Efficacy of biologics for alveolar ridge preservation/reconstruction and implant site development: An American Academy of Periodontology best evidence systematic review.

BACKGROUND The use of biologics may be indicated for alveolar ridge preservation (ARP) and reconstruction (ARR), and implant site development (ISD). The present systematic review aimed to analyze the effect of autologous blood-derived products (ABPs), enamel matrix derivative (EMD), recombinant human platelet-derived growth factor-BB (rhPDGF-BB), and recombinant human bone morphogenetic protein-2 (rhBMP-2), on the outcomes of ARP/ARR and ISD therapy (i.e., alveolar ridge augmentation [ARA] and maxillary sinus floor augmentation [MSFA]). METHODS An electronic search for eligible articles published from January 2000 to October 2021 was conducted. Randomized clinical trials evaluating the efficacy of ABPs, EMD, rhBMP-2, and rhPDGF-BB for ARP/ARR and ISD were included according to pre-established eligibility criteria. Data on linear and volumetric dimensional changes, histomorphometric findings, and a variety of secondary outcomes (i.e., clinical, implant-related, digital imaging, safety, and patient-reported outcome measures [PROMs]) were extracted and critically analyzed. Risk of bias assessment of the selected investigations was also conducted. RESULTS A total of 39 articles were included and analyzed qualitatively. Due to the high level of heterogeneity across studies, quantitative analyses were not feasible. Most studies in the topic of ARP/ARR revealed that the use of biologics rendered similar results compared with conventional protocols. However, when juxtaposed to unassisted healing or socket filling using collagen sponges, the application of biologics did contribute to attenuate post-extraction alveolar ridge atrophy in most investigations. Additionally, histomorphometric outcomes were positively influenced by the application of biologics. The use of biologics in ARA interventions did not yield superior clinical or radiographic outcomes compared with control therapies. Nevertheless, ABPs enhanced new bone formation and reduced the likelihood of early wound dehiscence. The use of biologics in MSFA interventions did not translate into superior clinical or radiographic outcomes. It was observed, though, that the use of some biologics may promote bone formation during earlier stages of healing. Only four clinical investigations evaluated PROMs and reported a modest beneficial impact of the use of biologics on pain and swelling. No severe adverse events in association with the use of the biologics evaluated in this systematic review were noted. CONCLUSIONS Outcomes of therapy after post-extraction ARP/ARR and ARA in edentulous ridges were comparable among different therapeutic modalities evaluated in this systematic review. Nevertheless, the use of biologics (i.e., PRF, EMD, rhPDGF-BB, and rhBMP-2) in combination with a bone graft material generally results into superior histomorphometric outcomes and faster wound healing compared with control groups

Association of Preventive Maintenance Therapy Compliance and Periâ Implant Diseases: A Crossâ Sectional Study

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141123/1/jper1030.pd

Microstructural and densiometric analysis of extra oral bone block grafts for maxillary horizontal bone augmentation: a comparison between calvarial bone and iliac crest

Purpose The main purpose of the present clinical study was to compare architectural metric parameters using micro‐computed tomography (μ‐ CT ) between sites grafted with blocks harvested from the intramembranous origin calvarium and endochondral origin iliac crest for horizontal bone augmentation in the maxilla. The second aim was to compare primary stability of implants placed in both types of block grafts. Material and Methods Nine consecutive healthy partially edentulous patients requiring extensive horizontal bone reconstruction in the maxilla were included in this study from J uly 2011 to M arch 2012. A total of 14 block grafts (seven each from the calvarium and iliac crest) were studied. After 6–7 months of the bone regeneration surgery, 43 implants were placed. Twenty‐four implants (55.2%) were placed on calvaria (group 1) and 19 (44.8%) on iliac crest (group 2). All implants were clinically stable. A resonance frequency analysis ( RFA ) and μ‐ CT analysis were performed. Furthermore, two randomly biopsies were selected for histomorphometric analysis. Results Micro‐ CT analyses evidenced completely different parametric values between intramembranous and endochondral extra oral bone block grafts, being the group 1 higher in density and in % of bone volume. However, these parametric values cannot be considered statistically different due to the sample size, excepting the trabecular thickness, which is statistically higher for group 1 ( P  = 0.06). Conclusion Calvarial bone blocks for horizontal maxillary augmentation provided a higher degree of bone volume and density than the iliac crest bone grafts. Nonetheless, both grafts provide implant with the same primary stability, as assessed by RFA .Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/106829/1/clr12159.pd

