Prevalence of the Alveolar Antral Artery and Its Accessory Arteries in Cone-Beam Computed Tomography Scans.

Alveolar antral artery (AAA) damage can cause perioperative hemorrhage during osteotomy. The aim of this study was to assess the prevalence of AAA presence and evaluate its characteristics using cone-beam computerized tomography (CBCT). One hundred maxillary sinuses were evaluated from 70 CBCT scans. The anteroposterior dimension of each sinus was divided into four equal quarters, and the main artery presence was noted for each section. Arterial diameter as well as distance to sinus floor and to alveolar ridge were measured, and the position of the main artery according to its location relative to the lateral sinus wall was determined. In cases where additional arteries were detected, their diameter and position were also determined. Artery prevalence was 87.0%. In 42% and 8% of the cases respectively, a second and third artery were visualized. No significant association was found between the prevalence of the arteries and age of participants. However, the prevalence of a secondary artery among men (56.4%) was significantly higher than in women (32.8%) (P = .02). Moreover, the main artery diameter was significantly different between sections (P = .014), as was its position. AAA was radiographically detectable in the majority of studied sinuses. In 2 cases, 3 arteries were visible. Arteries with a diameter ≥ 2 mm were not frequent. However, arteries exceeding this diameter must be factored in when choosing surgical techniques. The findings of this study suggest there might be accessory arteries associated with AAA. Therefore, preoperative radiological CBCT examination is necessary prior to any sinus floor elevation surgery.

Standard Drilling Versus Ultrasonic Implant Site Preparation: A Clinical Study at 4 Weeks After Insertion of Conical Implants.

OBJECTIVE: Clinically evaluate implants placed after ultrasonic implant site preparation (UISP) and standard drilling (SD). MATERIALS AND METHODS: Ten patients received 21 implants placed using UISP (n = 11) or SD (n = 10). Bone quality was hand assessed and final insertion torque (IT), resonance frequency analysis (ISQ) at baseline and ISQ, and removal torque values (RTV) at 4 weeks were recorded and compared. RESULTS: Mean IT values were 70.91 and 72.40 N/cm in UISP and SD groups, respectively, and were not statistically different. IT significantly correlated to bone quality. Mean ISQ values at baseline and 4 weeks were not significantly different and were 74.72 and 74.73 for UISP and 76.70 and 73.20 for SD, respectively. Mean ISQ at baseline significantly correlated to IT values and bone quality in both groups. Mean RTV values in both UISP (51.32 N/cm) and SD (53.1 N/cm) were not significantly different but significantly correlated to IT values. All implants achieved osseointegration and were restored. CONCLUSION: Implant placement after ultrasonic preparation can be considered a predictable technique leading to clinical and biological responses similar to SD 4 weeks after insertion.

Bone-to-Implant Contact in Implants with Plasma-Treated Nanostructured Calcium-Incorporated Surface (XPEEDActive) Compared to Non-Plasma-Treated Implants (XPEED): A Human Histologic Study at 4 Weeks.

Titanium implants undergo an aging process through surface hydrocarbon deposition, resulting in decreased wettability and bioactivity. Plasma treatment was shown to significantly reduce surface hydrocarbons, thus improving implant hydrophilicity and enhancing the osseointegration process. This study investigates the effect of plasma surface treatment on bone-to-implant contact (BIC) of implants presenting a nanostructured calcium-incorporated surface (XPEED®). Following a Randomized Controlled Trial (RCT) design, patients undergoing implant surgery in the posterior maxilla received additional plasma-treated (n = 7) or -untreated (n = 5) 3.5 × 8 mm implants that were retrieved after a 4-week healing period for histological examination. Histomorphometric analysis showed that plasma-treated implants exhibited a 38.7% BIC rate compared to 22.4% of untreated implants (p = 0.002), indicating enhanced osseointegration potential. Histological images also revealed increased bone formation and active osteoblastic activity around plasma-treated implants when compared to untreated specimens. The findings suggest that plasma treatment improves surface hydrophilicity and biological response, facilitating early bone formation around titanium implants. This study underscores the importance of surface modifications in optimizing implant integration and supports the use of plasma treatment to enhance osseointegration, thereby improving clinical outcomes in implant dentistry and offering benefits for immediate and early loading protocols, particularly in soft bone conditions.

