Alveolar Ridge Preservation with a Novel Cross-Linked Collagen Sponge: Histological Findings from a Case Report.

Alveolar ridge preservation (ARP) is a well-documented procedure to maintain bone volume after tooth extraction in order to place implants. However, at the end of the healing process, the residual biomaterial that is not reabsorbed remains embedded in the bone over time. Ribose cross-linked biomaterials demonstrated their ability to promote osteoconduction and complete resorption. The aim of this study was to evaluate the histological healing pattern of a novel ribose cross-linked collagen sponge used as a grafting material left exposed in human sockets at the time of tooth extraction. On a single patient, non-restorable lower first molars were extracted on both sides, and a ribose cross-linked collagen sponge was placed bilaterally in the cavities and left uncovered at the end of the surgery. After six months, core biopsies were taken immediately prior to implant placement; after the sample preparation, a histological analysis was performed. The results are very promising for substitution with newly formed bone and the amount of residual material. Ribose cross-linked collagen sponge could represent a valid alternative to conventional biomaterials for ARP procedures with no need for flap advancement and/or the addition of a membrane to cover the graft, reducing the invasiveness, complexity, and costs of the treatment.

Ossification and Bone Regeneration in a Canine GBR Model, Part 2: Glycated Cross-Linked Collagenated Alloplastic Hydroxyapatite Scaffold vs Non-Cross-Linked Collagenated Xenographic Bone Hydroxyapatite.

PURPOSE: To compare bone substitutes composed of glycated collagen with synthetic micro-sized (1 to 10 µm) hydroxyapatite (OB) vs non-cross-linked collagen matrix with large-particle (250 to 1,000 µm) bovine-derived hydroxyapatite (BOC). MATERIALS AND METHODS: The P1 to P4 premolars were bilaterally extracted from the mandibles of 19 Beagle dogs. After 21 days, osteotomies were created in each dog that received OB or BOC and were covered with a collagen membrane or were left untreated. The animals were randomly divided into three groups based on sacrifice time (4, 12, or 24 weeks). The right and left hemimandibles were trimmed to facilitate imaging and histology, and all tissues were placed in 10% neutral-buffered formalin. Microcomputed tomography (MicroCT 40 Scanner, Scanco) was used to analyze bone sections. Bone volume, residual material volume, and bone mineral density were determined for each treatment site (OB and BOC) based on a volume of interest that encompassed the original defect. Additionally, blinded histopathologic assessment (based on the ISO 10993-6 scoring system) and histomorphometry were performed on sections ground to < 100 µm thick and stained with Stevenel's blue. RESULTS: No clinical side effects were noted. No statistical differences were observed for OB vs BOC regarding the mineral volume percentage. Compared to OB, BOC had significantly higher mean mineralization densities at 12 weeks (P < .01), but this difference did not extend to 24 weeks. For residual grafting material, bone maturation, alveolar ridge restoration, and inflammatory response, OB showed a residual amount of bone graft and no statistical differences compared to BOC. CONCLUSION: Both OB and BOC represent valid treatment options for critically sized bone defects. Both bone fillers outperformed the sham-operated, ungrafted (empty) control, demonstrating statistically improved bone growth and ridge restoration.

Ossification and Bone Regeneration in a Canine GBR Model, Part 1: Thick vs Thin Glycated Cross-Linked Collagen Devices.

Purpose: To compare glycated multilayered membranes (OV) to a commercially available thin-layer membrane (OP) in a lateral ridge augmentation model in dogs. Materials and Methods: This was designed as a three-arm study, where one negative control (empty defect) was compared to two test arms: alveolar bone defects grafted with a mixture of 90% deproteinized bovine bone mineral and 10% porcine collagen, then covered with either a thick- (OV) or thin-layered (OP) membrane. Animals were randomly divided into three groups corresponding to the final sacrifice times of 4 weeks, 12 weeks, and 24 weeks. Sections underwent microCT, histology, histopathology, and histomorphometry. Results: No statistical differences were observed for OV compared to OP regarding the percentage of mineral volume and mean mineral density, amount of bone maturation, percentage of bone graft and membrane remaining in the grafted area, alveolar ridge width measurements, membrane mineralization, or ossification. Test groups presented significantly higher values compared to the empty control for all the endpoints. Conclusions: Within its limitations, this in vivo study highlighted that multilayered thick glycated membranes can serve as effective occlusive barriers for up to 6 months.

