Histological and histomorphometric analysis of bone tissue using customized titanium meshes with or without resorbable membranes: A randomized clinical trial.

OBJECTIVES: To date, no clinical studies have investigated the effect of using resorbable collagen membrane in conjunction with customized titanium mesh to promote bone formation in guided bone regeneration. Therefore, a non-inferiority analysis (one-sided 95% CI approach) was designed to compare the augmented bone gained using meshes with and without collagen membranes, through histological and histomorphometric investigations. MATERIALS AND METHODS: Thirty patients undergoing bone augmentation procedures at both maxillary and mandible sites were randomly treated with customized titanium meshes alone (M-, n = 15) or covered with resorbable membrane (M+, n = 15), in both cases filled with autogenous bone and xenograft. After 6 months of healing, bone tissue biopsies were taken from the augmented region. The bone tissue (B.Ar), grafting material (G.Ar), and non-mineralized tissue (NMT.Ar) areas were quantified through histomorphometric analysis, as were the osteoid area (O.Ar) and its width. RESULTS: Collagen membrane did not appear to significantly influence the investigated parameters: B.Ar, G.Ar, NMT.Ar, and O.Ar were similar between Group M- (34.3%, 11.5%, 54.1%, 1.95 µm2 , respectively) and Group M+ (35.3%, 14.6%, 50.2%, and 1.75 µm2 , respectively). Considering the overall population, significantly higher rates of newly formed bone were obtained in mandibular sites, while non-mineralized and dense connective tissue rates were higher in the maxilla (p < .05). CONCLUSIONS: The application of collagen membrane over titanium mesh did not lead to significant results. Bone formation appeared significantly different in the maxilla compared with the mandible. Additional studies are required to further investigate the issues observed.

A 3D micro-CT assessment of composition and structure of bone tissue after vertical and horizontal alveolar ridge augmentation using CAD/CAM-customized titanium mesh.

OBJECTIVES: To date, no studies have exploited micro-CT in humans to evaluate bone morphology and structure after bone augmentation with CAD/CAM-customized titanium mesh, in mandible and maxilla. The aim of this study was to assess the composition and microstructure of bone biopsy through micro-CT analysis. MATERIALS AND METHODS: Bone augmentation at both maxillary and mandible sites was performed on 30 patients randomly treated with customized mesh, either alone (M-) or covered with resorbable membrane (M+), in both cases filled 50:50 with autogenous bone and xenograft. After 6 months, biopsies were taken and micro-CT was performed on consecutive 1-mm-thick VOIs from coronal to apical side, measuring tissue volumes, trabecular thickness, spacing, and number. RESULTS: In both groups, irrespective of membrane use, bone tissue (M-: 29.76% vs. M+: 30.84%) and residual graft material (M-: 14.87% vs. M+: 13.11%) values were similar. Differences were site-related (maxillary vs. mandibular) with higher percentage of bone tissue and trabecular density of low-mineralized bone and overall bone in the mandible. CONCLUSIONS: The composition and structure of bone tissue, as assessed by micro-CT after alveolar ridge augmentation using CAD/CAM-customized titanium meshes, showed similar features regardless of whether a collagen membrane was applied.

Guided bone regeneration using titanium mesh to augment 3-dimensional alveolar defects prior to implant placement. A pilot study.

OBJECTIVES: To evaluate the outcomes of bone regeneration using a customized titanium mesh scaffold to cover a bone graft for reconstruction of complex defects of the jaws. MATERIALS AND METHODS: 19 large defects were digitally reconstructed using CT scans according to the prosthetic requirements. A titanium mesh scaffold was designed to cover the bone (autologous/bovine bone particulate) graft. At least 6 months after surgery, a new cone-beam CT was taken. The pre- and postoperative CT datasets were then converted into three-dimensional models and digitally aligned. The actual mesh position was compared to the virtual position to assess the reliability of the digital project. The reconstructed bone volumes (RBVs) were calculated according to the planned bone volumes (PBVs), outlining the areas under the mesh. These values were then correlated with the number of exposures, locations of atrophy, and virtually planned bone volume. RESULTS: The mean matching value between the planned position of the mesh and the actual one was 82 ± 13.4%. 52.3% (40% early and 60% late) exposures were observed, with 15.8% exhibiting infection. 26.3% resulted as failures. The amount of reconstructed bone volume (RBV) in respect to PBV was 65 ± 40.5%, including failures, and 88.2 ± 8.32% without considering the failures. The results of the exposure event were statistically significant (p = .006) in conditioning the bone volume regenerated. CONCLUSIONS: This study obtained up to 88% of bone regeneration in 74% of the cases. The failures encountered (26%) should underline the operator's expertise relevance in conditioning the final result.

