Long-term outcomes of osteotome sinus floor elevation without grafting in severely atrophic maxilla: A 10-year prospective study.

OBJECTIVE: The aim of the present study was to report 10-year results of osteotome sinus floor elevation (OSFE) without grafting severely atrophic maxilla (residual bone height ≤4 mm). MATERIALS AND METHODS: Patients undergoing OSFE without grafting and implant placement were included for 10-year examinations. Implant survival, complication-free survival, modified bleeding index (mBI), modified plaque index (mPI), pocket probing depth (PPD), peri-implant marginal bone loss (MBL), endo-sinus bone gain (ESBG) and mean cost of recurrence were evaluated. RESULTS: Overall, 23 patients with 35 implants attended 10-year examination. Cemented implant crowns or implant-supported fixed dental prostheses were delivered to the patients. Kaplan-Meier implant survival was 89.2% at implant level and 84.1% at patient level. Complication-free survival was 26.0% at patient level and 37.0% at implant level. The average complication-free survival time was 74.6 months (95% CI: 63.2-86.0 months) at implant level and 69.1 months (95% CI: 54.8-83.4 months) at patient level. The mBI, mPI, PPD, MBL and ESBG at 10-year follow-up were 0.91 ± 0.58, 0.48 ± 0.51, 2.94 ± 0.79 mm, 1.63 ± 0.83 mm and 2.72 ± 0.51 mm, respectively. The cost of managing recurrence was 43.6% of the initial cost of treatment. CONCLUSION: The results of the present study indicate that OSFE without grafting is a reliable treatment option in severely atrophic maxilla. Acceptable survival rate, stable MBL and ESBG could be achieved within 10 years. Low complication-free survival and high costs of recurrence management need to be considered.

Short versus longer implants with osteotome sinus floor elevation for moderately atrophic posterior maxillae: A 1-year randomized clinical trial.

PURPOSE: To compare the clinical, radiographic outcomes and patient satisfaction of short-6-mm implants and longer implants combined with osteotome sinus floor elevation (OSFE). MATERIALS AND METHODS: Two hundred and twenty-five patients with 225 implants were included and randomly assigned into three groups (each group: 75 implants) using randomizing table method: group 6 mm (6 mm implants alone), group 8 mm + O (8 mm implants + OSFE) and group 10 mm + O (10 mm implants + OSFE). Outcomes measures were as follows: implant survival, complication, resonance frequency analysis measurement, surgical time, bleeding on probing (BOP), pocket probing depth (PPD), modified plaque index (mPI), marginal bone loss (MBL) and patient satisfaction. RESULTS: The dropout rate was 3.6% at 1 year. Implant survival rates were 96%, 100% and 100% in group 6 mm, group 8 mm + O and group 10 mm + O, respectively. In group 6 mm, the survival rates of implants with diameter of 4.1 mm were 90% (27/30), while the survival rates of implants with diameter of 4.8 mm were 100% (42/42). The surgical time (min) in group 6 mm was significantly shorter than those in group 8 mm + O and group 10 mm + O (13.6 ± 2.2, 19.4 ± 3.7 and 18.3 ± 4.3, respectively, p = 0.03). No significant differences in ISQ values, BOP, PPD, mPI and MBL were found among three groups. Significant higher value of intra-operative discomfort was found in group 6 mm (p = 0.02). CONCLUSION: All treatment options provided acceptable clinical and radiographic results up to 1 year after loading. The current 1-year results must be confirmed by longer follow-ups of at least 5 years.

A novel semiautomatic segmentation protocol to evaluate guided bone regeneration outcomes: A pilot randomized, controlled clinical trial.

