Cyanoacrylate tissue adhesive versus silk sutures for mandibular third molar surgery: a systematic review and meta-analysis.

OBJECTIVE: Cyanoacrylate tissue adhesive has been presented as an alternative to sutures and several studies have compared them. The objective of this meta-analysis was to evaluate the effect of cyanoacrylate tissue adhesive on postoperative pain and swelling, following mandibular third molar surgery. MATERIALS AND METHODS: Database search was conducted in MEDLINE/PubMed and Scopus, along with extensive search in the grey literature, including randomized and non-randomized clinical trials that applied cyanoacrylate adhesive for closing mandibular third molar surgical sites and compared it with silk sutures, assessing postoperative pain and swelling. The search ended on September 22, 2023. RESULTS: Of 886 identified articles, six were included and meta-analyzed. Applying cyanoacrylate demonstrated a reduction in the overall postoperative pain (SMD = -0.57, 95% CI -1.00 to -0.15, p = 0.009). A similar outcome was noted when pain was evaluated on the first and last postoperative days, based on controlled clinical trials (SMD = -0.47, 95% CI -0.92 to -0.03, p = 0.04), and randomized trials (SMD = -0.97, 95% CI -1.31 to -0.62, p < 0.00001). Patients/sides received cyanoacrylate showed a decrease in postoperative swelling (SMD = -0.26, 95% CI -0.51 to -0.01, p = 0.04). Following the GRADE rating system, the quality of evidence on pain and swelling was judged as moderate and low, respectively. CONCLUSIONS: The use of cyanoacrylate adhesive may offer benefit in reducing postoperative pain and swelling following mandibular third molar surgery. Nevertheless, this should be further investigated, considering the low number of included reports. CLINICAL RELEVANCE: The current results could help clinicians who perform this procedure to manage postoperative pain and swelling more effectively.

Periosteum-derived Micrografts for bone regeneration.

Bone regeneration is currently one of the most widely researched topics in regenerative medicine. Several bone-grafting materials have been introduced and compared. However, the limitations of the currently available grafts have led researchers to investigate new materials to be used. In contrast, the periosteum performs endogenous bone regeneration as seen in physiological bone fracture repair, and transplanted periosteum has been used to induce bone regeneration in animal models. Although many of the introduced bone grafting materials have not been clinically evaluated, the use of the periosteum for bone regeneration has been documented in several clinical situations. Recently, the Micrograft concept, which was initially used to treat burn patients, where the tissue sample is cut into smaller pieces to expand the area that they can cover, has been applied to oral periosteal tissue for inclusion in scaffolds for bone defect healing, and was evaluated in various clinical bone augmentation procedures. This article first presents a brief overview of some of the commonly used bone grafts and their limitations. Next, it provides background information on the periosteum, including its histology and the cell biology and signaling involved in its osteogenic effect, periosteum-derived Micrografts, their osteogenic potential, and their recent clinical applications for bone augmentation.

The clinical efficacy of autogenous dentin blocks prepared chairside for alveolar ridge augmentation: A systematic review and meta-analysis.

OBJECTIVES: This systematic review aimed to evaluate the current evidence on the effectiveness of autogenous dentin block graft prepared chairside for alveolar ridge augmentation and compare its clinical outcomes to the main available grafting materials and techniques. MATERIALS AND METHODS: Three databases were screened, including prospective clinical studies, utilizing autogenous dentin blocks for ridge augmentation, with at least 3 months of postoperative follow-up. RESULTS: Eight articles were included, and four of them were meta-analyzed. Dentin blocks demonstrated similar vertical bone gain and significantly higher width gain, compared to bone blocks (WMD = 0.03, 95% CI -0.51 to 0.57, p = .92 and WMD = 1.34, 95% CI 0.57 to 2.12, p = .0007, respectively). Vertical and horizontal resorption were similar between the two groups (WMD = -0.36, 95% CI -0.91 to 0.18, p = .19, and WMD = -0.47, 95% CI -1.05 to 0.11, p = .11, respectively). Dentin blocks showed more incidences of postoperative complications, however, with no statistical significance (RR = 4.30, 95% CI 0.97 to 18.96, p = .054). The need for additional augmentation upon implant placement was also similar between both grafts (RR = 0.95, 95% CI 0.39 to 2.28, p = .90). Recorded incidences of graft exposure were low (2.27%), and no study stated surgical site infection. CONCLUSION: Within its limitations, this study indicates that the autogenous dentin blocks prepared chairside could be a possible alternative to the other established bone augmentation techniques for staged ridge augmentation. Nevertheless, future studies are needed to confirm its efficacy and implant success/survival in sites grafted with this material.

