone augmentation.

Horizontal bone loss after tooth extraction is a common finding that demands bone reconstruction in various cases. The aim of this study was to assess the horizontal alveolar status in partially and completely edentulous patients using cone-beam computed tomography (CBCT). In total, 1516 CBCT scans of 1404 adult patients were analyzed. Assessment of the images was performed in accordance with the previously published horizontal alveolar change (HAC) classification, which categorizes horizontal bone defects into four classes: HAC 1, HAC 2, HAC 3 and HAC 4 (from the least severe to the most severe condition). Analysis of 1048 scans from partially edentulous patients presented a distribution of 63.55%, 22.14%, 13.36% and 0.95% in HAC 1, HAC 2, HAC 3 and HAC 4, respectively. Analysis of 468 scans from completely edentulous patient images presented a distribution of 19.87%, 28.63%, 41.67% and 9.83% in HAC 1, HAC 2, HAC 3 and HAC 4, respectively. Based on these results, as in HAC 4, no cancellous bone was found between the cortical buccal and lingual/palatal bone plates, it seems reasonable to state that the absence of cancellous bone is higher in completely edentulous patients than in partially edentulous patients. Therefore, the absence of cancellous bone seems to be higher in completely edentulous than in partially edentulous patients.

Bone augmentation is an extremely common procedure in implant dentistry today because of significant advancements with reactive biomaterials, a better understanding of the mechanism of action that is found with growth factors contained in platelets, and improvements in surgical techniques. The expectation is for the surgeon to place the dental implant in the position that best serves the requirements of the prosthetic restorations. With the increasing demands that patients have for ideal prosthetic results, surgeons are expected to predictably augment both hard and soft tissues to provide the anticipated esthetic and functional outcomes. Bone grafting can be performed before, during, and after the implant placement; however, these augmentation procedures come with increased cost, the risk of complications such as infection or failure, and lengthening of the total treatment time. In addition, a plethora of grafting materials are available commercially, where they are often inadequately studied, or there is minimal information regarding their predictability or long-term success, or ability to support dental implants. It is clear that although the surgical field has seen major progress since early implant surgical techniques in the 1980s, major challenges still exist with hard tissue augmentation procedures. This review will discuss these challenges that are increased and often specific to bone graft healing, and which are becoming more common as implant site development often requires bone augmentation to improve volume or contour deficiencies. The risk factors that patients may present with that will affect outcomes with bone augmentation procedures are identified, and recommendations for the prevention of complications or managing complications once they have occurred are provided., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Purpose: The purpose of this in vitro study was to determine the minimum installation torque required to attach the transducer (measuring peg) to the implant to provide an accurate assessment of implant stability using resonance frequency analysis., Materials and Methods: One hundred 4 ×11-mm screw-shaped titanium implants were inserted into a uniform polyurethane block with similar density to bone in a standardized surgical protocol. The implants were distributed into 10 groups, with 10 implants each (G1 to G10). In G1, the transducer was manually attached by a female operator and in G2 by a male operator using the manual connector provided by the manufacturer. For the remaining groups (G3 to G10), the transducers were installed using a connector adapted to a digital torque wrench with different torque settings: 3 Ncm (G3), 4 Ncm (G4), 5 Ncm (G5), 6 Ncm (G6), 10 Ncm (G7), 13 Ncm (G8), 17 Ncm (G9), and 20 Ncm (G10). Stability was measured for all groups using the Osstell equipment (Diagnosis of Integration) and the implant stability quotient (ISQ) annotated for statistical comparison between the groups., Results: The mean ± standard deviation ISQ values for groups G1 to G10 were 9.50 ± 5.54, 19.05 ± 2.67, 29.25 ± 4.22, 26.55 ± 5.37, 40.90 ± 0.99, 69.60 ± 2.41, 71.30 ± 0.82, 71.20 ± 1.32, 72.40 ± 0.97, and 70.90 ± 0.88, respectively. Statistical comparisons determined that the amplitudes of the confidence intervals, relative to the standard deviations, were lowest for groups G5, G7, G8, G9, and G10. For the means, the lowest amplitudes of the confidence intervals were observed in G6, G7, G8, G9, and G10. When checking the conjugated confidence intervals (mean and standard deviation), the results were homogenous for G7, G8, G9, and G10. When the torque of 20 Ncm was reached, the connection between the transducer and the implant failed., Conclusion: In this in vitro model experiment, transducer torques between 10 and 17 Ncm appear to be adequate for accurate measurement of implant stability, allowing more precise comparisons without damaging the prosthetic connection in the implant.