Preliminary Evaluation of a NitrAdine-Based Brushing Solution for Patients Suffering from Gingivitis: A Prospective Clinical Case-Control Study.

OBJECTIVES: This article aimed to evaluate the clinical efficacy of a nonantibiotic biofilm-removal formulation based on NitrAdine (PerioTabs), combined with a regular home oral hygiene regimen, in Caucasian patients with gingivitis. MATERIALS AND METHODS: A sample of 60 patients were included in this clinical prospective study. All selected subjects underwent regular prophylaxis and professional oral hygiene at baseline; 30 days later, they were recalled for the measurements of the reference parameters about bleeding on probing (full-mouth bleeding upon probing score [FMBS]) and plaque index (full-mouth plaque score [FMPS]); no other clinical procedure was performed. Consequently, half of the patients (n = 30) were instructed to use PerioTabs for 10 days. The remaining patients (n = 30) were used as the negative control, only instructed to continue with their usual oral hygiene regimen. Fifteen days after, the clinical parameters of FMBS and FMPS were re-evaluated in both groups. RESULTS: Changes in the scores of clinical indices FMBS and FMPS were calculated and compared. A significant difference between pre- and post-values, for both FMBS and FMPS, was noticed in the test group; in particular, the bleeding index value demonstrated the more significant changes: 22 participants showed a clinically meaningful improvement, and 5 had a small improvement. Only three patients had no evidence of change. In addition, 50% of patients had a reduction in plaque levels. No side effects were reported. CONCLUSIONS: The adjunctive use of 10-day PerioTabs treatment in the daily oral hygiene routine seemed to be efficient in reducing gingival bleeding and plaque accumulation, with absence of adverse effects. These results should be confirmed in studies with a larger number of participants following a controlled-blinded design.

A Modified Bilaminar Technique with the Use of a Fibrin-Fibronectin System for a Single Gingival Recession: A Case Report with a Follow-Up of 3 Years.

This case report described a modified bilaminar technique for treating a single gingival recession. Patient presented a gingival recession in a maxillary canine. Tooth was in a buccally prominent position and soft keratinized tissue apical to the recession was reduced but still present. A split-full-split thickness trapezoidal flap was designed. Root's surface was prepared with curettes. Epithelial-connective tissue graft was harvested from the palate with reduced dimension. After deepithelialization, the graft was placed with a fibrin-fibronectin system at the maximum root coverage level, and the flap coronally advanced and sutured. At 3-year follow-up control, the free gingival margin was still stable at the postsurgery position, with a thicker biotype corresponding to the grafted area, with no probing and a suitable aesthetic result.

The Long-Term Evaluation of Two-Unit Fixed Partial Dentures on Short, Threaded Implants: Delayed Versus Immediate Loading.

Placement of short implants is a common approach to rehabilitate edentulous areas. The objective of this study was to evaluate the long-term survival of 7.0- and 8.5-mm implants placed in either a delayed or immediate loading protocol. Life table analysis revealed the implants treated with the delayed loading protocol had a 90.9% survival rate and the implants treated with the immediate loading protocol had a survival rate of 92.0%. The results of this 8-year prospective study demonstrate similar survival rates of short, cylindrical threaded implants placed by either a delayed or immediate loading protocol.

Esthetic and Physical Changes of Innovative Titanium Surface Properties Obtained with Laser Technology.

