Radiographic evaluation of marginal bone levels around implants supporting splinted fixed bridges: A retrospective study on 412 implants.

OBJECTIVES: The effect of the implant position within the prosthesis on bone remodeling is scarcely documented so far. Thus, the aim of the present study was to investigate whether central implants may suffer higher peri-implant marginal bone levels (MBL) compared to laterals in case of fixed splinted bridges supported by ≥ three implants. MATERIALS AND METHODS: Partially edentulous subjects rehabilitated with at least one fixed bridge supported by ≥ three dental implants were enrolled. MBL was assessed radiographically by means of intraoral radiographs acquired with phosphor plates and imported in a dedicated software. MBL was calculated as the distance between the implant platform level and the most coronal visible bone-to-implant contact. A three-level linear mixed effects model was used for investigating the fixed effect of patient-, prosthesis-, and implant-level variables on the MBL. RESULTS: Overall, 90 patients rehabilitated with 130 splinted fixed bridges supported by 412 implants were included. The median follow-up was 136 months. The mean peri-implant MBL resulted statistically significantly higher at central implants if compared to lateral implants (p < .01). The estimated MBL averages for central and external implants were 1.68 and 1.18 mm, respectively. The prosthesis-level variables suggested that a cement-retained bridge was prone to a significant 0.82 mm higher MBL than a screw-retained one. Implant surface showed an association with MBL changes, although less pronounced than implant retention. CONCLUSIONS: In case of ≥3 adjacent implants supporting splinted bridges, central implants were more predisposed to MBL compared to laterals. At the prosthesis level, implants supporting cement-retained bridges were statistically more susceptible to MBL compared to screw-retained ones. Surface characteristics can also influence MBL stability at the implant level.

Oral health-related quality of life in implant-supported rehabilitations: a prospective single-center observational cohort study.

BACKGROUND: Oral Health-Related Quality of Life (OHRQoL) is a comprehensive concept covering daily comfort, self-esteem, and satisfaction with oral health, including functional, psychological, and social aspects, as well as pain experiences. Despite abundant research on OHRQoL related to oral diseases and hygiene, there is limited data on how patients perceive changes after implant-prosthetic rehabilitation. This study aimed to evaluate OHRQoL and aesthetic perception using OHIP-14 and VAS scales respectively, before (baseline-TB), during (provisional prostheses-TP), and after (definitive prostheses-TD) implant-prosthetic rehabilitation. It also explored the impact of biological sex, substitution numbers, and aesthetic interventions on OHRQoL and VAS scores, along with changes in OHIP-14 domains. METHODS: A longitudinal prospective single-center observational cohort study was conducted with patients requiring implant-prosthetic rehabilitation. Quality of life relating to dental implants was assessed through the Italian version of Oral Health Impact Profile-14 (IOHIP-14), which has a summary score from 14 to 70. Patients' perceived aesthetic was analyzed through a VAS scale from 0 to 100. Generalized Linear Mixed Effect Models, Linear Mixed Effect Models, and Friedman test analyzed patient responses. RESULTS: 99 patients (35 males, 64 females) aged 61-74, receiving various prosthetic interventions, were enrolled. Both provisional and definitive prosthetic interventions significantly decreased the odds of a worse quality of life compared to baseline, with odds ratios of 0.04 and 0.01 respectively. VAS scores increased significantly after both interventions, with estimated increases of 30.44 and 51.97 points respectively. Patient-level variability was notable, with an Intraclass Correlation Coefficient (ICC) of 0.43. While biological sex, substitution numbers, and aesthetic interventions didn't significantly affect VAS scores, OHRQoL domains showed significant changes post-intervention. CONCLUSIONS: These findings support the effectiveness of implant-prosthetic interventions in improving the quality of life and perceived aesthetics of patients undergoing oral rehabilitation. They have important implications for clinical practice, highlighting the importance of individualized treatment approaches to optimize patient outcomes and satisfaction in oral health care.

Detection and sensing of oral xenobiotics in edentulous patients rehabilitated with titanium dental implants: Insights from a scoping review.

