Clinical outcomes following atrophic alveolar ridge reconstruction using collagenated xenogeneic bone block or autogenous bone block: One-year follow-up of a randomized controlled clinical.

AIM: This investigation aimed to evaluate the 1-year survival of implants placed after staged lateral alveolar ridge augmentation using equine-derived collagenated xenogeneic bone blocks (CXBBs) or autogenous bone block (ABB). MATERIALS AND METHODS: Fifty patients who underwent lateral augmentation in a previous trial were included. The primary outcome measure was implant survival at the 1-year follow-up, and secondary outcomes included implant success, peri-implant clinical and volumetric parameters, pink aesthetic scores (PES) and patient-reported outcome measures. Data analysis involved Fisher's exact test, the Mann-Whitney U-test and the Wilcoxon signed-rank test. RESULTS: In this study, no late implant failures were observed. The cumulative survival rates were 78.6% for the CXBB group and 90.9% for the ABB group, with no difference between the groups. Similarly, the success rates were 53.6% and 63.6%, respectively, showing no significant difference. Peri-implant clinical and volumetric parameters indicated the presence of healthy peri-implant tissues surrounding implants placed in both CXBB- and ABB-augmented sites. PES were 8.5 and 11.0 for implants placed in CXBB- and ABB-augmented sites, respectively. Furthermore, patient satisfaction rates were high and similar between the groups. CONCLUSIONS: Dental implants placed in both CXBB- and ABB-augmented ridges demonstrated no statistically significant differences in clinical, volumetric and aesthetic outcomes, along with high patient satisfaction rates.

Group 5 ITI Consensus Report: Implant placement and loading protocols.

OBJECTIVES: Working Group 5 was convened to discuss and find consensus on the topics of implant placement and loading protocols associated with single missing teeth in the anterior maxilla (aesthetic zone). Consensus statements, clinical recommendations, patient perspectives and future research suggestions were developed and presented to the plenary for discussion and approval. MATERIALS AND METHODS: Two systematic reviews were developed and submitted prior to the conference. The group considered in detail the systematic reviews and developed statements, clinical recommendations, patient perspectives and future research suggestions based on the findings of the reviews and experience of group members. Definitive versions were developed after presentation to and discussion by the plenary. RESULTS: Five consensus statements were developed and approved from each systematic review. Twelve clinical recommendations were developed by the group based on both reviews and experience. Three patient perspectives were developed, and five suggestions made for future research. CONCLUSIONS: Based on the findings of the systematic reviews and experience of group members, the Type 1A protocol (immediate placement and immediate loading), when utilized in the anterior maxilla under favorable conditions, is considered predictable and is associated with high survival rates. The procedure is considered clinically viable and is associated with aesthetic outcomes, although surgical, technical, and biological complications can occur.

Effectiveness and clinical performance of early implant placement for the replacement of single teeth in anterior areas: A systematic review.

AIM: To assess the effectiveness and clinical performance of early implant placement, 4-8 (Type 2) or 12-16 weeks (Type 3) after extraction, in single anterior sites. METHODS: Studies reporting on Type 2 and Type 3 implant placement were identified. Findings were summarized in evidence tables. Main outcome was implant survival. Peri-implant soft and hard tissues changes, periodontal parameters, aesthetics and patient-reported outcomes were also evaluated. Quality of reporting of the included studies was evaluated through Consort, Newcastle-Ottawa scale and IHE quality appraisal checklist. RESULTS: Nineteen eligible articles (seven from one RCT, three from two CCTs and nine from three case series) reporting on 140 patients and 140 implants were included. Type 3 implants showed comparable results to Type 4: 95% vs. 100% survival rates. Studies reported high values of implant survival, minimal technical and biological complications and high aesthetic scores in both short and long-term follow-ups for both Type 2 and Type 3 implant placement. Quality evaluation highlighted important weaknesses in the included trials. CONCLUSIONS: Limited data on Type 2 and Type 3 implant placement appear to indicate that they can perform well both short and long term. However, the limited number of cases, the significant heterogeneity of the included studies and the high risk of biases importantly reduce the generalizability of the findings. CRD42018117363.

Influence of surgical guide support and implant site location on accuracy of static Computer-Assisted Implant Surgery.

OBJECTIVE: To investigate the effect of surgical guide support and implant site location on the accuracy of static Computer-Assisted Implant Surgery (sCAIS) in partially edentulous patients. MATERIALS AND METHODS: 375 replica implants were inserted in 85 study models. Surgical implant placement was done using static 3D printed surgical guides, which were designed to be supported either by all the teeth present in the model (full arch), or by 4-teeth), 3-teeth or 2-teeth. Each study model included three single-tooth gap (STG) situations; one extraction socket site and two implants placed in a distal extension situation. Preplanned and postoperative implant positions were compared using the treatment-evaluation tool in digital software. 3-dimensional and angular deviations were measured. Statistical analysis was done using ANOVA, and pairwise t tests and Bonferroni-Holm's adjustment were applied as a post hoc test. RESULTS: Accuracy of surgical guides used in sCAIS was significantly affected by the number and type of teeth used for its support. Guides supported by 4 teeth were not significantly different from accuracy of full-arch-supported guides (p > .05). Guide support by posterior teeth was associated with an increased level of accuracy, when compared to anterior teeth guide support. Implants placed in extraction sockets were associated with significantly higher 3D and angular deviation values (p < .05), and surgical guides with a distal extension situation resulted in significantly higher deviation values (p < .05). CONCLUSION: The number and location of teeth supporting the surgical guide can significantly influence the accuracy of sCAIS, with 4 teeth providing equal accuracy to full-arch guides in (STG) situations.