Stability of guided bone regeneration with two ratios of biphasic calcium phosphate at implant sites in the esthetic zone: A randomized controlled clinical trial.

AIMS: The aim of this randomized, double-blind, clinical trial was to compare the stability of the horizontal dimensions (facial bone thickness) of augmented bone using biphasic calcium phosphate (BCP) with hydroxyapatite/ß-tricalcium phosphate ratio of either 60/40 or 70/30. MATERIALS AND METHODS: Sixty dental implants placed with contour augmentation in the esthetic zone were randomized to 60/40 BCP (n = 30) or 70/30 BCP (n = 30). Cone-beam computed tomographic was used to assess facial bone thickness post-implantation and 6 months later at implant platform and 2, 4, and 6 mm apical to it. RESULTS: The percentage of horizontal dimension reduction was 23.64%, 12.83%, 9.62%, and 8.21% in 70/30 BCP group, while 44.26%, 31.91%, 25.88%, and 21.49% in 60/40 BCP group at the level of the implant platform and 2, 4, and 6 mm apical, respectively. Statistically significant difference was found at 6 months at all levels of measurement (p-value < .05). CONCLUSIONS: BCP bone grafts with HA/ß-TCP ratio of 60/40 and 70/30 showed comparable outcomes for contour augmentation simultaneously with implant placement. Interestingly, the 70/30 ratio was significantly superior in maintaining facial thickness and showed more stable horizontal dimensions of the augmented site.

Computer-assisted and robotic implant surgery: Assessing the outcome measures of accuracy and educational implications.

OBJECTIVE: This scoping review aimed to (1) critically evaluate the outcomes measures used to assess the accuracy of implant placement with Computer Assisted Implant Surgery (CAIS) and (2) review the evidence supporting the efficient implementation of CAIS in training and education of clinicians. METHODS: A scoping literature review was conducted aiming to identify (a) clinical trials assessing accuracy of implant placement with CAIS, and (b) clinical trials or simulation/cadaver studies where CAIS was utilised and assessed for the training/education of clinicians. Studies since 1995 were assessed for suitability and data related to the outcomes measures of accuracy and educational efficacy were extracted and synthesised. RESULTS: Accuracy of CAIS has been mainly assessed through surrogate measures. Individual clinical trials have not shown any difference between static and dynamic CAIS, but recent meta-analyses suggest an advantage of dynamic CAIS in reducing angular deviation. The combination of static and dynamic CAIS might offer higher accuracy than each of the two used alone. Dynamic CAIS is suitable for novice surgeons and might even have added value as an education tool for implant surgery, although mastering the technique requires longer training than static. CONCLUSION: Meta-analyses of large samples, new and diverse outcomes measures, as well as benchmarking of levels of accuracy with specific clinical outcomes will help to better understand the potential and limitations of CAIS. Dynamic CAIS is suitable for novice operators, but educational interventions distributed over longer periods of time will be required for mastery of the process.

The accuracy of implant placement using a combination of static and dynamic computer-assisted implant surgery in fully edentulous arches: A prospective controlled clinical study.

OBJECTIVE: To compare the accuracy of implant position, using a combination of static and dynamic computer-assisted implant surgery (CAIS), with either static, dynamic, or freehand implant placement, in fully edentulous arches. MATERIALS AND METHODS: Twenty-one patients with a total of 88 fixtures were included. Implants were divided equally into four groups: a combination of static and dynamic CAIS (SD group), static CAIS (S group), dynamic CAIS (D group), and freehand placement (FH group). Angular deviation, as well as the 3D platform and apex deviations, were measured for all groups. Furthermore, the direction of implant deviation was recorded and compared. RESULTS: The FH group showed significantly more deviation compared to all groups, considering all the aspects, and at both the implant platform and apex. A significant difference in angular deviation between the SD and S groups (p < .001), and between the SD and D groups (p < .001) was noted, favoring the SD group. When evaluating implant distribution, the FH group showed a tendency towards the buccal, apical, and distal directions at platform and apex, while in the D group, implants shifted more to the buccal. In contrast, the SD group did not show a trend toward any specific direction. The S and SD groups did not show a statistical significance considering any direction. CONCLUSIONS: The combination of static and dynamic CAIS increases the accuracy of implant placement in fully edentulous arches when compared with either static or dynamic CAIS alone, as well as freehand placement.