AIM: The purpose of the study was the evaluation of the esthetic and physical changes produced on colored titanium Grade 5 (Ti6Al4V) laser treated surfaces to be used in implant dentistry for esthetic success. MATERIALS AND METHODS: Colored titanium surfaces were obtained with laser treatment. The physical and topographic properties were evaluated by stereo, light, and electron microscopy and profilometric analyses. L*a*b* colorimetric coordinates were measured by spectrometry, and the superficial chemical characteristics were evaluated by energy dispersive X-ray analysis. RESULTS: Within the complete palette of titanium colors, pinks (P1-P2), incarnadine (I), and white (W) obtained by laser were selected. The topography, texture, hues, saturation, roughness, and porosity of the samples were compared with those of machined (M) and sand-blasted and etched (SBAE) control surfaces. P1, P2, and I, similar in hue and roughness (Ra @ 0.5 µm), had a microgroove spacing of 56 µm and a decreasing porosity. The W sample with a "checkerboard" texture and a light color (L* 96.31) was similar to the M samples (Ra = 0.32 µm), but different from SBAE (Ra = 1.41 µm, L* 65.47). DISCUSSION: The aspects of hard and soft tissue could result in an esthetic failure of the dental implant by showing the dark color of the fixture or abutment. The two different pinks and incarnadine surfaces showed favorable esthetic and physical features to promote dental implant success even in the maxillary anterior area with gingival recession, asymmetry, and deficiency. CONCLUSION: Titanium colored laser surfaces represent a valid alternative to those currently traditionally obtained and interesting and potential perspectives in the management of dental implants' esthetic failure.

The Creeping Attachment Induced Technique (CAIT) in Natural and Restored Teeth: Case Reports with 24 Months of Follow-Up.

This article describes a nonsurgical approach for treating gingival recessions and increasing gingival thickness around the natural teeth. Two female patients, presenting gingival recessions at the maxillary frontal teeth, were treated. Patient #1 had a discrepancy among the central maxillary incisors' gingival margin, and tooth UL1 needed to be restored. Patient #2 presented a buccal gingival recession at tooth UL3. In both cases, the sulcular gingival margin was gently disephitelized with a diamond bur leaving the soft tissue healing by itself. After 4 weeks, the procedure was reperformed. After 6 months, the gingival margins appeared thicker and a creeping attachment was achieved in both cases, obtaining gingival symmetry, related to the adjacent or contralateral teeth, and root coverage. Gingival asymmetry, gingival recessions, and gingival thickness may be improved by means of a guided gentle nonsurgical stimulation, providing creeping attachment in the natural and also restored teeth, with a healthy and stable tissue after 24 months of follow-up.

Morphometric Changes Induced by Cold Argon Plasma Treatment on Osteoblasts Grown on Different Dental Implant Surfaces.

Treatments for enhancing surface energy were studied in an effort to create a more favorable environment for cell adhesion. Cold argon plasma (CAP) is able to improve titanium-cell contact, producing hydrophilic surfaces with higher wettability. The aim of this in vitro study was to estimate the early cell morphology after CAP treatment of different commercially available titanium surfaces. Surface wettability was significantly augmented in all the treated samples. The authors investigated how CAP affected the behavior of osteoblasts by evaluating the cell morphology outcome. Cell surface areas differed in a statistically significant way when plasma-treated samples were compared to the untreated ones. The positive effect of CAP was shown on smooth, moderately rough, and rough implant surfaces.

Sinus Floor Elevation with Modified Crestal Approach and Single Loaded Short Implants: A Case Report with 4 Years of Follow-Up.

Tooth extraction is usually followed by bone reduction. In the maxillary posterior region, this remodelling combined with sinus pneumatisation and periodontal defects may lead to a reduced basal bone height available for implant placement. Sinus floor elevation can be performed with different surgical techniques. Crestal approach has demonstrated to be effective, less invasive, and associated with a reduced morbidity. This article reports a modified sinus floor elevation by means of rotary, noncutting instruments, addition of xenograft, and 2 short-threaded implant placements. The aim of the study was to evaluate the implant's success and intrasinus radiographical bone gain after 4 years of functional loading. The premolar implant site presented a starting basal bone height of 6 mm, while the molar site was of 2 mm. In the first surgical step, sinus floor elevation was performed mesially and the implant was inserted, and distally only sinus floor elevation was performed. After 6 months, the mesial implant was uncovered and the second implant was inserted; 4 months later, the second fixture was uncovered, and both fixtures were loaded with single provisional screw-retained crowns and later with single screw-retained porcelain fused to metal crowns. Implants integrated successfully, and crestal bone remodelling did not exceed the smooth collar. Bone gain was 3 mm for the mesial implant and more than 5 mm for the distal one.