El acuerdo comprensivo de inversiones (CAI) entre la Unión Europea y China

La Unión Europea y China llegaron a finales de 2020 a un principio de acuerdo para un nuevo tratado bilateral de inversiones, el primero de estas características que firmará la Unión como conjunto. El acuerdo viene a igualar la falta de reciprocidad en las mismas, a aumentar la transparencia entre ambas, a prohibir la transferencia forzada de tecnología y a obligar a China a adoptar convenios internacionales sobre trabajos forzados. Más allá de sus efectos económicos, hay quien critica el texto por dejar de lado al aliado histórico de Estados Unidos y ayudar a crear una China más fuerte justo cuando en el terreno internacional se muestra más beligerante. El trabajo analiza la situación de partida y lo que cambiará de aprobarse el texto.The European Union and China reached at the end of 2020 a principle of agreement for a new bilateral investment treaty, the first of its kind that the EU will sign as a whole. The agreement comes to balance the current lack of reciprocity in the relations, to add more transparency, to ban forced technology transfers and to make China sign international treaties on forced labour. Beyond it economic effects, many argue that the EU has left behind its historical ally, the United States, and is helping make China a stronger power in the world stage in the moment when it is acting in a belligerent way. This work analyses the starting point and what will change when the text is approved.Departamento de Derecho PúblicoMáster en Estudios Avanzados en la Unión Europe

Comparison between microcomputed tomography and cone‐beam computed tomography radiologic bone to assess atrophic posterior maxilla density and microarchitecture

Purpose The aim of this study was to analyze the relationship between bone density obtained by cone‐beam computed tomography ( CBCT ) and morphometric parameters of bone analyzed by microcomputed tomography (μ‐ CT ). Material and methods An overall of 32 subjects ≤8 mm of bone height were included in the study. One site per patient was randomly selected to obtain bone core. Totally, 27 biopsies were available for μ‐ CT analysis. In addition, CBCT was taken after positioning a previously fabricated acrylic resin template with a 2‐mm‐diameter metal rod at the randomly selected implant site to study radiographic bone density ( RBD ). The relationship between μ‐ CT and CBCT quantitative variable and RBD was analyzed using Spearman correlation. Results Positive correlations between BV / TV ( r  = 0.769, P  < 0.001), BS / TV ( r  = 0.563, P  = 0.002), T b. T h ( r  = 0.491, P  = 0.009), T b. N ( r  = 0.518, P  = 0.005) and v BMD ( r  = 0.699, P  < 0.001) with RBD were identified. On the contrary, BS / BV ( r  = −0.509, P  = 0.006), T b. S p ( r  = −0.539, P  = 0.003) and T b. P f ( r  = −0.636, P  < 0.001) were negatively correlated with RBD . Moreover, SMI ( r  = −0.380, P  = 0.050) and DA (−0.245, P  = 0.217) were negatively correlated but not statistically significant. Conclusion This study demonstrated the correlation between radiographic bone density ( RBD ) and bone density assessed by μ‐ CT . Therefore, our data supported the use of CBCT as pre‐operative tool for implant treatment planning because it is shown to be reliable to assess atrophic posterior maxilla density and microarchitecture.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/106929/1/clr12133.pd

Patientâ Centered Perspectives and Understanding of Periâ Implantitis

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141085/1/jper1153.pd

Maxillary Sinus Lateral Wall Thickness and Morphologic Patterns in the Atrophic Posterior Maxilla

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141013/1/jper0676.pd

Influence of Atrophic Posterior Maxilla Ridge Height on Bone Density and Microarchitecture