This animal study evaluated the osseointegration level of a new nanotextured titanium surface produced by anodization. Ti-cp micro-implants (1.5 mm diameter by 2.5 mm in length) divided into two groups: titanium nanotextured surface treatment (Test Group) and acid etched surface treatment (Control Group). Surface characterization included morphology analysis using scanning electron microscopy and wettability by measuring contact angle. Sixteen Wistar rats were submitted to two micro implants surgical placement procedures. In each rat, one type of micro implant placed in each tibia. The animals sacrificed after two (T1) and six weeks (T2) post-implantation. After the euthanasia, tibias processed for histomorphometric analysis, which allowed the evaluation of bone to implant contact (BIC) and the bone area fraction occupancy between the threads (BAFO). Our surface analysis data showed that the Control Group exhibited an irregular and non-homogenous topography while the Test Group showed a nanotextured surface. The Test Group showed higher wettability (contact angle = 5.1 ± 0.7°) than the Control Group (contact angle = 75.5 ± 4.6°). Concerning the histomorphometric analysis results for T1, Control and Test groups showed BIC percentages of 41.3 ± 15.2% and 63.1 ± 8.7% ( p < 0.05), respectively, and for BAFO, 28.7 ± 13.7% and 54.8 ± 7.5%, respectively ( p < 0.05). For T2, the histomorphometric analysis for Control and Test groups showed BIC percentages of 51.2 ± 11.4% and 64.8 ± 7.4% ( p < 0.05), respectively and for BAFO, 36.4 ± 10.3% and 57.9 ± 9.3% ( p < 0.05), respectively. The findings of the current study confirmed that the novel nanotextured surface exhibited superior wettability, improved peri-implant bone formation, and expedited osseointegration., Competing Interests: The authors declare no conflict of interest.

Purpose: To introduce a proof of concept technique and new integrated workflow to optimize the functional and esthetic outcome of the implant-supported restorations by means of a 3-dimensional (3D) facially-driven, digital assisted treatment plan., Methods: The Smiling Scan technique permits the creation of a virtual dental patient (VDP) showing a broad smile under static conditions. The patient is exposed to a cone beam computed tomography scan (CBCT), displaying a broad smile for the duration of the examination. Intraoral optical surface scanning (IOS) of the dental and soft tissue anatomy or extraoral optical surface scanning (EOS) of the study casts are achieved. The superimposition of the digital imaging and communications in medicine (DICOM) files with standard tessellation language (STL) files is performed using the virtual planning software program permitting the creation of a VDP., Conclusions: The smiling scan is an effective, easy to use, and low-cost technique to develop a more comprehensive and simplified facially driven computer-assisted treatment plan, allowing a prosthetically driven implant placement and the delivery of an immediate computer aided design (CAD) computer aided manufacturing (CAM) temporary fixed dental prostheses (CAD/CAM technology)., (Copyright © 2018 Japan Prosthodontic Society. Published by Elsevier Ltd. All rights reserved.)

Purpose: The aim of this study was to assess the clinical effectiveness of alveolar distraction osteogenesis (ADO) versus recombinant human bone morphogenetic protein-2 (rh-BMP-2) for vertical ridge augmentation. Few data have been published on vertical bone regeneration using rh-BMP-2., Materials and Methods: The authors implemented a retrospective cohort study and enrolled a sample composed of patients with deficient alveolar vertical bone height. The primary predictor variable was vertical augmentation with BMP-2 and a titanium mesh or ADO. The primary outcome variable was gain in vertical bone height (millimeters) measured using computed tomography. The secondary outcome variable was postoperative complications, namely need for further grafting before or simultaneous with implant placement, soft tissue dehiscence, paresthesia, infection, implant failure, and pain. Other outcomes included implant stability at time of placement and follow-up (implant stability quotient by resonance frequency analysis), surgical time (minutes), and total treatment time until implant placement (weeks). Other study variables included location of reconstruction (maxilla or mandible). Appropriate bivariate statistics were computed and statistical significance was set a P value less than .05., Results: The retrospective review yielded 21 patients in the BMP group and 19 in the ADO group. For the BMP-2 group, the average vertical bone gain was 2.96 ± 1.8 mm overall (maxilla, mean 3.6 ± 3.1 mm; mandible, mean 2.32 ± 1.8 mm). For the ADO group, this gain was 4 ± 1.69 mm overall (maxilla, mean 2.8 ± 1.94 mm; mandible, mean 5.2 ± 4.67 mm). For complications, group BMP showed a statistically minor tendency for more postoperative problems, such as wound dehiscence. For implant survival, group BMP showed a 92.2% survival rate versus 96.3% in group ADO at 3 to 45 months after delivery of the prosthesis (average, 22 months)., Conclusion: The 2 techniques showed similar values in absolute vertical bone gain. Group ADO showed a slightly better outcome in outright vertical regenerative potential, albeit with a more frequent need for regrafting before and simultaneous with implant placement. Group BMP showed a lesser need for regrafting, despite having a higher postoperative complication rate., (Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: We carried out guided bone regeneration of cranial bone defects in rats using the bovine bone substitute Bio-Oss and a collagen membrane and performed histological observations of the bone repair process., Materials and Methods: Bone defects were created in the cranial bones of 30 15-week-old Sprague-Dawley rats. We made 3 groups. A is unfilled, B is Bio-Oss, and C is Bio-Oss plus a collagen membrane. At 4 or 8 weeks postoperatively, tissue samples were taken. The Kawamoto technique was used for histological evaluation., Results: There was no new bone formation in group A. In groups B and C, new bone formation was evident around the Bio-Oss. In group C, new bone formation was evident in the centers of the bone defects, detached from the cut edge of the cranial bone., Conclusion: Our results suggested that the Bio-Oss acts as a scaffold for bone repair, and the use of a collagen membrane may anchor the Bio-Oss closely to the cranial bone and assist the bone repair response.

