The biological properties of OGI surfaces positively act on osteogenic and angiogenic commitment of mesenchymal stem cells

Osteogenesis process displays a fundamental role during dental implant osteointegration. In the present work, we studied the influence of Osteon Growth Induction (OGI) surface properties on the angiogenic and osteogenic behaviors of Mesenchymal Stem cells (MSC). MSC derived from dental pulp and HUVEC (Human Umbilical Vein Endothelial Cells) were grown in on OGI titanium surfaces, and cell proliferation and DNA synthesis were evaluated by MTT [3-(4,5-dimethylthiazol-2yl)-2,5-diphenyltetrazolium bromide] test and DNA quantification. Gene expression has been performed in order to evaluate the presence of mRNA related to endothelial and osteogenesis markers. Moreover, morphological and biochemical analyses of osteogenesis commitments has been performed. On OGI surfaces, MSC and HUVEC are able to proliferate. Gene expression profiler confirms that MSC on OGI surfaces are able to express endothelial and osteogenic markers, and that these expression are higher compared the expression on control surfaces. In conclusion On OGI surfaces proliferation, expression and morphological analyses of angiogenesis-associated markers in MSC are promoted. This process induces an increasing on their osteogenesis commitmen

The 'Alternating Osteotome Technique': a surgical approach for combined ridge expansion and sinus floor elevation. A multicentre prospective study with a three-year follow-up

The aim of this multicentre prospective study was to evaluate the efficacy and safety of a surgical approach based on a novel osteotome technique, in order to obtain both alveolar ridge expansion and sinus floor elevation. Partially edentulous patients requiring an implant-prosthetic rehabilitation with a fixed prosthesis in the posterior maxilla were included in this study according to pre-established inclusion and exclusion criteria. All implants were placed after site preparation with the 'Alternating Osteotome Technique', which consists of the use of alternating concave and convex osteotomes. After a 4 to 6-month healing period, all implants were restored with a definitive fixed prosthesis. Clinical and radiographic examinations were scheduled over a 36-month follow-up of functional loading according to a well-established protocol. Statistical analysis was used to detect any significant differences or correlations (P = 0.05). Seventy-six patients were consecutively treated with a total of 120 implants in three different centres. The mean ridge expansion and sinus floor elevation were 1.8 ± 0.3 and 2.5 ± 0.7, respectively. After three years of functioning, the implant success rate was 99.1% since one implant had failed and the mean marginal bone loss was 0.6 ± 0.3 mm. No complications occurred during the intraoperative and postoperative periods. All parameters analysed were stable and steady throughout the three-year follow-up. The 'Alternating Osteotome Technique' enables the dental surgeon to achieve an adequate implant osteotomy with limited ridge expansion and sinus floor elevation, increasing modestly the vertical and horizontal dimensions of the alveolar crest but reducing significantly the risk of surgical complications

The Effect of Keratinized Mucosa on Peri-Implant Health and Patient-Reported Outcome Measures: A Systematic Review and Meta-Analysis

Objectives: The aim of this systematic review was to analyze the effect of keratinized mucosa (KM) on different peri-implant health-related parameters and on patient-reported outcome measures (PROMs). Material and methods: Randomized controlled trials, cohort, cross-sectional and case-control human studies with a follow-up period of at least 6 months comparing two groups of patients with presence or absence of KM, or with KM < 2 mm or & GE;2 mm were included. Primary outcomes were implant failures, PROMs and BoP (BoP/mBI). Additional outcomes were PPD, plaque accumulation (mPI/PI), gingival inflammation (GI/mGI), marginal bone loss (MBL), soft tissue recession (REC) and biological complications. Results: Fifteen studies were included (one RCT, two cohort prospective and twelve cross-sectional). Meta-analysis was performed for cross-sectional studies. Implant failure and complications were not presented as outcome measures, and five studies analyzed PROMs. Results from the meta-analysis reported no evidence of any statistical significant difference between groups in PPD, BoP and MBL, while a statistical significant difference in GI/BI, PI and REC was present in favor of the group with KW & GE; 2 mm. More biological complications were present in the group with no KM/KM < 2 mm but few cases were present to draw any conclusions. Although a meta-analysis could not be performed, a consistent trend toward the worst pain/discomfort in KM < 2 mm was observed. Conclusions: No clear evidence was found supporting the role of KM in peri-implant health and PROMs, even if more plaque and marginal inflammation were present in the KM < 2 mm group. Clinical relevance: KM could have a role in patients with erratic maintenance and patient comfort

Cleaning and decompression of inferior alveolar canal to treat dysesthesia and paresthesia following endodontic treatment of a third molar

