Single-piece zirconia versus single-piece titanium, narrow-diameter dental implants in the anterior maxilla: 5-year post-loading results of a randomized clinical trial.

OBJECTIVES: The aim of this study was to evaluate esthetic parameters in the anterior maxillary region by comparing single-piece zirconia versus titanium narrow-diameter implants. Additionally, clinical, radiological and patient-reported outcome measures (PROMs) were analyzed. MATERIALS AND METHODS: Thirty implants (tissue level implant) were placed in 30 patients in the maxillary esthetic sector. Depending on randomization, a zirconia (test) or titanium implant (control) was placed. Esthetic, clinical, and radiological parameters, including the implant crown esthetic index (ICAI), pink esthetic score (PES), probing pocket depth, bleeding on probing, plaque index, and marginal bone levels, were evaluated at 12, 36 and 60 months after loading. RESULTS: Sixty months after crown placement, no significant differences were found between groups. The ICAI values were 5.25 ± 4.21 and 4.50 ± 2.98 for the test and control groups, respectively. The corresponding PES values were 7.44 ± 1.93 and 7.43 ± 1.74 for the test and control groups, respectively. There were no significant intergroup differences for the rest of the parameters evaluated. CONCLUSION: It can be suggested that monotype zirconia implants may serve as a potential alternative to titanium implants in selected clinical scenarios. While the results demonstrated comparable esthetic, clinical, and radiological aspects for zirconia implants as compared to titanium implants after a 5-year follow-up period, further research with larger sample sizes and longer-term follow-up is recommended.

Titanium vs ceramic single dental implants in the anterior maxilla: A 12-month randomized clinical trial.

OBJECTIVE: The aim of this randomized clinical trial was to compare ceramic and titanium implants with respect to the esthetic and clinical parameters, and patient-reported outcome measures (PROMs). MATERIAL AND METHODS: Thirty patients received thirty implants (8-12 mm in length, 3.3 mm diameter, and a tissue level design) to replace single teeth in the anterior maxilla. Patients were randomly allocated to receive a ceramic or a titanium implant. Esthetic, clinical parameters, and PROMs were evaluated 18 months after surgery. RESULTS: At 12 months post-final loading, there were no significant differences between groups with respect to esthetics. Mean Index Crown Aesthetic score was 6.31 (95% C.I. 4.59-8.04) and 6.07 (95% C.I. 4.21-7.93) for ceramic and titanium implants, respectively. The pink esthetic score (PES) was 7.81 (95% C.I. 6.90-8.73) for ceramic implants and 7.86 (95% C.I. 7.11-8.60) for titanium implants, with no significant differences between groups. No statistically significant differences were found for any of the other clinical parameters and PROMs. CONCLUSIONS: Monotype ceramic implants have proven to be a good treatment option in the upper anterior sector, showing favorable esthetic results, being comparable to titanium implants. This clinical trial has been registered in clinical trials with the identifier CI_RCT_US16 and registration number NCT04707677. A retrospective registration of the clinical trial was carried out since registration was not mandatory on the date the study began.

Saving Single-rooted Teeth with Combined Endodontic-periodontal Lesions.

INTRODUCTION: Teeth affected by combined endodontic-periodontal lesions are usually considered by all prognosis classifications as hopeless teeth. The development of new biomaterials combined with modern endodontic and periodontal regeneration techniques may improve dental prognosis and maintain the affected teeth. Moreover, 1 of the replacement options for those teeth, dental implants, has shown an increasing number of biological and technical complications. METHODS: Five patients were included in this case series study. Full periodontal and radiographic examination revealed generalized chronic periodontitis. Moreover, endodontic-periodontal lesions affecting single-rooted teeth were detected in those patients with tissue destruction beyond the apex. After splinting those teeth, conventional endodontic and nonsurgical periodontal treatment was performed. Three months later, periodontal regeneration was applied at those teeth in order to reconstruct supporting tissues and to improve dental prognosis. RESULTS: After a follow-up period ranging from 14 months to 17 years, it was observed that all teeth remain asymptomatic and in normal function. No signs of apical pathosis were observed, and the periodontium was stable. All patients were included in a strict maintenance program to check the periodontal and apical status. CONCLUSIONS: This case series shows that it is possible to change the prognosis of teeth affected by combined endodontic-periodontal lesions, even if the periodontal support is destroyed beyond the apex.

Morbidity and economic complications following mucogingival surgery in a hemophiliac HIV-infected patient: a case report.

BACKGROUND: This report describes the surgical treatment of a gingival recession in a hemophiliac HIV-infected patient. To our knowledge, mucogingival surgery has not been described previously in these patients. METHODS: Under the supervision of the patient's hematologist, a subepithelial connective tissue graft procedure was carried out to treat the recession. The treatment was performed after substitution therapy with factor VIII concentrate, supported by local antifibrinolytic treatment with epsilonaminocaproic acid. RESULTS: One week after surgery, the grafted zone showed a normal healing, but an area of necrosis appeared at the donor palatal site with spontaneous bleeding. The administration of factor VIII concentrate had to be prolonged to arrest the hemorrhage. In total, 44,500 units of factor VIII concentrate were used, the cost of which reached around $20,000. After 1 month the donor site had re-epithelialized by secondary intention. The root coverage was around 85% successful. CONCLUSIONS: Because of the surgical risk and the high economic cost in the use of the factor VIII concentrate, we do not recommend performing mucogingival surgery in HIV-infected hemophiliacs unless it is absolutely necessary. Prevention and early treatment must be the goal in the management of these patients.