Comparative Clinical Behavior of Zirconia versus Titanium Dental Implants: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Objective: The goal of this systematic review and meta-analysis was to assess whether there were clinically relevant differences in the treatment of edentulous areas comparing zirconia (Zr) and titanium (Ti) dental implants. The null hypothesis is that no differences can be observed in terms of the clinical parameters; the positive hypothesis I is that Zr implants have generally better results compared to Ti implants; and the positive hypothesis II is that Ti implants have a generally superior result than Zr implants. Methods: This review work was registered on the PROSPERO platform, and its development was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. The electronic search process was conducted on three databases (PubMed/Scopus/Web of Science), including randomized controlled trials (RCTs) from the past 10 years (up to April 2024). Identified articles were analyzed and included/excluded based on pre-defined selection and exclusion criteria. The quality assessment and risk of bias were evaluated using a Cochrane risk-of-bias assessment tool specifically designed for randomized trials (RoB2). A meta-analysis was conducted to correlate different treatment options based on the described outcomes; a random-effects model was used in the analysis of the variables. The analysis of heterogeneity was conducted by means of Cochran's Q-test and Higgins' I2 statistic. Results: Six RCTs were enrolled; 152 patients (90 males and 62 females) and 448 implants (267 Zr and 181 Ti) were included. Dental implant placement involved both the maxillary and mandibular arches. The implant sites showed heterogeneity in receiving Zr and Ti dental implants; in particular, 22 dental implants were placed in the mid-palatal region and 426 dental implants in the alveolar region (255 were in Zr and 171 in Ti). Regarding the success rate, it was better for Zr but with no statistical difference (p > 0.05); bleeding on probing had slight differences between Ti with 0.34% ± 0.42 and Zr with 0.26% ± 0.36 (p > 0.05); plaque score showed 0.46 ± 0.47 for Ti compared to 0.44 ± 0.49 for Zr (p > 0.05); no statistically significant difference was observed for pink esthetic score (PES). Statistically significant results were found for survival rate, which favored Ti implants (77.6%) compared to Zr (70.3%) (p < 0.05), and for marginal bone loss, which showed less loss in Ti implants (0.18 mm ± 0.47) compared to 0.42 mm ± 0.40 in Zr at 12 months (p < 0.001). Conclusions: The present systematic review and meta-analysis identified the positive hypothesis I and rejected the null and positive hypothesis II; it was possible to conclude that Ti dental implants have a better survival rate and less marginal bone loss than Zr dental implants after 1-year follow-up.

Mechanical Behavior of Five Different Morse Taper Implants and Abutments with Different Conical Internal Connections and Angles: An In Vitro Experimental Study.

The present study evaluated the mechanical behavior of five designs of Morse taper (MT) connections with and without the application of loads. For this, the detorque of the fixing screw and the traction force required to disconnect the abutment from the implant were assessed. A total of 100 sets of implants/abutments (IAs) with MT-type connections were used, comprising five groups (n = 20/group): (1) Group Imp 11.5: IA sets with a cone angulation of 11.5°; (2) Group SIN 11.5: with a cone angulation of 11.5°; (3) Group SIN 16: with a cone angulation of 16°; (4) Group Neo 16: with a cone angulation of 16°; and (5) Group Str 15: with a cone angulation of 15°. All sets received the torque recommended by the manufacturer. After applying the torque, the counter torque of the fixing screws was measured in ten IA sets of each group without the application of cyclic loads (frequencies ≤ 2 Hz, 360,000 cycles, and force at 150 Ncm). The other ten sets of each group were subjected to cyclic loads, after which the detorque was measured. Afterwards, the force for disconnection between the implant and the abutment was measured by traction on all the samples. The untwisting of the abutment fixation screws showed a decrease in relation to the initial torque applied in all groups. In the unloaded samples, it was found to be -25.7% in Group 1, -30.4% in Group 2, -36.8% in Group 3, -29.6% in Group 4, and -25.7% in Group 5. After the applied loads, it was found to be -44% in Group 1, -43.5% in Group 2, -48.5% in Group 3, -47.2% in Group 4, and -49.8% in Group 5. The values for the IA sets were zero for SIN 16 (Group 3) and Neo16 (Group 4), both without and with loads. In the other three groups, without loads, the disconnection value was 56.3 ± 2.21 N (Group 1), 30.7 ± 2.00 N (Group 2), and 26.0 ± 2.52 N (Group 5). After applying loads, the values were 63.5 ± 3.06 N for Group 1, 34.2 ± 2.45 N in Group 2, and 23.1 ± 1.29 N in Group 5. It was concluded that in terms of the mechanical behavior of the five designs of MT IA sets, with and without the application of loads, the Imp 11.5, SIN 11.5, and Srt 15 groups showed better results compared to the SIN 16 and Neo 16 groups, showing that lower values of cone angulation increase the friction between the parts (IA), thus avoiding the need to maintain the torque of the fixing screw to maintain the union of the sets.