STATEMENT OF PROBLEM: Titanium has been considered the standard element in implant manufacturing. Recent studies have evaluated the role of titanium as a biological modulator of oral health. However, evidence regarding the association between the release of metal particles and peri-implantitis is lacking. PURPOSE: The purpose of this scoping review was to evaluate the literature regarding the release of metal particles in peri-implant tissues correlated with the methods of detection and the local and systemic implications. MATERIAL AND METHODS: The study was performed in adherence with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines and was registered with the National Institute for Health Research PROSPERO (Submission No. 275576; ID: CRD42021275576). A systematic search was conducted in the Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE via PubMed, Scopus, and Web of Science bibliographic databases, complemented by a manual evaluation. Only in vivo human studies written in the English language and published between January 2000 and June 2022 were included. RESULTS: In total, 10 studies were included according to eligibility criteria. Different tissues and analytic techniques were reported: the characterization technique most used was inductively coupled plasma mass spectrometry. All 10 studies analyzed the release of metal particles in patients with dental implants, continuously detecting titanium. None of the studies reported a significant association between metal particles and biological effects. CONCLUSIONS: Titanium is still considered the material of choice in implant dentistry, despite the detection of metal particles in peri-implant tissues. Further studies are necessary to evaluate the association between analytes and local health or inflammatory status.

Photobiomodulation Therapy Improves Postoperative Pain and Edema in Third Molar Surgeries: A Randomized, Comparative, Double-Blind, and Prospective Clinical Trial.

PURPOSE: Laser light has biological effects that can modulate inflammatory processes. Thus, this study aimed to evaluate the effects of photobiomodulation (PBM) therapy on pain, edema, and trismus after the extraction of retained third molars. METHODS: A split-mouth, double-blind, randomized clinical trial (RCT) was conducted in 13 patients with similar bilateral third molars who received intraoral application PBM therapy at 4 points with a diode laser at 810 nm wavelength, 6 J (100 mW, 60 seconds/point) on 1 side (the PBM side); and laser irradiation simulation on the other side (SHAM side). The pain was assessed through visual analog scale (VAS) at 0, 12, 24, 48, and 72 hours, number of analgesic-relief (NAR), and mean time of first analgesic use; edema, through VAS, and linear facial measurements at 0, 24, 48, and 72 hours; and trismus, through the mouth opening measurements at 0, 24, 48, and 72 hours. The repeated-measures analysis was applied to assess the effect of the treatment, followed by Tukey's post hoc test for multiple comparisons (P < .05). RESULTS: Thirteen patients (61.77% male and 38.63% female) with age of 24.16 ± 2.06 participated in this research. VAS showed that PBM controlled pain better (7.56 ± 6.25) than SHAM (32.25 ± 22.78) at 24 hours (P < .001) and 48 hours (19.47 ± 9.27 and 39.87 ± 4.21, respectively) (P = .011). VAS also showed that PBM controlled edema better (19.7 ± 13.27) than SHAM (32.38 ± 15.28) at 24 hours (P = .037) and 48 hours (19.47 ± 13.11 and 39.87 ± 22.77, respectively) (P = .002). CONCLUSION: The PBM therapy in this study resulted in pain and edema reduction after third molar surgery and may be considered as adjuvant therapy after the surgical procedure.

Autogenous Chin Block Grafts for Implant-Supported Rehabilitation: A 20-Year Follow-Up Case Series.

The aim of the present study was to analyze the survival and success rates of dental implants placed in atrophic alveolar ridges reconstructed with mandibular symphysis autogenous onlay bone grafts, with a 20-year follow-up. A sample of five patients referred to the authors' department between 2000 and 2001 seeking for an implant-supported fixed rehabilitation. Patients were treated by means of autogenous bone blocks grafted from the mandibular symphysis and covered with bone substitutes (DBB) and a resorbable membrane. Then delayed implants were placed and finally prosthetic restoration was performed. In total, 10 implants placed in 5 patients were evaluated with a follow-up of 20 years. Both implant survival and success rate were 100%. The mean marginal bone loss was 0.32  [[EQUATION]]  0.39 mm (range 0-1.3 mm). Considering the conditions of peri-implant hard and soft tissues, the diagnosis of peri-implant health was made for all the implants included. According to this study, implants placed in alveolar ridges augmented by means of autogenous chin bone grafts showed long-term survival and high success rates. A correct management of peri-implant soft tissues and an accurate prosthetic rehabilitation are also fundamental to obtain the durable success of the treatment.

Cast-free digital workflow for implant-supported rehabilitation in a completely edentulous patient: A clinical report.