Endodontic overfilling involving the mandibular canal may cause an injury of the inferior alveolar nerve (IAN). We report a case of disabling dysesthesia and paresthesia of a 70-year-old man after endodontic treatment of his mandibular left third molar that caused leakage of root canal filling material into the mandibular canal. After radiographic evaluation, extraction of the third molar and distal osteotomy, a surgical exploration was performed and followed by removal of the material and decompression of the IAN. The patient reported an improvement in sensation and immediate disappearance of dysesthesia already from the first postoperative day

Clinical and histological evaluation of socket preservation using smartbone®, a novel heterologous bone substitute: A case series study

Objectives. The aim of this case series study was to evaluate, clinically and histologically, the performances of a novel composite xenohybrid bone substitute. Methods. Ten non-restorable teeth were extracted and socket preservation was performed with a bovine heterologous graft enriched with collagen and resorbable biopolymers (SmartBone®). The socket was covered with a collagen membrane firmly sutured. After five months of healing, implant site was prepared by means of a trephine bur and a dental implant was inserted. Specimens were sent for histological analysis. After three months of healing, patients received a provisional restoration followed by a definitive crown. Results. All socket preservations healed uneventfully and, after five months, it was possible to insert implants with no additional bone augmentation procedures. All placed implants osseointegrated successfully and were in function after a minimum follow-up period of 30 months. Conclusions. The tested biomaterial confirmed good clinical performance and, even if left exposed to the oral cavity covered with a collagen membrane, did not show signs of infection. Further research is desirable with a larger sample and variations of socket preservation technique to better understand the potential of this novel bone substitute

Evaluation of the Esthetic Results of 64 Nonfunctional Immediately Loaded Postextraction Implants in the Maxilla: Correlation between Interproximal Alveolar Crest and Soft Tissues at 3 Years of Follow-Up

Purpose: Many authors have emphasized that immediate loading protocols enable better esthetic results to be achieved compared with delayed loading, especially in the case of postextraction implants that are capable of maintaining the original esthetics of soft tissues. The aim of this study was to establish correlations between the interproximal crest, interproximal papilla, and marginal facial gingiva of immediately loaded postextraction implants by evaluating clinical and radiographic data. Materials and Methods: Fifty-eight consecutive patients underwent a tooth extraction and immediate implant placement with 64 postextraction implants, which were immediately loaded using a provisional single crown from June 2005 to December 2006. At 6months after surgery, all implants were restored with a definitive single crown. Clinical and radiographic data were recorded at the time of surgery, at the time of definitive restoration, and after 3years of functioning, in order to evaluate soft tissues esthetics and bone tissue condition. Statistical analysis was used to assess significant correlations between the interproximal crest, interproximal papilla, and marginal facial gingiva (p=0.05). Results: After 3years of functioning, the implant success rate was 100% because no implants had failed. All parameters were stable and steady during the 3-year follow-up. The regression test revealed a statistically significant correlation between interproximal crest levels and interproximal papilla volume (p=0.0134), and also between interproximal crest levels and marginal gingiva levels (p=0.0226). Conclusions: Postextraction immediately loaded implants represent a predictable technique that should be considered the treatment of choice in cases of single anterior tooth restoration and other cases. Esthetic results seem to depend on correct positioning of the implants, considering the correlation between bone tissue and related soft tissues. Maintaining the original condition of both bone and soft tissues around the tooth to be removed is the key to obtaining optimal esthetic outcomes

Prevention of BRONJ Using PRGF in a Totally Edentulous Patient Restored With Postextraction Implants: A Case Report

Introduction The aim of this report was to show results of post-extraction implants placed to rehabilitate an atrophic mandible using a protocol based on CTX records and PRGF application in order to prevent BRONJ. Case Presentation A 65-year-old male affected by rheumatoid arthritis who was a chronic consumer of bisphosphonates and methylprednisolone was referred to the authors seeking restoration of his mandible with a full-arch prosthesis. Bisphosphonates were suspended, and the marker for bone turnover (CTX) was recorded every 3 months until it exceeded 200 pg/mL. During surgery, PRGF was applied to all the implant sites and the alveolar ridge before suturing. No complications occurred during the healing period, and no signs or symptoms of BRONJ were detected throughout the 1-year follow-up. Conclusions The protocol described in this report can be a viable solution for preventing BRONJ in a patient who is consuming bisphosphonates and corticosteroids and undergoes implant surgery. Its purpose is to reduce the risk of infection and hasten the healing of bone and soft tissue

Peri-implant conditions around sintered porous-surfaced (SPS) implants. A 36-month prospective cohort study

