Introducing a novel educational training programme in dental implantology for pregraduate dental students.

INTRODUCTION: This study aimed to determine whether implant surgery procedures can be implemented in the dental curriculum by designing novel courses for students. Additionally, this study assesses the perception of these courses and how they can be established in the future. MATERIALS AND METHODS: Students from the third to fifth years participated in a programme consisting of 4 modules according to their academic year. The modules taught theoretical and practical content as well as clinical references. After participating, the students completed two questionnaires with research questions (RQ1 = evaluation of the relevance and effects; RQ2 = impact of modules 3 and 4) to evaluate the programme. The questionnaires consisted of 52 statements, each rated on a 6-point scale (1 'totally disagree' to 6 'totally agree'). Cronbach's alpha analysis was used, and median values, interquartile ranges and Pearson correlations (p-value) were statistically calculated. RESULTS: In total, 94 students completed the questionnaires. Cronbach's alpha exceeded 0.7 for all constructs except for one (skills training). The highest evaluated median was 6, and the lowest was 4.75. Pearson correlations were significant (<0.05) for perceived importance/lectures, perceived importance/tutor performance, lectures/skills training, skills training/tutor performance and tutor performance/lectures. Seventeen analysed free comments expressed strong interest in implantology courses for the curriculum. 88% of the students wished for more practical exercises in dental implantology during the curriculum or suggested expanding the programme in the future. CONCLUSION: The programme was highly accepted among dental students. The students wished for more practice in the future to perform supervised procedures on patients.

Indications and surgical technique for distraction osteogenesis of the alveolar bone for augmentation prior to insertion of dental implants.

When bone is limited, short, ultra-short, or narrow implants help to restore oral rehabilitation with an acceptable long-term outcome. This becomes more difficult with severe vertical bone loss. Guided bone regeneration, onlay block transplantation, or sandwich osteotomy have been established to build up these defects. The alternative to the alveolar distraction osteogenesis (ADO) has only been established in some centers, with a standardized protocol. On the one hand, ADO is a biological procedure that allows almost a "restitutio ad integrum" when building up hard and soft tissue. On the other hand, there are clear indications, limitations, and complications of the procedure in the literature. In addition to the literature, concept of Tissue Regeneration by Alveolar Callusdistraction Cologne (TRACC), which has been practiced successfully for over two decades, will be presented for different indications.

How Can Imbalance in Oral Microbiota and Immune Response Lead to Dental Implant Problems?

Dental implantology is one of the most dynamically developing fields of dentistry, which, despite developing clinical knowledge and new technologies, is still associated with many complications that may lead to the loss of the implant or the development of the disease, including peri-implantitis. One of the reasons for this condition may be the fact that dental implants cannot yield a proper osseointegration process due to the development of oral microbiota dysbiosis and the accompanying inflammation caused by immunological imbalance. This study aims to present current knowledge as to the impact of oral microflora dysbiosis and deregulation of the immune system on the course of failures observed in dental implantology. Evidence points to a strong correlation between these biological disturbances and implant complications, often stemming from improper osseointegration, pathogenic biofilms on implants, as well as an exacerbated inflammatory response. Technological enhancements in implant design may mitigate pathogen colonization and inflammation, underscoring implant success rates.

3D maxillofacial surgery planning - one decade development of technology.

Nowadays, techniques and the use of patient specific implants seem to be the recent high technology standard in reconstructive surgery. Surgery planning is as old as the surgery procedures themselves. Any good surgeon, before entering the operating theatre, has a plan for how to proceed. It is based on knowledge and experience in combination of evaluation of all case relevant information. In fact, virtual surgery planning and CAD/CAM reflects the technological "state of the art" into the medical daily practice. Recently, 3D printing technologies became easy and accessible for everyone. Virtual 3D images substituted the plaster models, the film profile analysis switched to digital, 3D printed bone models of the case helped to understand the morphology of the deformity and prepare the osteotomies with "hands on the bone". The authors' own 20 years of experience on surgical planning, the development of digital technologies in oral and maxillofacial surgery is traced and comments on case examples are presented.

Visual grading experiments and optimization in CBCT dental implantology imaging: preliminary application of integrated visual grading regression.