Alveolar Ridge Preservation Using the One-Piece Autologous Tuberosity Graft: A Clinical, Radiological, and Histological Pilot Study.

This prospective study investigated clinically and radiologically the effectiveness of the use of a combined hard and soft tissue graft retrieved from the maxillary tuberosity and designed for alveolar ridge preservation following tooth extraction. Seven patients scheduled for a single mono-rooted tooth extraction were included in the study. After atraumatic extraction, sockets were filled with a "one-piece" dual tissue graft harvested from the tuberosity using an adjusted trephine. CBCTs were performed before the extraction and 4 months after ridge preservation, to analyze the vertical and horizontal alterations of the ridge, using ITK-Snap software. Clinical measurements of both soft and hard tissues were also assessed during the extraction and implant placement. All sites healed uneventfully. After 4 months, the 3D super-imposition of both CBCTs showed a mean bone volume resorption of 65 ± 76.7 mm3 (10.2 ± 10%). The mean horizontal reduction at 2, 4, and 6 mm from the top of the crest was respectively 1.5 ± 1.3 mm, 0.47 ± 1.4 mm and 0.57 ± 0.7 mm, while the mean vertical loss was 0.026 mm ± 2 mm. The mean soft tissue horizontal gain was 1.73 ± 1.12 mm. The "one-piece" autologous tuberosity graft was proven to be a safe and effective alveolar ridge preservation technique and may represent a feasible, user-friendly, time saving, low-cost solution for minimizing dimensional loss following tooth extraction.

Arsenic Trioxide-Induced Mandibular Osteomyelitis Associated with Mycotic Infestation: A Case Report.

Arsenic trioxide used in endodontic treatments has been shown to cause severe damages to surrounding bone and periodontal tissues. This report describes a case of alveolar osteomyelitis triggered by arsenic trioxide pulp devitalization and associated with mycotic infestation. Following clinical and radiological examinations, the concerned tooth was extracted, bone sequestrum was removed and granulation tissue was debrided. Histopathological biopsy examination, stained with hematoxylin/eosin, Grocott's silver methenamine and periodic acid-Schiff, confirmed the diagnosis of chemical osteomyelitis associated with fungal infestation. Six months postoperatively, normal bone healing was observed.

Nanostructured Calcium-Incorporated Surface Compared to Machined and SLA Dental Implants-A Split-Mouth Randomized Case/Double-Control Histological Human Study.

Background: Implant surface topography is a key element in achieving osseointegration. Nanostructured surfaces have shown promising results in accelerating and improving bone healing around dental implants. The main objective of the present clinical and histological study is to compare, at 4 and 6 weeks, (w) bone-to-implant contact in implants having either machined surface (MAC), sandblasted, large grit, acid-etched implant surface (SLA) medium roughness surface or a nanostructured calcium-incorporated surface (XPEED®). Methods: 35 mini-implants of 3.5 × 8.5 mm with three different surface treatments (XPEED® (n = 16)­SLA (n = 13)­MAC (n = 6), were placed in the posterior maxilla of 11 patients (6 females and 5 males) then, retrieved at either 4 or 6w in a randomized split-mouth study design. Results: The BIC rates measured at 4w and 6w respectively, were: 16.8% (±5.0) and 29.0% (±3.1) for MAC surface; 18.5% (±2.3) and 33.7% (±3.3) for SLA surface; 22.4% (±1.3) and 38.6% (±3.2) for XPEED® surface. In all types of investigated surfaces, the time factor appeared to significantly increase the bone to implant contact (BIC) rate (p < 0.05). XPEED® surface showed significantly higher BIC values when compared to both SLA and MAC values at 4w (p < 0.05). Also, at 6w, both roughened surfaces (SLA and XPEED®) showed significantly higher values (p < 0.05) than turned surface (MAC). Conclusions: Nanostructured Calcium titanate coating is able to enhance bone deposition around implants at early healing stages.