The growing interest in minimally invasive implant placement and delivery of a prefabricated provisional prosthesis immediately, thus minimizing "time to teeth," has led to the development of numerous 3-dimensional (3D) planning software programs. Given the enhancements associated with fully digital workflows, such as better 3D soft-tissue visualization and virtual tooth rendering, computer-guided implant surgery and immediate function has become an effective and reliable procedure. This article describes how modern implant planning software programs provide a comprehensive digital platform that enables efficient interplay between the surgical and restorative aspects of implant treatment. These new technologies that streamline the overall digital workflow allow transformation of the digital wax-up into a personalized, CAD/CAM-milled provisional restoration. Thus, collaborative digital workflows provide a novel approach for time-efficient delivery of a customized, screw-retained provisional restoration on the day of implant surgery, resulting in improved predictability for immediate function in the partially edentate patient.

The lack of guidelines for bone augmentation procedures might compromise decision making in implantology. The objective of this study was to perform a retrospective study to verify the outcomes of horizontal bone reconstruction in implant dentistry with different types of materials and amounts of native bone in the recipient bed to allow for a new guideline for horizontal bone reconstruction. One hundred preoperative CT scans were retrospectively evaluated and categorized in accordance to horizontal bone defects as presence (Group P) or absence (Group A) of cancellous bone in the recipient bed. Different approaches were used to treat the edentulous ridge and the outcomes were defined either as satisfactory or unsatisfactory regarding the possibility of implant placement. The percentage distribution of the patients according to the presence or absence of cancellous bone was 92% for Group P and 8% for Group A. In Group P, 98% of the patients had satisfactory outcomes, and the use of autografts had 100% of satisfactory outcomes in this group. In Group A, 37.5% of the patients had satisfactory outcomes, and the use of autografts also yielded 100% of satisfactory outcomes. The use of allografts and xenografts in Group A had 0% and 33.3% of satisfactory outcomes, respectively. Therefore, it seems reasonable to speculate that the presence of cancellous bone might be predictive and predictable when the decision includes bone substitutes. In cases of absence of cancellous bone in the recipient bed, the use of a vitalized graft seems to be mandatory.

Purpose: To observe, histologically, bone induced by recombinant human bone morphogenetic protein-2 (rhBMP-2) in onlay grafted and sinus lifted alveolaris., Material and Methods: Eighteen patients were treated with rhBMP-2 at concentration 1.5 mg/mL with an absorbable collagen sponge (ACS). The treated bone was harvested with small trephine bur at 5 or 7 months after surgery for the micro Computer Scanning (CT) and light microscopic observation., Results: Micro CT showed clearly 3-dimensional trabecular bone structure. New bone formation and bone marrow structure were observed in the observed area. Osteoblastic cells existed along the new bone, and osteopontin was localized in the bone matrix weakly. In the connective tissue around the new bone, many CD34-positive blood vessel cells were present. Some tartrate-resistant acid phosphatase (TRAP)-positive osteoclastic cells were observed around bone at this stage., Conclusion: The application of rhBMP-2 with ACS induced a new bone accompanied by blood vessels in atrophied alveolaris. This suggests that rhBMP-2 is capable of osteoinductivity in human jaw.