Use of Local Melatonin with Xenogeneic Bone Graft to Treat Critical-Size Bone Defects in Rats with Osteoporosis: A Randomized Study.

The aim of this study was to evaluate the effect of local administration of melatonin (MLT) on molecular biomarkers and calvaria bone critical defects in female rats with or without osteoporosis, associated or not with a xenogeneic biomaterial. Forty-eight female rats were randomly divided into two groups: (O) ovariectomized and (S) placebo groups. After 45 days of osteoporosis induction, two critical-size defects (5 mm diameter) were created on the calvaria. The groups were subdivided according to the following treatment: (C) Clot, MLT, MLT associated with Bio-Oss® (MLTBO), and Bio-Oss® (BO). After 45 days, the defect samples were collected and processed for microtomography, histomorphometry, and biomolecular analysis (Col-I, BMP-2, and OPN). All animals had one femur harvested to confirm the osteoporosis. Microtomography analysis demonstrated a bone mineral density reduction in the O group. Regarding bone healing, the S group presented greater filling of the defects than the O group; however, in the O group, the defects treated with MLT showed higher mineral filling than the other treatments. There was no difference between the treatments performed in the S group (p = 0.05). Otherwise, O-MLT had neoformed bone higher than in the other groups (p = 0.05). The groups that did not receive biomaterial demonstrated lower levels of Col-I secretion; S-MLT and S-MLTBO presented higher levels of OPN, while O-C presented statistically lower results (p < 0.05); O-BO showed greater BMP-2 secretion (p < 0.05). In the presence of ovariectomy-induced osteoporosis, MLT treatment increased the newly formed bone area, regulated the inflammatory response, and increased OPN expression.

Implant Stability and Histomorphometric Analysis Comparing Two Different Implant Macrogeometries Placed in Fresh Sockets: An Experimental Study in Sheep.

PURPOSE: The aim of the present animal study was to examine the impact of two implant designs that promote different insertion torque values on implant stability and evaluate, histomorphometrically, the bone healing for immediate implant placement in fresh sockets. MATERIALS AND METHODS: Twelve female sheep (35.0±5.0kg) and 48 conical Morse-taper dental implants divided into two groups (n = 24 per group): G1 group, where the implants present a design that can provide high insertion torque values; and G2 group, where the implants present a design that can provide low insertion torque values. Both had the same surface treatment, and dimensions (4.0 mm in diameter and 10 mm in length). The first two posterior teeth (both sides) were extracted carefully. Sequentially, there were osteotomies in the mesial socket of each molar tooth. The final implant position was 2 mm below the buccal bone crest level. On the right side, implants of the G1 were placed anteriorly, followed by implants of the G2; and, on the left side, it was the reverse. A digital torquemeter was used to measure the maximum final insertion torque value (f-IT). The initial implant stability quotient (ISQ) was measured immediately after the implant insertion (T0) and immediately after the euthanasia and removing the mandibles with the implants. The animals were euthanized (n=6 animals/ time) at 21 days (T1) and 35 days (T2). The t-test was used to compare statistical differences for each intragroup parameter analyzed. Pearson's correlation was used to analyze possible correlations: f-IT and BIC%, f-IT and ISQ, and ISQ and %BIC. RESULTS: Regarding the insertion torque, the G1 presented higher values than the G2, with a statistically significant difference (p<0.0001). The ISQ mean values were higher in the B-L direction than those obtained for M-D for both groups. %BIC measurements showed higher values in samples from G2 than G1 at both times and in both directions. New bone, medullary spaces, and collagen matrix had statistical differences between the groups at each evaluation time. CONCLUSION: Using implants with a modified macrogeometry plays a significant role in implant stability and the healing process of bone tissue around the implant. It is important for clinicians to carefully consider implant macrogeometry when planning dental implant surgery to achieve optimal implant stability and successful osseointegration, mainly in cases of immediate implant placement.

The Impact of Technology Teaching in the Dental Predoctoral Curriculum on Students' Perception of Digital Dentistry.

The goal was to assess dental students' perception of digital technologies after participating in a CAD/CAM exercise for scanning, designing, and manufacturing computer-aided provisional fixed dental restorations. A survey was conducted among second- (pre-D2 and post-D2), first- (D1, negative control), third-, and fourth-year dental students (D3 and D4, positive controls). Only OSU College of Dentistry students who completed the activity and completed the surveys were included. Seven questions were rated, which evaluated changes in knowledge, skill, interest, the importance of technology availability in an office, patients' perception of technology, the importance of having the technology, and the expected frequency of clinics utilizing the technology. Statistical analysis was performed with a significance level of 0.05. A total of 74 pre-D2 and 77 post-D2 questionnaires were completed. Additionally, 63 D1, 43 D3, and 39 D4 participants responded to the survey. Significant differences were found for "knowledge" and "skill" between the pre-D2 and post-D2 and pre-D2 and control groups (p < 0.001). There was a significant difference between the post-D2 participants and all the controls in terms of "interest" (p = 0.0127) and preference for in-practice technology availability (p < 0.05). There were significant results between the post-D2 participants and all the controls regarding the importance of technology availability in an office (p < 0.001) and the expected frequency of clinics utilizing the technology (p = 0.01). No significance was found for "value of technology to patients" and "the importance of having the technology". The presence of technology in practice and in educational academic environments significantly improved students' interest and perception of their knowledge and skill.