Immediate versus delayed implant placement after anterior single tooth extraction: the timing randomized controlled clinical trial.

AIM: To compare need for bone augmentation, surgical complications, periodontal, radiographic, aesthetic and patient reported outcomes in subjects receiving implant placement at the time of extraction (Immediate Implant) or 12 weeks thereafter. METHODS: Subjects requiring single tooth extraction in the anterior and premolar areas were recruited in seven private practices. Implant position and choice of platform were restoratively driven. Measurements were performed by calibrated and masked examiners. RESULTS: IMI was unfeasible in 7.5% of cases. One hundred and 24 subjects were randomized. One implant was lost in the IMI group. IMI required bone augmentation in 72% of cases compared with 43.9% for delayed (p = 0.01), while wound failure occurred in 26.1% and 5.3% of cases, respectively (p = 0.02). At 1 year, IMI had deeper probing depths (4.1 ± 1.2 mm versus 3.3 ± 1.1 mm, p < 0.01). A trend for greater radiographic bone loss was observed at IMI over the initial 3-year period (p-trend < 0.01). Inadequate pink aesthetic scores were obtained in 19% of delayed and in 42% of IMI implant cases (p = 0.03). No differences in patient reported outcomes were observed. CONCLUSIONS: Immediate implant placement should not be recommended when aesthetics are important, IMI should be limited to selected cases. Longer follow-up is needed to assess differences in complication rates.

Implant-supported prostheses esthetic outcomes after socket preservation technique.

Bone and soft tissue remodeling after tooth extraction may have dramatic effects. The socket preservation technique has demonstrated to be effective in maintaining volume before implant placement. The Pink Esthetic Score (PES) is an easy and complete evaluation of esthetic parameters. The aim of this study was to compare the PES index of anterior teeth needing to be replaced and the correspondent implant-supported prostheses after the socket preservation technique with 1 year of follow-up. Twenty-four patients were enrolled in this study. Eighteen maxillary central incisors and 6 maxillary lateral incisors were extracted, and then, every alveolar site was treated with the socket preservation technique and filled with Bio-Oss, mixed with fibrin glue, and covered with a collagen sponge. After 6 months of undisturbed healing, implants were placed and left healing for 4 months. After they were regularly loaded and at 1 year of follow-up, peri-implant PESs were recorded. All implants integrated successfully. No dropouts were recorded. Comparing PES results before extraction (mean, 12.25) and after implant loading (mean, 12.35), those around implants are similar if not better, and there are no statistically significant differences as analyzed with the t-test. The socket preservation technique combined with delayed implant placement and a standard healing time before implant loading has demonstrated to be effective in maintaining volumes and also esthetic values around implants compared with PES values before tooth extraction.

Short (5 and 7 mm long) porous implants in the posterior atrophic maxilla: a 5-year report of a prospective single-cohort study.