Vertical ridge augmentation (VRA) with Ti-reinforced d-PTFE membranes or Ti meshes and collagen membranes: 1-year results of a randomized clinical trial.

OBJECTIVES: The aim of this study was to evaluate hard and soft tissues around implants placed in posterior mandible 1 year after vertical ridge augmentation (VRA). MATERIALS AND METHODS: 40 patients with vertical defects were enrolled and treated according to the study protocol. Patients were randomly divided into two study groups: reinforced PTFE membranes (group A) and titanium meshes plus collagen membranes (group B). All patients received simultaneous implants which were evaluated after prosthetic restoration at baseline and after 1 year, using the following parameters: peri-implant bone levels (PBLs), interproximal bone peaks (IBPs), pocket probing depth (PPD), bleeding on probing (BoP), plaque index (mPI), gingival index (mGI), keratinized tissue thickness/width (tKT and wKT), and fornix depth (FD). Statistical analysis was performed to investigate any statistically significant differences and/or correlations (p = .05). RESULTS: 30 patients were completely followed up according to the study protocol. After 1 year, implants showed a change in PBL from 0.12 to 0.76 mm, with marginal bone loss of 0.67 and 0.61 mm for group A and group B, respectively, without significant differences (p > .9337). The estimated difference between treatments for the change from baseline in PBL was -0.05 (95% CI -0.27 to 0.16). Statistical analysis revealed strong correlations between PBL and IBP (p < .0001). However, no significant differences were observed for PPD, mPI, mGI, tKT, wKT, and FD (p > .05). CONCLUSION: The results indicate that GBR treatment with titanium meshes plus collagen membranes (Group B) compared to reinforced PTFE membranes does not appear to be inferior or superior in terms of PBL change. In both groups, hard and soft tissues were stable after 1 year of follow-up, with a peri-implant bone loss less than 1.0 mm in the first year (study registered at ClinicalTrials.gov NCT04332679).

Vertical and horizontal ridge augmentation using customized CAD/CAM titanium mesh with versus without resorbable membranes. A randomized clinical trial.

OBJECTIVES: The aim was to evaluate the role of resorbable membranes applied over customized titanium meshes related to soft tissue healing and bone regeneration after vertical/horizontal bone augmentation. MATERIALS AND METHODS: Thirty patients with partial edentulism of the maxilla/mandible, with vertical/horizontal reabsorption of the alveolar bone, and needing implant-supported restorations, were randomly divided into two groups: Group A was treated using only custom-made meshes (Mesh-) and Group B using custom-made meshes with cross-linked collagen membranes (Mesh+). Data collection included surgical/technical and healing complications, "pseudo-periosteum" thickness, bone density, planned bone volume (PBV), regenerated bone volume (RBV), regeneration rate (RR), vertical bone gain (VBG), and implant survival in regenerated areas. Statistical analysis was performed between the two study groups using a significance level of α = .05. RESULTS: Regarding the healing complications, the noninferiority analysis proved to be inconclusive, despite the better results of group Mesh+ (13%) compared to group Mesh- (33%): estimated value -1.13 CI-95% from -0.44 to 0.17. Superiority approach confirmed the absence of significant differences (p = .39). RBV was 803.27 mm3 and 843.13 mm3 , respectively, and higher RR was observed in group Mesh+ (82.3%) compared to Mesh- (74.3%), although this value did not reach a statistical significance (p = .44). All 30 patients completed the study, receiving 71 implants; 68 out of them were clinically stable and in function. CONCLUSION: The results showed that customized meshes alone do not appear to be inferior to customized meshes covered by cross-linked collagen membranes in terms of healing complication rates and regeneration rates, although superior results were observed in group Mesh+compared to group Mesh- for all variables.

Clinical and volumetric outcomes after vertical ridge augmentation using computer-aided-design/computer-aided manufacturing (CAD/CAM) customized titanium meshes: a pilot study.

