Single-crown restorations in premolar-molar regions: short (<= 6.5) vs longer implants: retrospective cohort study

Purpose To compare the survival, changes in marginal bone level and prosthetic complications rate of short (= 7.5) supporting a single-crown restoration in the maxillary/mandibular premolar or molar region. Methods This cohort study was conducted following the STROBE statement recommendations for observational studies. Clinical outcomes of 88 short implants in 78 patients and 88 long implants in 88 patients were examined. All the implants had been placed by the same surgeon and restored following the same prosthetic concept; using a transepithelial abutment (intermediate abutment) and a screw retained restoration. Results All the implants were in function after the follow-up period since insertion (median: 31 months; range 11 to 84 for SiG vs median: 35 months; range: 6-117 for CG; p = 0.139). No statistical differences (p = 0.342) were observed related to prosthetic complications (screw loosening 2/88 vs 5/88 CG, ceramic chipping 1/88 vs 0/88, temporary crown resin chipping 1/88 vs 0/88 for SiG and CG, respectively) or related to marginal bone level (Mesial or Distal MBL >= 2 mm in 1/88 implants for SiG vs 3/88 for CG; p = 0.312). Conclusions Within the limitations of this study, no survival differences have been observed between short implants and longer implants in single-crown restorations in posterior maxilla/mandible

Oral Pemphigoid Recalcitrant Lesion Treated with PRGF Infiltration. Case Report

Mucous membrane pemphigoid (MMP) is a heterogeneous group of chronic autoimmune subepithelial blistering diseases. Oral involvement is present in almost all patients, may represent the onset of the disease, and causes different degrees of pain, dysphagia, soreness, and bleeding. Treatment is based on systemic and/or oral corticoids, or other immunosuppressants. Occasionally, oral lesions can show a poor response to standard treatments. We present the case of a 61-year-old female patient with a painful extensive MMP oral ulcerative lesion recalcitrant to previous systemic azathioprine and local triamcinolone treatment, which was successfully treated in a novel way using PRGF infiltrations as adjuvant. After four weekly infiltrations, pain was reduced from 10 to 0 in a VAS and the lesion was completely healed. The patient continued with a low dose maintenance immunosuppressive treatment (prednisone 5 mg/day PO), and after 13 months of follow-up, there was no relapse of the lesion and no side effects. Although future research is necessary to confirm these observations, PRGF could be a useful adjuvant for the management of extensive mucous membrane pemphigoid oral lesions

Clinical outcomes of dental implants placed in the same region where previous implants failed due to peri-implantitis: a retrospective study

[EN]Purpose There is paucity in the studies that assess dental implants replacing failed dental implants due to peri-implantitis. This study aims to evaluate the clinical outcomes of these implants in terms of implant survival and marginal bone loss. Methods Patients in this retrospective study were selected if having one or more implants removed due to peri-implantitis and the placement and loading of dental implants in the same region from April 2010 to December 2019. Information was collected about the patient's demographic data, implant dimensions, surgical and prosthetic variables. Changes in peri-implant bone level, cumulative implant survival rate and technical complications were assessed. Results Three hundred and eighty one dental implants in 146 patients that were placed in the same position or one-tooth position mesially/distally to the site of explantation were included. The patients' mean age was 63 +/- 10 years. Ninety seven patients were females and 49 were males. After a mean follow-up of 34 +/- 17 months, two implants failed. The cumulative survival rate was 99%. The marginal bone loss was -0.1 +/- 0.6. Immediate or delay replacement of the failed implant did not affect implant survival or marginal bone stability. All the prostheses were screw-retained and presented the following complications: ceramic chipping (3 events), resin tooth fracture (1 event) and prosthetic screw loosening (1 event). Conclusions Dental implants replacing failed implants due to peri-implantitis would be an option in the management of peri-implantitis. They showed high survival rate and marginal bone stability

Bone-Regenerative Ability of Platelet-Rich Plasma Following Sinus Augmentation with Anorganic Bovine Bone: A Systematic Review with Meta-Analysis