Implant primary stability determined by resonance frequency analysis: correlation with insertion torque, histologic bone volume, and torsional stability at 6 weeks.

OBJECTIVE: To determine if resonance frequency analysis (RFA) correlated with insertion torque (IT), bone volume (BV), and clinical osseointegration at 6 weeks. MATERIALS AND METHODS: For 18 patients, BV was evaluated histologically by retrieving bone core biopsies before placement of 40 dental implants. Peak IT was recorded at implant placement, and RFA values (implant stability quotient [ISQ]) were noted at baseline, 3 weeks, and 6 weeks. Osseointegration was evaluated at 6 weeks when torquing abutments to 30 N. ISQ values were correlated with IT, BV and abutment torquing results. Data were statistically analyzed. RESULTS: ISQ values significantly decreased at 3 weeks and increased at 6 weeks. There was a significant positive correlation between BV and ISQ at baseline and at 3 weeks, but not at 6 weeks, and between ISQ and jaw location, implant diameter and IT at baseline, 3 weeks, and 6 weeks. There was a significant correlation between spinning/painful implants during abutment torquing and low ISQ, low BV, and low IT values. CONCLUSION: Correlations between BV and IT values, and ISQ suggest that RFA may indicate primary implant stability. BV, IT, and ISQ values may anticipate the degree of osseointegration at 6 weeks.

Frictional keratoses on the facial attached gingiva are rare clinical findings and do not belong to the category of leukoplakia.

PURPOSE: To investigate the clinical and histologic features of frictional keratoses located exclusively on the facial attached gingiva and establish whether these belong to the category of leukoplakia. MATERIALS AND METHODS: Over a period of 15 years, 159 patients presenting with oral keratotic plaques, located exclusively on the facial attached gingival mucosa, excluding the edentulous alveolar ridge and retromolar pad area, were retrospectively selected. Clinical and histologic features and the symptoms and progression of these lesions were carefully assessed. RESULTS: The presence of oral frictional keratosis located exclusively on the facial attached gingival mucosa was clinically and immunohistologically diagnosed in 14 of 159 patients (8.8%). Eleven patients (78.5%) showed unilateral involvement, whereas 3 patients (21.5%) had bilateral involvement. The disappearance of the lesions was accomplished in only 9 of 14 patients, resulting from discontinuation of bad habits. Clinically, these lesions appeared as distinct, sharply demarcated, isolated, asymptomatic, homogeneous whitish-plaques that were neither removable nor painful. The plaques did not create discomfort, change shape, or develop into malignancy. Histologically, these plaques showed features superimposable to those present in benign alveolar ridge keratoses. CONCLUSION: The results highlighted that frictional keratoses on the facial attached gingival mucosa 1) are rare findings, 2) clinically appear as "true leukoplakia" but histologically have the same features as benign alveolar ridge keratoses, 3) have no propensity for malignant transformation, 4) have a good prognosis, and 5) have a specific cause, and resolution is accomplished if the frictional element is eliminated. Thus, these must be removed from the category of leukoplakia.

Peak insertion torque correlated to histologically and clinically evaluated bone density.

OBJECTIVE: : Establish a correlation between dental implant insertion torque (IT) and bone density. MATERIALS AND METHODS: : In 18 patients, implant site preparation was initiated using a trephine drill to retrieve a bone biopsy and completed with standard drills. Bone type was assessed during drilling according to surgeon's tactile sense. Forty implants were placed and peak IT values were recorded. Osseointegration was evaluated clinically at abutment connection. Data were analyzed using Pearson product-moment correlation coefficient. RESULTS: : All implants but one achieved osseointegration. D1 and D4 bone types were significantly assessed using tactile sense. IT values ranged from 15 to 150 Ncm with a mean value of 78.30 Ncm. Mean IT was significantly higher in D1 bone (126.67 Ncm) and lower in D4 bone (40.22 Ncm) (P value <0.0001), whereas intermediate values were noted in D2 and D3 bone with no significant difference between these bone types (P value = 0.462). Statistically significant correlation was found between bone volume and IT values (r = +0.771, P < 0.0001). No statistically significant correlation was found between implant length and/or diameter and IT in all bone densities. CONCLUSION: : Clinical assessment of bone density during drilling may be achieved in hard and soft bone but not in intermediate densities. Increasing peak IT values correlated with increasing bone volume. High IT does not seem to alter osseointegration process.