The Use of Tissue Grafts Associated with Immediate Implant Placement to Achieve Better Peri-Implant Stability and Efficacy: A Systematic Review and Meta-Analysis.

Background: The goal of this systematic study and meta-analysis was to evaluate the efficacy of hard and/or soft tissue grafts associated with type-1 implants on healing and treatment outcomes. The primary outcomes studied were implant survival rate, pocket depth, marginal peri-implant recession, bone loss, bone thickness (volumetric change), interproximal bone level, mesial and distal papilla migration, and radiographic evaluation; and the secondary parameters were Pink Esthetic Score (PES), vertical distance from implant shoulder and bone, Visual Analogue Score (VAS), Implant Stability Quotient (ISQ), and biological complications (fistulas, pain, mucositis, and peri-implantitis). Methods: The PICO strategy was used to formulate the hypothesis under study: "For patients who underwent extraction and immediate implant placement, what is the efficacy of using any type of graft (bone or soft tissue) compared to non-grafting regarding the peri-implant parameters?" The electronic search process was performed on the MedLine/PubMed and Cochrane databases. It included randomized controlled trials (RCTs) from the last 11 years (from 2012 to November 2023), which were identified and analyzed. Results: Nine RCTs (κ = 0.98) were selected (403 patients and 425 implants); they were divided into three groups: bone graft (75 patients and 75 implants inserted), bone graft and membrane (213 patients and 235 implants inserted), and without bone graft (115 patients and 115 implants inserted). Three studies calculated the mid-facial mucosa level and two reported better results when a connective tissue graft was combined with the xenograft, whereas another study found better results in the combination of a dual-zone technique with a xenograft. Three studies evaluated the total Pink Esthetic Score (PES) at 12 months, where the authors found no significant difference in using a xenogeneic graft with or without a membrane. In the same period, the facial bone thickness was assessed in two articles; the authors reported better results in graft-treated and flapless groups. The risk-of-bias assessment found four studies with low risk, four with moderate risk, and one with a high risk of bias. The meta-analysis showed a medium level of heterogeneity for the mid-facial mucosa level analysis (I2 = 46%) and an overall effect size of 0.79 (95% CI [0.18; 1.40]), a statistically significant results (p = 0.01), with a tendency to favor the experimental group. Also, there was a medium level of heterogeneity among studies regarding total PES (I2 = 45%), with no significant differences between studies (p = 0.91). Homogeneous results (I2 = 0%) were found among studies analyzing facial bone thickness, favoring the experimental group; the forest plot showed an effect of 0.37 (95% CI [0.25; 0.50]), which was statistically significant (p < 0.00001) for this parameter. Conclusions: Then, it was possible to conclude that using bone and soft tissue grafting techniques associated with immediate implant placement (IIP), even though they are not fundamental, was a valuable resource to prevent significant tissue reduction, reaching greater bone stability and higher levels in the Pink Esthetic Score (PES) and Visual Analogue Score (VAS).

Fibroblasts and osteoblasts behavior after contact with different titanium surfaces used as implant abutment: An in vitro experimental study.

Background: The goal of this in vitro study was to compare three different surfaces: two types of implant surfaces commercially available ([a] smooth/machined and [b] acid-treated surface) versus (c) anodized surface. Discs were manufactured with commercially pure titanium (CP) grade IV, which were subsequently analyzed by scanning microscopy and fibroblastic and osteoblastic cell cultures. Methods: Ninety-nine discs (5 × 2 mm) were manufactured in titanium grade IV and received different surface treatments: (i) Mach group: machined; (ii) AA group: double acid etch; and (iii) AN group: anodizing treatment. Three discs from each group were analyzed by Scanning Electron Microscopy (SEM) to obtain surface topography images and qualitatively analyzed by EDS. Balb/c 3T3 fibroblasts and pre-osteoblastic cells (MC3T3-E1 lineage) were used to investigate each group's biological response (n = 10/cellular type). The data were compared statistically using the ANOVA one-way test, considered as a statistically significant difference p < 0.05. Results: The AA group had numerous micropores with diameters between 5 and 10 µm, while nanopores between 1 and 5 nm were measured in the AN group. The EDX spectrum showed a high titanium concentration in all the analyzed samples. The contact angle and wetting tension were higher in the AA, whereas similar results were observed for the other groups. A lower result was observed for base width in the AA, which was higher in the other two groups. The AN showed the best values in the fibroblast cells, followed by Mach and AA; whereas, in the culture of the MC3T3 cells, the result was precisely the opposite (AA > Mach > AN). There was similar behavior for cell adhesion for the test groups (Mach and AN), with greater adhesion of Balb/c 3T3 fibroblasts compared to MC3T3 cells; in the AA group, there was greater adherence for MC3T3 cells compared to Balb/c 3T3 fibroblasts. Conclusions: The findings suggest that different surface characteristics can produce different biological responses, possibly cell-line dependent. These findings have important implications for the design of implantable medical devices, where the surface characteristics can significantly impact its biocompatibility.