OBJECTIVES: The aims of this study were to (a) present a novel morphological contour interpolation (MCI) algorithm based method to evaluate grafted bone alterations following guided bone regeneration (GBR), (b) compare clinical and radiological outcomes of GBR with two different collagen membranes. MATERIALS AND METHODS: The data were retrieved from an ongoing randomized controlled trial. Patients were randomly allocated into two groups: (a) control group (CG): Bio-Gide (b) test group (TG): bovine dermis-derived collagen membrane. Cone beam computed tomography examinations were performed 1 week (T0) and 6 months after surgery (T1). PES/WES at T1, grafted bone volume and density changes from T0 to T1 were recorded. RESULTS: Thirty-six patients (16/20 in test/control group, respectively) were enrolled in the present study. Excellent inter-observer reliability (ICC ≥ 0.97) was revealed for repeated measurements using this method. Significant volumetric reduction of grafted bone were found in both groups (test group: from 0.60 to 0.39 cm3 , p < 0.01; control group: from 0.54 to 0.31 cm3 , p < 0.01). Mean bone density (gray-scale values) significantly increased from 305.12 to 456.69 in CG (p < 0.01). In TG, it slightly increased from 304.75 to 393.27 (p = 0.25). The mean PES/WES values were 13.84 (6.62/7.22) and 13.90 (6.70/7.20) for TG and CG, respectively. As for inter-group comparison, no significant differences of grafted bone volume change, density change and PES/WES were found between two groups. CONCLUSION: Within the limitations of this study, the novel MCI-based method is a reproducible tool to segment and visualize changes of grafted bone in 3D. Furthermore, both collagen membranes could be used as a barrier membrane for GBR in humans.

Endo-sinus bone formation after transalveolar sinus floor elevation without grafting with simultaneous implant placement: Histological and histomorphometric assessment in a dog model.

AIM: To evaluate endo-sinus new bone formation and implant osseointegration after transalveolar sinus floor elevation (TSFE) and simultaneous implant placement without any grafting materials and to investigate the influence of implant surface modification on bone healing process under this circumstance. MATERIALS AND METHODS: Transalveolar sinus floor elevation and simultaneous implant placement were conducted bilaterally on 12 Labrador dogs. No grafting materials were used during surgery. Implants with two different surfaces (SLA and SLActive) were placed in a split-mouth design. The animals were sacrificed 4, 8 and 24 weeks after surgery for histological and histomorphometric assessments. Bone-to-implant contact (BIC%), alveolar bone height (ABH) and the percentages of mineralized bone (MB%) in the area of interest were analysed. The probing depth (PD) and bleeding on probing (BOP) were also assessed to describe peri-implant health conditions. RESULTS: Sprouts of new bone in direct contact with implant surface were seen in the elevated area at every time point. Newly formed woven bone under sinus membrane was visible. SLActive implants exhibited favourable results compared with SLA implants regarding ABH at 4 weeks and BIC% at 4 and 8 weeks. Sites with BOP positive could be observed in both groups at any time point. No newly formed bone can be found on the implant apex with either SLA or SLActive surfaces at any time point. CONCLUSIONS: Spontaneous new bone formation from the parent bone walls could be observed after TFE without any grafting materials. No clear evidence of bone formation from the Schneiderian membrane could be found. Even though there were trends for quicker bone response of SLActive implants, this study failed to show the absolute advantage of SLActive in achieving endo-sinus bone formation.

Long-term outcomes of narrow diameter implants in posterior jaws: A retrospective study with at least 8-year follow-up.

OBJECTIVE: The aim of this study was to evaluate the long-term survival, complications, peri-implant conditions, marginal bone loss, and patient satisfaction of fixed dental prostheses supported by narrow diameter implants (NDIs) in the posterior jaws. MATERIALS AND METHODS: This study was designed as a retrospective cohort study with a mean follow-up time of 10.1 years (SD: 2.5 years). Patients receiving NDIs in posterior jaw were reviewed. Implant survival, hardware complication, modified plaque index (mPI), peri-implant probing depth (PPD), percentage of bleeding on probing (BOP%), marginal bone loss (MBL), and patient satisfaction were evaluated. Log-rank test and t test were used to detect the influence of implant location and restoration type. RESULTS: Sixty-seven patients with 98 NDIs (Premolar site: 81, Molar site: 17, Single crowns: 33, Splinted restorations: 65) were included. The overall implant survival rates were 96.9% at implant level and 97.0% at patient level. Veneer chipping was the most common hardware complication. The veneer chipping rates were 19.4% at patient level and 18.4% at implant level. All patients showed acceptable oral hygiene. Thus, the average MBL was 1.19 mm at implant level and 1.15 mm at patient level. Eight implants (8.5%) and six patients (9.2%) were diagnosed with peri-implantitis. Fifty-eight patients (89.2%) were satisfied with the esthetics of the restorations, while 55 patients (84.6%) were satisfied with the function of the restorations. CONCLUSION: Narrow diameter implants could be a predictable treatment option in the long term. High survival rates, high patient satisfaction, acceptable complication rates and marginal bone loss could be achieved. Further long-term studies are needed to evaluate the predictability of NDIs in molar sites.