Digitalization of edentulous areas restored with dental implants is still considered a demanding procedure, mainly because of the lack of fixed reference landmarks, together with an increased interimplant distance. To overcome such limitations, an auxiliary device is introduced with the 3-fold purpose of stretching the soft tissues with a fixed object connected to the scan bodies, creating areas with nonhomogeneous architectures between the implants, and shortening the interimplant distance with the interposition of solid geometric figures. The rationale was to increase the accuracy of digital scans in a cast-free digital implant workflow.

Accuracy evaluation of computer-guided implant surgery associated with prototyped surgical guides.

STATEMENT OF PROBLEM: Correct implant placement by means of a pretreatment planning software program is still subject to deviations between the planned and achieved implant positions. Inaccuracy at this level may have drastic consequences, including neurovascular trauma. Further data are therefore needed to evaluate the accuracy of such computer-guided implant planning software programs. PURPOSE: The purpose of this clinical study was to evaluate the accuracy of computer-guided implant surgery associated with prototyped surgical guides. MATERIAL AND METHODS: Cone beam computed tomography (CBCT) scans were made of the participants with a tomographic guide to merge anatomic and prosthetic data. This allowed virtual planning with a prosthetically guided approach respecting the anatomy of the participant. A prototyped surgical guide was then fabricated from the virtual plan, determining the intrasurgical position of the implants. Flapless guided implant surgery was carried out according to the manufacturer's instructions. A second CBCT was made 30 days after the surgery, to enable overlapping of the data from before and after the implant placement. The angular, coronal, central, and apical deviations of the placed implants were measured and compared with those virtually planned. The data were submitted to descriptive statistic and intraclass correlation coefficient (ICC), analysis of variance, and the Student t test (α=.05). RESULTS: A total of 61 implants were analyzed. The mean angular deviation was 2.04 degrees. The mean coronal, central, and apical linear deviations were 0.68 mm, 0.72 mm, and 0.82 mm, respectively. No statistically significant difference was found between the virtual and the real position of the implants inserted. A tendency toward a greater absolute error was observed in the mandible than in the maxilla in terms of angular (P=.047), central (P=.043), and coronal error (P=.031). CONCLUSIONS: Flapless computer-guided implant surgery with virtual planning had some angular and linear deviations; nevertheless, this technique should be acceptably safe and accurate.

Dense Polytetrafluoroethylene Membrane versus Titanium Mesh in Vertical Ridge Augmentation: Clinical and Histological Results of a Split-mouth Prospective Study.

AIM AND OBJECTIVE: The aim of the present split-mouth prospective study was to evaluate clinically and histologically the bone regeneration obtained following preprosthetic vertical bone augmentation performed with titanium-reinforced dense polytetrafluoroethylene membrane (d-PM) compared to titanium mesh (TM). MATERIALS AND METHODS: Healthy adult patients presenting with bilateral partial edentulism in the posterior mandible requiring vertical ridge augmentation for implant placement purposes were consecutively included. One side of the mandible was randomly assigned to the use of d-PM, the other to TM. The graft consisted in a mixture of autogenous bone harvested nearby the surgical site and deproteinized bovine bone mineral particles in a 1:1 ratio. On each side during bone augmentation surgery, a 2-mm diameter mini-implant was inserted for clinical and histological analyses. After a healing period of 8 months, the second surgical phase was carried out to remove the nonresorbable barriers, to evaluate clinically the vertical bone gain, and to collect a bone biopsy that included the mini-implant. During the same surgical session, dental implants were inserted in a prosthetically guided position. RESULTS: A total of five patients were enrolled. Eight out of 10 sites healed uneventfully. In the remaining two sites, premature exposure of the TM was observed. Mean vertical bone gain of 4.2 and 1.5 mm was achieved in d-PM and TM groups, respectively (p = 0.06). A mean mineralized tissue of 48.28 and 35.54% was observed in d-PM and TM groups, respectively (p = 0.51). CONCLUSION: The vertical bone gain, although not significantly, was higher in the d-PM group. Similar histological outcomes were noticed if exposure did not occur. In case of wound dehiscence, major resorption was observed. CLINICAL SIGNIFICANCE: Both d-PM and TM can be used to augment atrophic localized ridges vertically. The outcome of bone regeneration seems to be impaired by exposure of the device. How to cite this article: Maiorana C, Fontana F, Rasia dal Polo M, et al. Dense Polytetrafluoroethylene Membrane versus Titanium Mesh in Vertical Ridge Augmentation: Clinical and Histological Results of a Split-mouth Prospective Study. J Contemp Dent Pract 2021;22(5):465-472.

