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Purpose: To evaluate the influence of immediate loading on the osseointegration and bone density of implants placed in a healed alveolar bone crest and supporting single crowns. Materials and Methods: Two solid titanium transmucosal mini-implants were placed in the distal regions of the mandible in 14 patients. One mini-implant was immediately functionally loaded, whereas the other was left unloaded. After 2 months of healing, biopsy samples were retrieved and the levels of new bone, old bone, and total bone (new + old) were assessed. Results: Histologic examination was performed on biopsies from 12 patients (n = 12). The new bone-to-implant contact percentage (BIC%) was 40.3% ± 16.8% and 55.1% ± 19.1% (P = .043) at the unloaded and loaded sites, respectively; in addition, the total BIC% was 44.9% ± 17.0% and 59.5% ± 18.8%, respectively (P = .034). The new bone density was 45.9% ± 11.6% for the unloaded implants and 45.9% ± 16.7% for the loaded implants (P = .622). Conclusions: Immediate loading had a positive effect on bone apposition at the implant surface, but no effect on bone density was observed after 2 months of healing. [ABSTRACT FROM AUTHOR]

Purpose: Marginal bone resorption (MBR) around dental implants may sometimes be a self-limiting condition due to balancing immunologic reactions against utilized materials rather than a progressive bacterial infection. Contrary to previous assumptions from ligature-induced experimental peri-implantitis studies, a recent 8-week experiment by the present authors showed that marginal ligatures trigger an inflammatory immune response, resulting in bone resorption around implants in the absence of plaque. The present study aimed to investigate whether this inflammatory/immunologic reaction attenuates or progresses toward implant failure after a longer healing time (12 weeks). Materials and Methods: Sterile silk ligatures were placed around the top of titanium (Ti) implants and compressed against the femoral cortical bone plate of six rabbits. A nonligated implant was used as a control. After 12 weeks of submerged healing, ground sections of implants and surrounding tissues were investigated with light microscopy. The marginal soft tissues were also analyzed using selected quantitative polymerase chain reaction (qPCR) markers. Results: Histologically, the ligatures were outlined by immune cells, including multinucleated giant cells (MNGCs), with adjacent fibrous encapsulation and resorbed peripheral bone that contrasted from the osseointegrated nonligated control implants. The difference in expression of qPCR markers was not significant, but > two-fold upregulation of markers CDIIb, IL1β, ARG1, NCF1, and CD4 and > twofold downregulation of CD8 indicated a mild, focal inflammatory/immune response against the ligatures compared to controls, with upregulation of M1 and M2 macrophages, neutrophils, and helper T-cells as well as downregulation of killer T cells. Further, the bone formation markers OC and ALPL were > two-fold downregulated (consistent with the lack of osseointegration of the ligatures) compared to control implants. Conclusions: Marginal silk ligatures trigger an inflammatory/immune response and aseptic bone resorption around implants. Compared to the previous 8-week study, the inflammatory reaction against the silk appears to attenuate with time, with only a mild persisting inflammation that may block osseointegration; instead, a fibrous tissue encapsulation-type reaction is maintained. This may explain why traditional ligature experiments have required regular exchange of ligatures for the bone resorption to progress. [ABSTRACT FROM AUTHOR]

Purpose: To estimate the effect of simvastatin gel in the osseointegration of dental implants using bone scintigraphy. Materials and Methods: A total of 20 participants with missing mandibular first molars and D2 type bone were assigned equally to two groups. Group A received 1.2% simvastatin and group B received placebo gels during the placement of implants. The participants were subjected to bone scintigraphy to determine the osteoblastic activity at baseline, 30 days, and 90 days after implant placement. Results: Group A had a significant increase in osteoblastic activity between baseline, day 30, and day 90 (P < .05), with a higher mean of 100.06% ± 21.644% on day 30. Group B had a significant increase in osteoblastic activity only between baseline and day 30 and between baseline and day 90 (P < .05). There was no difference between days 30 and 90 (P > .05), with a higher mean of 79.20% ± 18.255% on day 30. A bivariate analysis performed at different time periods revealed a significant difference between groups A and B on day 30. Conclusions: Implants placed with 1.2% simvastatin gel showed enhanced osteoblastic activity in the 4th week after implant placement, indicating that there was a faster rate of osseointegration at an early stage. [ABSTRACT FROM AUTHOR]

Purpose: Dental implants are an established treatment option for varying edentulous conditions that has grown in popularity since the 1990s. This increased clinical application has shown a parallel increase in implant-related research. The objective of this paper was to perform a comprehensive bibliometric analysis of five dental implantology journals from 1991 to 2023. Materials and Methods: A search was done in the Web of Science database between 1991 and 2023 in five journals with a focus on dental implantology: Clinical Oral Implant Research, Clinical Implant Dentistry and Related Research, Implant Dentistry, The International Journal of Oral & Maxillofacial Implants, and International Journal of Oral Implantology. Results marked as a correction, retraction notice, retracted article, meeting abstract, or withdrawn publication were removed from the analysis. The time period analyzed was divided into four time periods, organized by decade: 1991 to 2000, 2001 to 2010, 2011 to 2020, and 2021 to 2023. Additionally, the top 100 cited papers were also exported separately. Authors and countries with most publications were tabulated from the Web of Science database. VOSviewer software was used to create network maps of keywords and title word occurrences for each of the time periods. HistCite software was used to analyze the number of publications and citation counts. Results: Network maps of keywords and title word occurrences suggested an early focus on osseointegration and titanium implants between 1991 and 2000. Publications between 2001 and 2010 saw a focus on in vivo studies, implant surface, and peri-implantitis. Publications from 2011 and later saw a focus on bone regeneration, complications, and zygomatic implants. The USA ranked highest in total number of publications in all analyzed time periods. Conclusions: Within the limitations of the present study, a comprehensive bibliometric analysis from 1990 to 2023 was reported. Trends in keywords and titles of implant publications were identified in these journals, which mirrored the trends seen in clinical practice. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effects of sinus membrane stabilization (via suturing) and dental implant placement on the endo-sinus bone formation in lateral sinus elevations performed without grafting. Materials and Methods: Maxillary sinus elevation surgery using the lateral approach was performed bilaterally on 30 New Zealand white rabbits. The maxillary sinus areas were divided into control and test groups. In the control group, a titanium screw was placed after sinus membrane elevation; in the test group, the sinus membrane was sutured to the lateral walls, and a titanium screw was placed in the center of the alveolar crest. The subjects were sacrificed at 4 and 8 weeks. Then samples were collected, and a microcomputed tomography (micro-CT) analysis was performed. In addition, the volume of newly formed bone, percentage of osseointegration, sinus volume, residual bone height, and implant protrusion length were measured using micro-CT analysis. Results: The sinus volume, volume of newly formed bone, and percentage of osseointegration in the test group were significantly higher than in the control group at 4 weeks (P = .01, P = .04, P = .02, respectively). While the volume of newly formed bone was 17.1 ± 3.08 mm3 in the control group, it was 26.9 ± 14.26 mm3 in the test group at 4 weeks. The volume of newly formed bone significantly decreased from 26.9 ± 14.26 mm3 to 17 ± 3.66 mm3 at 8 weeks (P = .02). No significant difference in residual bone height was found at 4 and 8 weeks (P = .07). No significant difference in implant protrusion length was found between the control and test groups (P = .18). Protrusion length and new bone formation in the sinus showed a negative relationship (P = .01). Conclusions: Suturing the sinus membrane to the lateral sinus wall is an effective approach for increasing osseointegration, bone volume, and sinus volume in the short term. A slow-absorbing suture material can be used to maintain sinus and bone volumes in the long term. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effect of interleukin-6 (IL-6) inhibitor (tocilizumab) on bacterial infection-associated bone resorption around implants during osseointegration in rabbits. Materials and Methods: At total of 24 male, 9-monthold New Zealand white rabbits were included, and their two mandibular anterior teeth were extracted. Three months after extraction, 24 one-piece Dentium implants (Ø 2.5 mm, intraosseous length of 12 mm) were inserted in the anterior mandible, and the rabbits were divided into four groups (n = 6 per group). Different treatment methods were used in each group: blank control group (BC); only silk ligation (negative control [NC]); silk ligation and injection with minocycline hydrochloride ointment (positive control [PC]); and silk ligation and injection with tocilizumab at 8 mg/kg via the auricle vein (experimental [EP]). Eight weeks later, the animals were sacrificed, and samples were collected and then analyzed using microcomputed tomography (microCT) scanning, immunohistochemical analysis, and histologic analysis. Results: From the microCT measurement, the ratio of the bone volume to the total volume (BV/TV) in the EP group was 67.00% ± 2.72%, which was higher than that in the other three groups (58.85% ± 2.43% in the BC group, 55.72% ± 2.48% in the PC group, and 36.52% ± 3.02% in the NC group). From immunohistochemical analysis, the expression of IL-6 was found to be higher in the NC group than in the BC, PC, and EP groups, but there was no statistical difference between these three groups. Furthermore, the RANKL (receptor activator of nuclear factor-κB ligand) expression was the lowest in the EP group, followed by the BC group, the PC group, and the NC group, which had the highest expression; there was no difference between the NC and PC groups. Upon histologic analysis, significant new bone was found on the implant surfaces in the EP group, sparse and less new bone could be seen in the BC and PC groups, and the most serious bone resorption occurred in the NC group. Conclusions: Tocilizumab, an inhibitor of IL-6, has a certain effect in preventing bone loss around implants caused by bacterial infection during the osseointegration period. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the efficacy of combined therapy of teriparatide and raloxifene on the osseointegration of titanium dental implants in a rabbit model of osteoporotic bone. Materials and Methods: Sixty female rabbits were randomly divided into six groups. The sham ovariectomy group (control) consisted of animals that received no medication. Animals in the ovariectomy group (OVX) underwent ovariectomy and received no medication. The combined group consisted of ovariectomized animals that received combined teriparatide (10 mg/kg) for 12 weeks and raloxifene (10 mg/kg) for 12 weeks. The sequential group (SEQ) consisted of ovariectomized animals that received teriparatide (10 mg/kg) for the first 6 weeks and raloxifene therapy (10 mg/kg) for the following 6 weeks sequentially. The parathormone (PTH) and raloxifene (RAL) groups consisted of ovariectomized animals that received only teriparatide (10 mg/kg) for 12 weeks or raloxifene (10 mg/kg) for 12 weeks, respectively. Dental implants (Bilimplant) were placed in the proximal metaphysis of both tibias in all rabbits. Histomorphometric and microCT studies were performed on the specimens obtained from the right tibia bone. Removal torque (RTQ) and implant stability quotient (ISQ) tests were performed on the specimens obtained from the left tibia bone. The results were compared and evaluated statistically. Results: RTQ analysis revealed a statistically significant difference between the mean values of the combined group (93.01 ± 27.19 Ncm) and the OVX group (49.6 ± 12.5 Ncm) (P = .015). The highest mean T0 (implantation day) value was obtained in the control group (67.1 ± 3.4 Ncm), and the lowest mean value was obtained in the OVX group (61.4 ± 3.8 Ncm). The highest T1 mean (3 months after implantation) was obtained by the combined group (76.6 ± 3.8 Ncm), and the lowest mean was obtained by the OVX group (68.9 ± 6.2 Ncm). Histomorphometric analyses showed that the mean percentage of bone-to-implant contact (BIC%) of the combined group (51.2%) was significantly higher than that of the OVX group (28.6%) (P =.006). In the microCT examinations, it was found that the mean BIC% value of the combined group (41.1%) was significantly higher than that of the OVX group (24.1%) (P < .001). Conclusions: According to the results of the current study, combined therapy of teriparatide and raloxifene improves the BIC and osseointegration of titanium dental implants in osteoporotic bone compared with sequential or independent therapy with these agents. [ABSTRACT FROM AUTHOR]