Background: The objective of this systematic review is to assess the effect of the adjuvant use of platelet-rich plasma (PRP) and its type on new bone formation by anorganic bovine bone during maxillary sinus floor augmentation procedure. Methods: PubMed, Cochrane Central Register of Controlled Trials, and Ovid databases were searched for relevant studies published up to 16 September 2021. Randomized clinical trials (RCTs) and non-randomized controlled clinical trials (CCTs) that reported data on the new bone formation (measured by histomorphometric analysis) were considered. Risk of bias and quality assessment of included studies were evaluated following the Cochrane Handbook for Systematic Reviews of Interventions and the Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I) tool. Strength of evidence was assessed following the approach of the Agency for Healthcare Research and Quality (AHRQ) through its evidence-based practice center (AHRQ EPC). The meta-analysis was based on the primary outcome of newly formed bone, for which the standard mean difference was calculated. Results: After the application of eligibility criteria, six clinical trials (three RCTs and three CCTs) covering 85 maxillary sinus floor elevation procedures were included. The pooled new bone formation value for PRP was 1.67 (95% CI: −0.15 to 3.49; I2: 86%), indicating the absence of significant effect. Plasma rich in growth factors (PRGF) was the pure PRP tested in five of the included studies. When sub-group (type of PRP) meta-analysis was performed, significantly higher new bone formation was observed in the PRGF group [2.85 (95% CI: 0.07 to 5.64; I2: 88%)] in comparison to the control group. Conclusions: A beneficial effect on new bone formation after maxillary sinus floor elevation can be obtained when anorganic bovine bone is mixed with PRGF

Bone Substitutes

In daily clinical practise we frequently encounter situations in which the bone volume is insufficient for an ideal dental implant placement. Bone regeneration can provide the structural support necessary in these cases. Procedures such as sinus lifting and alveolar ridge augmentation have reached high levels of predictability and already are of major importance in implant practise. Interest for bone substitutes for alveolar ridge augmentation or preservation appears in the early 1980 ¿s alongside the development of endoosseous dental implants. Although first studies regarding bone substitutes dates from 1920 by Albee (Albee, 1920), until 1980 ¿s there are very few studies in reference this issue. From 1980 ¿s until nowadays an exponential number of studies about bone substitutes have been made. The reason for this increasing interest in bone substitutes stems from the fact that about 10- 20% of the patients that need treatments with dental implants, require bone regeneration procedures before implant placement. Moreover, more than 60% of the population in industrialized countries need dental prosthetic replacements (Peterson, 2006), ideally with implants. This is the reason why the market of dental implants is experiencing an increase of approximately 15% every year. Bone regeneration procedures are becoming an almost daily practice in dentistry all around the world as a result of the wide acceptance of dental implants as the ¿ideal ¿ option for oral rehabilitation. Bone regeneration procedures are critical for the success of dental implant treatments in cases where there is a deficiency in bone width and/or height. The cornerstone in these treatments is the use of bone substitutes to create a bone mantle that covers the screw to enhance implant stability and treatment outcome. In this chapter, we will discuss the different types of bone substitutes and recent developments achieved to enhance the outcomes of bone regeneration procedures with the newest available biomaterials. The term ¿bone graft ¿ was defined by Muschler (Bauer, 2000) as: ¿any implanted material that alone or in combination with other materials promotes a bone healing response by providing oteogenic, osteoinductive or osteoconductive properties ¿. An osteogenic material can be defined as one that has inherent capacity to form bone, which implies to contain living cells that are capable of differentiation into bone cells. An osteoinductive material 92 Implant Dentistry ¿ The Most Promising Discipline of Dentistry provides biologic signals capable to induce local cells to enter a pathway of differentiation leading to mature osteoblasts. An osteoconductive biomaterial provides a three-dimensional interconnected scaffold where local bone tissue may regenerate new living bone. However, osteoconductive biomaterials are unable to form bone or to induce its formation. Another property that is interesting to find especially in bone substitutes is biodegradability. This is defined as the capacity of degradation of a particle by two mechanisms principally; through a passive chemical degradation or dissolution, and through active cellular activity mediated by osteoclast and/or macrophages. Moreover, the biological properties of bone substitute biomaterials are also influenced by their porosity, surface geometry and surface chemistry. The events leading to bone healing and regeneration are influenced by all the variables mentioned above. These properties are related to the biomaterial itself, however, host factors such as bone quality, vascularity of the graft bed and tobacco addiction may also influence the final outcome of a bone regeneration procedure with a bone substitute.Estomatologí