BACKGROUND: One of the most recent innovations in bone augmentation surgery is represented by computer-aided-design/computer-aided-manufacturing (CAD/CAM) customized titanium meshes, which can be used to restore vertical bone defects before implant-prosthetic rehabilitations. The aim of this study was to evaluate the effectiveness/reliability of this technique in a consecutive series of cases. METHODS: Ten patients in need of bone augmentation before implant therapy were treated using CAD/CAM customized titanium meshes. A digital workflow was adopted to design virtual meshes on 3D bone models. Then, Direct Metal Laser Sintering (DMLS) technology was used to produce the titanium meshes, and vertical ridge augmentation was performed according to an established surgical protocol. Surgical complications, healing complications, vertical bone gain (VBG), planned bone volume (PBV), lacking bone volume (LBV), regenerated bone volume (RBV), average regeneration rate (RR) and implant success rate were evaluated. RESULTS: All augmented sites were successfully restored with definitive implant-supported fixed partial dentures. Measurements showed an average VBG of 4.5 ± 1.8 mm at surgical re-entry. Surgical and healing complications occurred in 30% and 10% of cases, respectively. Mean values of PBV, LBV, and RBV were 984, 92, and 892 mm3, respectively. The average RR achieved was 89%. All 26 implants were successfully in function after 1 year of follow-up. CONCLUSIONS: The results of this study suggest that the bone augmentation by means of DMLS custom-made titanium meshes can be considered a reliable and effective technique in restoring vertical bone defects.

Stability of Periodontal Healing Distal to the Mandibular Second Molar After Third Molar Coronectomy: A 3-Year Follow-Up Study.

PURPOSE: The stability of the periodontal attachment distal to the mandibular second molar after coronectomy of the third molar is still unclear. This study addressed the question of whether periodontal measures are stable over time among patients undergoing coronectomy. MATERIALS AND METHODS: This prospective cohort study enrolled 30 patients treated at the Unit of Oral and Maxillofacial Surgery of the University of Bologna. The predictor variables were the probing pocket depth (PPD), distance between the marginal crest and the bottom of the osseous defect (BOD), and distance between the cementoenamel junction and the BOD. Three points on the distal surface of the second molar were recorded: distobuccal, distomedial, and distolingual sites. The distobuccal site was used as the statistical unit. The Wilcoxon test for paired data and Kendall τb were used to evaluate all variables. The significance level was set at P < .05. RESULTS: The 3-year follow-up was completed by 27 patients (7 male and 20 female patients; mean age, 28 ± 7 years) with 30 third molars. At 3 years, the PPD was 4 ± 1.25 mm; no significant changes in PPD were recorded for all sites from 9 months to 3 years. For the marginal crest-BOD distance and the cementoenamel junction-BOD distance, significant reductions were evident between preoperative values and those at 9 to 36 months (P = .001) and between values at 9 and 36 months (P = .02). CONCLUSIONS: A clinical healthy periodontium distal to the second molar was observed 36 months after coronectomy. However, further studies are necessary to confirm these preliminary clinical results.

Coronectomy: A Surgical Option for Impacted Third Molars in Close Proximity to the Inferior Alveolar Nerve-A 5-Year Follow-Up Study.

PURPOSE: The extraction of third molars is the most common surgical procedure performed in the oral cavity. Coronectomy is a surgical protocol to reduce the risk of neurologic lesions to the inferior alveolar nerve (IAN). We evaluated early (up to 1 month) and late (from 2 to 60 months) postoperative complications. MATERIALS AND METHODS: This prospective cohort study enrolled patients treated at the Unit of Oral and Maxillofacial Surgery, University of Bologna. The predictor variable was the time after coronectomy with up to 5 years' follow-up. To assess the rate of postoperative complications, the outcome variables were neurologic injuries, postoperative pain, swelling, fever, alveolitis, pulpitis, and root exposure. The success rate, need for a second surgical procedure, probing pocket depth, and bleeding on probing also were investigated. Univariate and bivariate descriptive statistics, Kaplan-Meier analysis, and Cox hazards modeling were performed to evaluate the variables. RESULTS: We performed 116 coronectomies in 94 healthy patients (37 men and 57 women; mean age, 28.99 ± 8.9 years). At 5 years' follow-up, we re-evaluated 63 patients with 76 coronectomies. In total, 30 complications were verified. No cases of neurologic lesions to the IAN or lingual nerve were observed after surgery. In the first 3 years, the surgeons extracted migrated roots in 5 cases (6%) without any neurologic lesions to the IAN. No complications were observed from the third to fifth year. CONCLUSIONS: This prospective study on coronectomy of third molars in a close relationship with the mandibular canal found no cases of neurologic lesions, no cases of late infection of the retained roots at 5 years, and a low rate of immediate postoperative complications. Further investigations should include a follow-up study at 10 years and more research about the mechanism of pulp healing.