Purpose: The structural and compositional similarities between dentin and alveolar bone form the basis for utilizing dentin for bone regeneration. Various authors have recommended using treated mineralized, partially demineralized, or demineralized dentin grafts instead of xenografts because of their comparable clinical and radiographic results and lower costs. The current study therefore compared the effect of untreated mineralized dentin grafts (UMDGs) versus xenografts in vertical and horizontal augmentation around dental implants that were immediately placed in the mandibular anterior region. Materials and Methods: A total of 56 patients who required immediate dental implant placement in the mandibular anterior region were randomly allocated to group I (study), where ground dentin was washed with normal saline and placed around the dental implants, or group II (control), where a xenograft was used. The primary implant stability was measured at the time of implant placement. Secondary implant stability, plaque index (PI), bleeding index (BI), probing depth (PD), and keratinized mucosa width (KMW) were assessed at baseline (time of definitive abutment and provisional crown placement) and then at 3, 6, and 12 months. Pain and the number of analgesics consumed were assessed daily during the first postoperative week. Marginal bone loss (MBL) and radiodensity were assessed radiographically. Results: There were no significant differences between the groups in terms of postoperative pain, the number of analgesic tablets consumed, peri-implant mucositis, or peri-implantitis. Both groups showed comparable results for the PI, BI, and PD. Moreover, there was no statistical difference between the groups with regard to primary implant stability and secondary implant stability at baseline and 12 months. Group I showed significantly lower secondary implant stability after loading at 3 and 6 months and significantly greater bone loss and lower bone density before exposure. KMW and MBL after exposure were significantly higher in group I at all time points. Conclusions: Although UMDGs showed similar clinical results to xenografts, including primary and secondary implant stability, they had higher resorption rates than xenografts. Therefore, treatment of the dentin graft is required. Thus, the authors do not recommend using UMDGs. [ABSTRACT FROM AUTHOR]

Purpose: To answer the following focus question: In preclinical in vivo experimental models, do oral implants placed in overdimensioned (OD) sites present greater biomechanical properties and histomorphometric parameters of osseointegration compared to implants placed in standard or undersized implant sockets? Materials and Methods: Online databases were searched for controlled animal studies reporting on OD sites up to February 2023. The relative implant-final drill discrepancy (IDD) was used to categorize the control and test groups according to surgical drilling protocol: (1) control: undersized (IDD > 0.5 mm) or standard (IDD = 0.2 to 0.5 mm); and (2) test OD: stress-free oversized (IDD = 0.0 to -0.1 mm); test GAP: friction-free oversized (IDD = -0.1 mm). Random-effects meta-analyses were performed for the outcomes of insertion and removal torque values (ITV and RTV, respectively), bone-to-implant contact (%BIC), and bone density (%BD) for short- (0 to 2 weeks), intermediate- (3 to 4 weeks), and long-term (= 5 weeks) healing periods. Results: Of the 527 records identified, 13 studies met the eligibility criteria. Histologically, the OD and GAP groups prevented ischemic necrosis and extensive bone resorption at the bone-implant interface in both the marginal cortical layer and the trabeculae. Faster and increased rates of bone formation, characterized by primary osteons and highly vascularized tissue, took place in OD sites between 1 and 5 weeks of healing. Meta-analyses indicated statistically significant benefits in favor of (1) control vs OD for short-term healing in extraoral sites, with pooled estimates (weighted mean difference) of ITV = 25.35 Ncm, %BIC = 2.10%, and %BD = 26.19%; (2) control vs OD for long-term healing in intraoral sites, with %BD = 11.69%; (3) control vs GAP for intermediate-term healing in extraoral sites, with %BD = 3.03%; and (4) control vs GAP for long-term healing in extraoral sites, with RTV = 5.57 Ncm. Conclusions: Oversized surgical preparation of the implant site does not seem to provide any additional benefit compared to standard or undersized sites regarding quantitative parameters of osseointegration. However, it does minimize marginal bone resorption and yields better-quality bone healing, despite the comparable results among different experimental animal models in the late postoperative period. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effect of continuous perioperative clopidogrel treatment on the osseointegration of titanium implants. Materials and Methods: A total of 32 New Zealand rabbits were randomly divided between two groups: a clopidogrel group (n = 16) and a control group (n = 16). For 1 week prior to the surgical placement of a titanium implant in their medial femoral condyle, rabbits in the clopidogrel group received 3 mg/kg of clopidogrel daily, and the control group received only the vehicle. This treatment was continued for another 6 weeks postoperatively. At 6 weeks, the rabbits were euthanized and postmortem histologic and histomorphometric evaluation of the implants was performed. Results: The surgical procedures and postoperative period were uneventful and well tolerated by all animals without any surgical wound dehiscence, signs of infection, or other complication. No implant failure was observed in any of the groups. Histomorphometric analysis showed that bone-to-implant contact (BIC) was 48.77% for the clopidogrel group and 34.65% for the control group, with statistically significant difference between them (P < .001). Moreover, clopidogrel group had significantly greater bone tissue density (40.52% vs 28.74%, respectively; P <.001) and mean trabecular thickness (284.7 μm vs 180.7 μm, respectively; P < .001) in proximity to the implant surface than the control group, while the mean trabecular number had no difference between groups (1.56 vs 1.60, respectively; P = .961). Conclusions: The present study showed that continuous clopidogrel treatment does not negatively affect osseointegration, but rather promotes it in terms of BIC and bone density around the titanium implants. Further studies on the effect of the P2Y12 receptor and its antagonists on peri-implant bone homeostasis may provide useful information or applications for long-term success of dental implant therapy. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the available evidence and assess the effect of different implant coatings on healing outcomes. Materials and Methods: Using the PICOS strategy, a structured question was formed. A protocol was agreed upon and registered with PROSPERO (no. CRD42022321926). The MEDLINE, Embase, Cochrane Database of Systematic Reviews, Scopus, Web of Science, Pubmed, and ScienceDirect databases were searched using a structured strategy. Study selection was independently carried out in duplicate, first by title and abstract, then by full-text assessment. Quality and risk of bias were independently assessed in duplicate using AMSTAR 2 and ROBIS. Data extraction was independently undertaken in duplicate using a predefined extraction form. Results: The search yielded 11 systematic reviews for inclusion. The most commonly assessed coatings were based on calcium phosphate--including hydroxyapatite (HA), brushite, and bioabsorbable nano-HA--followed by bisphosphonate, then bioactive glass coatings. Included reviews most frequently assessed marginal bone loss (MBL), bone-to-implant contact (BIC), and survival/success rates. There was considerable heterogeneity and small sample sizes. The quality assessment suggested low confidence in the reviews and high risk of bias. Conclusions: The included reviews provide weak evidence that implant coatings improve osseointegration and reduce MBL following implant placement. There was weak evidence for progressive complications for calcium phosphate coatings. Further research and long-term multicenter controlled clinical trials with improved standardization and control of bias are required to better understand the effects of coating implants. [ABSTRACT FROM AUTHOR]