PurposeThere is limited evidence available on the influence of residual ridge height (RH) on bone density. Therefore, this study aimed to investigate the correlation between the atrophic posterior RH in the maxilla and its bone density as determined by microcomputed tomography (μ‐CT).Material and MethodsThirty‐two subjects with atrophic posterior maxilla of residual RH <8 mm were included in this study. A preoperative cone beam CT scan with a radiographic stent was taken for each patient. A bone core biopsy was thus obtained from the predetermined surgical site. Out of 32 biopsies, 27 were intact and sent for μ‐CT analysis.ResultsA statistically significant positive correlation between bone volumetric fraction (BV/TV) and RH was identified (r = 0.417, p = .03). A statistically significant negative correlation between trabecular pattern factor and RH was also found (r = −0.415, p = .03). The rest of the morphometric parameters analyzed did not have any significant correlation to RH.ConclusionBV/TV is potentially influenced by the residual bone height at the posterior maxilla. The lesser the RH, the lower the bone quantity and quality present.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/110564/1/cid12075.pd

Basis of bone metabolism around dental implants during osseointegration and periâ implant bone loss

Despite the growing number of publications in the field of implant dentistry, there are limited studies to date investigating the biology and metabolism of bone healing around dental implants and their implications in periâ implant marginal bone loss. The aim of this review article is to provide a thorough understanding of the biological events taking place during osseointegration and the subsequent early and late phases of bone remodeling around dental implants. An update on the coupling mechanism occurring during bone resorptionâ bone remodeling is provided, focused on the relevance of the osteocytes, bone lining cells and immune cells during bone maintenance. An electronic and manual literature search was conducted by three independent reviewers in several databases, including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Oral Health Group Trials Register databases for articles up to September 2016 with no language restriction. Local bone metabolism is subject to signals from systemic calciumâ phosphate homeostasis and bone remodeling. Three areas of interest were reviewed due to recent reported compromises in bone healing including the putative effects of (1) cholesterol, (2) hyperlipidemia, and (3) low vitamin D intake. Moreover, the prominent influence of osteocytes and immune cells is discussed as being key regulators during dental implant osseointegration and maintenance. These cells are of crucial importance in the presence of biofilm accumulation and their associated byproducts that leads to hard and soft tissue breakdown; the so called periâ implantitis. Factors that could negatively impact osteoclastogenesis or osteal macrophage activation should be monitored in future research including implant placement/torque protocols, bone characteristics, as well as meticulous maintenance programs to favor osseointegration and future longâ term stability and success of dental implants. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 105A: 2075â 2089, 2017.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/137387/1/jbma36060.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/137387/2/jbma36060_am.pd

Defect angle as prognostic indicator in the reconstructive therapy of peri-implantitis.

OBJECTIVE To analyze the influence of the characteristics of bone defects caused by peri-implantitis on the clinical resolution and radiographic bone gain following reconstructive surgery. METHODS This is a secondary analysis of a randomized clinical trial. Periapical x-rays of bone defects, caused by peri-implantitis exhibiting intrabony component, were analyzed at baseline and 12-month follow-up after reconstructive surgery. Therapy consisted of anti-infective therapy along with a mixture of allografts with or without a collagen barrier membrane. The association of defect configuration, defect angle (DA), defect width (DW), and baseline marginal bone level (MBL) with clinical resolution (based on a prior defined composite criteria) and radiographic bone gain was correlated by means of generalized estimating equations. RESULTS Overall, 33 patients with a total of 48 implants exhibiting peri-implantitis were included. None of the evaluated variables yielded statistical significance with disease resolution. Defect configuration demonstrated statistical significance when compared to class 1B and 3B, favoring radiographic bone gain for the former (p = 0.005). DW and MBL did not demonstrate statistical significance with radiographic bone gain. On the contrary, DA exhibited strong statistical significance with bone gain (p < 0.001) in the simple and multiple logistic regression analyses. Mean DA reported in this study was 40°, and this resulted in 1.85 mm radiographic bone gain. To achieve ≥1 mm of bone gain, DA must be <57°, while to attain ≥2 mm of bone gain, DA must be <30°. CONCLUSION Baseline DA of peri-implantitis intrabony components predicts radiographic bone gain in reconstructive therapy (NCT05282667-this clinical trial was not registered prior to participant recruitment and randomization)