Digital three-dimensional assessment of free gingival graft remodeling over 12 months.

OBJECTIVE: To digitally evaluate the three-dimensional (3D) remodelling of FGG used to treat RT2 gingival recessions and lack of keratinized tissue on mandibular incisor teeth. METHODS: Data from 45 patients included in a previous multicentric RCT were analyzed. Silicone impressions were taken before (baseline) and 3, 6 and 12 months after standardized FGG placement. Casts were scanned and images were superimposed, using digital software, to obtain measurements of estimated soft tissue thickness (eTT; 1, 3, and 5 mm apical to baseline gingival margin). In addition, soft tissue volume (STV) and creeping attachment (CA) were assessed. RESULTS: All patients exhibited postoperative eTT and STV increases, at all time points. The greatest mean thickness gain was observed at eTT3 (1.0 ± 0.4 mm) at 12 months. At 12 months, STV was 52.3 ± 21.1 mm3, without relevant changes compared to the 3- and 6-month follow-up. CA, which was observed as early as six months postoperatively, was evident in ∼85 % of teeth at 12 months. CONCLUSIONS: Application of FGG was an effective phenotype modification therapy, as shown by the significantly increased tissue thickness postoperatively. Despite the use of FGG technique not aiming for root coverage, digital 3D assessment documented the early and frequent postoperative occurrence of CA, which helped improve recession treatment outcomes. CLINICAL SIGNIFICANCE: The use of 3D assessment methodology allows precise identification of the tissue gain obtained with FGG, which, regardless of technique, results in predictable phenotype modification and frequent occurrence of creeping attachment.

Conventional versus flap-protected free gingival graft: a multicenter randomized clinical trial.

The purpose of this study was to compare the outcomes of a modified gingival graft technique, in which the released flap is positioned and sutured over the graft, with the conventional free gingival graft (FGG) procedure, when both are used for gingival augmentation. A 12-month, multicenter parallel randomized controlled trial was conducted. Subjects with buccal RT2 gingival recessions and keratinized tissue width (KTW) < 2 mm in at least one mandibular incisor were randomized to control group (n = 20; conventional FGG) or test group (n = 20; modified FGG; flap sutured over FGG using sling sutures). The primary outcome (KTW) was measured at baseline and after 3, 6 and 12 months, as was keratinized tissue thickness (KTT). Postoperative pain (POP) and analgesic intake were also recorded. Both techniques promoted a significant increase in KTW and KTT when compared to baseline (p < 0.05) with no significant differences between groups (KTW change of 6.1±1.5 mm and 5.4±1.6 mm, for control and test, respectively; p=0.16). However, test group patients reported less POP after 7 days and used less analgesic medication than control group patients (p < 0.05). We concluded that the modified FGG was comparable to conventional FGG in augmenting keratinized tissue width and thickness at mandibular incisors, but resulted in less patient morbidity.

The Impact of the ITI International Team for Implantology on Implant Dentistry: A Retrospective and Descriptive Analysis of 30 Years of Research Support.

PURPOSE: The purpose of this study was to analyze the projects submitted to the ITI International Team for Implantology for funding and the scientific publications ensuing from these projects, over a period of 30 years. MATERIALS AND METHODS: This analysis was performed based on information available in the database of the ITI. For each project, data related to institution, country of origin, and grant status (financed or rejected) were extracted. For the financed projects, the grant amount and number of publications were recorded. Publications were searched independently by two investigators. For all publications, the study topic, study design, and citation number were recorded. RESULTS: From a total of 1,372 submitted projects from 51 different countries and 308 different institutions, 514 (37.46%) were financed by the ITI. This amounts to more than CHF 52 million invested in favor of implant dentistry and related fields. A total of 552 publications (including original research and reviews) were identified related to these projects, with the majority being in vitro studies (n = 198), and the most common topic researched was implant surface modification (n = 134). The United States was the country and the University of Bern was the institution with the largest number of financed projects and published papers. CONCLUSION: This analysis revealed that the ITI has been actively supporting research in the field of implant dentistry and related areas globally. Several concepts in present-day implantology are based on literature from ITI-funded projects.

Correlation between age, gender, and the number of diagnoses of temporomandibular disorders through magnetic resonance imaging: A retrospective observational study.