Influence of Timing on the Horizontal Stability of Connective Tissue Grafts for Buccal Soft Tissue Augmentation at Single Implants: A Prospective Controlled Pilot Study.

PURPOSE: The timing for soft tissue augmentation during implant therapy is still debated. Therefore, the present study clinically evaluated whether immediate versus delayed soft tissue augmentation procedures had an impact on the stability of peri-implant mucosal thickness (PMT). MATERIALS AND METHODS: Patients requiring a single implant posterior to the canines in association with soft tissue augmentation procedures at the buccal aspect of single implants using a connective tissue graft (CTG) were enrolled. Patients were randomly allocated to 2 different timing protocols: simultaneous implant and CTG placement (test group) or implant placement and then CTG placement after 3 months (control group). PMT was measured clinically at the mid-buccal aspect of the implant site by bone sounding with an endodontic K-file using customized acrylic stents. PMT measurements were recorded before and after implant placement and at 1, 2, 3, 4, 6, 9, and 12 months after implant insertion. Parametric statistical tests were used to compare PMT between the test and control groups at each study period and to evaluate changes in PMT over time. The level of significance was set at a P value less than .05. RESULTS: Fourteen implants placed in 14 patients were available for statistical comparison. At 12 months, the difference in PMT between the test and control groups was 0.12 ± 0.51 mm. This difference was not statistically significant (P = .54). A significant increase in PMT was observed from baseline to 12 months after implantation in the test (P = .004) and control (P < .001) groups. CONCLUSIONS: The present study indicated that changes in PMT after CTG placement were not influenced by the timing of soft tissue augmentation and remained stable up to 1 year after implant insertion.

Comparative in vivo study of alloy titanium implants with two different surfaces: biomechanical and SEM analysis.

OBJECTIVES: The purpose of this study was to evaluate the biomechanical behavior of the interface formed between bone and implants with machined surfaces (MS) and those modified by Al2O3 sandblasting and acid etching (SBAS). MATERIALS AND METHODS: Before surgery, topographic characterization was performed by SEM-EDX and by mean roughness measurements. Ten Albinus rabbits received randomly 20 Ti-6Al-4V implants on its right and left tibiae, with one implant placed in each tibia. After implant insertion, the implant stability quotient (ISQ) was measured by means of resonance frequency analysis (RFA). After 3 and 6 weeks, the ISQ was again measured, followed by torque removal measurements. Analysis of variance and Tukey tests were used to analyze the data. The surface of the implants removed was evaluated by SEM-EDX. Immunohistochemical analysis of osteopontin (OPN) and osteocalcin (OC) protein was performed in bone tissue. RESULTS: The topographic characterization showed differences between the analyzed surfaces, and the mean roughness values of SBAS group were statistically higher than MS. Overall, higher statistically significant ISQ values were observed in the SBAS group compared to the MS group (p = 0.012). The intra-group comparison of ISQ values in the SBAS group showed statistically significant differences between 0 and 3 weeks (p = 0.032) and 0 and 6 weeks (p = 0.003). The torque removal measurements of group SBAS were statistically higher when compared with the torque removal measurements of group MS in the time intervals of 3 weeks (p = 0.002) and 6 weeks (p < 0.001). SEM-EDX of the implant surfaces removed in SBAS group showed greater bone tissue covering and mean values atomic in percentage of Ca, P, and O statistically superior (p < 0.05) than MS group. Immunohistochemical reactions showed intense OC immunolabeling at 6 weeks postoperative for SBAS group. CONCLUSIONS: The topographical modifications made in group SBAS allowed a better mechanical interlocking between the implant and bone tissue.

Maxillary Alveolar Ridge Atrophy Reconstructed With Autogenous Bone Graft Harvested From the Proximal Ulna.