This assessment evaluated the clinical feasibility of using narrow-diameter implants to support a mandibular overdenture. Twelve patients presenting with an edentulous mandible were recruited from nine dental offices. Each patient received two to four implants in the mandible. The implants were placed without additional bone augmentation, and a total of 36 implants were placed. All sites achieved satisfactory crestal bone stability and soft tissue maintenance 1 year after the final prosthetic restoration. This investigation was supported by the Osseointegration Foundation, working in conjunction with the Zest Anchors implant company. There are three basic valuable activities that emerge from a professional foundation, which were reflected in this case study. They include disseminating information to practitioners, persuading young clinicians to become research investigators, and reaching out to patients in need of treatment who cannot afford it without a charitable opportunity. [ABSTRACT FROM AUTHOR]

Ti6Al4V superalloy is recognized as a good candidate for bone implants owing to its biocompatibility, corrosion resistance, and high strength-to-weight ratio. While dense metal implants are associated with stress shielding issues due to the difference in densities, stiffness, and modulus of elasticity compared to bone tissues, the surface of the implant/scaffold should mimic the properties of the bone of interest to assure a good integration with a strong interface. In this study, we investigated the additive manufacturing of porous Ti6Al4V scaffolds and coating modification for enhanced osteoconduction using osteoblast cells. The results showed the successful fabrication of porous Ti6Al4V scaffolds with adequate strength. Additionally, the surface treatment with NaOH and Dopamine Hydrochloride (DOPA) promoted the formation of Dopamine Hydrochloride (DOPA) coating with an optimized coating process, providing an environment that supports higher cell viability and growth compared to the uncoated Ti6Al4V scaffolds, as demonstrated by the higher proliferation ratios observed from day 1 to day 29. These findings bring valuable insights into the surface modification of 3D-printed scaffolds for improved osteoconduction through the coating process in solutions.

Considering the biological activity of osteoblasts is crucial when devising new approaches to enhance the osseointegration of implant surfaces, as their behavior profoundly influences clinical outcomes. An established inverse correlation exists between osteoblast proliferation and their functional differentiation, which constrains the rapid generation of a significant amount of bone. Examining the surface morphology of implants reveals that roughened titanium surfaces facilitate rapid but thin bone formation, whereas smooth, machined surfaces promote greater volumes of bone formation albeit at a slower pace. Consequently, osteoblasts differentiate faster on roughened surfaces but at the expense of proliferation speed. Moreover, the attachment and initial spreading behavior of osteoblasts are notably compromised on microrough surfaces. This review delves into our current understanding and recent advances in nanonodular texturing, meso-scale texturing, and UV photofunctionalization as potential strategies to address the biological dilemma of osteoblast kinetics, aiming to improve the quality and quantity of osseointegration. We discuss how these topographical and physicochemical strategies effectively mitigate and even overcome the dichotomy of osteoblast behavior and the biological challenges posed by microrough surfaces. Indeed, surfaces modified with these strategies exhibit enhanced recruitment, attachment, spread, and proliferation of osteoblasts compared to smooth surfaces, while maintaining or amplifying the inherent advantage of cell differentiation. These technology platforms suggest promising avenues for the development of future implants.

Dental implant therapy, established as standard-of-care nearly three decades ago with the advent of microrough titanium surfaces, revolutionized clinical outcomes through enhanced osseointegration. However, despite this pivotal advancement, challenges persist, including prolonged healing times, restricted clinical indications, plateauing success rates, and a notable incidence of peri-implantitis. This review explores the biological merits and constraints of microrough surfaces and evaluates the current landscape of nanofeatured dental implant surfaces, aiming to illuminate strategies for addressing existing impediments in implant therapy. Currently available nanofeatured dental implants incorporated nano-structures onto their predecessor microrough surfaces. While nanofeature integration into microrough surfaces demonstrates potential for enhancing early-stage osseointegration, it falls short of surpassing its predecessors in terms of osseointegration capacity. This discrepancy may be attributed, in part, to the inherent dichotomy kinetics of osteoblasts, wherein increased surface roughness by nanofeatures enhances osteoblast differentiation but concomitantly impedes cell attachment and proliferation. We also showcase a controllable, hybrid micro-nano titanium model surface and contrast it with commercially-available nanofeatured surfaces. Unlike the commercial nanofeatured surfaces, the controllable micro-nano hybrid surface exhibits superior potential for enhancing both cell differentiation and proliferation. Hence, present nanofeatured dental implants represent an evolutionary step from conventional microrough implants, yet they presently lack transformative capacity to surmount existing limitations. Further research and development endeavors are imperative to devise optimized surfaces rooted in fundamental science, thereby propelling technological progress in the field.

Purpose: To evaluate the effect of supraphysiologic administration of testosterone in an early and late model of implant osseointegration in rat tibiae. Materials and Methods: A total of 40 rats were randomly allocated into four groups (n = 10/group), which were divided according to the type of experiment and time of osseointegration: (1) vehicle (14 days), (2) testosterone (14 days), (3) vehicle (42 days), and (4) testosterone (42 days). Testosterone cypionate (7.5 mg/kg) administration started 4 weeks before implant placement, and the injections were performed daily until euthanasia. Machined-surface titanium implants (2.2 mm in diameter and 4 mm high) were placed bilaterally in the tibia of animals 28 days after the first testosterone injection. At days 14 and 42 after implant placement, euthanasia was performed and the tibiae were harvested to perform biomechanical evaluation and histomorphometric analysis of bone-to-implant contact (BIC%) and bone between the threads (BBT%). Results: There was no statistical difference in the removal torque of the implants between the groups treated with the vehicle (control group) or testosterone (P > .05). At 14 days of osseointegration, the BIC% and BBT% did not differ between vehicle or testosterone groups (P > .05), while at 42 days, both the BIC% and BBT% were significantly reduced by testosterone compared to the vehicle group (P < .05). Conclusions: Testosterone cypionate in supraphysiologic dose impaired late-phase osseointegration in rat tibiae. [ABSTRACT FROM AUTHOR]

Purpose: To assess the pain, swelling, infection, and alteration in sensation following the flapless placement of zygomatic implants guided by dynamic navigation. Materials and Methods: A randomized controlled trial was conducted on 20 patients. In group 1, the placement of the zygomatic implants was carried out without reflecting a mucoperiosteal flap (flapless). In group 2, a mucoperiosteal flap was raised (flapped). Two zygomatic implants were placed in each patient (one on each side) under local anesthesia, guided by dynamic navigation. Postoperative evaluations included pain (using the visual analogue scale [VAS]), swelling (using standard measurements), maxillary sinus infection, and alteration of sensation (using mechanical stimuli, thermal threshold detection, and a two-point discrimination test). The assessments were carried out at 2 days, 1 week, and then 1, 2, and 3 months postoperatively. Results: In group 1, all implants except for one were successfully osseointegrated. Immediate postoperative pain and swelling were both significantly greater in group 2 (P < .01). No alteration in sensation was detected in any case in the two groups. There were a total of three cases of chronic sinusitis: one in group 1 and two in group 2. Conclusions: The flapless placement of zygomatic implants guided by dynamic navigation and under local anesthesia improves postoperative recovery. [ABSTRACT FROM AUTHOR]

To develop a peri-implantitis model in a Gottingen minipig and evaluate the effect of local application of salicylic acid poly(anhydride-ester) (SAPAE) on peri-implantitis progression in healthy, metabolic syndrome (MS), and type-2 diabetes mellitus (T2DM) subjects. Eighteen animals were allocated to three groups: (i) control, (ii) MS (diet for obesity induction), and (iii) T2DM (diet plus streptozotocin for T2DM induction). Maxillary and mandible premolars and first molar were extracted. After 3 months of healing, four implants per side were placed in both jaws of each animal. After 2 months, peri-implantitis was induced by plaque formation using silk ligatures. SAPAE polymer was mixed with mineral oil (3.75 mg/μL) and topically applied biweekly for up to 60 days to halt peri-implantitis progression. Periodontal probing was used to assess pocket depth over time, followed by histomorphologic analysis of harvested samples. The adopted protocol resulted in the onset of peri-implantitis, with healthy minipigs taking twice as long to reach the same level of probing depth relative to MS and T2DM subjects (∼3.0 mm), irrespective of jaw. In a qualitative analysis, SAPAE therapy revealed decreased levels of inflammation in the normoglycemic, MS, and T2DM groups. SAPAE application around implants significantly reduced the progression of peri-implantitis after ∼15 days of therapy, with ∼30% lower probing depth for all systemic conditions and similar rates of probing depth increase per week between the control and SAPAE groups. MS and T2DM conditions presented a faster progression of the peri-implant pocket depth. SAPAE treatment reduced peri-implantitis progression in healthy, MS, and T2DM groups.