Objectives: To quantitatively compare stability of dental implants with varying lengths, diameters, and intraoral locations., Study Design: Retrospectively, 200 consecutive NobelReplace Tapered Groovy implants of varying lengths and diameters were evaluated via implant stability quotient readings at placement (T1) and follow-up (T2). Data were analyzed by analysis of variance and simple linear regression tests., Results: Intraoral location was statistically significant at T1 and T2. Although implant diameter was not statistically significant, implant length resulted in T1 (P = .08) and T2 (P = .09), which may have a clinically relevant effect on implant stability. An overall implant survival rate of 98% was achieved. Gender and age did not seem to affect implant stability quotient values at placement, follow-up, or implant survival., Conclusions: Intraoral location is an important factor in implant stability, with implants placed in the mandible being more stable than implants placed in the maxilla both at T1 and T2. Length may have a clinically relevant effect on implant stability., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Statement of Problem: In patients with an altered skeletal maxillomandibular relationship and bone resorption, the rehabilitation of edentulous jaws by combining 4 implants, 2 straight medially and 2 tilted distally, may be preferred to avoid a bone augmentation procedure., Purpose: The purpose of this single cohort 1-year prospective study was to evaluate the clinical performance of a 4-implant overdenture fully supported by a computer-aided designed and computer-aided manufactured (CAD-CAM) titanium bar., Material and Methods: This single cohort prospective study included edentulous participants rehabilitated with a 4-implant overdenture in 1 of the 2 jaws. The outcomes were implant and prosthetic survival and success rates, any biologic and technical complications, periimplant marginal bone loss, changes in the oral health impact profile (OHIP), bleeding on probing, and the plaque index., Results: Eighteen participants received 72 implants. One year after implant placement, no implants or prosthesis had failed, and no biologic or technical complications had been observed. At the 1-year follow-up, the mean marginal bone loss was 0.29 ±0.16 mm. The OHIP summary scores demonstrated a significant improvement in oral health-related quality of life. At the 1-year follow-up, positive bleeding was found in 2 participants (11.1%) around 3 implants (4.1%). Three participants (16.6%), accounting for 5 implants (6.9%), showed a slight amount of plaque., Conclusions: A 4-implant overdenture supported by a CAD-CAM titanium bar may be a reliable option for the treatment of the edentulous mandible and maxilla over a 1-year period. Oral health-related quality of life significantly improved in all treated participants., (Copyright © 2016 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Purpose: The purpose of this study was to investigate the predictive value of resonance frequency analysis in assessing implant survival. This was accomplished by determining the correlation between implant stability quotients (ISQs) and implant survival following different placement staging (1-stage vs 2-stage) and loading (early vs traditional) protocols., Materials and Methods: A retrospective study was performed on implant patient data collected over a 5-year period. Patients ranged in age from 16 to 91 years. We analyzed 703 implants during placement and 1,254 implants before loading. All implants were placed with respective ISQs recorded by 1 oral and maxillofacial surgeon. Receiver operating characteristic (ROC) statistical analysis was used to calculate sensitivity and specificity values corresponding to various ISQ cutoff points for different placement staging and loading protocols; χ(2) tests were used to identify significant differences., Results: In predicting implant failure, sensitivity progressively increased and specificity decreased as ISQ cutoff values increased. All failures occurred at an ISQ less than 66 for the placement staging protocol and an ISQ less than 67 for the loading protocol. When ISQ values were below 60, higher survival rates were observed when implants were placed using a 2-stage rather than a 1-stage placement staging protocol (P < .05). The area under the ROC curve for placement staging was 0.80, and the area under the ROC curve for loading was 0.89. An implant survival rate of over 98% was achieved., Conclusions: Resonance frequency analysis is a noninvasive technique used to measure the stability of implants and to help guide placement staging and loading protocols. This study showed that increasing ISQ values correlated with increased sensitivity in detecting implant failure. Given the high survival rates of dental implants, additional studies can further elucidate the relationship between ISQ values and survival rates., (Copyright © 2016 The American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Aim: This study evaluated the efficacy of replacing single missing teeth in the posterior quadrants of the maxilla and/or mandible with an implant-supported dental prosthesis., Material and Methods: Three scientific literature databases - Medline (Pubmed), Ovid Medline and Cochrane Central Register of Controlled Trials (CENTRAL) - were used to perform a search of publications over a period from 1985 to 2014. One hundred and forty one (141) articles were reviewed; 36 articles met the inclusion criteria and were included in the final review., Results: The survival rates, success rates and mean bone loss for immediate implant placement were 96.9%, 100% and 0.85 mm, respectively. The survival rates, success rates and mean bone loss for delayed implant placement were 96.8%, 94.1% and 0.55 mm respectively. The survival rate, success rate and the mean bone loss in studies comparing immediate versus delayed implant placement showed 96.8% and 96.3%, 85.8% and 93.3%, and 0.57 ± 0.57 mm and 0.55 ± 0.37 mm, respectively., Conclusion: The prognosis for single molar implants provides a viable treatment option for replacing a single missing tooth in the posterior quadrants of the maxilla and mandible. There does not appear to be a significant difference in the survival rates of immediately placed implants compared with delayed implant placement. However, the success rates were slightly higher with delayed loading protocols than immediate loading protocols.

Aim: To systematically scrutinise the scientific literature to evaluate the accuracy of computer-guided implant placement for single missing teeth, as well as to analyse the eventual clinical advantages and treatment outcomes., Material and Methods: The electronic and manual literature search of clinical studies published from January 2002 up to November 2015 was carried out using specified indexing terms. Outcomes were accuracy; implant and prosthetic failures; biological and mechanical complications; marginal bone loss (MBL); sulcus bleeding index (SBI); plaque score (PS); pink esthetic score [PES]; aesthetic and clinical outcomes., Results: The search yielded 1027 relevant titles and abstracts, found during the electronic (n = 1020) and manual (n = 7) searches. After data extraction, and screening of titles, abstracts, and full-texts, 32 studies fulfilled inclusion criteria and were included in the critical review: two randomised controlled clinical trials, six prospective observational single cohort studies, one retrospective observational study, three in vitro comparative studies, 10 case reports and 10 systematic reviews. A total of 209 patients (18 to 67 years old) were treated with 342 implants using computer-guided implant surgery. The follow-up ranged from 12 to 52 months. The cumulative survival rate ranged from 96.5% to 100%. Eleven implant planning softwares and guided surgery systems were used and evaluated., Conclusions: Computer-guided surgery for single missing teeth provides comprehensive treatment planning, reliable implant positioning, favourable clinical outcomes and aesthetics. A tooth-supported template for the treatment of single missing teeth results in greater accuracy of implant positioning than with mucosa-supported or bone-supported templates. The limited scientific evidence available suggests that guided surgery leads to implant survival rates as good as conventional freehand protocols. Computer-guided surgery implies additional costs, that should be analysed in terms of cost-effectiveness, considering the reduction of surgery time, postoperative pain and swelling, as well as, the potential increased accuracy. Long-term randomised clinical trials are eagerly needed to investigate the clinical performance of guided surgery in partially edentate patients.