Evaluating Glass Ionomer Cement Longevity in the Primary and Permanent Teeth-An Umbrella Review.

The aim of this umbrella review was to evaluate the longevity of glass ionomer cement (GIC) as a restorative material for primary and permanent teeth. Research in the literature was conducted in three databases (MedLine/PubMed, Web of Science, and Scopus). The inclusion criteria were: (1) to be a systematic review of clinical trials that (2) evaluated the clinical longevity of GICs as a restorative material in primary and/or permanent teeth; the exclusion criteria were: (1) not being a systematic review of clinical trials; (2) not evaluating longevity/clinical performance of GICs as a restorative material; and (3) studies of dental restorative materials in teeth with enamel alterations, root caries, and non-carious cervical lesions. Twenty-four eligible articles were identified, and 13 were included. The follow-up periods ranged from 6 months to 6 years. Different types of GICs were evaluated in the included studies: resin-modified glass ionomer cement (RMGIC), compomers, and low- and high-viscosity glass ionomer cement. Some studies compared amalgam and composite resins to GICs regarding longevity/clinical performance. Analyzing the AMSTAR-2 results, none of the articles had positive criteria in all the evaluated requisites, and none of the articles had an a priori design. The criteria considered for the analysis of the risk of bias of the included studies were evaluated through the ROBIS tool, and the results of this analysis showed that seven studies had a low risk of bias; three studies had positive results in all criteria except for one criterion of unclear risk; and two studies showed a high risk of bias. GRADE tool was used to determine the quality of evidence; for the degree of recommendations, all studies were classified as Class II, meaning there was still conflicting evidence on the clinical performance/longevity of GICs and their recommendations compared to other materials. The level of evidence was classified as Level B, meaning that the data were obtained from less robust meta-analyses and single randomized clinical trials. To the best of our knowledge, this is the first umbrella review approaching GIC in permanent teeth. GICs are a good choice in both dentitions, but primary dentition presents more evidence, especially regarding the atraumatic restorative treatment (ART) technique. Within the limitation of this study, it is still questionable if GIC is a good restorative material in the medium/long term for permanent and primary dentition. Many of the included studies presented a high risk of bias and low quality. The techniques, type of GIC, type of cavity, and operator experience highly influence clinical performance. Thus, clinical decision-making should be based on the dental practitioner's ability, each case analysis, and the patient's wishes. More evidence is needed to determine which is the best material for definitive restorations in permanent and primary dentition.

Minimally invasive periodontal regeneration with the buccal approach: a systematic review and meta-analysis of clinical studies.

OBJECTIVE: The aim of this study was to investigate clinical periodontal parameters after treatment using the Minimally Invasive Surgical Technique (MIST), Modified Minimally Invasive Surgical Technique (M-MIST), and/or any technique for papilla preservation, such as Entire Papilla Preservation (EPP), modified-papilla preservation technique (M-PPT), or simplified-papilla preservation technique (SPPT). METHODS: The focus question was "For patients with periodontal intrabony defects (P), what is the best minimally invasive regenerative approach (I), comparing MIST, M-MIST, and papilla preservation techniques' outcomes (C) to improve PD, CAL, GR, and periodontal stability (O)?" An online search was conducted on PubMed, Cochrane Library, and Embase. Only randomized clinical trials and case series with a minimum of 10 enrolled patients were included. The risk of bias was evaluated using the Critical Appraisal tools in JBI Systematic Reviews. The meta-analysis compared the data obtained for the periodontal parameters analyzed, and the heterogeneity was verified. RESULTS: After the screening, nine articles were included. Seven studies applied MIST and its modifications; two used M-PPT, one SPPT, and one approached EPP. A general statistically significant PD reduction and CAL gain were noted between the groups, comparing baseline and follow-up for all articles, independently of the technique or materials used. Also, all studies showed a non-significant increase in the gingival recession. Four studies had a low risk of bias, four had a moderate risk, and only 1 had a high risk. Moderate heterogeneity was found in one analysis for CAL (65.73%); moderate and substantial heterogeneity was found in the PD results (71.91% and 89.19%); and no heterogeneity was found within all analyses for gingival recession (0%). CONCLUSION: MIST, M-MIST, and papilla preservation techniques demonstrated their potential and efficacy to improve periodontal conditions of sites with intrabony defects with minimal morbidity.