The effect of photodynamic therapy on pathogenic bacteria around peri-implant sulcus and in the cavity between abutment and implant after healing phase: A prospective clinical study.

OBJECTIVES: To compare levels of pathogens from peri-implant sulcus versus abutment screw cavities after photodynamic therapy. MATERIAL AND METHODS: Twenty patients were included. Photodynamic therapy (PDT) was applied both in sulcus and cavities after sampling following suprastructures loading, and repeated after 2 weeks. Two samples each containing four paper points were collected for each implant at baseline, 2 weeks, 3 months: (i) peri-implant sulcus and (ii) abutment screw cavities. Seventy-five percent ethanol was applied in another 20 patients as the control group in the same way. qPCR was used to quantify periodontal pathogens: Porphyromonas gingivalis, Fusobacterium nucleatum, Streptococcus mutans. RESULTS: PDT showed a better bacterial reduction than ethanol. P. g. and F. n. were most frequently detected, while less for S. m. P. gingivalis' proportion from both sites was significantly higher than the other two bacteria (P < 0.05), except for 2 weeks' peri-implant sulcus sample. Bacteria counts from abutment screw cavities were always less than those from peri-implant sulcus and was significantly lower for total bacteria at 3 months (P < 0.05). Total bacterial from abutment screw cavities significantly reduced at 3 months compared to baseline (P < 0.05). CONCLUSIONS: PDT appears to be effective in bacterial reduction compared to ethanol and can reduce P. gingivalis with short time intervals, as well as decreasing total bacteria counts within abutment screw cavities in the long run, suggesting PDT an effective way sterilizing inner surface of oral implant suprastrutures. Lasers Surg. Med. 50:433-439, 2018. © 2018 Wiley Periodicals, Inc.

Evaluation of Mandibular Lingual Foramina With Cone-Beam Computed Tomography.

The aim of this study was to evaluate the characteristics of 3 kinds of mandibular lingual foramina through cone beam computed tomography images to analyze its diameter, frequency, location and its correlation with age in southeast Chinese mainland population. Lingual foramina in 299 patients were grouped into midline lingual foramina (MLF), lateral lingual foramina (LLF), and nutrient foramina (NF) with diameters and frequency measured. Vertical distances from foramina to mandibular inferior border were recorded as Hinf. Data were analyzed using ANOVA, independent sample t tests and Pearson correlation. Results showed that MLF had a frequency of 99.3% at midline symphysis. Average diameter and Hinf of MLF were 0.65 ±â€Š0.19 and 13.79 ±â€Š2.15 mm, respectively. Lateral lingual foramina had a frequency of 63.2% with the majority observed in premolar region. Average diameter and Hinf of LLF were 0.62 ±â€Š0.19 and 6.90 ±â€Š1.88 mm, respectively. Nutrient foramina had a frequency of 91.3% and was most frequently detected between mandibular incisors. Average diameter and Hinf of NF were 0.57 ±â€Š0.15 and 28.39 ±â€Š2.38 mm, respectively. Mean diameter of MLF and NF of each patient correlated with age (r = 0.174 and 0.201, respectively, P < 0.05). No statistical correlation was observed between average diameter of LLF and age (r = 0.114, P > 0.05). Preoperative cone beam computed tomography is a valuable aid in locating lingual foramina, which could be used as an indication to avoid unwanted hemorrhage in implant surgery.

Resonance frequency analysis of implants placed with osteotome sinus floor elevation in posterior maxillae.