Osteoporosis is an increasingly prevalent disease. The development of an osteoporosis-like experimental animal model is of great importance for the study of peri-implant osteogenesis in osteoporosis. The present authors aimed to establish a rapid modeling method of osteoporotic rabbits for implant-bone analysis and validate whether the models can affect the implant osseointegration. The present study included 29 female New Zealand rabbits (age: 5 to 6 months). Two rabbits were lost during anesthetization. Of the remaining 27 rabbits, 18 received an ovariectomy, with 9 receiving dexamethasone injections for 8 weeks (OVX+D group) and 9 receiving equivalent-volume saline injections (OVX group). As a control group, the remaining 9 rabbits were sham-operated and received an equivalent volume of normal saline (SHAM group). Then, serum biochemical markers of bone metabolism were detected and densitometric measurements were performed. Implants were then placed in the tibias of each rabbit. Bone samples (including implants) were obtained after 4, 8, and 12 weeks of healing and were subjected to histologic and histomorphometric analyses. The results showed that the OVX+D group experienced a 32% reduction in bone mineral density (BMD) from baseline. The BMD of the OVX+D group was significantly lower than that of the SHAM and OVX groups. Moreover, alkaline phosphatase (ALP) blood concentrations of in the OVX+D group were increased significantly. The osteoporotic rabbits exhibited marked decreases in osseointegration, characterized by slowed bone formation and decreased bone-to-implant contact (BIC). The combination of an ovariectomy and dexamethasone injections could experimentally induce osteoporosis in rabbits in the short term, which can be used as an appropriate animal model to study the osseointegration of implants under osteoporosis. [ABSTRACT FROM AUTHOR]

Periodontal intrabony defects (IBDs) are commonly encountered in dental practice and are usually treated by open flap debridement (OFD) with or without bone grafts and/or guided tissue regeneration (GTR), platelet-rich fibrin (PRF), or other additives. A difficulty with these approaches is maintaining the space for bone growth at the determined location. In this report, autologous sticky bone (ASB) was used and compared to a simple mixture of PRF and bone graft (PRF-BG) using the identical graft material-bioactive glass morsels-to assess its regenerative potential in IBDs, as sticky bone is known to maintain the space, according to previous research. A total of 21 IBDs were treated by OFD, PRF-BG mixture, or ASB. Regenerative assessment was clinically and radiographically performed by CBCT at 1 year. All the treatment modalities (OFD, PRF-BG, and ASB) showed statistically significant improvements clinically and radiographically at 1 year in terms of probing pocket depth reduction (PPDR), clinical attachment level gain (CALG), CBCT defect fill (CBCT-DF), and CBCT defect resolution (CBCT-DR); P < .05. The ASB group depicted the most favorable results (P < .05) in terms of the parameters at 1 year followed by the PRF-BG group and then the OFD group. Treatment of periodontal IBDs with ASB resulted in significant improvements in clinical and CBCT parameters compared to baseline at 1 year, and intrasurgical graft handling was much better in the ASB group. [ABSTRACT FROM AUTHOR]

This study compared the onset of vascular bleeding between osseodensification and conventional drilling of implant osteotomy sites. Patients with type III trabecular bone requiring a single missing tooth replacement were included and allocated to either Group A (test) or Group B (control). In Group A, the osseodensification group (OD), an implant osteotomy was carried out using Densah Burs (Versah) in the counterclockwise direction; in Group B, the standard drilling group (SD), Densah Burs were run in the clockwise direction. An endoscope was introduced into the osteotomy to visualize and measure the time taken for initiation of bleeding (Bl) and for blood to fill the osteotomy site (BF). A total of 40 osteotomy sites (23 in the maxilla and 17 in the mandible) were included in this cross-sectional study. The mean age of study participants was 50.1 ± 8.28 years. The mean Bl time for Groups A and B was 18.54 ± 2.48 seconds and 16.89 ± 1.92 seconds, respectively (P = .02); the mean BF time for Groups A and B was 41.92 ± 3.19 seconds and 37.95 ± 2.73 seconds, respectively (P < .001). Osseodensification does not seem to negatively affect or induce loss of bone vascularity. Clinicians should note that osseodensified sites might take slightly longer to fill with blood following an osteotomy. [ABSTRACT FROM AUTHOR]

The article discusses socket shield technique (SST), a surgical approach to minimize postextraction osseous and gingival changes. Topics include same clinical outcome in practice between the SST and the root membrane technique, one key requirement for the application of SST, complications reported with the technique, and gradual modifications made on SST as a novel technique.

Purpose: To assess the clinical performance of a two-piece zirconia implant system, with a focus on biologic complications. Materials and Methods: A total of 39 patients received 91 two-piece zirconia implants. The patients were recruited from two private clinics and were monitored for 5 to 12 years (median: 5.6 years). The primary outcomes were biologic complications, such as peri-implant infections (peri-implant mucositis and peri-implantitis), and the secondary outcome was radiographically evident marginal bone loss (MBL). Results: Three patients (7.7%) with 9 total implants (9.9%) presented with peri-implant mucositis. MBL that did not exceed the first thread was evident at 32 mesial sites (35%) and 25 distal sites (27.4%). MBL exceeding the first thread but not the third thread was evident at 6 mesial and 5 distal sites (thread pitch: 0.7 mm). Only one peri-implant pocket deepened (4 mm) and showed bleeding; however, the estimated MBL did not exceed 1.65 mm. No peri-implantitis occurred, and no implant was lost. Conclusions: This prospective study shows high survival rates and a seemingly low prevalence of biologic and prosthetic complications for this two-piece zirconia implant system over an observation period of up to 12 years. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the process of early oral osseointegration of titanium (Ti) implants in diabetic 129/Sv mice through microCT and histologic and immunohistochemical analysis. Materials and Methods: A group of 30 male 129/Sv mice was equally subdivided into two groups: (1) nondiabetic (ND), in which mice did not undergo systemic alterations and received a standard diet, and (2) diabetic (D), in which mice were provided a high-fat diet from the age of 6 weeks until the conclusion of the study and received two intraperitoneal (IP) injections of streptozotocin (STZ) at a concentration of 100 mg/Kg each. Each mouse underwent extraction of a maxillary first molar, and customized Ti screws (0.50 mm diameter, 1.5 mm length) were placed in the residual alveolar sockets of the palatal roots. At 7 and 21 days after implant placement, the animals were euthanized for maxilla and pancreas collection. Maxillae containing Ti implants were analyzed with microCT, histology, and immunohistochemistry for cells that were positive for F4/80, CD146, runt-related transcription factor 2 (Runx2), and proliferating cell nuclear antigen (PCNA). Pancreata were histologically analyzed. Quantitative data were statistically analyzed with a significance level at 5% (P < .05). Results: ND mice presented successful healing and osseointegration, with a significantly higher fraction of bone volume compared to D mice, both at the alveolar sockets (53.39 ± 5.93 and 46.08 ± 3.18, respectively) and at the implant sites (68.88 ± 7.07 and 44.40 ± 6.98, respectively) 21 days after implant placement. Histologic evaluation revealed that the ND mice showed a significant decrease in inflammatory infiltrate and a significant increase in newly formed bone matrix at 21 days, whereas peri-implant sites in the D mice were predominantly encapsulated by fibrous tissue and chronic inflammatory infiltrate. Immunohistochemical characterization revealed higher Runx2 osteoblast differentiation and higher cell proliferation activity in the ND mice at 7 days, while higher amounts of macrophages were present in D mice at 7 and 21 days. Interestingly, no differences were found in CD146-positive cells when comparing ND and D mice. Conclusions: This study evaluated the effects of immediate dental implant placement in 129/Sv diabetic mice by using specific healing markers to identify changes in cellular events involved in early oral osseointegration. This approach may serve as tool to evaluate new materials and surface coatings to improve osseointegration in diabetic patients. [ABSTRACT FROM AUTHOR]

