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Titanium has been proposed as a mesh material for guided bone regeneration (GBR) since the 1990s. To overcome difficulties in shaping and adapting meshes to the defect, digital techniques were introduced to digitally print meshes capable of fitting the bone perfectly, reproduced through the patient's CT scan. Five patients were included in this case series, and their CBCT data were acquired and sent to the producer of the titanium meshes. 3D regenerative surgery was performed with titanium meshes and a mix of demineralized bovine bone matrix (DBBM) and autogenous bone (1:1 ratio). Radiographic measures were evaluated on paraxial sections of the CBCT through a dedicated software. When possible, regenerated bone samples were obtained at implant insertion. Four out of five regenerated areas healed without local or systemic complications. One mesh was removed after 2 months and 2 weeks due to exposure. The mean vertical bone gain was 4.3 ± 1.5 mm (range: 2.5 to 7 mm). Two histologic samples were obtained. In sample 1, bone tissue area and graft material area were 44.4% and 12.5%, respectively; in sample 2, the same parameters were 15.6% and 16.9%, respectively. [ABSTRACT FROM AUTHOR]

Introduction: Patients with mucosal cysts in the maxillary sinus require special consideration in patients who require implant therapy for the restoration when undergoing implant therapy for the restoration of the posterior maxillary dentition. Treatment strategies for these clinical situations remain controversial in the literature. Thus, this study seeks to describe a safe and effective therapeutic strategy for sinus augmentation in patients with pre‐existing maxillary antral cysts. Methods: A total of 15 patients and 18 sinuses were consecutively enrolled in this cohort study and underwent maxillary antral cyst treatment by needle aspiration and simultaneous maxillary sinus augmentation (MSA). During surgical procedures, threeimplants (Zimmer Biomet, Indiana, USA) were positioned in 11 sinuses and two implants (Zimmer Biomet, Indiana, USA) were positioned in 5 sinuses. Results: Overall implant success and survival rates were 100% and 97.8%, respectively at 1 year and 5‐year follow‐ups. Crestal bone resorption averaged 0.3 ± 0.2 mm 5‐year post‐loading, showing bone stability. Implant survival rate at 5‐year follow‐up expressed predictability of the technique comparable to historical data when MSA was performed alone. Crestal bone resorption averaged 0.3 ± 0.2 mm 5 years post‐loading and shows bone stability utilizing mucosal cyst aspiration with concomitant MSA procedures. Quality of life evaluation at 1‐week post‐op showed similar results to published historical data. In 81% (13 sinuses), the CBCT examination at 5‐year follow‐up showed no cyst reformation, in 19% (3 sinuses) cyst reformation was visible, but smaller in size when compared to the pre‐op CBCT evaluation, and all the patients were asymptomatic. Conclusions: Maxillary sinus mucosal cyst aspiration with concomitant MSA, may be a viable option to treat maxillary sinus cyst. [ABSTRACT FROM AUTHOR]

Introduction. Missing anatomy is one of the main causes of endodontic failures, and accurate knowledge of teeth anatomy is a prerequisite for adequate root canal treatment. The aim of the present cone beam computed tomography (CBCT) study was to describe the anatomical characteristics of the mesiobuccal (MB) root canals of maxillary molars and to understand if a correlation exists between the position of the canal orifices and the anatomical features of the root. Methods. For the purposes of the study, a total of 100 CBCT scans of maxillary molars with two MB canals were selected and studied. The features of root canal anatomy of the MB root of the same teeth were analyzed and recorded (root length, confluence, and Vertucci classification). The distance between MB1 and MB2 orifices and the palatal orifice were recorded, as well as the distance between the orifices and the line joining the palatal orifice and the others. A statistical analysis was performed by providing descriptive measures, the measure of the correlation between different parameters, and the influence of some of these measures on the presence of a confluence between MB1 and MB2. Results. It resulted that the most frequent configuration is type II Vertucci. The length measured on the sagittal plane was significantly correlated to the presence of a confluence in the MB root. When the root length was higher than 14.56 mm, the confluence is three times more frequent than when the length is lower (OR = 3.635). The area under the curve (AUC) of the receiver operator characteristic (ROC) curve for length on the sagittal plane was 0.632 (P = 0.036). Conclusions. The presence of a confluence between the MB canals of maxillary molars is correlated to the length of the root that could be measured on the sagittal plane and to the distance between the canal orifices. The relative position of the root canal orifices in relation to anatomic landmarks needs to be further explored. [ABSTRACT FROM AUTHOR]