Clinical osseointegration of bone level implants with conical shape and textured surface with low primary stability.

BACKGROUND: Evidence shows lower chance for osseointegration of implants without sufficient primary stability. The present retrospective study observed bone level conical screw implants with textured surface without primary stability. METHODS: Twenty-six Stark conical screw implants, with V-Blast (Vanish Blast) surface treatment were placed with low primary stability, (insertion torque lower than 10 N/cm and visible mobility at lateral load of 250 g). A soft diet was prescribed. osseointegration was assessed applying 30 Ncm of reverse torque 6 months after placement. RESULTS: The 26 implants that did not achieve primary stability still had a survival rate of 96% after the observation period and were classified as successful according with ICOI Pisa consensus conference success, survival, failure classification .96% of the implants showed clinical osteointegration and were successfully restored. After 12 months, all implants remained functional. CONCLUSIONS: It can be concluded that bone-level implants with V-Blast surface in absence of functional loading are able to achieve osteointegration, even with low primary stability.

Early postoperative reactions following lateral sinus floor elevation using piezosurgery: A radiographic study.

BACKGROUND AND PURPOSE: Early postoperative reactions occur following lateral sinus floor elevation (LSFE). This article radiographically describes, quantifies, and measures these early postoperative changes inside grafted maxillary sinus area. MATERIALS AND METHODS: In 24 patients, 31 maxillary sinuses were performed using piezosurgery and grafted by bioceramic materials. Cone beam computed tomography was done preoperatively and then postoperatively, randomly, at either day 1 (n = 6), 2 (n = 11), 3 (n = 8), or 7 (n = 6) and at 6 months for all patients. Membrane thickening and subsequent swelling ratio, submucosal edema, and air bubbles inside grafted area were noted and measured. Inflammation was classified as mild, moderate, or severe. RESULTS: Preoperative mean membrane thickness was 0.75 mm then following LSFE it significantly increased at days 1, 2, 3, and 7 and was respectively 2.36, 4.14, 6.05, and 6.63 mm. Mean swelling ratio significantly increased over time and was 11.37, 13.73, 16.34 and 35.78 at days 1, 2, 3, and 7, respectively. Submucosal edema height was noted in 24 cases. It had a mean value of 3.35 mm and increased significantly with time. Inflammation inside grafted area was mild in 7, moderate in 15, and severe in 9 of the cases. It significantly increased with time. Apical air bubble was present in 19 cases and had mean dimensions of 6.6 × 4.6 mm. No inflammatory signs were noted at 6 months. CONCLUSIONS: Inflammatory reactions are always noted following LSFE and tend to increase with time reaching peak values at 7 days. All inflammatory changes significantly subsided at 6 months.

Primary Stability Optimization by Using Fixtures with Different Thread Depth According To Bone Density: A Clinical Prospective Study on Early Loaded Implants.