This study uses a general formulation of integrated visual grading regression (IVGR) and applies it to cone beam computed tomography (CBCT) scan data related to anatomical landmarks for dental implantology. The aim was to assess and predict a minimum acceptable dose for diagnostic imaging and reporting. A skull phantom was imaged with a CBCT unit at various diagnostic exposures. Key anatomical landmarks within the images were independently reviewed by three trained observers. Each provided an overall image quality score. Statistical analysis was carried out to examine the acceptability of the images taken, using an IVGR analysis that was formulized as a three-stage protocol including defining an integrated score, development of an ordinal regression, and investigation of the possibility for dose reduction through estimated parameters. For a unit increase in the logarithm of radiation dose, the odds ratio that the integrated score for an image assessed by observers being rated in a higher category was 3.940 (95% confidence interval: 1.016-15.280). When assessed by the observers, the minimum dose required to achieve a 75% probability for an image to be classified as at least acceptable was 1346.91 mGy·cm2 dose area product (DAP), a 31% reduction compared to the 1962 mGy·cm2 DAP default dosage of the CBCT unit. The kappa values of the intra and inter-observer reliability indicated moderate agreements, while a discrepancy among observers was also identified because each, as expected, perceived visibility differently. The results of this work demonstrate the IVGR's predictive value of dose saving in the effort to reduce dose to patients while maintaining reportable diagnostic image quality.

Use of CGF in Oral and Implant Surgery: From Laboratory Evidence to Clinical Evaluation.

Edentulism is the condition of having lost natural teeth, and has serious social, psychological, and emotional consequences. The need for implant services in edentulous patients has dramatically increased during the last decades. In this study, the effects of concentrated growth factor (CGF), an autologous blood-derived biomaterial, in improving the process of osseointegration of dental implants have been evaluated. Here, permeation of dental implants with CGF has been obtained by using a Round up device. These CGF-coated dental implants retained a complex internal structure capable of releasing growth factors (VEGF, TGF-ß1, and BMP-2) and matrix metalloproteinases (MMP-2 and MMP-9) over time. The CGF-permeated implants induced the osteogenic differentiation of human bone marrow stem cells (hBMSC) as confirmed by matrix mineralization and the expression of osteogenic differentiation markers. Moreover, CGF provided dental implants with a biocompatible and biologically active surface that significantly improved adhesion of endothelial cells on CGF-coated implants compared to control implants (without CGF). Finally, data obtained from surgical interventions with CGF-permeated dental implants presented better results in terms of optimal osseointegration and reduced post-surgical complications. These data, taken together, highlight new and interesting perspectives in the use of CGF in the dental implantology field to improve osseointegration and promote the healing process.

Periodontal, Functional, and Esthetic Integration of Peri-Implant Soft Tissue: WHS Concept.

The long-term functional success of implant treatment depends on the stability of the crestal bone around the implant platform. The esthetic result is achieved by adequate quality and quantity of soft tissue in the peri-implant area. The soft tissue creates the buffer area that ensures the mechanical and biological protection of the underlying bone. Therefore, it is necessary to maintain in the long term, not only implant osseointegration, but also the integrity of the soft tissue around the sub- and suprastructures of the implant restoration. To create the protective soft tissue area, it is necessary to ensure 3 criteria. This treatment approach will be defined as TWS-soft tissue management: T for thickness, W for width, and S for stability. There are many ways to achieve the first 2 criteria, which are described in the literature. Achieving the third criterion of stability has become possible only recently because of the development of digital treatment planning, surgically guided, and prosthetic-assisted technology that uses a 1-time abutment and its implementation into the dental practice. The purpose of this article is to present with clinical cases a detailed description of each criterion.

First comparison of a new dynamic navigation system and surgical guides for implantology: an in vitro study.