Objectives: The specific aim of this study was to assess sintered porous-surfaced (SPS) implant system from a biological point of view, through a prospective study of the health status and the evolution of the peri-implant tissues over time and analysis of the changes observed in the various peri-implant parameters. Material and Methods: Hundred and fifty-one patients were treated consecutively from 2005 to 2007 using 280 SPS implants, which were restored with a single crown or a partial fixed denture. To accurately monitor the health and biological evolution of peri-implant soft and hard tissues, a number of clinical parameters were adopted, such as the modified Plaque Index (mPI), the modified sulcus Bleeding Index (mBI), Peri-implant Probing Depth (PPD), and Crestal Bone Level (CBL). Clinical and radiographic examinations were scheduled over a 36-month follow-up of functional loading according to a well-established protocol generally applied to determine implant success rates and Peri-implant Bone Loss (PBL). Statistical analysis was used to determine any significant differences or correlations (P = 0.05). Results: A total of 259 SPS implants in 136 patients were followed up for 36 months. According to Buser's success criteria, the overall implant-based success rate was 98.1% and the mean PBL was 0.48 \ub1 0.29 mm. MBI and mPI mean values showed statistically significant differences between baseline and follow-up analyses (P < 0.001). No statistically significant differences in mean PPD values were found between baseline and control analyses (P = 0.060). Conclusion: This prospective cohort study revealed that the biological behavior of SPS implant system was characterized by high tissue stability during the observation period, both as regards soft and hard tissues. In particular, the crestal bone remodeling pattern was very similar to that reported in other studies, confirming that the bone loss around SPS implants, at least at 36 months, seems to be predictable

Influence of crown-implant ratio on implant success rate of ultra-short dental implants: results of a 8- to 10-year retrospective study

Objectives The use of short implants has been suggested in recent years as an option for facilitating prosthetic restoration in resorbed jawbones. The aim of the present study was to determine how implant success rate is affected in the long term when ultra-short implants are rehabilitated with fixed restorations, resulting in a crown to implant (C/I) ratio of more than 3:1. Materials and methods The study was conducted as an analysis on all patients operated from December 2005 to November 2007 with ultra-short dental implants. All implants were sintered porous-surfaced (SPS) with a length of 5 mm and a diameter of 5 mm (5 x 5 mm) and were restored with a single crown or a fixed dental prosthesis (FDP). Data collected included implant positioning site, crestal bone levels (CBL), and clinical and anatomical C/I ratios, and pre-established success criteria were used to evaluate the success rate of the implants. Statistical analysis was used to determine any significant differences or correlations (p = 0.05). Results Forty-one patients completed the follow-up and were eligible for this retrospective study on a total of 50 ultra-short SPS implants. The mean follow-up was 9.5 years (range 8.3 to 10.2 years). Three of the 50 implants failed because they were lost due to peri-implantitis, while all the other 47 met the pre-established success criteria giving an overall implant success rate of 94%. During the follow-up period, the mean peri-implant bone loss (PBL) was 0.41 + 0.36 mm. Conclusions This study shows that ultra-short SPS implants can prove a reliable solution for prosthetic restoration in patients with severe alveolar bone atrophy. In selected patients with a sufficient bone width, ultra-short implants with a resulting C/I ratio of more than 3:1 presented no contraindications

Primary and Secondary Stability of Implants in Postextraction and Healed Sites: A Randomized Controlled Clinical Trial

PURPOSE: This randomized clinical trial aimed to investigate the relationships between insertion torque, implant stability quotient (ISQ), and crestal bone loss (CBL) of implants placed in fresh or 12-week healed extraction sites. MATERIALS AND METHODS: Forty patients were randomly assigned to one of two groups and had one implant placed immediately (test group, n = 20) or 12 weeks after extraction (control group, n = 20) at premolar or molar sites. For all implants, insertion torque and ISQ scores at insertion and loading were recorded. Patients were followed for up to 12 months. RESULTS: Implant success was 100% in both groups. No differences were observed concerning both ISQ at insertion and ISQ at loading. A stronger correlation was detected between ISQ at insertion and insertion torque in the postextractive group (R = 0.83), than in the delayed group (R = 0.39), while ISQ at loading and insertion torque showed no correlation. CBL at 12 months was significantly different between test (0.68 \ub1 0.43 mm) and control (0.40 \ub1 0.26 mm, P = .02) groups. CONCLUSION: Implant placement timing (immediate or delayed) may affect correlation between insertion torque and ISQ at insertion with ISQ at loading. While insertion torque influences ISQ at insertion, it does not affect ISQ at loading because of successful osseointegration. Postextraction and delayed implants seem to have similar ISQ at insertion and at loading, but different CBL after 12 months of follow-up because of postextraction bone remodeling