Are mucous retention cysts and pseudocysts in the maxillary sinus a risk factor for dental implants? A systematic review

Mucous retention cysts and pseudocysts of the maxillary sinus are benign lesions present in up to 13% of adult patients. Different surgical approaches for sinus lift and dental implant placement in the presence of these lesions have been proposed. A systematic review was performed following the PRISMA statement recommendations to answer the PICO question: Does the aspiration or removal of mucous retention cysts/pseudocysts before or during sinus lifting and dental implant placing, affect the survival of the implants? The study was pre-registered in PROSPERO (CRD42020185528). Included articles quality was assessed using the ?NIH quality assessment tool? and ?The Newcastle-Ottawa scale?. Previous literature in this field is scarce and with a low level of evidence. There are no randomized prospective studies. Only 19 studies were identified, being composed of 2 cohort studies and 17 case series/reports. These studies involved 182 patients with a previous history of mucous retention cyst or pseudocyst in 195 maxillary sinuses where 233 implants were placed. The mean age of the patients was 45.5 (range: 12-80 years); 122 (67%) were male patients and 60 (33%) were female patients. The mean follow-up of the patients was 17.6 (range: 4-90 months). Only two fail was reported. No differences were identified in relation to the surgical approach or in relation to the removal/aspiration of the sinus lesion (prior to or simultaneous to sinus grafting) or not. The level of evidence was grade 4 according to the CEBM and further studies are needed to confirm this observations, but with the available data, dental implants placement after sinus lift procedure in patients with mucous retention cysts and pseudocysts seems to be safe and present high survival regardless on the removal of the lesion or not

The use of topical corticosteroides in the treatment of oral lichen planus in Spain : a national survey

Explore the treatment of oral lichen planus with topical corticosteroids by the healthcare professionals in Spain. A questionnaire targeted health professionals who treat OLP, in particular maxillofacial surgeons, dermatologist and dentist. The dissemination of the questionnaires was conducted through professional associations and dental and medical societies. The questionnaire was previously evaluated by means of a cognitive pre-test procedure to ensure that the questions were opportune and appropriate, understandable and acceptable among the professionals. Of the 890 questionnaires sent a total of 190 questionnaires were answered by 90 dentists, 60 dermatol gists and 40 by maxillofacial surgeons. The most frequent treatment was 0.1% triamcinolone acetonide in orobase 3 times a day. The effectiveness of the topical corticosteroid treatment was 6.68 (SD= 2.26) in a scale of 1 to 10. The 30% of the dentists and 10.49% of maxillofacial surgeons combined treatment with other drugs. The most frequent one (80%) was nystatin (100,000 IU per millimetre). Dermatologists did not use other treatments in combination with corticosteroids. There is a need for national guidelines in treatment for oral lichen planus (treatment criteria, drug, dose, treatment time and method of application of corticosteroid) that can be applied by all professionals who treat this disease

The Dual-Responsive Interaction of Particulated Hyaline Cartilage and Plasma Rich in Growth Factors (PRGF) in the Repair of Cartilage Defects: An In Vitro Study

The treatment of chondral and osteochondral defects is challenging. These types of lesions are painful and progress to osteoarthritis over time. Tissue engineering offers tools to address this unmet medical need. The use of an autologous cartilage construct consisting of hyaline cartilage chips embedded in plasma rich in growth factors (PRGF) has been proposed as a therapeutic alternative. The purpose of this study was to dig into the potential mechanisms behind the in vitro remodelling process that might explain the clinical success of this technique and facilitate its optimisation. Chondrocyte viability and cellular behaviour over eight weeks of in vitro culture, type II collagen synthesis, the dual delivery of growth factors by hyaline cartilage and PRGF matrix, and the ultrastructure of the construct and its remodelling were characterised. The main finding of this research is that the cartilage fragments embedded in the three-dimensional PRGF scaffold contain viable chondrocytes that are able to migrate into the fibrin network, proliferate and synthesise extracellular matrix after the second week of in vitro culture. The characterization of this three-dimensional matrix is key to unravelling the molecular kinetics responsible for its efficacy.This study received funding from the Basque Country Government, within the Hazitek program, and support program for collaborative research in strategic area, within the project named EndoCarTech (grant number ZL-2020/00937)