AIM: The transfer of 3D implant position planning to the clinical site is challenging. The aim of this study was to compare in vitro this transfer accuracy by using dynamic real-time navigation or static surgical guides. MATERIALS AND METHODS: Deviations between planned and actual pilot drill positions were calculated (Denacam and NobelGuide; each n = 90), matching pre- and postoperative CBCT images: entry point, angle, tip (each 3D); depth, mesiodistal/bucco-oral entry points, and angles (each 1D). The influence of the maxilla and mandible, implant region (anterior/posterior), and marker position (ipsilateral/contralateral, Denacam only) was investigated (Mann-Whitney U test). RESULTS: No significant differences occurred regarding entry point (3D), mesiodistal/bucco-oral entry points (1D) or mesiodistal angle (1D) (P > 0.05). The angular and tip deviations (3D) were significantly smaller using Denacam (2.16 ± 0.59 degrees, 0.80 ± 0.55 mm; NobelGuide 2.54 ± 1.19 degrees, 1.09 ± 0.56 mm; P = 0.024, P < 0.0001). The deviations in depth and bucco-oral angle (1D) were significantly smaller using NobelGuide (1.05 ± 0.50 mm, 1.02 ± 1.16 degrees; Denacam 1.50 ± 0.64 mm, 1.51 ± 0.82 degrees; P < 0.0001). Significantly smaller deviations occurred within the mandible (Denacam, 5/8 parameters). Region and marker position showed no influence. No distinct influences were found with the use of NobelGuide. CONCLUSION: Denacam might possibly be a promising alternative to static surgical guides.

Effects of disinfection and sterilization on the dimensional changes and mechanical properties of 3D printed surgical guides for implant therapy - pilot study.

BACKGROUND: The purpose of this research was to investigate the effects of disinfection and three different sterilization methods on the dimensional changes and mechanical properties of three-dimensional (3D) printed surgical guide for implant therapy. The objective was to assess the effects of sterilization procedures in 3D printed drill guide templates with destructive and non-destructive material testing. METHODS: Fifteen identical drill guide templates were produced using a 3D printer. The surgical guides were classified into five groups: three controls, three disinfected (4% Gigasept®, 60 min), three plasma sterilized, three autoclave sterilized (+ 1 bar, 121 °C, 20 min), and three autoclave sterilized (+ 2 bar, 134 °C, 10 min). The templates were digitalized with a Steinbichler SCAN ST 3D scanner. Length was measured under an SZX16 stereomicroscope. A scanning electron microscope was used to study the surface morphology of the drill templates. The hardness, and flexural and compressive strength were measured to assess any changes in the physical characteristics of the material caused by sterilization. The drill guide templates were also examined with a Dage XiDAT 6600 X-ray. During the X-ray examinations, the following parameters were used: 100 kV voltage, 128 AVG averaging, 0.8 W power. One-way analysis of variance (ANOVA) was used to detect the difference between groups. RESULTS: Evaluation of the hardness measurements of the various specimens shows that the hardness of the material was not changed by the plasma sterilization (p = 0.0680), steam sterilization on 121 °C (p = 0.6033) or disinfection process (p = 0.1399). The statistical analysis revealed significant difference in hardness strength of the autoclave sterilized (134 °C) specimens (p = 0.0002). There was no significant difference between the goups regarding the scanning electron microscopic and stereomicroscopic examinations. There was no significant difference regarding the X-ray visibility of the templates to the effect of the disinfection (p = 0.7844), plasma sterilization (p = 0.4091) and steam sterilization on 121 °C (p = 0.9277) and steam sterilization on 131 °C (p = 0.093). The effect of the sterilization was the same in case of both flexural and compressive strength of the material. CONCLUSIONS: Our findings indicate that plasma sterilization and steam sterilization at 121 °C were both suitable for sterilizing the tested 3D printed surgical guides.

Management of a Complex Case during COVID-19 Time Using One-day Digital Dentistry: A Case Report.

AIM AND OBJECTIVE: The aim of the present case report is to describe the digital management of an implant prosthetic rehabilitation performed by the use of different digital technologies, which allowed to successfully perform in 1 day both the surgical and the prosthetical stages with a minimally invasive approach and a high standard of care. BACKGROUND: Coronavirus disease-2019 (COVID-19) pandemic is affecting dental everyday practice. Clinicians have to reduce the number of patients per day and the time they spend in the dental office. Minimally invasive and digital approaches, with less possible exposure and interaction, are suggested to reduce the risk of infection. CASE DESCRIPTION: The failure of a short-span implant prosthetic rehabilitation combined with pain and mobility of the involved teeth was the main complaint reported by a 78-year-old male patient, who asked an urgent appointment to solve the problem. An intraoral scanner allowed the clinician to immediately take a preliminary digital impression of the arch to be treated. The resulting 3D files were sent by e-mail to the dental technician who provided a digital wax-up for the computerized workflow. Computer-aided implantology (CAI) performed using an in-office cone-beam computed tomography (CBCT) allowed clinician to guide the surgical approach in a prosthetic manner. Such an integration inside a well-defined workflow was the key for a successful and rapid treatment. CONCLUSION: By using new innovative digital technology, the treatment was completed in 1 day, reducing the risk of COVID-19 by limiting the number of appointments and reducing contacts in confined environments like the dental office and public transportations. It also helped to reduce materials production and people movement in the treatment of dental emergency. CLINICAL SIGNIFICANCE: The possibility of performing an effective treatment saving time by using efficient technology and a minimally invasive procedure highlights the importance of digital planning in order to optimize every single step of the treatment. Digital workflow reduces also the movement of potentially infected materials from the office to the dental laboratory.