OBJECTIVE: The aim of this study was to evaluate the correlation among age, gender and the number of temporomandibular disorder (TMD) findings. METHODS: The records from 228 patients with TMD were analyzed for the presence of these findings: morphological changes, disc displacement with reduction (DDWR) and without reduction (DDWOR), bone edema, effusion, and avascular necrosis. Statistical analyses were conducted using multinomial regression with a 5% significance level. RESULTS: DDWR was the most frequent finding. Group 1 was composed of 94 patients (41.22%), Group 2, of 67 patients (29.38%), and Group 3, of 67 patients (29.38%). Men were significantly less likely to belong to Group 3 than women (p = 0.5517). Older patients were slightly more likely to fall in Groups 2 and 3 than in Group 1. DISCUSSION: Women were shown to be more susceptible to developing a higher number of concomitant conditions than men, and the number of findings tended to increase with age.

Influence of implant macrodesign and insertion connection technology on the accuracy of static computer-assisted implant surgery.

OBJECTIVE: The aim of this study was to evaluate the effect of three different macrodesigns and two different insertion devices on the accuracy of static computer-assisted implant surgery (sCAIS). MATERIALS AND METHODS: Ninety implant replicas with three different macrodesigns: Soft tissue level (TL), bone level (BL), and bone level tapered (BLT) were placed in 30 dental models with two implant insertion devices: Guided adapter and guided screwed-in mount. Preoperative and postoperative positions of implants were compared and the mean angular deviation, crestal, and apical three-dimensional (3D) deviation were calculated for each implant macrodesign and each insertion device. Data were analyzed using analysis of variance, post hoc t-tests and Bonferroni-Holm's adjustment method. P values less than .05 were considered statistically significant. RESULTS: BLT implants had lower mean 3D deviation values at the crest and the apex when compared with 3D deviations with BL and TL implants (P < .05). Also, BLT implants had lower angular deviations, when compared with BL and TL Implants, however, angular deviations were not statistically significant (P > .05). Considering the insertion device method, no significant differences were noted between insertion devices irrespective of the deviation analyzed. CONCLUSION: The macrodesign of dental implants may have an influence on the accuracy of sCAIS, with tapered designs offering slightly better positional accuracy than parallel-walled macrodesigns independent on the method of insertion used.

Conventional versus flap-protected free gingival graft: a multicenter randomized clinical trial

Abstract The purpose of this study was to compare the outcomes of a modified gingival graft technique, in which the released flap is positioned and sutured over the graft, with the conventional free gingival graft (FGG) procedure, when both are used for gingival augmentation. A 12-month, multicenter parallel randomized controlled trial was conducted. Subjects with buccal RT2 gingival recessions and keratinized tissue width (KTW) < 2 mm in at least one mandibular incisor were randomized to control group (n = 20; conventional FGG) or test group (n = 20; modified FGG; flap sutured over FGG using sling sutures). The primary outcome (KTW) was measured at baseline and after 3, 6 and 12 months, as was keratinized tissue thickness (KTT). Postoperative pain (POP) and analgesic intake were also recorded. Both techniques promoted a significant increase in KTW and KTT when compared to baseline (p < 0.05) with no significant differences between groups (KTW change of 6.1±1.5 mm and 5.4±1.6 mm, for control and test, respectively; p=0.16). However, test group patients reported less POP after 7 days and used less analgesic medication than control group patients (p < 0.05). We concluded that the modified FGG was comparable to conventional FGG in augmenting keratinized tissue width and thickness at mandibular incisors, but resulted in less patient morbidity.

Mandible reconstruction using rhBMP-2: case report and literature review.

Recombinant human bone morphogenetic protein-type 2 (rhBMP-2) is used in oral and maxillofacial procedures due to its endochondral bone formation capacity, and this is also the reason for its use off-label in jaw reconstruction. This study reports a case of an extensive central giant cell lesion along the mandibular body and symphysis. Treatment consisted of enucleation and curettage followed by off-label use of rhBMP-2 associated with bovine bone xenograft. The literature concerning mandibular reconstruction using rhBMP-2 was also reviewed.

Carcinoma in situ in a patient with erythroleukoplakia: challenges in the diagnosis and in the therapeutic choice / Carcinoma in situ in erythroleukoplakia

A 41-year-old Caucasian male smoker presented a red and white plaque on the left jugal mucosa suggestive of oral erythroleukoplakia (OEL). Biopsy followed by microscopic examination revealed carcinoma in situ. Since OEL is considered a precancerous lesion with a high malignant transformation potential, the present case set out to discuss the challenges in diagnosing the condition and choosing the most appropriate treatment. The discussion deals with issues such as whether there is a limit for choosing either a radical or a more conservative approach to treatment and the importance of using a procedure that allows a microscopic examination of the entire lesion. Carcinoma in situ associated with OEL made the treatment planning even more complex in the present case. In order to avoid a mutilating approach, multiple excisions with safety margins were performed, and the patient was instructed not to smoke. A strict 12-month follow-up shows no signs of recurrence of the OEL... (AU)