Background: In addition to non‐surgical root canal treatment or retreatment, apical surgery may be carried out to manage teeth with apical periodontitis. However, it is unclear which treatment option is more effective. Objective: To systematically review the effectiveness of apical surgery compared with non‐surgical treatment or retreatment in terms of clinical and patient‐related outcomes in teeth with apical periodontitis. Methods: A literature search of electronic databases, the grey literature, the reference lists of included articles and previous reviews, and a hand search of leading endodontic journals, was conducted. Randomised and non‐randomised control trials, and longitudinal observational studies on patients undergoing surgical (treatment group) and non‐surgical root canal treatment or retreatment (control group) of teeth with apical periodontitis were included. The risk of bias was appraised using the Cochrane risk‐of‐bias tool; ROBINS‐I and the Newcastle‐Ottawa Scale. Results: Five studies, consisting of two randomised clinical trials, two non‐randomised clinical trials, and a retrospective cohort study, were included. The interobserver agreement was high and kappa correlation coefficient was good. In total 529 teeth were available for follow‐up that varied from 6 months to 8.7 years. The overall risk of bias was high for four studies and raised some concerns in one study. Apical surgery showed seemly better results regarding periapical healing and less need for more and further intervention, although tooth survival was higher in the control group. Given the heterogeneity of the studies, meta‐analysis was not possible. Discussion: Previous systematic reviews have conducted an indirect comparison by separately pooling the outcomes of studies analysing either non‐surgical, or surgical, treatment. In this systematic review, only studies that compared both treatments were included. Most results of this and previous reviews were similar. Conclusion: No treatment option showed clear superiority. However, to arrive at statistically supported conclusions there is a need for additional high‐quality comparative trials. Registration: PROSPERO database (Registration number CRD42021260300). [ABSTRACT FROM AUTHOR]

The aim of this histomorphometric study was to compare the outcome of sinus floor augmentation procedures using bovine bone mineral and a xenograft enriched with gelatin and a polymer. In 20 patients a single sinus floor elevation procedure with a lateral window approach was performed. In half of the patients, sinuses were grafted with a deproteinized bovine bone mineral--DBBM (control group)--while in the remaining 10, a xenograft enriched by polymer and gelatin--NBS (test group)--was applied. In the DBBM group, histomorphometric analysis revealed 23.14 ± 10.62% of lamellar bone, 19.43% ± 9.18% of woven bone, 23.35% ± 6.04% of osteoid, 17.16% ± 6.13% of biomaterial particles, and 16.93% ± 9.78% of medullary spaces. In the NBS group, histomorphometric analysis found 39.64% ± 12.02% of lamellar bone, 16.28% ± 7.75% of woven bone, 17.51% ± 4.87% of osteoid, 12.72% ± 5.36% of biomaterial particles, and 13.84% ± 6.53% of medullary spaces. Differences between groups for proportion of lamellar bone (P = .004) and osteoid (P = .0287) were statistically significant. Inflammatory infiltration was appreciated only in the NBS group. The enriched xenograft showed a statistically significant higher proportion of lamellar bone and osteoid; however, this was accompanied by an accentuated inflammatory infiltrate. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the present randomized controlled clinical trial was to evaluate the outcomes of the use of free gingival graft (FGG), of a collagen matrix and of vestibuloplasty to increase the amount of keratinized attached mucosa (KM) before healing abutment placement. Method and materials: The study was a randomized, parallel-group controlled investigation. All patients were treated to increase the KM width before placement of implant-supported prostheses. The implants were placed 3 to 6 months before the interventions. Three techniques were tested: an apically positioned flap (control group), FGG (test group 1), and use of a collagen matrix (test group 2). Biopsy was performed during healing abutment placement by means of a mucotome. Results: A total of 63 patients were recruited and treated, and 58 were available for follow-up visits. After 4 weeks, the KM width gain was 1.93 ± 0.85 mm, 4.85 ± 1.11 mm, and 3.03 ± 0.58 mm, respectively, for control group, test group 1, and test group 2. Postoperative pain was significantly higher in the FGG group than in the others. Edema and hyperemia decreased gradually during the first week without significant differences among groups. Conclusion: Despite the limitations of the study, it was found that FGG was the most effective technique to augment the amount of KM in sites of implant placement. The use of a collagen matrix could be a viable alternative to diminish the intervention's impact on patients' postoperative quality of life. [ABSTRACT FROM AUTHOR]