Biofunctionalization of porcine-derived collagen matrix using enamel matrix derivative and platelet-rich fibrin: influence on mature endothelial cell characteristics in vitro.

OBJECTIVES: The present study evaluated the effect of an enamel matrix derivative (EMD) and platelet-rich fibrin (PRF)-modified porcine-derived collagen matrix (PDCM) on human umbilical vein endothelial cells (HUVEC) in vitro. MATERIALS AND METHODS: PDCM (mucoderm®) was prepared to 6 mm (±0.1 mm) diameter discs. PDCM samples were incubated with either EMD, PRF, or control solutions for 100 min at 4 °C before the experiments. Cell-inducing properties of test materials on HUVEC cells were tested with cell proliferation assays (MTT, PrestoBlue®), a cytotoxicity assay (ToxiLight®), a Boyden chamber migration assay, and a cell attachment assay. Scanning electron microscopy (SEM) imaging was performed to determine the surface and the architecture of the modified matrices. RESULTS: Cell proliferation was elevated in the EMD and PRF groups compared with control (p each ≤0.046). PRF modification increased HUVEC migration ability by 8-fold compared with both control and EMD groups (p each <0.001). Both treatments significantly promoted the cell attachment of HUVEC to PDCM, as assessed by direct cell counts on the matrices (p each <0.001). CONCLUSIONS: HUVEC cell characteristics were overall improved by EMD- and PRF- modified PDCM. Adsorbed bioactive molecules to the PDCM surface may have contributed to a more preferable environment to surrounding cells. CLINICAL RELEVANCE: The results may give evidence that PDCM modification with EMD or PRF, respectively, might be a useful approach to improve clinical outcomes, to prevent inflammatory reactions and wound-healing disturbances, and to expand the clinical application area of PDCM.

Possibilities and limitations of computer-assisted implant planning and guided surgery in the anterior region.

Three-dimensional (3D) implant positioning is an important prognostic factor for anterior dental implants. Modern 3D imaging and implant treatment planning systems are available today for precise dental implant planning and placement. The transfer of implant position information to industrially manufactured templates for guided implant surgery has been possible for years now. What is new is the possibility of combining the datasets with the surface scan data of a diagnostic wax-up and setup for prosthetic-driven implant planning. Digital setups can also be used. This article describes and discusses the available options for digital implant planning and guided surgery.

Dental Implants and Incisor Bridge Placement in a Dog.

Veterinary dentistry has tended to follow the trends and advancements in the human dental field. As for any procedure performed on a patient, whether human or animal, an informed decision is based on the available evidence regarding treatment options. This is certainly true for the more involved treatments in veterinary dentistry which can include the disciplines of endodontics and dental implantology. A number of published case reports have been accepted by the specialty that endodontic therapy is indeed a predictable and a valuable service that can be offered to pet owners. Oral implantology has become an accepted and predictable procedure in the human dental field and can now be offered to pet owners if performed by suitable trained veterinary clinicians. The success rate for endosseous implant osseointegration is very high in humans. Success rates are also very high in animals used for implantology research. Canine studies have shown good bone-to-implant contact of around 73% in osseointegrated endosseous implants based on histological sections. Radiographic and histological findings demonstrate stable alveolar crestal bone levels after loading endosseous implants for up to 12 months in a dog model. This article discusses use of dental implants in the rostral mandible of a companion dog to replace periodontally diseased incisors, their restoration, to return the animal to full dental function and 3-year follow-up.