Purpose: The study aims to evaluate clinically the thickness of the alveolar ridge mucosa underneath a zirconia implant-supported restoration with a modified ovate pontic., Materials and Methods: Sixty-five patients, 32 women and 33 men (mean age: 65.5 years; range 38-81), were included. A total of 383 implants (303 in the maxilla; 80 in the mandible), supporting 81 full or partial fixed dental prostheses (65 in the maxilla; 16 in the mandible), were either cement- or screw-retained. Three years after loading, a total of 219 pontic sites (153 in the maxilla; 66 in the mandible) were measured, and the thickness of the alveolar ridge mucosa between the prosthetic surface and the underlying bone crest were recorded., Results: The overall implant and prosthesis survival rates at 3 years were 98.7% and 100%, respectively. No implant complications were reported, scoring a cumulative implant success rate of 100%. In the maxilla, the overall mean thickness of the alveolar ridge mucosa was 2.32 ± 0.57 mm. In the mandible, the overall mean thickness of the alveolar ridge mucosa was 2.20 ± 0.62 mm. There was no statistical difference between the overall mean values in the maxilla and mandible (p = .471)., Conclusion: This radiologic retrospective study suggests the existence of a physiological barrier, named prosthetic biological width, underneath a novel pontic-designed restoration., (© 2015 Wiley Periodicals, Inc.)

Objective: The purpose of this study is to evaluate sinus membrane perforations and the incidence of complications in a residency program., Study Design: Data from 107 consecutive direct sinus augmentation procedures were reviewed retrospectively from 2008 to 2012., Discussion: All perforations were repaired intraoperatively with the use of a collagen tape. Intraoperative membrane perforations were observed in 64 of 107 cases (59.8%). Of the perforations, 58 were less than 5 mm in diameter and 6 were 5 mm or greater in diameter. It was found that there were 6 cases (5.6%) that experienced postoperative complications. Of those, 3 occurred in cases with no perforations, 2 with perforations less than 5 mm in diameter, and 1 with a perforation 5 mm or more in diameter. These differences were not statistically significant (P > .05). All observed post-operative complications were related to symptoms of acute infection., Conclusions: Although membrane perforation was a frequent intraoperative finding, there was no evidence that the presence and size of membrane perforation influences the likelihood of postoperative complications., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Purpose: To evaluate the clinical and radiological performance of an immediately loaded novel implant design over a 3-year period., Materials and Methods: This prospective study includes 54 consecutive partially edentulous patients treated between December 2010 and October 2011. Outcome measures were: implant and prosthetic failures; biological and mechanical complications; marginal bone loss (MBL); sulcus bleeding index (SBI); and plaque score (PS)., Results: A total of 118 (29 narrow platform, 70 regular platform and 19 wide platform) NobelReplace Conical Connection implants were placed in both post-extraction sockets and healed sites and immediately loaded. The mean insertion torque was 63.4 ± 7.1 Ncm. One hundred out of 118 implants (84.7%) were inserted with a torque ranging between 55 and 70 Ncm. Each patient received a single prosthesis. At the 3-year follow-up, no patient dropped out and only two post-extractive implants failed (1.7%) in two patients (3.7%). The only complication (1.9%) observed was an event of periimplantitis, consisting of a mean mesiodistal peri-implant bone loss of 3.2 mm reported in a healed site of a smoker patient at the 2-year follow-up examination. No prosthesis failures were detected. The cumulative mean MBL between implant placements at the 3-year follow-up was 0.68 mm (95% CI: 0.44, 0.92). At the 3-year follow-up session, the SBI and PS were 5.7% and 15.4%, respectively., Conclusions: The NobelReplace Conical Connection implant can be considered as a valuable treatment option for immediate implant placement and loading in the partially edentulous patients over a 3-year period. Insertion torques ranging between 55 and 70 Ncm are not detrimental to osseointegration.

