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

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

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

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

The Mineral Apposition Rate on Implants with Either a Sandblasted Acid-Etched Implant Surface (SLA) or a Nanostructured Calcium-Incorporated Surface (XPEED®): A Histological Split-Mouth, Randomized Case/Control Human Study.

This study aimed to histologically evaluate the effects of XPEED® and SLA surface on the mineral apposition rate (MAR) at 3 and 5 weeks in titanium dental implants placed in human bone. In total, 17 titanium dental implants with XPEED® surface (n = 9) used as test and SLA surface (n = 8) used as control were included in this study. Each patient received four doses of tetracycline 500 mg at 12 h intervals 2 weeks prior to biopsy retrieval. Implant retrieval was performed, and retrieved biopsies were carefully treated for histomorphometric evaluation under epifluorescence microscopy. At 3 and 5 weeks, newly formed bone appeared in direct contact with both types of tested surfaces. At 3 weeks, the MAR value was, respectively, 2.0 (±0.18) µm/day for XPEED® implants and 1.5 (±0.10) µm/day for SLA implants (p = 0.017). At 5 weeks, lower MAR values for both XPEED® and SLA implants were noted, with 1.2 (±0.10) µm/day and 1.1 (±0.10) µm/day, respectively (p = 0.046). The overall evaluation by linear regression analysis for both time and implant surfaces showed a decreased osteoblast activity at 5 weeks compared to 3 weeks (p < 0.005). The results of the present study show that the bone apposition rate occurs faster around implants with XPEED® surface at 3 weeks and 5 weeks of healing. MAR values may support the use of implants with XPEED® surfaces in early loading protocols.

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

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

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

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

Key factors influencing short implant success.

AIM: This systematic article reviews the literature on the confounding parameters that affect short implant survival in order to establish specific surgical and prosthetic protocols that create an optimal biomechanical scenario and ensure implant longevity. MATERIALS AND METHODS: The available literature was screened for randomized clinical trials and prospective cohort and retrospective studies, published up to February 20, 2020, on the prognosis of short-length implants placed in posterior jaws. Studies evaluating the 5-year clinical performance of short dental implants (5 mm or 6 mm) in fixed rehabilitations of partially edentulous posterior jaws were included. RESULTS: Eleven studies were selected after assessment of inclusion and exclusion criteria, of which 8 were RCTs, 2 were prospective studies, and 1 was a retrospective study. After 5 years in function, 22 short (12 in maxilla and 10 in mandible) and 10 standard (2 in maxilla and 8 in mandible) implants were lost, resulting in high survival rates independent of implant length or location. More biological complications were found in standard implants especially those placed in augmented posterior mandibles (135 complications compared to 48 in short mandibular implants). Splinted prostheses were associated with less technical complications (15 out of 53 complications affecting short implants). CONCLUSION: The findings of this review showed that, when used correctly, short implants achieve predictable and promising long-term outcomes, provided they are placed following a comprehensive surgical and prosthetic protocol, based on the different biomechanical parameters essential to optimize long-term prognosis. CLINICAL SIGNIFICANCE: The use of short implants in clinical practice has considerably increased in a wide variety of cases, given that they offer several advantages for both patient and practitioner. Recent literature shows that, when specific criteria are respected, new generations of short implants present high, long-term survival rates. This review is designed to provide a thorough understanding of the surgical and prosthetic protocols that create an optimal biomechanical scenario for short implants and improve their prognosis.

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

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

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

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

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

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