The past forty-three years of dental implantology literature. A global mapping and scientometric analysis.

PURPOSE: The aim of this research is to make a scientometric analysis of the dental implantology literature and to present the results in a more understandable way to the reader by visualizing them with maps. METHODS: The dental implantology literature was accessed through the Web of Science database. Scientometric data was obtained with Citespace 6.1 software, co-citation, clustering analysis, citation burst, and mapping analyzes were performed. Scimago Graphica software was used for additional visualizations. RESULTS: A total of 35,704 articles were included in the analysis. There were 88,616 authors, 72,333 institutes, 142 countries/regions, and 3,265 journals contributing to the dental implantology literature. The United States was first with 7,334 publications and 225,868 citations. The literature between 1980 and 2023 was divided into 19 different clusters, and the literature between 2000 and 2023 was divided into 16 different clusters. CONCLUSIONS: Key themes in the field include the use of autogenous bone, advancements in implant surface technology, and the use of platform switching and intraoral scanners. Emerging topics of interest include esthetic considerations in the treatment of the anterior region, stress distribution, the use of zirconia, and the impact of implant treatment on oral health-related quality of life. With similar scientometric analysis studies to be done in the future, the progress of the literature can be followed on the basis of evidence.

Advancements in dental implantology: The alveolar ridge split technique for enhanced osseointegration.

The alveolar ridge split (ARS) technique is a pivotal advancement in dental implantology, addressing the limitation of insufficient bone width for implant placement. This review traces the historical development of ARS from its initial conceptualization to current practices and future directions. Emphasizing the technique's development, indications, procedural overview, and osteotomy variations, we highlight its minimally invasive nature, which reduces patient morbidity and treatment time. This article reviews various osteotomy methods within ARS, examining their applications, benefits, and limitations. Furthermore, it discusses the technique's role in expanding treatment options for patients with compromised alveolar structures, underpinned by a high implant survival rate and the potential for immediate implant placement. We also cover the necessity of meticulous surgical technique, the importance of patient-specific factors, and the promising future of ARS facilitated by advancements in biomaterials and regenerative medicine. In summary, this review provides a comprehensive overview of ARS, offering valuable insights for dental professionals and informing future clinical practices and research in implantology.

Comparative Analysis of the Effects of Two Different Drill Designs on Insertion Torque and Primary Stability during Osteotomy - An In Vivo Animal Study.

Objective: This study aims to evaluate the effects of two drill designs on insertion torque (IT) and implant stability quotient (ISQ) during osteotomy. Methodology: This in vivo animal study involved eight female New Zealand white rabbits divided into two groups: Group A underwent osteotomy using standard drills from the Zimmer surgical kit, and Group B used Densah drills. IT values and ISQ were taken during and after implant placement. Rabbits received premedication, and postoperative care was provided. Results: Significant differences in peak IT were observed between the two groups, with Group B demonstrating a statistically significant advantage. However, no significant differences were found in ISQ between the groups. Conclusion: This study highlights the potential benefits of osseodensification in enhancing primary stability during osteotomy.

Minimally Invasive Extraction System Benex-Clinical Evaluation and Comparison.

Tooth extraction is one of the oldest and most well-known surgical procedures in dental medicine. It is still routinely performed by general practitioners and dental undergraduates. The Benex extraction system allows for the extraction of teeth in a vertical direction, which avoids most trauma against surrounding alveolar bone and soft tissues. The study included 56 patients who were recruited from the Department of Oral Surgery, Medical University-Plovdiv. The patients were split into two groups of 28 patients-Group I (control group) and Group II (study group). For each group, the success of the extraction, buccal cortical plate preservation, pain experience and early wound healing were assessed. There was no statistical significance between the success of the extractions in both groups. The Benex extractions preserved the buccal cortical plate in 95% of the cases, whereas the forceps extractions preserved it in only 71.8%, which is statistically significant. On the seventh day, patients in Group II reported less pain, without a significant difference. There was a significantly bigger number of completely healed extraction wounds on the 10th day. Atraumatic extractions allow for more hard and soft tissues to be preserved in the extraction site. This is essential for a successful outcome and the aesthetically pleasing results of the following dental restoration.

Evaluation of the Stability of Open-Tray Impression Coping Using Two Different Impression Materials at Three Different Subgingival Implant Placement Depths.