Purpose: The purpose was to objectively measure the stability of immediately placed implants compared with implants placed at healed sites using implant stability quotient (ISQ) values obtained by resonance frequency analysis., Materials and Methods: Data were collected from 137 Nobel Replace Tapered Groovy Implants placed in 85 patients 19 to 93 years old. All implants were placed by the same surgeon from May 2007 to October 2011. Forty-one implants were placed immediately after extraction with MasterGraft bone grafting material and 96 were placed in healed sites with no grafting material. ISQ values obtained by the Osstell ISQ System were recorded at the time of implant placement and at a subsequent follow-up appointment (T2). T2 was split into 2- to 3-month and 4- to 6-month groups depending on when their follow-up ISQ values were obtained. Data were analyzed using simple linear regression., Results: Implants placed in healed sites had higher average ISQ values at implant placement compared with immediately placed implants; however, mean ISQ values in the 2 immediate implant groups exceeded the ISQ threshold of 65. Immediately placed implants in the 2- to 3-month and 4- to 6-month groups had average ISQ values of 65.60 and 68.65, respectively, whereas implants placed in healed sites had averages of 76.73 (2- to 3-month group) and 71.23 (4- to 6-month group). These differences were statistically significant (P < .05). At subsequent follow-up appointments, implants placed in healed sites had higher mean ISQ values. Implants in healed sites had ISQ averages of 79.58 (2- to 3-month group) and 77.31 (4- to 6-month group), whereas immediately placed implants had averages of 73.88 and 70.14. These differences were statistically significant (P < .05). Moreover, these mean ISQ values in immediate implants exceeded the ISQ threshold of 65., Conclusion: Although mean ISQ values of immediately placed implants are lower than those of delayed implants at implant placement and follow-up appointments, immediate implant mean ISQ values consistently remain higher than the clinically successful ISQ threshold of 65 throughout the osseointegration process. These results support the immediate placement of implants in extraction sockets under favorable conditions., (Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

This report presents an 8-year follow-up of a patient treated with computer-assisted implant planning, template-guided implant placement, and immediate loading. A preoperative diagnostic evaluation resulted in a more predictable implant placement with respect to anatomic structures and the planned prosthesis. Implants were placed in both the maxilla and the mandible, and immediate loading in both arches was provided., (Copyright © 2014 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Purpose: To compare the clinical and radiological outcomes of two implant designs with different prosthetic interfaces and neck configurations., Materials and Methods: Thirty-four partially edentate patients randomly received at least one NobelActive implant (Nobel Biocare, Göteborg, Sweden) with back-tapered collar, internal conical connection and platform shifting design, and one NobelSpeedy implant (Nobel Biocare) with external hexagon and flat-to-flat implant-abutment interface according to a split-mouth design. Follow-up continued to 3 years post-loading. The primary outcome measures were the success rates of the implants and prostheses, and the occurrence of any surgical and prosthetic complications during the entire follow-up. Secondary outcome measures were: horizontal and vertical peri-implant marginal bone level (MBL) changes, resonance frequency analysis values at implant placement and loading (4 months), sulcus bleeding index (SBI) and plaque score (PS)., Results: No drop-out occurred. No implants and prostheses failures were observed to the 3-year follow-up. MBL changes were statistically significant different with better results for the NobelActive implants for both horizontal and vertical measurements (P = 0.000). After 3 years post-loading, the NobelActive implants underwent a mean vertical bone resorption of 0.66 mm, compared with 1.25 mm for the NobelSpeedy Groovy implants (P = 0.000); the mean horizontal bone resorption was 0.19 mm for the NobelActive implants and 0.60 mm for the NobelSpeedy Groovy implants (P = 0.000). A high ISQ value was found for both implants, and no statistically significant difference was found for ISQ mean values between interventions (P = 0.941 at baseline; P = 0.454 at implantabutment connection; P = 0.120 at prosthesis delivery). All implants showed good periodontal health at the 3-year-in-function visit, with no significant differences between groups., Conclusion: The results of this research suggest that in well-maintained patients, the MBL changes could be affected by the different implant design. After 4 months of unloaded healing, as well as after 3 years in function, both implants provided good results, however vertical and horizontal bone loss had statistically significant differences between the two groups (difference of 0.58 ± 0.10 mm for the vertical MBL, and 0.4 ± 0.05 mm for the horizontal MBL), with lower values in the Nobel Active implants, compared to the NobelSpeedy Groovy implants.

This study involved a histologic, enzyme histologic, immunohistologic, and three-dimensional microstructure evaluating the extent of osteogenesis and repair in the human alveolar extraction socket achievable with an artificial bone substitute. After tooth extraction in 7 patients, extraction sockets were filled with Mastergraft (15% hydroxyapatite, 85% β-tricalcium phosphate complex). Radiomicrographs and histologic examinations were performed on samples obtained during dental implant placement procedure. On micro-computed tomography, new bone was observed in all collected samples, and osteogenesis was observed to have taken place around the artificial bone substitute. Histologically, active osteogenesis was found throughout the region observed. Addition of new bone around the Mastergraft was observed, and osteoblast-like cells were present. Cells that had partially invaded the artificial bone included tartrate-resistant acid phosphate-positive and CD34-positive cells. These findings indicate that the Mastergraft artificial bone induced osteogenesis in the jawbone and seemed effective for repairing bone defects.