Intra- and inter-examiner reliability for diagnostic criteria of temporomandibular disorders (DC/TMD) - axis 1: assessment in a sample of students

Objective: The aim of this study was to analyze the intra- and inter-examiner reliability when using the DC/TMD axis 1 and verify the replicability and validity of the data obtained.Methods: The sample comprised 30 volunteers (students) of the Instituto Universitário de Ciências da Saúde Norte (Portugal). The calibration process consisted of a volunteer selection, theoretical and practical training, data collection, and agreement calculation. Examiners received proper previous training. Three dental practitioners applied the questionnaire (T1) and re-examined all the participants one week later (T2). To measure the degree of inter and intra-examiner agreement, multiple Kappa coefficients were obtained when nominal or ordinal variables were involved. When the correspondence between quantifiable variables was assessed, Pearson correlation coefficients and their statistical significance were replicated.Results: Regarding opening patterns, a strong overall agreement was obtained, only showing discrepancies in left-assisted and unassisted maximum openings (from -0.034 to -0.370 and -0.630 to -0.933, respectively). A high level of inter-examiner agreement during TMJ noise during the opening assessment was obtained, only displaying variations in clicks (Kappa -0.423 to 0.757). Protrusion movement showed negative kappa and weaker agreement of all measurements (Kappa between -0.034 and -0037). Small discrepancies were obtained from palpation assessment (left lateral pole- Kappa -0.034).Conclusion: There was no discernible and persistent difference in the amount of agreement among the three examiners, demonstrating that all three examiners were capable of participating in data collecting by employing the DC/TMD questionnaire. The findings indicated nearly perfect intra- and inter-examiner concordance scores.

Critical-size defects reconstruction with four different bone grafts associated with e-PTFE membrane: A histomorphometric experimental in vivo study.

OBJECTIVES: The goal of this study was to assess the newly formed bone and the remnant biomaterial by comparing four different bone grafts used to treat critical-size defects, associated or not with the non-resorbable membrane. MATERIALS AND METHODS: Two calvaria critical-size bone defects were created in 50 male Wistar rats. They were divided into blood (G1), autogenous (G2), bioglass (G3), hydroxyapatite (G4), and xenograft (G5) groups, associated or not with e-PTFE. The experimental periods were 15 and 45 days. Sections were prepared for histomorphometric assessment. All data were analyzed by the mixed-effects model with multiple comparisons (significance level, p < .05). RESULTS: A similar level of new bone was observed for all groups, associated with a high level of vascularization. G1 and G2 ensured sovereignty over the greater quantity of new bone. A non-significant result was reported comparing groups with and without membranes. No significant result was found between the experimental synthetic biomaterials (G3 and G4). G5L achieved 22.0% of new bone after 45 days (p > .05). All groups had a stable volume of biomaterial kept in the short term (p > .05). G2 was the best material for new bone formation and final volume of biomaterial, followed by G4 < G5 < G3. Thus, it is possible that G4 had a better degradation profile among the experimental groups. CONCLUSIONS: The best results were found in the autogenous group, with higher resorption and integration; non-significative new bone was found among the experimental groups; and the regeneration of critical bone defects using an e-PTFE barrier did not present significant results on new bone formation.

Mixed-Thickness Tunnel Access (MiTT) through a Linear Vertical Mucosal Incision for a Minimally Invasive Approach for Root Coverage Procedures in Anterior and Posterior Sites: Technical Description and Case Series with 1-Year Follow-Up.

PURPOSE: The goal of this article was to introduce a new root coverage (RC) technique, the mixed-thickness tunnel access (MiTT) technique, which approaches a full-split design and intends to augment soft tissues coronal to the gingival margin. It was shown step-by-step, and the results were presented in a case series. METHODS: Healthy individuals (non-diabetics) and non-smokers with gingival recession (GR) type 1 or 2 (RT1 or RT2) were included. After evaluation, prophylaxis was performed 14 days before the surgical procedure. During the surgical appointment, one or two vertical incision(s) on the mucosa (around 1-2 mm apical to the MGJ), lateral to the papilla base, was/were performed after anesthesia. Initially, there was a partial incision to detach the mucosa of the muscles (split design). It was permitted (but not mandatory) to perform intrasulcular incisions. Through the vertical incision, internally, subperiosteal access from the MGJ toward the gingival margin (coronally) was performed to create a full-thickness tunnel. Then, communication from the vertical incision with the gingival sulcus and the papilla base occurred, keeping the papilla tip intact. A connective tissue graft was harvested and inserted through the linear incision or intrasulcularly. There were interrupted sutures. An adjunctive material may be applied (e.g., Endogain). The root coverage was measured using a periodontal probe and considered fully covered when the gingival margin was 1 mm coronal to the cementum-enamel junction (CEJ). RESULTS: Nine healthy individuals (seven females and two males) aged 19 and 43 were enrolled. They were treated following the MiTT steps. Four cases had a single GR; two patients had two teeth involved; and three others had three or four GR. There were seven cases of RT1 and two RT2. All RT1 cases achieved 100% RC, while the mean RC obtained for RT2 was around 80%. CONCLUSION: The MiTT technique can be considered a more straightforward approach for minimally invasive surgical techniques, which is a feasible option to treat RC with a high success rate, predictability, and esthetic preservation. Therefore, there is a technical sensitivity to performing the full-split design procedure.