Purpose: To investigate cytokine levels in peri-implant crevicular fluid and thus evaluate the effects of concentrated growth factor (CGF) on osseointegration. Materials and Methods: A total of 40 mandibular implants were symmetrically placed in a group of 20 systemically healthy patients enrolled in the study. In each patient, one implant wetted with liquid infiltrated from fibrin matrix was placed in the test side (Group L), and the other implant was placed in the control side without the application of any material (Group C). Peri-implant crevicular fluid was collected at 2, 4, and 12 weeks later. Marginal bone loss was measured with panoramic radiographs taken immediately after implant placement and at 12 weeks. Resonance frequency analysis (RFA) of the implants was performed intraoperatively and at 4 and 12 weeks. Results: Stability values of the implants in the CGF liquid–treated sites were higher than those of the control group at week 12 (P = .005). There was no statistically significant difference between the two groups in terms of marginal bone loss (MBL). Group L showed increased levels of tumor necrosis factor alpha (TNF-α) and receptor activator of nuclear factor kappa-B ligand (RANKL) at 2 and 4 weeks. Also, levels of osteoprotegerin (OPG) were higher in Group L at week 4 compared to Group C (P = .033). Conclusions: The increased TNF-α, RANKL, and OPG levels in this study demonstrate that CGF liquid can be used to accelerate peri-implant bone remodeling in the early phase of osseointegration. [ABSTRACT FROM AUTHOR]

This retrospective study evaluated the survival rate and the clinical outcome of an endosseous implant system, as well as the marginal bone level (MBL) and the impact of the machined collar neck position on crestal bone level changes up to 2 years later. A total of 96 implants were placed in 57 patients and loaded with a final restoration after at least 3 months of healing: 15 implants were immediately placed into fresh extraction sockets, and 81 were placed in healed ridges. Marginal bone loss around implants was determined radiographically at 12 to 24 months postloading. The effects on marginal bone loss of the site (mandible vs maxilla), location (anterior vs posterior), immediate vs delayed implant, smoking habit, sex, implant length and diameter, prosthesis type (screw-retained/cemented), and the machined collar position were evaluated. The implant survival rate was 98.96% at 1 year. The mean MBL decreased significantly (0.238 mm) between baseline and loading (P < .001; post hoc test) and decreased by 0.154 mm between loading and 1 year, but this was not significant (P = .085; post hoc tests). After 2 years, the mean MBL decreased significantly (0.263 mm) between baseline and loading (P < .001) and decreased by 0.111 mm between loading and 1 year and by 0.199 mm between loading and 2 years, but these were not significant (P > .05; post hoc tests). The mean bone loss after 1 and 2 years was not significantly associated with implant type or site, smoking habit, or type of implant surgery (P = .792). However, the mean bone loss was significantly associated with the type of prosthesis and was significantly greater for cemented prostheses compared to screw-retained prostheses. A supracrestal position of the machined collar (tissue level) was associated with no bone loss, while placing the collar below the alveolar crest led to bone loss over 2 years. Of the factors evaluated, marginal bone loss after 1 and 2 years was significantly associated with prosthesis type and the machined collar position. [ABSTRACT FROM AUTHOR]

Immediate full-arch loading is a highly complex and techniquesensitive procedure. Digital impression techniques aim to replace conventional analog systems to carry out dental treatments in a more predictive, safer, and less time-consuming way. This case report describes a patient with a guarded periodontal prognosis, who was rehabilitated with implant-supported fixed prostheses after full-mouth extractions. Immediate full-arch loading was performed by means of two digital impression systems: photogrammetric technology with PIC dental in the maxillary arch, and MedicalFit in the mandible. Immediate provisional prostheses in acrylic resin (polymethyl methacrylate) were milled and placed within 12 hours after implant placement surgeries. Both provisional structures fitted properly providing adequate esthetics and function. After the implant osseointegration period, final digital impressions were registered, and definitive zirconia full-arch implant-supported prostheses were delivered. The 24-month follow-up did not show biologic or mechanical complications. [ABSTRACT FROM AUTHOR]

Objectives: Low bone density and lack of adequate vertical bone dimension as a result of maxillary sinus pneumatization present some of the most problematic cases for endosseous implant applications in posterior maxillary regions that hinder prosthetic rehabilitation. The overall objectives of the study were to assess the histologic, histomorphometric, and radiologic evaluation of biopsies gathered from maxillary sinuses that were grafted with three different bovine bone particles (Bio-Oss, Cerabone, and Ti-Oss) and analyze the volume of the bone graft and the quantity of new bone formation. Method and materials: Thirty-six patients with < 4 mm of residual ridge height unilaterally in the posterior maxilla were equally divided into three groups, each of which received different bovine bone particles for maxillary sinus augmentation. Six months later, biopsies were harvested for histologic and histomorphometric evaluations. Volumetric changes in maxillary sinus augmentation were analyzed at 1-week and 6-month time-points following maxillary sinus augmentation surgery. Results: Histomorphometric and histologic analysis revealed a significant difference between the Ti-Oss group compared with the Bio-Oss and Cerabone groups (P=.011). In terms of residual graft particlesand soft tissue, there were no significant differences between groups. 3D volumetric reductions between 1-week (baseline) and 6-month time-points recorded significant graft volume reduction in all groups (P < .05). Significantly greater bone resorption and lower new-bone formation were manifested in the Ti-Oss group in comparison to the other groups. Conclusions: Within the limits of thisstudy, histologic and radiologic results indicated that Bio-Oss and Cerabone could be used efficiently in sinus augmentation procedures, while further prospective studies are needed to evaluate the Ti-Oss material in maxillary sinus augmentation. [ABSTRACT FROM AUTHOR]

Biomedical coatings were elaborated by pulsed electrodeposition with hydrogen peroxide (H 2 O 2) into electrolytes on Ti 6 Al 4 V substrates, and the effect of H 2 O 2 concentration on the electrolyte and the heat treatment was studied. The experimental procedures employed in this study produce a consistent hydroxyapatite coating. This coating is well-suited for use in bio-implants, as it enhances the integration of the implant with surrounding bone tissue and improves the mechanical performance. The coatings' surface morphology and chemical composition were assessed using scanning electron microscopy (SEM) in conjunction with energy-dispersive X-ray spectroscopy (EDXS) for x-ray microanalysis. X-ray diffraction (XRD) was also utilized to identify the phases and composition of the coatings. Nanoindentation and scratch tests were conducted to analyze the nanomechanical properties and adhesion behavior. Potentiodynamic polarization was employed in the Ringer solution to evaluate the corrosion resistance and replicate the conditions of the human body environment. The results of our thorough investigation revealed that employing pulsed electrodeposition with 9 % H 2 O 2 in the electrolyte, combined with subsequent heat treatment, facilitated the creation of coatings comprising two distinct phases: stoichiometric hydroxyapatite (HAP) and β-tricalcium phosphate (β-TCP). Our meticulous research underscores the significance of this process in achieving these specific coating compositions. Under these tests listed above, this composite demonstrated favorable mechanical properties (E = 30.45 GPa and H = 72.2 MPa). It also exhibited superior scratch adhesion and a critical load of 23 MPa and 12 N, respectively. Additionally, an improvement in tribological comportment was observed, and the wear volume decreased from 4.15 106 μm3 to 2.44 106 μm3. The HAP coating heat treated with 9 % H 2 O 2 exhibited the highest corrosion resistance, with E corr at −0.189 V/SCE and i corr at −1.11 μA cm−2 [ABSTRACT FROM AUTHOR]

Dental implants are considered a superior option for the replacement of missing teeth. However, the invasive nature of the surgical procedure often results in significant postoperative inflammation, and the prolonged healing period of 3–6 months presents a notable disadvantage. High mobility group box 1 (HMGB1) is a critical mediator of acute inflammation following surgical injury, which can hinder the onset of osseointegration. This study aims to examine whether the inhibition of HMGB1 can mitigate acute inflammation and subsequently enhance osseointegration. The findings indicate that HMGB1 inhibition markedly reduces inflammation and promotes bone repair in murine models. Further in vitro investigations into the regulatory mechanisms of HMGB1 in macrophages reveal its role in increasing Yes-associated protein (YAP) activity, which contributes to pro-inflammatory polarization. Additionally, conditioned media derived from macrophages influenced by HMGB1 significantly impair the migratory and osteogenic capabilities of bone marrow-derived mesenchymal stem cells, which are essential for bone regeneration. In vivo experiments further validate that the administration of exogenous HMGB1 exacerbates postoperative acute inflammation and obstructs osseointegration. The study concludes that inhibiting HMGB1 fosters an anti-inflammatory polarization of macrophages, leading to diminished postoperative acute inflammation and expedited osseointegration around dental implants in mice. [Display omitted] • HMGB1 promotes macrophages proinflammatory polarization by activating YAP. • HMGB1-YAP activated macrophages impede mesenchymal stem cell osteogenesis. • HMGB1 inhibition reduces the inflammatory factors release in mice. • Early inflammation resolution boosts osseointegration around implants in mice. [ABSTRACT FROM AUTHOR]