Platelet-rich plasma may prevent titanium-mesh exposure in alveolar ridge augmentation with anorganic bovine bone

Objective: Bone augmentation with the titanium-mesh (Ti-mesh) technique is susceptible to a large rate of complications such as morbidity of bone graft donor site, and mesh exposure to the oral cavity. The purpose of this study was to evaluate the effectiveness of anorganic bovine bone (ABB) in alveolar bone augmentation with the Ti-mesh technique. In addition, we investigated the effect of platelet-rich plasma (PRP) in preventing mesh exposure by using it to cover the Ti-mesh. Patients and methods: Patients included in the clinical trial were randomly allocated by a blinded assistant into two groups. The 30 patients recruited for this study underwent 43 alveolar bone augmentation with the Ti-mesh technique using ABB as graft material in all of them. In 15 patients, the Ti-meshes were covered with PRP (PRP group) whereas in the other 15 the Ti-meshes were not (control group). After 6 months, patients were called for clinical, radiographic and histological evaluation, and implant placement surgery. A total of 97 implants were placed in the augmented bone and their evolution was followed up for a period of 24 months. Results: Significant differences were found between the two study groups in terms of complications and bone formation. In the control group, 28,5% of the cases suffered from mesh exposure, while in the PRP group, no exposures were registered. Radiographic analysis revealed that bone augmentation was higher in the PRP group than in the control group. Overall, 97,3% of implants placed in the control group and 100% of those placed in the PRP group were successful during the monitoring period. We suggest that the positive effect of PRP on the Ti-mesh technique is due to its capacity to improve soft tissue healing, thereby protecting the mesh and graft material secured beneath the gingival tissues. Conclusions: Alveolar bone augmentation using ABB alone in the Ti-Mesh technique is sufficient for implant rehabilitation. Besides, covering the Ti-meshes with PRP was a determining factor in avoiding mesh exposure. Ti-Mesh exposure provoked significant bone loss, but in most cases it did not affect the subsequent placement implants

Efficacy of mandibular advancement device in the treatment of obstructive sleep apnea syndrome: a randomized controlled crossover clinical trial

Background: Evaluation of the efficacy and safety of a mandibular advancement device (MAD) (KlearwayTM) in the treatment of mild-to-moderate obstructive sleep apnea and chronic roncopathy. Material and Methods: A randomized, placebo-controlled, double blinded, and crossover clinical trial was conducted. Placebo device (PD) defined as a splint in the centric occlusion that did not induce a mandibular advancement served as a control. The mandible was advanced to the maximum tolerable distance or to a minimum of 65% of the maximum protrusion. After each sequence of treatment, patients were assessed by questionnaires, conventional polysomnography, and objective measurement of snoring at the patient’s own home. Results: Forty two patients participated in the study and 38 completed the study. Patients mean age was 46 ±9 years and the 79% were males. The mean mandibular advancement was 8.6 ±2.8 mm. Patients used the MAD and the PD for 6.4 +2.4 hours and 6.2 +2.0 hours, respectively. Secondary effects (mostly mild) occurred in the 85.7% and the 86.8% of the users of MAD and PD, respectively. The MAD induced a decrease in the apnea-hypopnea index (AHI) from 15.3 +10.2 to 11.9 +15.5. The 50% reduction in the AHI was achieved in the 46.2% and the 18.4% of the patients treated with MAD and PD, respectively. The use of the MAD induced a reduction in the AHI by 3.4 +15.9 while the PD induced an increase by 10.6 +26.1. The subjective evaluation of the roncopathy indicated an improvement by the MAD and an increase in the perceptive quality of sleep. However, the objective evaluation of the roncopathy did not show significant improvements. Conclusions: The use of MAD is efficient to reduce the AHI and improve subjectively the roncopathy. MAD could be considered in the treatment of mild-to-moderate OSA and chronic roncopath