Evaluation of Crestal Bone Loss Around Straight and Tilted Implants in Patients Rehabilitated by Immediate-Loaded Full-Arch All-on-4 or All-on-6: A Prospective Study.

The aim of this prospective study was to compare implant success rate and crestal bone loss around tilted and straight implants supporting immediate-loading full-arch rehabilitations. Twenty consecutive patients with edentulous jaws treated between June 2013 and July 2015 who satisfied all inclusion and exclusion criteria were included in the study. All patients were rehabilitated through a full-arch restoration supported by 4 or 6 immediately loaded implants. Clinical and radiographic examinations were scheduled every 12 months to evaluate implant success rates and crestal bone levels. Significant differences in crestal bone levels and success rates between straight and tilted implants were investigated by means of independent statistical analysis; differences were regarded as significant if P < .05. Seventy straight and 50 tilted implants were placed to rehabilitate 14 mandibles and 12 maxillae in 20 patients. After a follow-up of 12 to 36 months, survival rate was 97.1% for straight implants and 96.0% for tilted implants; while success rates were 94.3% and 94.0%, respectively. Success and survival rates were not significantly different (P > .05). Change in crestal bone level was 0.5 ± 0.4 mm for straight implants and 0.6 ± 0.4 mm for tilted implants (P > .05). Straight and tilted implants seemed to have similar behavior after immediate loading rehabilitations. After functional loading, straight and tilted implants did not differ significantly in clinical outcome.

Periodontal Healing Distally to Second Mandibular Molar After Third Molar Coronectomy.

PURPOSE: Coronectomy of mandibular third molars is a procedure that still raises a number of questions. The aim of the present study was to answer one unsolved question: the periodontal healing distal to the mandibular second molar after third molar coronectomy. MATERIALS AND METHODS: A prospective cohort study was performed of 30 patients treated at the Unit of Oral and Maxillofacial Surgery of the Department of Biomedical and Neuromotor Science of the University of Bologna. The predictor variables were the probing pocket depth (PPD), the distance between the marginal crest (MC) and the bottom of the osseous defect (BOD), and the distance between the cementum enamel junction (CEJ) and the BOD. These clinical indexes were recorded on 3 points of the distal surface of second molar: the distobuccal (DB), distomedial (DM), and distolingual (DL) sites. The other variables evaluated included root migration and postoperative complications. The Wilcoxon test for paired data and Kendall's tau-b correlation coefficient was used to evaluate all variables. The significance level was set at P = .05. RESULTS: The cohort was composed of 30 patients with 34 high-risk mandibular third molars (9 men and 21 women), with a mean age of 28 ± 7 years. At 9 months, a statistically significant reduction in the PPD of 2 ± 3, 1 ± 2, and 2 ± 2 mm and a statistically significant reduction in the MC-BOD distance of 4 ± 4, 4 ± 4, and 4 ± 5 mm for the DB, DM, and DL sites, respectively, was observed (P = .001). Also, the intraoperative CEJ-BOD distance showed a statistically significant reduction for the DB, DM, and DL sites. CONCLUSIONS: After coronectomy, restoration of a clinical healthy periodontium distal to the second molar was observed. However, further studies are necessary to confirm these preliminary clinical results and to compare periodontal healing between coronectomy and complete extraction.

Minimally Invasive Approach Based on Pterygoid and Short Implants for Rehabilitation of an Extremely Atrophic Maxilla: Case Report.