Histomorphometric evaluation, SEM, and synchrotron analysis of the biological response of biodegradable and ceramic hydroxyapatite-based grafts: from the synthesis to the bed application.

This study aimed to analyze the physicochemical and histological properties of nanostructured hydroxyapatite and alginate composites produced at different temperatures with and without sintering and implanted in rabbit tibiae. Hydroxyapatite-alginate (HA) microspheres (425-600 µm) produced at 90 and 5 °C without (HA90 and HA5) or with sintering at 1000 °C (HA90S and HA5S) were characterized and applied to evaluate thein vitrodegradation; also were implanted in bone defects on rabbit's tibiae (n= 12). The animals were randomly divided into five groups (blood clot, HA90S, HA5S, HA90, and HA5) and euthanized after 7 and 28 d. X-ray diffraction and Fourier-transform infrared analysis of the non-sintered biomaterials showed a lower crystallinity than sintered materials, being more degradablein vitroandin vivo. However, the sinterization of HA5 led to the apatite phase's decomposition into tricalcium phosphate. Histomorphometric analysis showed the highest (p< 0.01) bone density in the blood clot group, similar bone levels among HA90S, HA90, and HA5, and significantly less bone in the HA5S. HA90 and HA5 groups presented higher degradation and homogeneous distribution of the new bone formation onto the surface of biomaterial fragments, compared to HA90S, presenting bone only around intact microspheres (p< 0.01). The elemental distribution (scanning electron microscope and energy dispersive spectroscopy andµXRF-SR analysis) of Ca, P, and Zn in the newly formed bone is similar to the cortical bone, indicating bone maturity at 28 d. The synthesized biomaterials are biocompatible and osteoconductive. The heat treatment directly influenced the material's behavior, where non-sintered HA90 and HA5 showed higher degradation, allowing a better distribution of the new bone onto the surface of the biomaterial fragments compared to HA90S presenting the same level of new bone, but only on the surface of the intact microspheres, potentially reducing the bone-biomaterial interface.

Bone tissue regeneration in peri-implantitis: A systematic review of randomized clinical trials.

Objectives: The goal of this systematic review was to analyze, in randomized controlled clinical trials (RCTs), regenerative techniques used to treat peri-implantitis (PI). Methods: Three databases (PubMed/Medline, EMBASE, and On-Line Knowledge Library) were accessed, applying the PICO strategy (Population [P], Intervention [I], Comparison [C], and Outcomes [O]), with the following focused questions: (i) "In patients who received regenerative treatments for peri-implantitis (P), is the regenerative surgical treatment (I) clinically effective and predictable compared to non-regenerative (C) to treat PI (O)?"; and (ii) "In patients who received regenerative treatments for peri-implantitis (P), the regenerative approach (I), compared to non-regenerative (C), significantly increase the prognosis and implant survival rate in the mid- and long-term (O)?" The inclusion criteria were RCTs published in English between 2012 and 2022, with at least a one-year follow-up, which applied regenerative techniques to treat peri-implantitis. Cochrane's collaboration tool for assessing the risk of bias was used. Main results: Nine articles were included with 404 patients (225 females and 179 males; mean age of 60.44 years). One study evaluated patients after 48 months and another after 88 months. The techniques and devices used were: (i) implantoplasty with Er:YAG laser, (ii) blood concentrate (growth factors), and (iii) EMD, with no statistically significant outcome. Two studies considered the use of titanium granules with a significant increase in radiographic bone identification, whereas regenerative techniques with bone graft (autogenous, alloplastic, and xenograft) were the majority chosen, associated or not, with a collagen membrane. Xenograft had better results radiographically when compared to the autogenous bone graft and presented better results for bone level. There was an overall decrease in bleeding on probing, independent of the control or test group, and a reduction in pocket depth in the groups analyzed. Titanium granules, EMD, Er:YAG laser, and CGF had non-significant results; better results were observed when using bone grafts. The RoB showed a low risk in four studies (44.44%), three with moderate (33.33%), and two with high risk (22.23%). Conclusion: Surgical regenerative treatment was a predictable option in the management of PI and in improving the clinical parameters of peri-implant tissues in the short term, mainly when using porous titanium granules, alloplastic bone grafts, and xenografts.

Deep Carious Lesions Management with Stepwise, Selective, or Non-Selective Removal in Permanent Dentition: A Systematic Review of Randomized Clinical Trials.