PURPOSE: The aim of this ongoing prospective study was to determine the 5-year survival rate of short porous dental implants in the posterior atrophic maxilla combined, when necessary, with crestal sinus floor elevation and often adding anorganic bovine bone. MATERIALS AND METHODS: In 87 partially edentulous patients, 110 short porous implants were placed and followed up for 5 years. The implants used were of two lengths (5 and 7 mm) and two diameters (4.1 and 5 mm) and were chosen according to the available crestal height and width. In 47 sites, osteotome sinus floor elevation was performed (in 8 cases compacting basal bone, in 39 adding a xenograft). The unloaded healing period was 6 months. A total of 63 implants were restored with single crowns and 47 were splinted to the adjacent implants. Outcome measures were prosthesis and implant failures, any complications, and peri-implant marginal bone resorption. RESULTS: Five years after loading, no patients dropped out. Eleven implants failed: 2 implants at uncovering and 9 after prosthetic loading. Eleven patients (12.6%) lost 1 implant. In 6 patients (6.9%) a prosthesis failure occurred (implants loaded with single crowns). One surgical complication (membrane perforation) occurred but the implant was normally inserted. No complications occurred during the healing period. In 3 patients, severe peri-implantitis occurred post loading and the implants had to be removed. Two abutments became loose and one crown chipped. At the end of the follow-up period the implant survival rate was 90%, and 93.1% with regard to prosthetic reconstruction. The mean peri-implant marginal bone loss was 1.4 mm. CONCLUSIONS: The use of short porous implants showed an acceptable clinical outcome in the treatment of the posterior maxilla in this interim 5-year report. Longer follow-ups are needed to confirm these results.

Short (5 and 7 mm long) porous implant in the posterior atrophic mandible: a 5-year report of a prospective study.

PURPOSE: The aim of this ongoing prospective study was to determine the 5-year survival rate of short porous implants in the posterior atrophic mandible. MATERIALS AND METHODS: In 40 partially edentulous patients, 55 short porous implants were placed. The implants used were of two lengths (5 and 7 mm) and two different diameters (4.1 and 5 mm) and were chosen according to the available crestal height and width. The unloaded healing period was 4 months. Twenty-one implants were restored with single crowns, 32 were splinted to the adjacent implant, 2 were used with an overdenture and were followed for 5 years. Outcome measures were prosthesis failures, implant failures and complications. RESULTS: No patients dropped out. Nine implants were removed: 1 implant at uncovering and 8 after prosthetic loading. Eight patients lost 1 implant and 1 patient lost 2 implants. Four crowns failed. No complications occurred during the healing period. In 2 patients severe peri-implantitis occurred after loading and the implants had to be removed. At the end of the follow-up period the survival rate was 84% at implant level and 80% at patient level. CONCLUSIONS: The use of short porous implants showed an acceptable clinical outcome in the treatment of the posterior mandible in this interim 5-year report. These preliminary results must be confirmed by longer follow-ups.

Short porous implants in the posterior maxilla: a 3-year report of a prospective study.

The aim of this ongoing prospective study was to determine the 36-month survival rate of short porous implants in the posterior maxilla with 2 to 7 mm of initial bone height in 48 patients. Forty-eight implants were placed; 35 were in sites with a bone height of 5 mm or less and 13 patients required sinus elevation with osteotomes in addition to a xenograft. All implants were loaded with single crowns. At the end of the follow-up period the survival rate was 97.92%. The use of short porous implants showed good predictability in the treatment of the posterior maxilla in this interim 3-year report.

A connective tissue graft envelope technique for the treatment of single gingival recessions: a 1-year study.

Root coverage is the goal of periodontal plastic surgery when treating gingival recessions. The aim of the present study was to evaluate the clinical results 1 year after treatment with an envelope connective tissue graft technique for single recessions. Forty consecutive patients with single recessions were treated. At baseline and 1 year after surgery, recession, probing pocket depth, clinical attachment level, and keratinized tissue height were recorded. After 1 year, the mean differences in recession (3.12 +/- 0.90 mm), clinical attachment level (3.92 +/- 1.00 mm), keratinized tissue height (3.75 +/- 0.95 mm), and probing pocket depth (0.50 +/- 0.64 mm) were statistically significant. Mean root coverage was 95.54% +/- 11.43%; 85% of the treated cases achieved complete root coverage. The envelope connective tissue graft technique showed high predictability in the treatment of single recessions.

Reconstruction of the maxillary midline papilla following a combined orthodontic-periodontic treatment in adult periodontal patients.