INTRODUCTION: Extremely atrophic maxillae can be considered the most important indication for three-dimensional maxillary reconstruction. Different bone-augmentation techniques have been suggested to accomplish this. This article illustrates a minimally invasive approach to rehabilitation of the extremely atrophic maxilla. MATERIAL AND METHODS: A 63-year-old male patient was referred for restoration of his totally edentulous maxilla with a fixed full-arch implant-prosthetic rehabilitation. Four short implants in the premaxillary region and 2 longer implants in the pterygomaxillary regions were inserted with piezoelectric implant site preparation. DISCUSSION: At the 1-year follow-up appointment, no clinical or radiographic changes in the soft-tissue contours or crestal bone levels were observed. CONCLUSION: This surgical approach, based on the combination of short implants in the premaxillary regions and pterygoid implants in the pterygomaxillary regions, represents a way to shorten treatment timing, minimize the risk of surgical complications, and reduce patient discomfort and costs.

Work flow for the prosthetic rehabilitation of atrophic patients with a minimal-intervention CAD/CAM approach.

The implant-supported fixed rehabilitation of patients with an atrophic edentulous crest remains a challenge if bone augmentation is not planned. A minimal intervention approach for bone regeneration is necessary to minimize the flap overextension needed to close the defect over the augmented bone. Prosthetically guided bone regeneration can determine the amount of bone augmentation necessary for definitive prosthetic fixed rehabilitation. The positions of the implants and prosthetic restoration were planned; a 0.3 mm thick titanium mesh was customized for bone augmentation by using computer-aided design and computer-aided manufacturing and rapid prototyped by laser sintering, and the definitive prosthetic rehabilitation was carried out according to the initial treatment plan. This resulted in minimal bone augmentation relative to the functional needs of the definitive prosthetic rehabilitation.

The influence of vertical ridge augmentation techniques on peri-implant bone loss: A systematic review and meta-analysis.

INTRODUCTION: The primary aim of this systematic review was to investigate and compare the outcomes of different vertical ridge augmentation (VRA) techniques in relation to peri-implant bone loss (PBL), after at least 12 months of functional loading. MATERIAL AND METHODS: The search was conducted to find all the studies about VRA and measurements of PBL with at least 12 months follow-up. Three pairwise meta-analysis (MA) was performed to completely evaluate the outcomes. RESULTS: A total of 42 studies were included, of which 11 were randomized clinical trials (RCTs). RCTs were available only for guided bone regeneration (GBR), onlay, and inlay techniques. The weighted mean estimate (WME) of PBL value was found to be 1.38 mm (95% confidence interval [95% CI]: 1.10-1.66) after a mean follow-up of 41.0 ± 27.8 months. GBR, Inlay, Onlay, osteodistraction, and SBB represented in weight 32.9%, 30.6%, 25.0%, 7.6%, and 3.9%, respectively; and their WME (95% CI) were 1.06 (0.87-1.26) mm, 1.72 (1.00-2.43) mm, 1.31 (0.87-1.75) mm, 1.81 (0.87-1.75) mm, and 0.66 (0.55-0.77) mm, respectively. Among the secondary outcomes, the analysis was conducted for vertical bone gain, healing complication rate, surgical complication rate, implant survival, and success rate. CONCLUSIONS: The primary findings of the meta-analysis, based on the changes between final and baseline values, showed that the peri-implant bone loss could be influenced by the type of intervention but there is a need to evaluate in RCTs the behavior of the peri-implant bone levels after long-term follow-up for all techniques.

Effectiveness of Bichat's Buccal Fat Pad (BFP) Technique for Vertical Ridge Augmentation in the Maxilla.

This study evaluated the efficacy of buccal fat pad (BFP) as a natural barrier to cover nonresorbable devices for vertical ridge augmentation (VRA). Twelve consecutive patients with 14 vertical bone defects in need of bone augmentation for implantprosthetic rehabilitation were treated according to the described protocol. VRA was performed by means of customized titanium meshes, titanium-reinforced d-PTFE membranes, or resorbable membranes and titanium plates. After buccal flap release, the BFP was identified and isolated, then mesially and coronally advanced to cover the whole augmented area. BFP was used as a pedicle flap in 11 cases and as a free graft in 3 cases. The mean BFP surface area was 13.5 ± 5.5 cm2. Healing was uneventful in all 14 augmented sites. No patients reported healing complications or facial volumetric changes. The mean vertical bone gain (VBG) was 4.2 ± 1.8 mm. In this limited number of cases, using the BFP as a natural barrier has proven to be efficient in bone augmentation, as it improved the healing process while reducing the risk of complications. Int J Periodontics Restorative Dent 2023;43:e99-e109. doi: 10.11607/prd.5473.