OBJECTIVE: The goal of this systematic study was to investigate the effectiveness of selective, stepwise, and non-selective removal techniques for caries removal in permanent teeth with deep carious lesions. The primary focus was the results found comparing techniques for caries removal to check whether there was pulp exposition; the secondary was the materials used for pulp protection and clinical findings reported within the included studies. METHODS: The search was performed in two databases (PubMed/MEDLINE and Web Of Science). The studies included in this systematic review were selected based on eligibility criteria. The inclusion criteria were: (1) randomized controlled trials (RCTs), (2) that compared the total removal of carious tissue with selective removal in permanent teeth with deep carious lesions, (3) with a follow-up period of at least 6 months, and (4) publications in English. Regarding the exclusion criteria, the following were not considered: (1) articles published in other languages, (2) articles that did not compare the different types of total/selective decay removal, and (3) articles published before January 2008. The risk of bias and the quality of the included studies were independently assessed by two reviewers using the RoB 2 tool. RESULTS: 5 out of 105 potentially eligible studies were included. Regarding the teeth included in the study, three articles performed management only on permanent molars, while other studies also performed management on incisors/canines/premolars/molars. Management protocols were divided into nonselective caries removal and partial caries removal (selective/stepwise). The theory of non-selective caries removal was considered an excessive, unnecessarily invasive option and a form of outdated management, and selective removal was preferred. CONCLUSION: The selective removal technique presented a higher success rate and fewer incidences of pulpal exposure than total removal, after up to 18 months of follow up. Moreover, only one session seemed to be a better management choice compared to two sessions because the cavity re-opening procedure is more prone to pulp exposure and highly depends on patient commitment. Otherwise, at 5 years of follow up, there was no difference between selective removal and total removal in management longevity. In addition, there were also no differences between the success of the materials used for definitive restorations in teeth subjected to any of the techniques evaluated.

Evaluation of Behavior of Castable versus Machined Solid Abutments for Morse Tapper Implant Connection: A Clinical Retrospective Study.

Objective: The primary objective of the present retrospective clinical study was to evaluate and compare the clinical performance presented by castable abutments developed for the MT system versus intermediate machined abutments, specifically regarding prosthetic or implant fractures/loss; the secondary objective was to verify the looseness of the abutments and the behavior of the peri-implant soft tissues. Methods: This clinical retrospective study was conducted on patients rehabilitated between 2019 and 2020. Inclusion criteria were patients in good general health, with an implants-supporting single crown; with solid machined abutments (control group) or castable UCLA abutments; with a connection portion (base) machined in cobalt-chrome (test group) over Morse taper DuoCone implants in the posterior mandible area; and at least two years in function. Clinical assessment was carried out by the same professional, considering the following parameters: (A) prosthetic: (i) loosening of the fixation screw, (ii) fracture of the screw and (iii) the number of times the patient had some type of complication after the installation of the prostheses were evaluated; (B) biological: (i) without keratinized mucosa (KM), (ii) 1 mm or less, (iii) between 1 and 2 mm and (iv) greater than 2 mm of KM width; and the presence or absence of mucositis. Furthermore, radiographic evaluation was performed in order to assess the marginal bone loss. These evaluations permitted to compare the groups analyzed and patients enrolled. Data were statistically analyzed, with the level of significance set at α = 0.05. Results: 79 patients with 120 MT implants were evaluated (80 castable UCLA abutments and 40 machined solid abutments). The follow-up was from 2 to 4 years. There was a 100% implant survival rate. Therefore, the control group showed two fractured abutments (5%) and no abutment loosening (95% for prosthetic survival rate), whereas the test group showed no abutment fracture but nine loosening screws (11.3%) (100% for prosthetic survival rate). Keratinized mucosa was considered thin or absent in 19 implants in the control group (47.5%) and 42 in the test group (52.5%). Mucositis was found in 11 implants in the control group (27.5%) and 27 in the test group (33.8%). A positive correlation was observed between the width of keratinized mucosa and mucositis (r = 0.521, p = 0.002). The mean marginal bone loss was 2.3 mm, ranging from 1.1 to 5.8 mm. No correlation was observed when considering marginal bone loss versus the three parameters (implant diameter, implant length and time of the prosthesis in function). Conclusions: The results suggest that UCLA-type abutments are a viable option for rehabilitating implants with Morse taper connections, suggesting lower fracture risk. Further research is necessary to confirm these findings and thoroughly evaluate the clinical performance and long-term outcomes.

New strategy for osseodensification during osteotomy in low-density bone: an in vitro experimental study.