OBJECTIVE: The aim of the present study was to evaluate the role of a combined orthodontic-periodontic treatment in determining the reconstruction of midline papilla lost following periodontitis. MATERIAL AND METHODS: Twenty-eight patients, with infrabony defect and extrusion of one maxillary central incisor, were treated. At baseline, all patients presented opening of the interdental diastema and loss of the papilla. At 7-10 days after open-flap surgery, the intrusive movement started. For each patient, probing pocket depth (PPD), clinical attachment level (CAL) and papilla presence index (PI) were assessed at baseline, end of treatment and after 1 year. PI was also evaluated independently in patients with narrow or wide periodontal biotype (NPB-WPB). RESULTS: All parameters showed statistical improvement between the initial and final measurements, and showed no changes at follow-up time. The mean residual PPD was 2.50 mm, with a decrease of 4.29 mm, while the mean CAL gain was 5.93 mm. Twenty-three out of 28 patients improved the PI score at the end of therapy. No statistical difference was recorded in PI values between groups NPB and WPB. CONCLUSION: The presented clinical protocol resulted in the improvement of all parameters examined. At the end of orthodontic treatment, a predictable reconstruction of the interdental papilla was reported, both in patients with thin or wide gingiva.

Orthodontic movement into infrabony defects in patients with advanced periodontal disease: a clinical and radiological study.

BACKGROUND: In cases of advanced periodontal disease with a pathologic flaring of frontal teeth, a combined periodontic-orthodontic therapy may be a reliable approach in order to solve both functional and esthetic problems. The aim of the present study was to evaluate the periodontal tissue alterations following periodontal surgery and orthodontic intrusion in migrated upper central incisors with intrabony defects. METHODS: Ten patients with advanced periodontal disease and an extruded maxillary central incisor infrabony defect at its mesial aspect and probing depth (PD) > or = 6 mm were included in the present study. At baseline, PD and clinical attachment level (CAL) were measured. The vertical and horizontal dimensions of the defects were assessed on standardized radiographs. Seven to 10 days after surgery the active orthodontic treatment started using the segmented arch technique, in order to intrude and move the teeth into the defects. Maintenance therapy was performed every 2 to 3 months until the orthodontic treatment was completed. RESULTS: At the end of treatment, mean PD reduction was 4.35 mm, with a residual mean PD of 2.80 mm. Mean CAL gain was 5.50 mm. The mean radiological vertical and horizontal bone fills were, respectively, 1.35 mm and 1.40 mm. All differences were of statistical significance (P<0.001). CONCLUSION: The present study showed that the combined orthodontic and periodontic therapy performed resulted in the realignment of extruded teeth with infrabony defects, obtaining a significant probing depth reduction, clinical attachment gain, and radiological bone fill.

Orthodontic movement into bone defects augmented with bovine bone mineral and fibrin sealer: a reentry case report.

Periodontal disease can lead to migration of anterior teeth with the presence of infrabony defects. This creates the opportunity for treating such patients with a combined orthodontic-periodontic treatment. In the presented clinical case, an adult periodontal patient with extrusion of the maxillary central incisors and an infrabony defect on their lingual aspects was treated. During the surgical procedure, the bone defects were augmented with a combination of porous bovine bone mineral (Bio-Oss) and a fibrin-fibronectin sealing system (Tissucol). Ten days after surgery, the active orthodontic treatment started, and the teeth were intruded and realigned, moving the roots into the defects. After 6 months, the orthodontic appliances were removed and the teeth were retained by means of a resin-bonded splint. At this time, reduction in probing pocket depth and gingival recession was detected. Twelve months after the initial surgery, a reentry procedure was performed, showing complete filling of the predisposing defects with the presence of bone-like hard tissue. These clinical results suggest that teeth can be successfully moved and intruded into bone defects previously augmented with bovine bone substitute and fibrin glue. During the orthodontic treatment, this combined augmentation material was able to be replaced by bone-like hard tissue. At the end of the therapy, an improvement in esthetics and periodontal health status was registered.