OBJECTIVES: To test the reliability and validity of implant stability quotient (ISQ) values used for assessment of the condition of bone-to-implant interface in the osteotome sinus floor elevation (OSFE) model and to evaluate the influence of residual bone height (RBH) on ISQ values. MATERIAL AND METHODS: Forty-six Straumann(®) tissue-level SLA implants (Φ4.8 mm*8 mm, wide neck, standard plus) placed in 39 patients applying OSFE without grafting were included in the study. Patients were assigned to three groups based on the RBH with one implant per patient randomly chosen: (1) 2 ≤ RBH < 4 mm (n = 14); (2) 4 ≤ RBH < 6 mm (n = 15); (3) 6 ≤ RBH < 8 mm (n = 10). ISQ values were determined with Osstell ISQ(®) at 0, 2, 4, 8, 12, 16, and 20 weeks postoperation. The reliability of RFA measurements was tested by the degree of dispersion of ISQ values at each time point, and the validity was tested by linear correlation between ISQ and RBH. ISQ values were then compared among groups at all observed time points. RESULTS: The implants achieved a mean ISQ value of 63.6 immediately after surgery and reached a higher ISQ level of 70 after 20 weeks with a dip at 4 weeks. A higher degree of dispersion of ISQ values was observed immediately after surgery compared to the other time points. No significant correlations were found between RBH and ISQ values and no significant difference in ISQ values among groups at all the time points. CONCLUSION: Within the limits of the study, it may be implied that ISQ values are not able to assess the condition of bone-to-implant interface and the role of single RFA measurement in determining loading protocol is questionable.

Transalveolar sinus floor elevation using osteotomes without grafting in severely atrophic maxilla: a 5-year prospective study.

OBJECTIVE: The aim of this study was to assess the clinical success of dental implants placed in severely atrophic maxilla (residual bone height ≤4 mm) using transalveolar sinus floor elevation (TSFE) without grafting. Furthermore, the implant stability during the healing period was also evaluated. MATERIALS AND METHODS: Twenty five generally healthy patients with 37 Straumann(®) Standard Plus SLA implants were included in the study. After a modified Summers TSFE without grafting was performed, the smooth collar was embedded 0.5-1 mm beneath the cortical bone level. Follow-ups were conducted at 12, 36, and 60 months after crown placement. Implant survival rate, resonance frequency analysis (RFA), and clinical and radiographic parameters were evaluated. RESULTS: At 5-year follow-up, 35 implants fulfilled the survival criteria, representing a 5-year cumulative survival rate of 94.6% at implant level and 92% at subject level. The mean value of implant stability quotient (ISQ) ranged from 67.8 to 72.8, and the lowest values were reached at 4 weeks. No significant difference was found with the passage of time in modified plaque index (P = 0.92), pocket probing depth (P = 0.34), and modified bleeding index (P = 0.4). The average residual bone height was 2.81 mm (SD: 0.74 mm) in this study. The average crestal bone loss (CBL) significantly increased from 0.83 mm at 1-year examination to 1.47 mm at 3-year examination (P < 0.001). The average CBL remained stable at years 3 and 5 (1.47 vs. 1.54 mm, P = 0.083). CONCLUSION: According to the current evidence, it is feasible to place cylindrical implants in severely atrophic maxilla. High survival rate could be achieved following TSFE without grafting at least within 5-year follow-up.

Osteotome sinus floor elevation with and without grafting: an animal study in Labrador dogs.

AIM: To evaluate implant stability and histological outcomes after osteotome sinus floor elevation (OSFE) procedure, and to compare new bone formation and implant osseointegration with and without grafting. MATERIAL AND METHODS: OSFE with simultaneous implant placement was conducted bilaterally on 6 Labrador dogs. Twenty-four implants were placed. The right side sinus (Group 1) was grafted with biphasic calcium phosphate (BCP), whereas the left side (Group 2) was left without any grafting materials. The animals were euthanized 8 and 24 weeks after surgery for histological and histomorphometric assessment. Bone-to-implant contact (BIC%), alveolar bone height (ABH), bone density (BD) and grafting material density (GMD) were measured. The implant stability (ISQ) was assessed using resonance frequency analysis (RFA) at implant placement and 1, 2, 4, 8, 12, 24 weeks after surgery. RESULTS: Endo-sinus new bone with direct contact to implant surface were observed in two groups at both time points. ABH showed no difference between groups at both time points. BIC% and BD in Group 2 (40.05%, 35.90%) was higher than those in Group 1 (23.30%,25.59%) at 24 weeks. Significant shrinkage of grafting material was seen in Group 1. The GMD in Group 1 at 8 weeks was 24.35%, while it dropped to 19.90% at 24 weeks. The changing pattern of ISQ for both groups were similar. CONCLUSIONS: Spontaneous new bone formation and better bone-to-implant contact were found for OSFE without grafting. The grafting material application during OSFE procedure showed no advantages in histological results.