The goal of this in vitro study was to evaluate and propose a new strategy for osseodensification technique using a drill counterclockwise to densification of bone of low density. Synthetic bone blocks of two different low densities (type III and IV) were used for the tests. The conventional drilling group (CD group) used Turbo-drill in a clockwise direction, and the osseodensification group (OD group) applied Turbo-drill in a counterclockwise direction. The applied tests were: (i) measurement of the temperature variation (ΔT) and (ii) measurement of the torque during the osteotomies, comparing the new strategy with the conventional drilling. Both groups were tested without (condition c1) and with (condition c2) irrigation, generating four subgroups: CDc1, CDc2, ODc1, and ODc2. Twenty osteotomies were made for each subgroup with a thermocouple positioned intra-bone (1 mm distant from the osteotomy) to measure the temperature produced. Other 20 samples/group were used to measure the torque value during each osteotomy in both synthetic bone density blocks. The mean of the ΔT during the osteotomies in type III bone was: 6.8 ± 1.26 °C for the CDc1 group, 9.5 ± 1.84 °C for the ODc1, 1.5 ± 1.35 °C for the CDc2, and 4.5 ± 1.43 °C for ODc2. Whereas, in the type IV bone, the ΔT was: 5.2 ± 1.30 °C for the CDc1 group, 7.0 ± 1.99 °C for the ODc1, 0.9 ± 1.05 °C for the CDc2, and 2.7 ± 1.30 °C for ODc2. The maximum torque during the osteotomies was: 8.8 ± 0.97 Ncm for CD samples and 11.6 ± 1.08 Ncm for OD samples in the type III bone; and 5.9 ± 0.99 Ncm for CD samples and 9.6 ± 1.29 Ncm for OD samples in the type IV bone. Statistical differences between the groups were detected in tests and conditions analyzed (p < 0.05). Using the drill counterclockwise for osseodensification in low-density bone generated a significantly greater torque of a drill than in CD and temperature variation during osteotomies. However, the temperature range displayed by the OD group was below critical levels that can cause damage to bone tissue.

Clinical and histomorphometric soft tissue assessment comparing free gingival graft and a collagen matrix as alveolar-sealer materials: a randomized controlled pilot clinical trial.

OBJECTIVE: This study aimed to compare the alveolar sealing performance between free gingival graft (FGG) and porcine collagen membrane (MS) and qualitatively assess patient-centered outcomes via a visual analog scale. METHOD AND MATERIALS: Eighteen patients were randomly divided into control (FGG) and test (MS) groups. After extraction, all the alveoli were filled with bovine bone grafts (small granules) and sealed. Follow-up was during the immediate postoperative period and after 3, 7, 15, 30, 60, 90, and 120 days. After 180 days, before implant placement, tissue samples were obtained for histologic analysis. The epithelial tissues were morphometrically measured for each sample. Qualitative information on the patient's perception of the treatment was collected after 7 days. RESULTS: A faster healing was observed for the MS group. After 60 days, all the sites from the MS were partially healed, in contrast with only five from the FGG. The histologic results after 120 days showed for the FGG group a predominant acute inflammatory process, whereas chronic processes were observed for the MS group. The mean epithelial heights found for the FGG and MS were 535.69 µm and 495.33 µm, respectively (P = .54). The intragroup analysis showed significant variance among the data (P < .001) for both groups. The qualitative result showed statistically more significative comfort for the MS group (P < .05). CONCLUSION: Within the limitations of the study, both techniques effectively promote alveolar sealing. However, the visual analog scale result was superior and more significant for the MS group, with faster wound healing and lower discomfort.

Influence of the Probiotic L. reuteri on Periodontal Clinical Parameters after Nonsurgical Treatment: A Systematic Review.

The aim of this systematic review was to evaluate the actual efficacy of Lactobacillus reuteri (L. reuteri) on the periodontal clinical parameters when used concomitantly to the nonsurgical periodontal treatment. Searches were conducted through PubMed Central, Online Knowledge Library, Science Direct, Scielo, and Cochrane databases from 2012 to 2022. The focused question was "In patients with periodontitis, will the probiotic L. reuteri, when administrated as an adjunct to nonsurgical periodontal treatment, compared to the nonsurgical periodontal treatment alone, result in better clinical outcomes?" The following information was extracted from the articles: author and year of publication, type of study, follow-up, sample size and number of defects, and clinical characteristics and details. All included studies were qualitatively assessed using the Critical Appraisal tools according to the Joanna Briggs Institute. Twenty-four articles were full-text reading, but only 9 articles were included. The number of patients enrolled was 287, aged between 18 and 56 years. All periodontal parameters were evaluated. The "follow-up" varied (14, 40, 84, 90, 180, and 360 days). Most articles supported the clinical benefits of L. reuteri as an adjunct to SRP compared to SRP alone. A common finding at the beginning period was thatno statistically different results were observed between the test and control groups; otherwise, at the last period, a significant improvement was found in favor of the probiotic use (p = 0.001) for all the clinical parameters. The use of L. reuteri as an adjunct to nonsurgical periodontal treatment may result in significantly better clinical outcomes than nonsurgical periodontal treatment alone; but the conclusion must be carefully interpreted because of the heterogeneity found among the studies.