Background: Macro- and micro-geometry are among the factors influencing implant stability and potentially determining loading protocol. The purpose of this study was to test a protocol for early loading by controlling implant stability with the selection of fixtures with different thread depth according to the bone density of the implant site. Materials and Methods: Patients needing implant therapy for fixed prosthetic rehabilitation were treated by inserting fixtures with four different thread diameters, selected based on clinical assessment of bone quality at placement (D1, D2, D3, and D4, according to Misch classification). Final insertion torque (IT) and implant stability quotient (ISQ) were recorded at baseline and ISQ measurements repeated after one, two, three, and four weeks. At the three-week measurement (four weeks after implant replacement), implants with ISQ > 70 Ncm were functionally loaded with provisional restorations. Marginal bone level was radiographically measured 12 months after implant insertion. Results: Fourteen patients were treated with the insertion of forty implants: Among them, 39 implants showing ISQ > 70 after 3 weeks of healing were loaded with provisional restoration. Mean IT value was 82.3 ± 33.2 Ncm and varied between the four different types of bone (107.2 ± 35.6 Ncm, 74.7 ± 14.0 Ncm, 76.5 ± 31.1 Ncm, and 55.2 ± 22.6 Ncm in D1, D2, D3, and D4 bone, respectively). Results showed significant differences except between D2 and D3 bone types. Mean ISQ at baseline was 79.3 ± 4.3 and values in D1, D2, D3, and D4 bone were 81.9 ± 2.0, 81.1 ± 1.0, 78.3 ± 3.7, and 73.2 ± 4.9, respectively. Results showed significant differences except between D1 and D2 bone types. IT and ISQ showed a significant positive correlation when analyzing the entire sample (p = 0.0002) and D4 bone type (p = 0.0008). The correlation between IT and ISQ was not significant when considering D1, D2, and D3 types (p = 0.28; p = 0.31; p = 0.16, respectively). ISQ values showed a slight drop at three weeks for D1, D2, and D3 bone while remaining almost unchanged in D4 bone. At 12-month follow-up, all implants (39 early loading, 1 conventional loading) had satisfactory function, showing an average marginal bone loss of 0.12 ± 0.12 mm, when compared to baseline levels. Conclusion: Matching implant macro-geometry to bone density can lead to adequate implant stability both in hard and soft bone. High primary stability and limited implant stability loss during the first month of healing could allow the application of early loading protocols with predictable clinical outcomes.

Changes in Sinus Membrane Thickness After Lateral Sinus Floor Elevation: A Radiographic Study.

PURPOSE: To radiographically monitor sinus membrane swelling after lateral sinus floor elevation surgery at short and long healing periods. MATERIALS AND METHODS: For 26 patients seeking posterior maxillary implant-supported reconstruction, 32 lateral sinus floor elevations were performed using Piezosurgery. Sinus membranes were grafted using synthetic calcium phosphate bone substitutes, and graft volume was measured in cubic centimeters for each case. Cone beam computed tomography (CBCT) examination was conducted preoperatively in all patients and for each grafted sinus at 1 day (n = 8), 2 days (n = 9), 3 days (n = 8), or 7 days (n = 7) after surgery. Control CBCT was then performed for all patients at 3, 6, and 12 months after surgery. Sinus membrane thickness was measured on cross-sectional CBCT images at nine standardized points per sinus, before lateral sinus floor elevation and at all postoperative examinations. RESULTS: Mean sinus membrane thickness was 0.73 mm before surgery, and 5 mm, 4.1 mm, 5.9 mm, and 7 mm, respectively, at 1, 2, 3, and 7 days after surgery. First week combined postoperative CBCT measurements of membrane thickness was 5.4 mm, then 1.3, 0.68, and 0.39 mm at 3, 6, and 12 months, respectively, after surgery. Membrane thickness significantly increased the first week after surgery and gradually decreased significantly at 3, 6, and 12 months in all groups (P < .001). First-week postoperative measurements showed a significant increase in membrane thickness at 3 days compared with the 1- and 2-day results (P < .001) and at 7 days compared with all other time points (P < .001). Membrane thickness at 2 days did not change significantly compared with 1-day measurements. Larger graft volume was positively correlated with an increase in membrane thickness after surgery at all time points (n = 32; r = 0.527; P < .001). CONCLUSION: After lateral sinus floor elevation surgery, transient swelling of sinus membrane is observed. It reaches a peak value 7 days after surgery and completely resolves over months. This swelling is correlated to the extent of sinus floor elevation.