Purpose: The purpose of this prospective study was to evaluate the safety and effectiveness of recombinant human morphogenetic protein-2 (rhBMP-2) on an absorbable collagen sponge (ACS) compared with an autogenous bone graft when used for 2-stage maxillary sinus floor augmentation. The study assessed new bone formation, placement integration, and functional loading after 6 months and long term for 2 years., Materials and Methods: A total of 160 subjects were randomized, enrolled, and followed from January 1999 to February 2004 at 21 centers in the United States. The subjects with less than 6 mm of native bone height were treated with 1.50 mg/mL rhBMP-2/ACS or with an autograft. The height and density measurements were quantified by computed tomography scans. Core biopsies were obtained at dental implant placement and used for histological analysis. Safety was evaluated by oral examinations, radiographs, serum chemistries, and hematology., Results: A significant amount of new bone was formed by 6 months postoperatively in each group. The mean change in bone height in the rhBMP-2/ACS subjects was 7.83 +/- 3.52 mm versus 9.46 +/- 4.11 mm for the bone graft subjects. At 6 months after dental restoration, the induced bone in the rhBMP-2/ACS group was significantly denser than that in the bone graft group. No marked differences were found in the histologic parameters evaluated between the 2 groups. The new bone was comparable to the native bone in density and structure in both groups. The success rate for the rhBMP-2/ACS group was 79% (64 of 81 subjects), and 201 of 251 implants placed in the bone graft group and 199 of 241 implants placed in the rhBMP-2/ACS group were integrated, retained, and functional at 6 months after loading. No adverse events were deemed related to the rhBMP-2/ACS treatment. The autograft group was noted to have a 17% rate of long-term parasthesia, pain, or gait disturbance related to the bone graft harvest., Conclusions: The results of our multicenter, randomized, prospective, clinical trial have shown the effectiveness and safety of rhBMP-2/ACS compared with bone graft for sinus floor augmentation. The study's primary endpoint was exceeded, and the implants placed in rhBMP-2/ACS and bone graft groups performed similarly after functional loading.

With the increased popularity of implants and focus on .. esthetics, there is great emphasis on idealized bone foundation and soft tissue contours. The goal of reconstructive procedures is to provide peri-implant bone that support and maintain gingival contours. This article reviews ridge deficiency diagnosis and predicts the need for bone augmentation before tooth extraction. It also presents early intervention to minimize bone loss, various bone reconstruction techniques, and suggests predictable methods for different clinical scenarios.

Purpose: The aim of this study was to evaluate early clinical results of computer-aided design (CAD)/computer-aided machining (CAM)-guided surgical implant placement (NobelGuide, Nobel Biocare, Yorba Linda, CA, USA) with focus on surgical and/or prosthetic complications, management, and prevention., Materials and Methods: Thirteen patients rehabilitated between March 2003 and October 2006 with CAD/CAM-guided dental implants and immediate loading (NobelGuide, Nobel Biocare) were evaluated. The treatment planning and procedures were carried out in accordance to the system protocol. The complications encountered in this case series were classified and assessed according to early (planning and procedural - surgical; prosthetic) and late complications (surgical; prosthetic)., Results: The prosthetic complications outnumbered surgical complications both in the early and late treatment phases. The main early surgical complication was bony interference that prevented complete seating of the prostheses. Most of the late surgical complications were implant failures with an overall failure rate of 9%. Fracture of the carbon fiber framework prosthesis was the main late prosthetic complication., Conclusions: The NobelGuide system is a reliable treatment modality, but not without its complications. Strict adherence to the system protocol is the key prevention of complications.

Purpose: A variety of techniques and materials have been used to establish the structural base of osseous tissue for supporting dental implants. The aim of this systematic review was to identify the most successful technique(s) to provide the necessary alveolar bone to place a dental implant and support long-term survival., Methods: A systematic online review of a main database and manual search of relevant articles from refereed journals were performed between 1980 and 2005. Updates and additions were made from September 2004 to May 2005. The hard tissue augmentation techniques were separated into 2 anatomic sites, the maxillary sinus and alveolar ridge. Within the alveolar ridge augmentation technique, different surgical approaches were identified and categorized, including guided bone regeneration (GBR), onlay/veneer grafting (OVG), combinations of onlay, veneer, interpositional inlay grafting (COG), distraction osteogenesis (DO), ridge splitting (RS), free and vascularized autografts for discontinuity defects (DD), mandibular interpositional grafting (MI), and socket preservation (SP). All identified articles were evaluated and screened by 2 independent reviewers to meet strict inclusion criteria. Articles meeting the inclusion criteria were further evaluated for data extraction. The initial search identified a total of 526 articles from the electronic database and manual search. Of these, 335 articles met the inclusion criteria after a review of the titles and abstracts. From the 335 articles, further review of the full text of the articles produced 90 articles that provided sufficient data for extraction and analysis., Results: For the maxillary sinus grafting (SG) technique, the results showed a total of 5,128 implants placed, with follow-up times ranging from 12 to 102 months. Implant survival was 92% for implants placed into autogenous and autogenous/composite grafts, 93.3% for implants placed into allogeneic/nonautogenous composite grafts, 81% for implants placed into alloplast and alloplast/xenograft materials, and 95.6% for implants placed into xenograft materials alone. For alveolar ridge augmentation, a total of 2,620 implants were placed, with follow-up ranging from 5 to 74 months. The implant survival rate was 95.5% for GBR, 90.4% for OVG, 94.7% for DO, and 83.8% for COG. Other techniques, such as DD, RS, SP, and MI, were difficult to analyze because of the small sample size and data heterogeneity within and across studies., Conclusions: The maxillary sinus augmentation procedure has been well documented, and the long-term clinical success/survival (> 5 years) of implants placed, regardless of graft material(s) used, compares favorably to implants placed conventionally, with no grafting procedure, as reported in other systematic reviews. Alveolar ridge augmentation techniques do not have detailed documentation or long-term follow-up studies, with the exception of GBR. However, studies that met the inclusion criteria seemed to be comparable and yielded favorable results in supporting dental implants. The alveolar ridge augmentation procedures may be more technique- and operator-experience-sensitive, and implant survival may be a function of residual bone supporting the dental implant rather than grafted bone. More in-depth, long-term, multicenter studies are required to provide further insight into augmentation procedures to support dental implant survival.