Vertical ridge augmentation with Ti-reinforced dense polytetrafluoroethylene (d-PTFE) membranes or Ti-meshes and collagen membranes: 3-year results of a randomized clinical trial.

BACKGROUND: The present study aimed to evaluate hard and soft tissue parameters around implants placed in augmented posterior mandible, comparing Ti-reinforced d-PTFE membranes with Ti-meshes covered with collagen membranes, after 3 years of follow-up. MATERIALS AND METHODS: Forty eligible patients were randomly assigned to group A (Ti-reinforced d-PTFE membrane) or group B (mesh covered with collagen membrane) for vertical ridge augmentation (VRA) and simultaneous implants. Implants were evaluated using specific peri-implant parameters for bone and soft tissues: probing pocket depth (PPD), modified plaque index (mPI), bleeding on probing (BoP), modified gingival index (mGI), thickness of keratinized tissue (tKT), width of keratinized tissue (wKT), fornix depth (FD), peri-implant bone level (PBL), interproximal bone peaks (IBP), marginal bone loss (MBL), interproximal bone loss (IBL). RESULTS: A total of 28 patients with 79 implants were evaluated after 3 years of follow-up. The mean value of MBL was 0.70 mm (group A = 0.73 mm; group B = 0.71 mm), while mean IBL was 0.54 mm (group A = 0.64 mm; group B = 0.40 mm). The treatment with meshes resulted not inferior to PTFE and their clinical results appeared similar. A strong correlation between PBL and IBP was confirmed. Both study groups showed an increase of tKT and wKT values. CONCLUSION: In the posterior mandible, VRA using both techniques provides stable PBLs up to 3 years. A correct soft tissue management and a strict professional oral hygiene protocol play a crucial role on peri-implant health over time.

Effectiveness Of Bichat's Buccal Fat Pad (BFP) Technique For Vertical Ridge Augmentation In The Maxilla.

The aim of this study was to evaluate the efficacy of buccal fat pads (BFP) as a natural barrier to cover nonresorbable devices for vertical ridge augmentation (VRA). A total of 12 consecutive patients with 14 vertical bone defects in need of bone augmentation for implant-prosthetic rehabilitation were treated according to the described protocol. VRA was performed by means of (1) customized titanium meshes, (2) titanium-reinforced PTFE membranes, or (3) resorbable membranes plus titanium plates. After buccal flap release, the BFP was identified, isolated, then mesially and coronally advanced to cover the whole augmented area. BFP was used as a pedicle flap in 11 cases and as free graft in 3 cases. The mean surface of the BFP obtained was 13.5 ± 5.5 cm2. In all 14 augmented sites, uneventful healing was assessed. No patients reported healing complications or facial volumetric changes. The mean VBG was 4.2 ± 1.8 mm. In this limited number of cases, the technique using the BFP as a natural barrier has proven to be efficient in bone augmentation, as it has shown to improve the healing process while reducing the risk of complications.

A novel technique for digitalisation and customisation of reinforced polytetrafluoroethylene meshes: Preliminary results of a clinical trial.

PURPOSE: To evaluate the clinical, radiographic and patient-related outcomes of a novel technique for digitalisation and customisation of reinforced polytetrafluoroethylene meshes in vertical ridge augmentation surgery. MATERIALS AND METHODS: A total of 10 patients (five men and five women, mean age 54 years) with vertical defects were included in the study. Prior to surgery, digital planning of bone augmentation, manufacturing of 3D printed models and replicas of the meshes and modelling of a customised reinforced polytetrafluoroethylene mesh were carried out. All patients were treated using a 50:50 mixture of xenogeneic and autogenous bone, customised reinforced polytetrafluoroethylene mesh and collagen membrane. After 6 to 9 months, computer-guided surgery was planned, the reinforced polytetrafluoroethylene mesh was removed and implants were placed in augmented sites using a fully guided surgical template. Patient-related outcomes, intraoperative timing, surgical and healing complications, vertical bone gain, bone density, pseudoperiosteum type and number and stability of implants were recorded. RESULTS: All 10 patients were treated without surgical complications. Healing was largely uneventful, with the exception of one case of abscess formation without mesh exposure (exposure rate 0%). The mean duration of digital planning was 17.0 minutes, reinforced polytetrafluoroethylene mesh customisation took 9.0 minutes, and the total intraoperative time was 91.3 minutes. The mean planned bone volume was 1.52 cc, vertical bone defect depth was 6.0 ± 1.7 mm and vertical bone gain was 5.5 ± 1.9 mm; most sites showed medium bone density and a Type 1 pseudoperiosteum. All patient-related outcomes were favourable. CONCLUSIONS: The preliminary results of this pilot study demonstrated the feasibility and reliability of a fully digital workflow for the customisation of reinforced polytetrafluoroethylene mesh in vertical ridge augmentation.