Aim: To investigate the influence of diabetes mellitus (DM) in a murine model of peri‐implantitis (PI). Materials and Methods: Twenty‐seven 4‐week‐old C57BL/6J male mice had their first and second maxillary left molars extracted. Eight weeks later, one machined implant was placed in each mouse. Four weeks after osseointegration, the mice were divided into three groups: (a) control (C), (b) PI and (c) DM + PI. DM was induced by streptozotocin (STZ) administration. After DM induction, PI was induced using ligatures for 2 weeks. The hemimaxillae were collected for micro‐CT and histological analyses. The primary outcomes consisted of linear (mm) and volumetric (mm3) bone loss. Secondary outcomes were based on histological analysis and included inflammatory infiltrate, osteoclastic activity, matrix organization, composition and remodelling. Data are presented as means ± SEM. Statistical analyses were performed using one‐way ANOVA, followed by Tukey's test. Results: Gingival tissue oedema was detected in the PI and DM + PI groups. Micro‐CT showed significantly increased linear and volumetric bone loss in the DM + PI group compared to the C and PI groups. H&E staining showed greater inflammatory response and bone resorption in the PI and DM + PI groups than in the C group. The DM + PI group had significantly higher osteoclast numbers than the C and PI groups. Picrosirius red stained less for types I and III collagen in the PI and DM + PI groups than in the C group. There was a significant increase in monocyte/macrophage (CD‐11b) counts and matrix metalloproteinases (MMP‐2 and MMP‐8) marker levels and a significant decrease in the matrix metalloproteinases inhibition marker (TIMP‐2) levels in the DM + PI group compared to the C and PI groups. Conclusions: DM exacerbates PI‐induced soft‐tissue inflammation, matrix degradation and bone loss. [ABSTRACT FROM AUTHOR]

An in vivo animal model of a weight‐bearing intra‐articular implant is crucial to the study of implant osseointegration and aseptic loosening caused by osseointegration failure. Osseointegration, defined as a direct structural and functional attachment between living bone tissue and the surface of a load‐carrying implant, is essential for implant stability and considered a prerequisite for the long‐term clinical success of implants in total joint arthroplasty. Compared to large animal models, murine models offer extensive genetic tools for tracing cell differentiation and proliferation. The 18‐ to 22‐week‐old C57BL/6J background mice underwent either press‐fitted or loose implantation of a titanium implant, achieving osseointegration or fibrous integration. A protocol was developed for both versions of the procedure, including a description of the relevant anatomy. Samples were subjected to microcomputed tomography and underwent biomechanical testing to access osseointegration. Lastly, samples were fixed and embedded for histological evaluation. The absence of mineralized tissue and weakened maximum pull‐out force in loose implantation samples indicated that these implants were less mechanically stable compared to the control at 4 weeks postoperation. Histological analysis demonstrated extensive fibrotic tissue in the peri‐implant area of loose implantation samples and excellent implant osseointegration in press‐fitted samples at 4 weeks. Both mechanically stable and unstable hemiarthroplasty models with either osseous ingrowth or a robust periprosthetic fibrosis were achieved in mice. We hope that this model can help address current limitations for in vivo study of aseptic loosening and lead to necessary translational benefits. [ABSTRACT FROM AUTHOR]

Background: Bioactive surface modifications have been proposed to enhance osseointegration and longevity of dental implants. This study aimed to systematically review and perform a meta-analysis on the effectiveness of various bioactive coatings in promoting bone integration and improving implant longevity. Methods: A systematic review was conducted, including studies that investigated bioactive surface modifications on titanium dental implants. Outcomes of interest were bone-to-implant contact (BIC) and implant longevity over a 30-day period. Data were extracted and analyzed using RevMan 5 (version 5.4.1), with forest plots generated to represent the mean difference (MD) and 95% confidence intervals (CI) under a random effects model. Results: The meta-analysis showed a significant improvement in BIC for surface-modified implants, with an overall MD of 7.29 (95% CI [2.94, 11.65]). Heterogeneity analysis indicated moderate heterogeneity (Tau² = 18.57, Chi² = 16.08, df = 8, P = 0.04, I² = 50%). The test for overall effect yielded Z = 3.28 (P = 0.001). For implant longevity, the overall MD was 7.52 (95% CI [3.18, 11.85]), with moderate heterogeneity (Tau² = 17.28, Chi² = 14.95, df = 8, P = 0.06, I² = 47%). The test for overall effect yielded Z = 3.40 (P = 0.0007). Conclusion: Bioactive surface changes significantly improved osseointegration and lifespan of dental implants. Collagen-based coatings consistently encouraged early bone integration, while BMP-2 combinations were effective for osseointegration. Optimizing bioactive agent doses and combinations was critical for achieving desired outcomes. [ABSTRACT FROM AUTHOR]

Although poly-ether-ether-ketone (PEEK) implants hold significant medical promise, their bioinert nature presents challenges in osseointegration and bone ingrowth within clinical contexts. To mitigate these challenges, the present study introduces Diamond PEEK/bioactive glass (BG) composite scaffolds, characterized by macro/micro dual-porous structures, precisely fabricated via laser powder bed fusion (LPBF) technology. The findings indicate that an increase in BG content within these scaffolds significantly augments their hydrophilicity and hydroxyapatite formation capacities. Stress-strain curve analysis demonstrates reliable load-bearing stability across all scaffold types. In vitro assessments confirmed the non-cytotoxicity of PEEK/BG samples and demonstrated improved osteogenic differentiation and mineralization with increased BG incorporation. Further, in vivo experiments illustrated that the Diamond porous structure of these scaffolds facilitated bone growth, an effect notably amplified with higher BG content. Particularly in groups with 15 wt.% and 25 wt.% BG scaffolds, new bone formation was observed not only within the macropores of the Diamond structure but also within the micropores inside the scaffold rod, suggesting an almost seamless fusion with the new bone. This demonstrates the scaffolds' effective osteointegration and bone ingrowth properties. This study conclusively established the effectiveness of Diamond-structured PEEK/BG composite scaffolds, fabricated via LPBF, in bone repair. It highlights the crucial role of BG in enhancing osteogenic potential through interaction with the macro/micro pores of the scaffold. This study addresses the bioinert nature of PEEK implants by developing Diamond-structured PEEK/bioactive glass (BG) composite scaffolds by laser powder bed fusion. The dual-porous macro/microstructure enhances hydrophilicity and hydroxyapatite formation, vital for bone regeneration. By adjusting the BG content, we controlled the melt viscosity and sintering rate, leading to the formation of beneficial microscale pores. These pores resolve the issue of ineffective bioactive fillers in previous LPBF-fabricated scaffolds, enhancing the osteogenic potential of BG and inducing superior bone ingrowth and osseointegration. In vitro and in vivo analyses show enhanced osteogenic differentiation, mineralization, and bone growth, underscoring the clinical potential of these scaffolds for bone repair. [Display omitted] [ABSTRACT FROM AUTHOR]

The study of the functional living organism through biological phenomena and their piezoelectric and electromagnetic interaction of particles and energy in the functional cells of organ systems that sustain life through homeostasis, and their relationship with the external environment, can be observed as a unique effect called the biopiezoelectromagnetic effect. Research in sciences, combined with the use of innovative technological tools and instruments at scales ranging from the subatomic to the astrophysical, have made it possible to observe, through these individual or combined effects, a phenomenon that is repeated in all structures: the conservation of elemental information. This approach makes it possible to research from the particle to the functional living organism in its environment and vice versa. It is possible to propose theories that link energy, particles and cells and their organised structural complexes within the same framework, analysing the biopiezoelectromagnetic effect and the constant effort to maintain the homeostasis of living organisms in an entropic environment. Biomaterials composed of crystals and quasicrystals promote the piezoelectric effect in living tissue-biomaterial contact. The piezoelectric effect is already known to stimulate and form a fibrocartilaginous bone callus and its subsequent hardening into mature bone but has never been directly associated with homeostasis, osseointegrated implants and biomaterial bonding. The synthesis described by evidence-based experiments over the past centuries is robust to describe the biopiezoelectromagnetic effect as a cascade of events in the functional living organism to maintain homeostasis and its binding properties as the basis of osseointegration and the foundation of biocompatibility. [ABSTRACT FROM AUTHOR]

This study presents the fabrication of carbon‐fiber‐reinforced polyetheretherketone (CF/PEEK) by 3D printing, which is subsequently coated with elastic nanofibers by electrospinning. CF/PEEK is an FDA‐approved implantable material possessing excellent mechanical properties similar to those of human cortical bone. As such, it is a prime candidate for replacing conventional metallic implants. However, it is limited by its bioinertness and inferior osteogenic properties. In this study, CF/PEEK is engineered to have improved hydrophilic properties and generated micro/nano‐topographical structures on its surface. This is achieved by electrospinning directly onto the 3D‐printed CF/PEEK with fibers incorporating hydroxyapatite particles and gelatin. The results show that the micro‐/nano‐topographical CF/PEEK demonstrates a significant increase in mineralizing potential compared to non‐coated implants, where no mineralized matrix is observed. These fiber coating modifications to CF/PEEK are a promising and important step forward in the improvement of in vivo implant‐bone osteointegration. [ABSTRACT FROM AUTHOR]