Atrophy of the alveolar ridge requires bone grafting at the implant site for rehabilitation of the masticatory function with dental implants. Despite the advances in the development of bone substitutes, autogenous bone graft remains the "criterion standard" because of its osteogenic, osteoinductive, osteoconductive potential, and non-immunogenic properties. However, harvesting of autogenous bone is not exempt from donor site morbidity. In this context, the use of autogenous bone derived from the proximal ulna might be a viable resource to obtain corticocancellous bone graft, as the harvesting from this donor site is associated with low morbidity. Thus, this article aimed to describe a case in which a maxillary sinus floor augmentation was performed by means of autogenous bone graft harvested from the proximal ulna, as the donor site. An appositional bone block graft harvested from the same region was used to augment the residual alveolar ridge. Clinically, healing proceeded uneventfully with no major complications. After 8 months, a proper amount of bone was found at the implant site, allowing a prosthetically driven implant insertion and subsequent implant-supported rehabilitation. Results were clinically and radiographically stable after a 3-year follow-up. The present case report suggested that proximal ulna as a donor site should be considered as a safe and reliable alternative for alveolar ridge augmentation. Besides the case presentation, a comprehensive review of the literature was also provided.

Virtually guided alveolar ridge reduction combined with computer-aided implant placement for a bimaxillary implant-supported rehabilitation: A clinical report.

Insufficient crown height space, particularly in the interforaminal region of edentulous ridges with knife-edge morphology, may prevent successful prosthetic rehabilitation. Such conditions require osteoplasty, which might complicate computer-guided implant placement. This clinical report illustrates the treatment of a patient with complete edentulism rehabilitated with a mandibular implant-supported fixed dental prosthesis by using a virtually guided approach. Both alveolar ridge reduction and prosthetically driven implant insertions were computer-guided by surgical stents to increase accuracy and predictability. This approach enabled the immediate loading of the implants with an interim prosthesis before the delivery of a definitive screw-retained fixed prosthesis. At the 1-year follow-up visit, clinical and radiographic examination revealed a stable outcome.

Oral Rehabilitation of a Patient With Ectodermal Dysplasia Treated With Fresh-Frozen Bone Allografts and Computer-Guided Implant Placement: A Clinical Case Report.

Ectodermal dysplasia (ED) is an inherited disorder characterized by abnormality of ectodermally derived structures. A recurrent oral finding is oligodontia, which in turn leads to a severely hypotrophic alveolar process with typical knife-edge morphology and adverse ridge contours. This unfavorable anatomy can seriously hamper proper implant placement. Fresh-frozen bone (FFB) allografts recently have been proposed to augment the residual bone volume for implant placement purposes; however, scientific evidence concerning the use of FFB to treat ED patients is absent. Similarly, data reporting computer-aided template-guided implant placement in medically compromised patients are limited. Thus the purpose of this report is to illustrate the oral rehabilitation of a female patient affected by ED and treated with appositional FFB block grafts and consecutive computer-guided flapless implant placement in a 2-stage procedure. Fixed implant-supported dental prostheses were finally delivered to the patient, which improved her self-esteem and quality of life. During the follow-up recall 1 year after the prosthetic loading, the clinical examination showed healthy peri-implant soft tissues with no signs of bleeding on probing or pathologic probing depths. The panoramic radiograph confirmed the clinical stability of the result. Peri-implant marginal bone levels were radiographically stable with neither pathologic bone loss at the mesial and distal aspects of each implant nor peri-implant radiolucency. Within the limitations of this report, the use of FFB allografts in association with computer-aided flapless implant surgery might be considered a useful technique in patients affected by ED.

Long-Term Retrospective Evaluation of Dental Implants Placed in Resorbed Jaws Reconstructed With Appositional Fresh-Frozen Bone Allografts.

INTRODUCTION: The aim of this study was to evaluate the outcome of fresh-frozen bone allografts in preprosthetic surgery for implant placement purposes. MATERIALS AND METHODS: The cohort comprised 45 patients treated with fresh-frozen bone block grafts and dental implants. Clinical and radiological evaluations were performed to evaluate the survival rate. The data were statistically analyzed with the Kaplan-Meier estimator to assess the influence of possible predictors of implant failure on survival. RESULTS: Overall, 262 implants were retrospectively analyzed. The survival rate was 90.84% over a mean follow-up of 50 months. Comparing the donor site and the position of the implants, no statistically significant differences could be detected (P = 0.7194 and P = 0.2901, respectively), whereas sex resulted in a marginally statistically significant difference (P = 0.0581). When considering age categorized on the median value (≤55/>55 years), age resulted in a statistically significant difference (P = 0.0340), with higher failures found in older people. CONCLUSION: Implant loss was strictly related to the lack of primary osseointegration. Female sex and old age were found to be risk factors, which could negatively influence implant survival.

Poly-D-L-Lactic Acid Membranes for Bone Regeneration.