Influence of implant-abutment interface design on bone and soft tissue levels around immediately placed and restored single-tooth implants: a randomized controlled clinical trial.

PURPOSE: The purpose of the present study was to compare the clinical and radiographic outcomes of single implants immediately placed and restored with two different implant-abutment connections. MATERIALS AND METHODS: Forty subjects requiring single maxillary premolar replacement were consecutively included in this study and prospectively followed for 12 months. One implant was placed at the time of tooth extraction and immediately restored in each patient. Subjects were randomly selected to receive either prosthetic abutments with a Morse taper connection and a platform switch (test group) or conventional abutments with an internal connection and a matching diameter (control group). A provisional screw-retained crown was positioned and adjusted for nonfunctional loading within 24 hours. Four months later, the definitive crowns were delivered. Periodontal parameters and clinical and radiographic measurements of soft and hard tissue levels were recorded at the moment of prosthesis placement and at 4 and 12 months afterward. Means of the two groups were compared using paired and independent-sample t tests (P = .05). RESULTS: Of the 40 patients recruited, 38 (24 women and 14 men) completed the study. No implants were lost in the control group, whereas one implant failed in the test group. At the 12-month examination, no statistically significant differences were seen between the two groups for periodontal parameters, marginal soft tissue level change, or papilla height (P > .05), but greater marginal bone loss was observed at the control sites (0.51 ± 0.24 mm) compared to the test sites (0.2 ± 0.17 mm) (P = .0004). CONCLUSION: Although the control group demonstrated a slight increase in marginal bone loss compared to the test group, the peri-implant soft tissues were very stable with both types of implant-abutment connection after 12 months of loading.

Preliminary Study with the Use of a Titanium Mesh as Space Maker and Implant Primary Stabilization for One-Stage Sinus Lift in Cases with Less Than 1.5 mm Residual Bone.

(1) Background: In the lateral area of the maxilla, the alveolar bone can lose significant volume due to maxillary sinus pneumatization following teeth extractions. This preliminary study evaluated the effectiveness of a novel technique for one-stage sinus lifting and simultaneous implant placement in cases with less than 1.5 mm residual alveolar bone. The subsequent survival rate at 1-year post-occlusal loading was assessed. (2) Methods: 15 patients were selected, the main inclusion criteria were the partially edentulous area in the posterior maxilla with alveolar bone height of less than 1.5 mm below the sinus. All of the patients underwent one-stage sinus lifting, along with simultaneous implant placement using a "butterfly" anchorage device to optimize the primary stability and xenograft bone as graft material. At 6 to 9 months after surgery, the anchorage device was removed and implants were loaded. Panoramic x-ray images were used to assess the new bone formation, while the biological stability was measured using resonance frequency analysis. (3) Results: 15 implants were inserted. The mean implant stability quotient (ISQ) value was 71.3 (SD = ±2.51) and the mean healing period was 7.3 (SD = ±1.23) months. The mean bone height after the healing period was 14.4 (SD = ±2.05). A statistically significant correlation was found between the healing period and the ISQ value (Spearman rho = 0.684, sig. = 0.005). No statistically significant correlation was found between the ISQ value and the new regenerated bone height (Person r = 0.389, sig. = 0.152). Smoking was identified as a risk factor involved in postoperative complications. (4) Conclusions: The results of the present preliminary study demonstrated that the proposed "butterfly" technique was effective when performing one-stage sinus lifting and simultaneous implant placement in cases with less than 1.5 mm of residual alveolar bone. The survival rate was 100% at 1-year post occlusal loading.