Traumatic brain injury (TBI)‐induced post‐traumatic epilepsy (PTE) is a serious brain disease that causes the loss of motor functions, cognitive impairments, and even death. Real‐time and long‐term electrophysiological signal monitoring has significant implication for the treatment of patient with TBI. Brain–computer interfaces (BCIs) utilizing flexible electrodes enable accurate epilepsy identification by electrocorticography (ECoG) signal monitoring. In this study, a customized flexible osteoid electrode is developed, which contributes to demands and personal differentiation among patients with TBI. The end product of osteoid electrode after full osseointegration will be a stable and firmly integrated structure within the bone tissue, providing a secure platform for continuous electrophysiological signal monitoring. The flexibility and conductivity of the osteoid electrode enables high‐quality and long‐term epilepsy monitoring. Biocompatibility of the osteoid electrode is also demonstrated by in vitro cell experiments. Simultaneously, the porous osteoid electrode also exhibits osseointegration ability based on potential long‐term ECoG signal monitoring, which suggests its potential for the comprehensive treatment of TBI patients. This work not only introduces a potential therapeutic scaffold for TBI‐related diseases, but also provides promising techniques for clinical ECoG monitoring in patients with TBI. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives Materials and Methods Results Conclusion Clinical Significance This study compares the restoration of single‐tooth implants with screw‐retained lithium‐disilicate hybrid‐abutment crowns and single‐tooth lithium‐disilicate crowns adhesively bonded to hybrid abutments with regard to objective clinical and subjective patient‐specific evaluation criteria over a time of observation of 3 years.Two bone‐level implants were placed in contralateral sides of the same jaw in 10 patients, each with two single‐tooth gaps. After osseointegration, implants were uncovered and an impression was taken. In accordance with the split‐mouth design, one implant in each patient was restored with a screw‐retained hybrid abutment crown and the other implant with a hybrid abutment and an adhesively bonded single‐tooth crown. The restorations were randomly allocated to the implants. Prefabricated titanium bases were used. The ceramic abutments and restorations were fabricated monolithically with pressed lithium‐disilicate ceramic. An objective evaluation (survival, technical, or biological complications, FIPS) by the practitioner and a subjective evaluation (satisfaction, OHIP) by the patient were carried out after 3, 6, 12, 24, and 36 months after restoration placement.Both restoration types showed a survival rate of 100% after 3 years of observation. No technical or biological complications occurred. No significant difference was observed between the two types of restoration neither for objective (survival, technical or biological complications, FIPS) nor subjective (satisfaction, OHIP) evaluation criteria (p > 0.05).No statistically significant differences were observed between screw‐retained and cemented pressed lithium‐disilicate restorations on bone‐level implants for both objective and subjective evaluation criteria, respectively.Monolithic hybrid‐abutment crowns (screw‐retained) and monolithic hybrid abutments with single‐tooth crowns (cemented) made of pressed lithium disilicate can be used to successfully restore single implants. [ABSTRACT FROM AUTHOR]

Bone formation on implant surfaces occurs via distance and contact osteogenesis, with osseointegration influenced by the implant's surface topography and coating. However, the traditional mechanisms of osseointegration around metal implant surfaces may not fully encompass the ultimate outcomes of using medical-grade polycaprolactone β-tricalcium phosphate calcium phosphate coated (mPCL-TCP-CaP) scaffolds for the reconstruction of large bone defects. Using histology, immunohistochemical (IHC) and scanning electron microscopy (SEM) analyses our studies on large bone defects using mPCL-TCP-CaP scaffolds show osteogenic cells forming a fibrous connective matrix around these scaffolds. Despite extensive research, the in vivo mechanisms of osseointegration of CaP-coated mPCL-TCP-CaP scaffolds remain unclear. This study investigates the structural details and spatial organization of the mPCL-TCP-CaP scaffold's interface, providing insights into the histodynamic processes involved in their osseointegration with CaP coatings. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Methods Results Conclusions The clinical management of partial bone defects in lower limbs, particularly those resulting from osteomyelitis, remains a significant challenge. This study aimed to systematically evaluate the effectiveness of 3D‐printed porous Ti6Al4V prostheses in addressing osteomyelitis‐induced partial bone defects.We established a comprehensive protocol for utilizing 3D‐printed prostheses for bone defect repair, encompassing 3D simulation of prosthesis implantation and internal fixation, finite element analysis (FEA), and clinical implementation. Mimics software facilitated simulation of fixation patterns and screw lengths. FEA modeled bone defects in the distal metaphyseal femur and distal diaphyseal tibia to assess changes in stress conduction pre‐ and post‐prosthesis implantation. The clinical study involved eight patients (average age: 56.3 years) with an average defect length of 14.9 cm. Postoperative outcomes were evaluated using X‐rays and the Lower Extremity Functional Scale (LEFS).FEA demonstrated that the implanted prostheses effectively shared stress and reduced the load on residual bone in both models, thus lowering the risk of fractures under external forces. The average follow‐up period was 24.5 months, with patients initiating weight‐bearing activities on average 7.8 days post‐surgery. Serial postoperative X‐rays demonstrated long‐term stability of the prostheses, with progressive bone regeneration around and integration with the prostheses. While two patients experienced infection recurrence requiring prosthesis removal and debridement, the remaining six showed significant improvement in LEFS scores, increasing from 31.5 preoperatively to 61.0 at the last follow‐up.3D‐printed porous Ti6Al4V prostheses effectively restore anatomical integrity and optimize stress conduction in lower limbs, resulting in substantial functional recovery. This innovative approach shows promise for wider clinical adoption and warrants further investigation in medical practice. [ABSTRACT FROM AUTHOR]

Concentrated Growth Factor (CGF) is a highly effective biomaterial known for its ability to promote tissue regeneration. While it's been studied extensively in intraoral procedures and bone grafting, its benefits in maxillary sinus lifting lack substantial evidence. This review aimed to evaluate CGF's effectiveness in maxillary sinus augmentation, focusing on clinical, radiographic, and histological outcomes. A comprehensive literature search was conducted across PubMed, Scopus, Web of Science, Google Scholar, and Cochrane Library databases using specific mesh terms and keywords and adhered to PRISMA guidelines. Studies up to March 2024 involving transcrestal or lateral maxillary sinus floor elevation with CGF, either alone or in combination with grafting materials, were included. Out of 783 publications, 13 studies met the eligibility criteria. The review assessed CGF's role in minimizing postoperative complications, enhancing new bone formation, and improving implant survival. Despite data variability among studies, the majority reported that CGF positively influenced maxillary sinus augmentation outcomes. While more robust randomized clinical trials are required to draw definitive conclusions, initial results are promising, and the findings suggest that CGF utilization in maxillary sinus augmentation seems to enhance clinical outcomes by promoting vascularization and regeneration at the surgical sites and improving both the quality and quantity of newly formed sinus bone. Furthermore, it exhibits potential for improving postoperative sequelae and achieving high implant survival rates. [ABSTRACT FROM AUTHOR]

Purpose: Diminished bone levels or the lack of osseointegration can lead to higher rates of failure of dental implants. The present study is aimed to evaluate the correlation between hypertension, diabetes mellitus and hyperlipidemia, on the marginal bone loss (MBL) surrounding dental implants among patients attending the University of Nevada, Las Vegas dental clinics. Methods: Clinical notes from patients at the University of Nevada, Las Vegas (UNLV) dental clinics were analyzed using AxiUm™ software. The study included patients with dental implants diagnosed with hypertension, diabetes mellitus, and hyperlipidemia who attended the UNLV School of Dental Medicine clinics from 2012 to 2022. Exclusions were made for patients with acquired immune deficiency syndrome and those with a limited number of radiographs. A search was conducted using keywords such as 'systemic disease,' 'marginal bone loss,' 'dental implant,' 'high cholesterol,' 'hypertension,' and 'diabetes' within the system. Results: Out of 1,310 potentially eligible patients, 57 fulfilled the inclusion criteria. The total number of evaluated implants was 165. 18% of the sample patients were 55 to 64 years of age, and 79% were 65 or above. 45.6% of patients reported having more than four systemic diseases and 67% of patients had four or more prescription medications. Patients diagnosed with hypertension (78.95%) or hyperlipidemia (73.68%) had the highest presence of marginal bone loss surrounding the dental implant(s) while those with diabetes (40.35%) had the least amount of MBL. Patients diagnosed with both hypertension and hyperlipidemia (29.82%) experienced the highest incidence of MBL around implants. The medications prescribed to combat these health issues, such as statins and antihypertensive, also showed the same trends and corresponded with a higher prevalence of MBL. Conclusions: Within the limitations of the present investigation, patients diagnosed with hyperlipidemia and hypertension were more likely to exhibit MBL surrounding dental implants. [ABSTRACT FROM AUTHOR]