PURPOSE: To histologically and histomorphometrically evaluate the biocompatibility and the biological properties of perforated and nonperforated poly-D-L-lactic acid (PDLLA) resorbable membranes, using a model of calvarial monocortical bone defects in domestic pigs. METHODS: A total of 6 10 × 10 × 10  mm circular calvarial bone defects were prepared in each of the 3 adult female large white domestic pigs and assigned to the following experimental groups: negative control, nonperforated membrane only, perforated membrane only, bone only, bone + nonperforated membrane, and bone + perforated membrane. The PDLLA membranes were fixed by PDLLA pins by means of an ultrasonic device. After 40 days, bone blocks containing the defects were harvested and histologically processed. RESULTS: A close contact between the PDLLA devices and the surrounding bone was found, and no trace of inflammatory tissue or signs of infection were detected. Bone regeneration occurred from the preexisting bone with a centripetal pattern. Incomplete bone filling was found in empty defects, whereas all sites filled with bone showed a complete bone formation, irrespectively of the presence and the type of membrane used. CONCLUSION: PDLLA membranes and pins showed to be highly biocompatible toward bone tissue and to do not interfere with the bone healing process of monocortical calvaria defects in domestic pigs. No adjunctive effect of PDLLA membranes, irrespectively of their perforated/nonperforated structure, could be evidenced in terms of bone regeneration under the present experimental conditions. Further studies are needed to investigate the regenerative potential of such devices in other clinically relevant models.

Alveolar ridge reconstruction with titanium meshes: a systematic review of the literature.

Alveolar bone regeneration by means of titanium meshes is a widespread procedure, however to date, only few relevant studies were reported in literature concerning this technique. Consequently, the aim of the present systematic review was to analyze the reliability of the titanium mesh as a barrier, in conjunction with horizontal and vertical ridge reconstruction for implant placement purposes. A total of 17 articles complying with the inclusion and exclusion criteria were reviewed. Three outcome variables were defined: a) horizontal and vertical bone regeneration obtained, b) complication rate, defined as the percentage of membrane exposures and c) evaluation of implant survival, success and failure rate.In regards to the vertical regeneration the mean was 4.91 mm (range: 2.56 - 8.6), while a mean of 4.36 mm (range: 3.75 - 5.65) was calculated for horizontal reconstruction.Considering the exposure rate, a mean of 16.1% was found, nevertheless, implant placement were placed in almost all of the sites. A mean success rate of 89,9%, a mean survival rate of 100% and a failure rate of 0% emerged from the data evaluation. A meta-analysis could not be performed due to the heterogeneity of the data, however the final results were comparable with those reported in case of bone regeneration obtained through other types of non-resorbable membranes. An advantage in favour of the titanium mesh was found in terms of bone loss after exposure, as implant placement was not jeopardized in almost all of the cases. It could be deduced that titanium meshes represented a reliable solution for alveolar ridge reconstruction. The clinical studies currently available in literature have shown the predictability of this technique in both lateral and vertical bone regeneration.

Xenograft Combined with a Mixture of Polynucleotides and Hyaluronic Acid (PNs-HA) for Horizontal Alveolar Bone Regeneration: Clinical and Histologic Assessments in a Case Series.

The present case series aims to investigate the use of polynucleotides mixed with hyaluronic acid (PNs-HA) in the form of gel to promote bone regeneration in horizontal alveolar defects. Overall, 6 adult patients underwent localized horizontal guided bone regeneration by means of xenogeneic bone substitute and a resorbable barrier with a staged approach. The graft consisted in a mixture of deproteinized bovine bone mineral (DBBM) particles and PNs-HA gel in a 3:1 ratio, respectively. The material was covered by a resorbable collagen membrane fixed with pins to the underlying bone. Implant placement was performed after 5 months. Healing proceeded uneventfully, and, upon re-entry, the graft appeared well vascularized and firmly attached to the recipient bone. Histologically, the regenerated bone appeared highly mineralized, well-organized in lamellae and totally embedding the residual granules of the biomaterial. Histomorphometric evaluations revealed that newly formed bone occupied on average 41.2% ± 12.4% of the analysed samples. Linear measurements performed on CBCT scans yielded an overall linear horizontal bone gain of 4.91 ± 0.88 mm. These data suggest that a mixture of DBBM and PNs-HA can be safely used to promote bone regeneration in case of horizontal alveolar defects.