Several techniques exist for the surgical placement of dental implants. The aim of this study was to assess systematically, the efficacy of these protocols by the evidence-based perspective. Five best-case studies involving 607 early/immediately loaded implants and 300 conventionally loaded implants were identified by examining the available literature and rigorous inclusion/exclusion criteria. Overall analyses demonstrated a 98.4 percent success rate for the early/immediate procedure and a 95.3 percent for the conventional protocol. Success rates in the articles reviewed were based on implant survival over a follow-up period of between one to two years. A meta-analysis was generated to evaluate the presented evidence and to aid in decision-making. Despite its common implementation, this technique presents many caveats, among which publication bias is one of the most common. To investigate the possible presence of publication bias, a funnel plot analysis complemented several statistical tests. By means of the systematic investigation of dental implants, the authors' results confirm the presence of publication bias in implant dentistry literature, which strongly suggests that clinicians ought not base their decisions solely on the results presented by a few published studies. Rather, it is recommended that clinicians cautiously draw conclusions and seek studies that present accountable and clinically relevant results. Furthermore, it is suggested that clinicians attend seminars to learn of the effective advances in evidence-based dentistry, so as to develop the ability to easily detect inadequate literature due to attempted correlation with the most current research. It is also recommended that additional research is necessary to analyze which fields of research are more prone to bias, thus forewarning clinicians before formulating clinical conclusions.

Purpose: This phase II study was designed to evaluate 2 concentrations of recombinant human bone morphogenetic protein-2 (rhBMP-2) for safety and efficacy in inducing adequate bone for endosseous dental implant in patients requiring staged maxillary sinus floor augmentation., Materials and Methods: Patients were treated with rhBMP-2 (via an absorbable collagen sponge [ACS]), at concentrations of 0.75 mg/mL (n = 18), 1.50 mg/mL (n = 17), or with bone graft (n = 13). Bone induction was assessed by alveolar ridge height, width, and density measurements from computed tomography scans obtained before and 4 months after treatment and 6 months post-functional loading of dental implants (density only)., Results: Mean increases in alveolar ridge height at 4 months after treatment were similar among the groups; 11.3 mm, 9.5 mm, and 10.2 mm, respectively, in the bone graft, 0.75 mg/mL, and 1.50 mg/mL rhBMP-2/ACS treatment groups. Mean increases in alveolar ridge width (buccal to lingual) at the crest of the ridge were statistically different among the treatment groups; 4.7 mm, 2.0 mm, and 2.0 mm, respectively, in the bone graft, 0.75 mg/mL, and 1.50 mg/mL treatment groups (P

Purpose: Increasing demands are placed on the oral and maxillofacial surgeon to perform early or immediate loading of dental implants due to demands and expectations of the referring doctor and patients. In order to provide the patient with an immediately loaded, functioning implant, the surgeon should consider incorporating the fabrication of the temporary restoration as an additional service for their implant patients., Materials and Methods: The armamentarium necessary for the oral and maxillofacial surgeon to deliver a temporary restoration will be described. The materials and components needed to provide this service will be listed and a sequence of steps to easily accomplish the fabrication of a temporary crown will be presented., Results: Temporary crowns cemented onto temporary or permanent implant abutments are ideal for the management of gingival contours. Initial soft tissue healing around the contours of the temporary crown, even with minimally invasive techniques, provides many advantages for the patient. There is less likelihood of gingival scarring, which minimizes the incidence of gingival recession and the patient is restored to normal form and function immediately., Conclusions: The fabrication of the temporary prosthesis by the oral and maxillofacial surgeon provides benefits for the surgeon, restorative doctor, as well as, the patient. By working closely with his or her restorative colleagues, the surgeon will be able to provide his or her implant patients with immediate return to form and function intraorally with minimum effort.