Excessive production of reactive oxygen species (ROS) around titanium implants under diabetic conditions causes persistent inflammation, leading to poor osseointegration and even implant failure. Surface modification is an effective way to promote ROS clearance, alleviate inflammation, and stimulate bone formation. In this study, a multifunctional coating is fabricated by introducing cerium (Ce)-containing mesoporous bioactive glass nanoparticles (Ce-MBGNs) onto the titanium surface via an electrophoretic deposition method. The incorporation of Ce-MBGNs remarkably improves surface hydrophilicity by increasing the surface areas. The bioactive ions are appropriately released, thereby promoting mesenchymal stem cell proliferation and differentiation under diabetic conditions. The conversion between Ce(III) and Ce(IV) endows Ce-MBGNs coating with antioxidative nanoenzymes properties to scavenge diabetes-induced ROS, resulting in macrophage polarization towards the anti-inflammatory phenotype. The therapeutic effect of Ce-MBGNs-modified titanium implants is also verified in diabetic rats by inhibiting inflammatory responses and accelerating early osseointegration. Taken together, the findings reveal that the ROS-scavenging and immunomodulation activity of the Ce-MBGNs coating contributes to enhanced osseointegration, and provides a novel implant surface for diabetic patients. [ABSTRACT FROM AUTHOR]

Macrophages play a central role in orchestrating the inflammatory response to implanted biomaterials and are sensitive to changes in the chemical and physical characteristics of the implant. Macrophages respond to biological, chemical, and physical cues by polarizing into pro-inflammatory (M1) or anti-inflammatory (M2) states. We previously showed that rough-hydrophilic titanium (Ti) implants skew macrophage polarization towards an anti-inflammatory phenotype and increase mesenchymal stem cell (MSC) recruitment and bone formation around the implant. In the present study, we aimed to investigate whether the adoptive transfer of macrophages in different polarization states would alter the inflammatory microenvironment and improve biomaterial integration in macrophage-competent and macrophage-ablated mice. We found that ablating macrophages increased the presence of neutrophils, reduced T cells and MSCs, and compromised the healing and biomaterial integration process. These effects could not be rescued with adoptive transfer of naïve or polarized macrophages. Adoptive transfer of M1 macrophages into macrophage-competent mice increased inflammatory cells and inflammatory microenvironment, resulting in decreased bone-to-implant contact. Adoptive transfer of M2 macrophages into macrophage-competent mice reduced the pro-inflammatory environment in the peri‑implant tissue and increased bone-to-implant contact. Taken together, our results show the importance of macrophages in controlling and modulating the inflammatory process in response to implanted biomaterials and suggest they can be used to improve outcomes following biomaterial implantation. Macrophages are central in orchestrating the inflammatory response to implanted biomaterials and are sensitive to biomaterial chemical and physical characteristics. Our study shows that a deficiency of macrophages results in prolonged inflammation and abolishes bone-biomaterial integration. Adoptive transfer of immunomodulatory macrophages into macrophage-competent mice reduced the inflammatory environment and increased bone-implant contact. [Display omitted] [ABSTRACT FROM AUTHOR]

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ABSTRACT Objectives Material and Methods Results Conclusions Trial Registration This controlled preclinical study analyzed the effect of implant surface characteristics on osseointegration and crestal bone formation in a grafted dehiscence defect minipig model.A standardized 3 mm × 3 mm acute‐type buccal dehiscence minipig model grafted with deproteinized bovine bone mineral and covered with a porcine collagen membrane after 2 and 8 weeks of healing was utilized. Crestal bone formation was analyzed histologically and histomorphometrically to compare three implant groups: (1) a novel, commercially available, gradient anodized (NGA) implant, to two custom‐made geometric replicas of implant “1,” (2) a superhydrophilic micro‐rough large‐grit sandblasted and acid‐etched surface, and (3) a relatively hydrophobic micro‐rough large‐grit sandblasted and acid‐etched surface.At 2 and 8 weeks, there was no difference between the amount and height of newly formed bone (NBH, new bone height; BATA, bone area to total area) for any of the groups (p > 0.05). First bone‐to‐implant contact (fBIC) and vertical bone creep (VBC) at 2 and 8 weeks were significantly increased for Groups 2 and 3 compared to Group 1 (p < 0.05). At 8 weeks, osseointegration in the dehiscence (dehiscence bone‐implant‐contact; dBIC) was significantly higher for Groups 2 and 3 compared to Group 1 (p < 0.05).The amount of newly formed bone (BATA) and NBH was not influenced by surface type. However, moderately rough surfaces demonstrated significantly superior levels of osseointegration (dBIC) and coronal bone apposition (fBIC) in the dehiscence defect compared to the NGA surface at 2 and 8 weeks.For this type of study, clinical trial registration is not required. This study was conducted at the Biomedical Department of Lund University (Lund, Sweden) and approved by the local Ethics Committee of the University (M‐192‐14) [ABSTRACT FROM AUTHOR]

Background: Indications for total hip arthroplasty (THA) have evolved over recent decades, with a growing trend toward operating on younger and more active patients. With this shift in patient demographics, there has been a change in femoral stem designs and proximal femoral morphology encountered. This study aimed to evaluate the potential correlation between femoral stem osteointegration and proximal femoral morphology using the Dorr and Noble classifications. Materials and methods: We conducted a retrospective review of 122 uncemented femoral stems (AMIstem Medacta, triple tapered). The demographic data analyzed included sex, age, stem size, and surgical indications. Preoperative radiographs were reviewed to determine the Dorr classification as well as the canal-to-calcar isthmus ratio, cortical index, and canal flare index. Postoperative radiographs were carefully reviewed to identify the presence of potential postoperative radiolucencies. Inter- and intra-observer agreements for these parameters were also analyzed. Results: Significant radiolucencies (> 2 mm) were found in 19.5% of the patients. Of all the variables analyzed, the cortical index was the only parameter significantly associated with the appearance of clinically significant radiolucency, with a threshold value of 0.62. Conclusions: The appearance of radiolucencies is multi-factorial. Nevertheless, in this study, a high cortical index (> 0.62), representing the champagne flute morphology, was found to be associated with the development of significant radiolucencies. [ABSTRACT FROM AUTHOR]

Introduction: Percutaneous Osseointegrated Implants (POIs) influence the load transfer path to the host bone. In turn, mechano-regulatory processes (strain adaptive bone remodeling) drive periprosthetic bone changes that influence implant stability and fixation outcome. These bone changes have not yet been reported for the Intraosseous Transcutaneous Amputation Prosthesis (ITAP) clinical trial. Objectives: This study will first standardize the zoning and reporting of periprosthetic bone change in POI radiographs. Second, it will retrospectively measure periprosthetic bone change from radiographs of 12 participants with an ITAP up to 11 years. Finally, the results will be qualitatively compared with those from participants with different POI designs. Materials and Methods: Twenty participants with unilateral transfemoral amputations received an ITAP in a 2-center UK clinical trial in either 2008/09 or 2013/14. Participant radiographs from one center were available (n = 12) over 11 years and have been collated and processed in a repeatable way. Transverse plane periprosthetic bone change measurements at 3 equidistant points along the implant stem were measured in AP and ML. Results: Total median bone growth in AP was double that in ML (57.6 mm and 31.12 mm, respectively). Median lateral and posterior bone change (1.44 mm and 1.09 mm) was greater than median medial and anterior (0.83 mm and −0.005 mm) bone changes, respectively. The greatest change in radial bone growth was observed distally and the least proximally. Conclusions: Bone changes were similar to other collared pressfit POIs in the literature. We demonstrate the influence of stem design and mechano-regulatory remodeling in stable fixation; however, additional influences on periprosthetic bone change were inferred from the results and further investigations are necessary. Clinical Relevance: To identify ITAP design features and fixations that minimize endosteal resorption, thus promoting implant stability and contributing to clinical guidelines for rehabilitation and future design and fixation choices. [ABSTRACT FROM AUTHOR]

This study evaluates the thermal impact of a one-drill protocol for osteotomy preparation in dental implant surgery. Our findings demonstrate a significant reduction in heat generation compared to traditional sequential drilling, suggesting potential benefits for implant osseointegration and patient comfort. Specifically, the one-drill protocol was associated with lower peak temperatures and a reduced duration of elevated temperatures. These findings suggest that the one-drill protocol may contribute to improved implant stability and reduce the risk of thermal-induced bone damage. While further research is needed to confirm these findings in clinical settings, the results of this study provide promising evidence for the potential advantages of the one-drill protocol in dental implant surgery. Additionally, the one-drill protocol may offer simplified surgical workflows and reduced instrument management, potentially leading to improved efficiency and cost-effectiveness in dental implant procedures. [ABSTRACT FROM AUTHOR]