Esthetic outcome of single implant crowns following type 1 and type 3 implant placement: a systematic review.

OBJECTIVE: The aim of the current review was to systematically appraise the esthetic outcome of soft tissue around single implant crowns following type 1 and type 3 implants placement in published dental literature. MATERIALS AND METHODS: A PubMed, Embase, and the Cochrane Central Register of Controlled Trials search up to March 2013 was conducted for articles published in the dental literature and limited to human trials with no language restricted. Furthermore, the reference lists of related articles were systematically screened, and additional manual searches were also performed. The primary outcome was pink esthetics score (PES). RESULTS: The electronic search in the database of PubMed, Embase, and the Cohrane Central Register of Controlled Trials resulted in the identification of 463 titles. These titles were initially screened by the two independent reviewers for possible inclusion. Screening the abstracts and titles led to 28 articles for future full-text consideration. From these articles, 18 studies were excluded. Manual search identified one article. After quality assessment, eight studies were included in this review. This review showed that no significant difference of PES index could be found between type 1 and type 3 implant placement. CONCLUSION: According to the current evidence, short-term esthetic outcomes of peri-implant soft tissue did not show significant difference following type 1 and type 3 implants placement with well-selected patients. However, caution should be taken for clinicians to extrapolate this result to all types of patients, as more randomized clinical trials are needed for long-term soft-tissue esthetic outcome in patients with high esthetic risk following type 1 implant placement. PES frequency, peri-implant condition and other risk factors for peri-implantitis are recommended to be reported for future studies.

Esthetic outcome and alterations of soft tissue around single implant crowns: a 2-year prospective study.

OBJECTIVE: The aim of this prospective study was to assess the esthetic outcome and alterations of peri-implant soft tissue using tissue-level implants. Furthermore, the influencing factors, including grafting and gingival biotype, of esthetic outcome of peri-implant soft tissue were also evaluated. MATERIALS AND METHODS: Of 38 patients with single missing anterior tooth in maxilla were treated with a Straumann (®) Standard Plus SLA implant. Bone augmentation was performed in 24 patients. Follow-up was conducted at 12 and 24 months after definitive crowns placement. Esthetic outcome using the pink esthetic score/white esthetic score (PES/WES) and clinical parameters were evaluated. RESULTS: The mean PES/WES value at baseline, 1-year, and 2-year examination was 13.79, 14.87, and 14.96. Significant improvement was found between baseline and 1-year examination (P < 0.01). And the improvement between 1-year and 2-year examination was not significant (P = 0.40). The mean PES changing value in patients with thick biotype was significantly higher than those with thin biotype at 2-year after definitive crowns placement (P = 0.03). Graft procedure had an unfavorable effect on mean PES value both at baseline and at follow-up (P < 0.01). No implants were lost at 2-year examination. Three patients experienced peri-implant infection. No significant difference was found with the passage of time in modified plaque index (mPI), probing pocket depth (PPD), and modified bleeding index (mBI). CONCLUSION: According to the present prospective clinical study, it can be concluded that it is feasible to use tissue-level implant to support single crowns in esthetic area. Favorable short-term esthetic outcome and stability of soft tissue around single implant crowns can be expected in patients with or without graft. However, graft procedures might have an unfavorable effect on the esthetic outcome. Gingival biotype can be considered as prognostic factor for esthetic outcome. RCTs with long-term follow-up are needed to provide evidence for the long-term stability of peri-implant soft tissue using tissue-level implant systems.

Effects of a hydroxyapatite-coated nanotube surface of titanium on MC3T3-E1 cells: an in vitro study.