Objective To evaluate and compare the stability of the open tray impression coping within the set impression while attaching the lab analog when polyether (PE) heavy body and polyvinyl siloxane (PVS) putty impression materials were used and the implant platform was placed sub-gingivally at three different depths. Methods Two impression materials, PE and PVS, and custom-made plexiglass models with embedded single implants to simulate implant positioning depths of 0 mm, 2 mm, and 4 mm, sub-gingivally, were used in the study. Open tray impressions were made after attaching impression coping to the implant embedded in the model. Implant lab analog was attached to the impression coping in the set impression, and its stability was measured using a universal testing machine. Forty-two open tray impressions were made in six groups, with seven impressions in each group. Descriptive statistics such as mean and standard deviation were calculated. A comparison of the mean stability between the two impression materials at each depth was done using an independent t-test. Comparison of the mean stability between the three different subgingival implant depths in each material was done by one-way ANOVA with the Scheffe multiple comparison test (post-hoc analysis). The level of significance was set at p<0.05. Results The stability of the impression coping was measured as the force in Newtons required for the displacement of the analog attached to the impression coping embedded in the set impression. PE with the embedded impression coping at a depth of 0 mm gave the highest mean stability value (4.37+/-0.41), and the least mean stability was offered by PVS with the embedded impression coping at 4 mm depth (1.88+/-0.37). When an independent t-test was done to compare the mean stability values of PE and PVS, there was a statistically significant difference at 0 mm, 2 mm, and 4 mm. On doing one-way ANOVA to compare the mean stability between the different depth groups, there was a statistically significant difference between the three depth groups in PE and PVS. Scheffe multiple comparison tests (post-hoc analysis) revealed a statistically significant difference between 0 mm, 2 mm, and 4 mm subgingival depths of the impression coping placement in both PE and PVS. Conclusion The accuracy of the master cast is an important determinant for the precise fit and long life of the final prosthesis. In the case of maxillary anterior implant placements where deep subgingival placement of the implant platform is needed for aesthetic and functional reasons, the impression material should be selected carefully to ensure the stability of the impression coping. Among the materials included in the present study, the PE impression material offered the maximum stability for impression coping compared to PVS.

Evaluation of Osteogenic Potential of a Polysaccharide-Based Hydrogel Coating on Titanium.

INTRODUCTION: Reducing the healing period after surgical placement of dental implants can facilitate the loading of dental prostheses. AIM: The aim is to compare the osteogenic potential of unmodified titanium disks with titanium disks that were surface-modified or hydrogel-coated. MATERIALS AND METHODOLOGY: One hundred eight titanium disks (Ø6 × 2-mm) were divided into three groups: (1) unmodified titanium as control (Ti-C); (2) sandblasted and acid-etched (Ti-SLA), and (3) coated with tamarind kernel polysaccharide hydrogel grafted with acrylic acid (Ti-TKP-AA). The osteogenic potential and cytotoxic effect of various groups of titanium were compared using human osteoblasts Saos-2. The surface topography of the titanium disks and morphology of osteoblasts grown on disks were investigated by scanning electron microscopy (n = 3). Cell attachment to the disks and actin expression intensity were investigated by confocal imaging (n = 3). Cytotoxicity was quantified by cell viability assay (n = 9). Osteoblast maturation was determined by alkaline phosphatase assay (n = 9). Cell mineralization was quantified by Alizarin red staining (n = 9). One-way analysis of variance followed by Tukey's multiple comparisons test was used for intergroup comparisons (α= 0.05). RESULTS: The surface modifications on Ti-SLA and Ti-TKP-AA support better morphology and proliferation of osteoblasts than Ti-C (P< 0.001) and significantly higher levels of actin cytoskeleton accumulation (P< 0.0001). Ti-TKP-AA showed a significantly higher maturation rate than Ti-C (P< 0.001). Ti-TKP-AA showed > twofold increased mineralization than Ti-C and Ti-SLA (P< 0.001). CONCLUSIONS: TKP-AA hydrogel-coated titanium promotes faster osteoblast proliferation, maturation, and mineralization than SLA-treated or untreated titanium. These advantages can be explored for achieving early osseointegration and prosthetic loading of titanium dental implants.