PURPOSE: To compare the biological behavior of mouse osteoblast-like cells (MC3T3-E1) on hydroxyapatite (HA)-coated nanotube surface of titanium and plasma-sprayed HA (HA-PS)-coated titanium surface. MATERIALS AND METHODS: The HA-coated nanotube surface of titanium were fabricated by anodization coupled with alternative immersion method (AIM). MC3T3-E1 osteoblast cells cultured in vitro were seeded onto these different surfaces; their growth states were examined by a confocal laser scanning microscope; the proliferation behavior, alkaline phosphatase (ALP) activity, osteocalcin (OCN) secretion, and analysis of osteoblastic gene expressions were also compared in detail. RESULTS: Significant increases in ALP activity and OCN production on days 7 and 14 (P < 0.05) were observed for AIM-coated HA (HA-AIM) surfaces. However, cells cultured on HA-AIM-coated surfaces showed a delayed growth pattern. Real-time polymerase chain reaction analyses showed significantly higher relative mRNA expression levels of osteoblastic genes (runt-related protein 2, osterix, osteopontin, OCN) in cells cultured on the HA-AIM-coated nanotube surfaces as compared with cells cultured on the HA-PS and baer Ti surfaces. CONCLUSION: The current research showed that the HA-AIM-coated nanotubular Ti surfaces enhance osteoblast differentiation, which had the potential to further improve osseointegration.

Bovine-originated xenografts versus synthetic bone grafting materials in lateral maxillary sinus floor augmentation: A systematic review and meta-analysis.

AIMS: This study aimed to systematically compare the patients undergoing lateral MSFA therapies utilizing bovine-originated xenografts versus varied synthetic bone grafting materials. METHODS: Pubmed, Scopus, Embase, and Cochrane Library were searched up to April 2023, compensated by a manual search in selected journals. Studies reporting histological outcomes (residual bone graft, newly formed bone, non-mineralized tissue) and clinical outcomes (implant survival, ISQ value) were included. Several analyses were performed, including meta-analysis, sensitivity study, and Egger's regression tests. RESULTS: Sixteen clinical/randomized control trials were included in this systematic review, among which 12 were enrolled in a meta-analysis. The percentage of newly formed bone within the grafted sinuses by hybrid HA/TCP was significantly higher than those by xenografts (WMD 2.85, 95%CI [0.72; 4.99]), but those grafted by pure HA (WMD -1.72, 95%CI [-3.15; -0.29]) or TCP (WMD -7.10, 95%CI [-13.02; -1.17]) were significantly lower than xenograft counterparts. The residual bone graft and non-mineralized tissue yielded by synthetic HA, TCP, and HA/TCP showed no significant differences with the xenograft group. CONCLUSION: The chemistry of grafted bone substitutes in lateral MSFA influenced the quantity of newly formed bone. Those grafted with hybrid HA/TCP yielded the highest amount of new bone compared to bovine-originated HA. However, this influence was not significant on residual bone graft and non-mineralized tissue.

Osteotome sinus floor elevation with or without grafting: a 3-year randomized controlled clinical trial.

AIMS: To evaluate the clinical and radiographic results of dental implant placed using osteotome sinus floor elevation (OSFE) with and without simultaneous grafting. MATERIALS & METHODS: Forty-five patients were randomly assigned into two groups: Group1: OSFE with deproteinized bovine bone mineral (DBBM) mixed with autogenous bone chips, and Group2: OSFE without grafting. The endo-sinus bone gain (ESBG) was assessed on radiographs at 6, 12, 24, 36 months following surgery as primary outcome measurement. Implant survivals and marginal bone loss (MBL) were assessed as secondary outcome measurements. RESULTS: Twenty-one implants in Group1 and 20 implants in Group2 were analysed. The residual bone height (RBH) was 4.63 ± 1.31 mm in average (4.67 ± 1.18 mm for Group1 and 4.58 ± 1.47 mm for Group2). The 3-year cumulative survival rates of implants were 95.2% for Group1 and 95.0% for Group2. The ESBG in Group1 reduced from 5.66 ± 0.99 mm at 6 months to 3.17 ± 1.95 mm at 36 months, whereas the ESBG in Group2 increased from 2.06 ± 1.01 mm at 6 months to 3.07 ± 1.68 mm at 36 months. The MBL after 3 years was 1.33 ± 0.46 mm in Group1 and 1.38 ± 0.23 mm in Group2. CONCLUSIONS: OSFE and simultaneous implant installation with and without grafting both resulted in predictable results. The application of grafting materials has no significant advantage in terms of clinical success.

Deep learning based dental implant failure prediction from periapical and panoramic films.

Background: Dental implant failure is a critical condition that can seriously compromise therapeutic efficacy. Insufficient bone volume, unfavorable bone quality, periodontal bone loss, and systemic conditions, including osteopenia/osteoporosis and diabetes mellitus, have been associated with implant failure. Early indicators of potential implant failure could help mitigate the risk of severe complications. This study aimed to develop an effective implant outcome prediction model using dental periapical and panoramic films. Methods: A total of 248 patients (89 with failed implants and 159 with successful implants) were examined. A total of 529 periapical images and 551 panoramic images were collected from the patients for a deep learning-based model. Based on radiographic peri-implant alveolar bone pattern, implant outcome was divided into three categories: implant failure with marginal bone loss, implant failure without marginal bone loss, and implant success. We extracted features using a deep convolutional neural network (CNN) and built a hybrid model to combine periapical and panoramic images. A comparison among three categories of receiver operating characteristic (ROC) curves was performed. The diagnostic accuracy, precision, recall and F1-score of the dataset were assessed. Results: Our model achieved an AUC (area under the ROC curve) of 0.972 for failure with marginal bone loss, 0.947 for failure without marginal bone loss and 0.975 for success. In all conditions, for periapical images alone, the diagnostic accuracy was 78.6%; the precision was 0.84, recall was 0.73, and F1-score was 0.75. For panoramic images alone, the diagnostic accuracy was 78.7%; the precision was 0.87, recall was 0.63, and F1-score was 0.66. Both periapical and panoramic images were used in our novel method, and the prediction accuracy was 87%. The precision was 0.85, recall was 0.88, and F1-score was 0.85. Conclusions: The deep learning model used features from periapical and panoramic images to effectively predict the occurrence of implant failure and might facilitate early clinical intervention for potential dental implant failures.

Debridement of contaminated implants using air-polishing coupled with pH-responsive maximin H5-embedded metal-organic frameworks.

The primary goal of peri-implantitis treatments remains the decontamination of implant surfaces exposed to polymicrobial biofilms and renders biocompatibility. In this study, we reported a synergistic strategy for the debridement and re-osteogenesis of contaminated titanium by using erythritol air abrasion (AA) coupled with an as-synthesized pH-responsive antimicrobial agent. Here, the anionic antibacterial peptide Maximin H5 C-terminally deaminated isoform (MH5C) was introduced into the Zeolitic Imidazolate Frameworks (ZIF-8) via a one-pot synthesis process. The formed MH5C@ZIF-8 nanoparticles (NPs) not only possessed suitable stability, but also guarantee the slow-release effect of MH5C. Antibacterial experiments revealed that MH5C@ZIF-8 NPs exhibited excellent antimicrobial abilities toward pathogenic bacteria of peri-implantitis, confirming ZIF-8 NPs as efficient nanoplatforms for delivering antibacterial peptide. To evaluate the comprehensive debridement efficiency, single-species as well as mixed-species biofilms were successively established on commercially used titanium surfaces and decontaminated with different methods: removed only by erythritol air abrasion, treated merely with MH5C@ZIF-8 NPs, or received both managements. The results demonstrated that only erythritol air abrasion accompanied with MH5C@ZIF-8 NPs at high concentrations eliminated almost all retained bacteria and impeded biofilm rehabilitation, while neither erythritol air abrasion nor MH5C@ZIF-8 NPs alone could achieve this. Subsequently, we evaluated the re-osteogenesis on previously contaminated surfaces which were treated with different debridement methods afterwards. We found that cell growth and osteogenic differentiation of bone marrow-derived mesenchymal stem cells (BMSCs) in the group received both treatments (AA + MH5C@ZIF-8) were higher than those in other groups. Our work emphasized the great potential of the synergistic therapy as a credible alternative for removing microorganisms and rendering re-osseointegration on contaminated implant surfaces, boding well for the comprehensive applications in peri-implantitis treatments.

Peri-implant tissue alteration around tissue-level and bone-level implants in fresh extraction sockets: a histomorphometric study in dogs.

BACKGROUND: To compare tissue alteration in fresh extraction sockets between bone-level and tissue-level implants with different neck designs. METHODS: Bilateral premolars of 6 adult Labrador dogs were extracted, and 24 bone-level and tissue-level implants with two different neck designs were immediately placed. At the same time, buccal bony wall thickness in fresh extraction sockets was also recorded. The Straumann® Bone Level (BL) and Standard Plus (SP) implants were positioned at two insertion depths: 1mm below and flush with the alveolar crest. All animals were sacrificed 6 months after the implant placement. Undecalcified block sections were obtained for histological measurement. Vertical bone resorption and biological widths were documented. Statistical analysis consisted of two sample t-test and Wilcoxon sign-rank test. RESULTS: All implants were histologically osseointegrated. There was no significant difference between BL implants and SP implants in vertical bone resorption regardless of the insertion depths (P>0.05). Meanwhile, significant difference was found in lingual biological width between BL (3.16 mm) and SP (2.43 mm) implants when placed 1mm below the alveolar crest (P<0.05). CONCLUSIONS: Within the limits, it seemed that different implant neck designs had little effect on bone remodeling in fresh extraction sockets. However, longer biological width was found in bone-level implants.

Bovine-Derived Xenografts Immobilized With Cryopreserved Stem Cells From Human Adipose and Dental Pulp Tissues Promote Bone Regeneration: A Radiographic and Histological Study.

Adipose tissue-derived stem cells (ADSCs) and dental pulp stem cells (DPSCs) have become promising sources for bone tissue engineering. Our study aimed at evaluating bone regeneration potential of cryopreserved ADSCs and DPSCs combined with bovine-derived xenografts with 10% porcine collagen. In vitro studies revealed that although DPSCs had higher proliferative abilities, ADSCs exhibited greater mineral depositions and higher osteogenic-related gene expression, indicating better osteogenic differentiation potential of ADSCs. After applying cryopreserved ADSCs and DPSCs in a critical-sized calvarial defect model, both cryopreserved mesenchymal stem cells significantly improved bone volume density and new bone area at 2, 4, and 8 weeks. Furthermore, the combined treatment with ADSCs and xenografts was more efficient in enhancing bone repair processes compared to combined treatment with DPCSs at all-time points. We also evaluated the sequential early bone healing process both histologically and radiographically, confirming a high agreement between these two methods. Based on these results, we propose grafting of the tissue-engineered construct seeded with cryopreserved ADSCs as a useful strategy in accelerating bone healing processes.

Intra- and inter-observer agreements in detecting peri-implant bone defects between periapical radiography and cone beam computed tomography: A clinical study.

BACKGROUND/PURPOSE: Information regarding agreements between periapical radiograph (PA) and cone beam computed tomography (CBCT) in detecting peri-implant defect is still scarce. The aim of this clinical study was to compare agreements between PA and CBCT in detecting peri-implant bone defect. MATERIALS AND METHODS: This retrospective clinical study enrolled 32 patients with both PA and CBCT filmed right after implant placement. Four modalities were used for film reading: PA1 (original), PA2 (enhanced brightness/contrast), CBCT1 (selected axial and mesial-distal direction images) and CBCT2 (all data with software). 2 experienced and 2 inexperienced observers scored all films. Intra- and inter-observer agreements were estimated with Cohen's kappa coefficient. Categorized agreements were compared and differences among four modalities were calculated. RESULTS: Agreements of PA were better than CBCT when detecting peri-implant bone defects in inter-observer agreements (median kappa 0.471 vs. 0.192; p = 0.016). Moreover, agreements in experienced observers were better than inexperienced observers (median kappa 0.883 vs. 0.567; p < 0.001). There was significant difference among four modalities except for experienced observer 2 (p = 0.218). CONCLUSION: Agreements of PA are better than CBCT when detecting peri-implant bone defects, especially for inter-observer agreements. Experienced observers are more consistent in assessment than inexperienced ones.