Accuracy of implant placement with a combined use of static and dynamic computer-assisted implant surgery in single tooth space: A randomized controlled trial.

OBJECTIVE: To compare implant accuracy of combined static and dynamic (SD) computer-assisted implant surgery (CAIS) with static (S), dynamic (D) CAIS, and freehand surgery (FH) for single implant placement. MATERIALS AND METHODS: One hundred and twenty patients were randomized into four groups. Implants were placed using both stereolithographic surgical guide and dynamic navigation in the SD group, stereolithographic surgical guide in S group, dynamic navigation in D group, and conventional freehand in FH group. Analysis of deviation between planned and final implant position, as well as K means analysis was conducted for implant deviation at platform, apex, and angle (primary outcomes) and directional distribution at platform and apex (secondary outcome). RESULTS: Significant differences were found among the four groups (p < .001): The 3D deviation at the platform (mm) of SD, S, D, and FH groups was 0.62 ± 0.50, 1.06 ± 0.67, 1.02 ± 0.45, and 1.48 ± 0.68, respectively, at apex (mm) was 0.75 ± 0.57, 1.40 ± 0.71, 1.28 ± 0.50, and 2.18 ± 0.95, respectively, and angle (degrees) was 1.24 ± 1.41, 3.18 ± 2.04, 3.28 ± 1.57, and 7.50 ± 4.06, respectively. Deviation at the platform of FH group was significantly more toward mesial (p = .026) and coronal (p = .014) direction, while at the apex, toward distal (p = .004) and lingual (p = .002) than SD group. CONCLUSION: The use of combined static and dynamic CAIS provided significantly higher accuracy than the two alone and freehand surgery for single implant placement.

Effect of Storage Time and Temperature on the Bioactivity of a Chitosan-Derived Epigenetic Modulation Scaffold.

The appropriate storage protocol is one of the main limitations of translating tissue engineering technology to commercialized clinical applications. Recently, the development of a chitosan-derived composite scaffold incorporated with bioactive molecules has been reported as an excellent material to repair a critical size bony defect in mice calvaria. This study aims to determine the storage time and appropriate storage temperature of Chitosan/Biphasic Calcium Phosphate/Trichostatin A composite scaffold (CS/BCP/TSA scaffold) in vitro. The mechanical properties and in vitro bioactivity of trichostatin A (TSA) released from CS/BCP/TSA scaffolds in different storage times and temperatures were evaluated. Different storage times (0, 14, and 28 days) and temperatures (-18, 4, and 25 °C) did not affect the porosity, compressive strength, shape memory, and amount of TSA released. However, scaffolds stored at 25 °C and 4 °C were found to lose their bioactivity after 3- and 7-day storage periods, respectively. Thus, the CS/BCP/TSA scaffold should be stored in freezing conditions to preserve the long-term stability of TSA.

Influence of the Residual Ridge Widths and Implant Thread Designs on Implant Positioning Using Static Implant Guided Surgery.

PURPOSE: Aggressive implant macrothread designs have been widely used. However, the effects of the aggressive thread design on the accuracy of static guided surgery, especially in a case of narrow residual ridge, have not been well-studied. The aim of this study was to evaluate the effects of two different implant macrothread designs and the residual ridge widths on the accuracy of tooth-supported static guided implant surgery. MATERIALS AND METHODS: Forty implant fixtures with two different macrodesigns: a conventional thread design bone level tapered (BLT), and an aggressive thread design bone level tapered (BLX) were placed in 40 simulated polyurethane models with narrow and wide residual ridges. The placed implant positions were compared with the planned implant position and angulational deviation, as well as three-dimensional (3D) deviations at the entry and apex of the implant were measured. One-way ANOVA with Tukey's multiple comparisons (ɑ = 0.05) were used to determine level of significance between the mean and variance deviation values. 95% confidence intervals and box plots were used to demonstrate the means and ranges of precision. RESULTS: In terms of angulational deviation, there was no statistically significant difference in the mean deviations for both types of implants, p = 1.55 and p = 0.84 for wide and narrow ridge groups, respectively. However, the range of deviation was much larger in the narrow ridge of the BLX group compared to the BLT group. In both narrow ridge and wide ridge, the BLX group had lower mean 3D deviation values at both the entry and the apex with statistically significant differences for both entry point of the wide ridge (p = 0.027) and narrow ridge (p = 0.022) as well as at the apex of the wide ridge (p = 0.006) but not the apex of the narrow ridge (p = 0.142). CONCLUSION: The aggressive larger thread design of dental implants may influence the accuracy of implant placement more than the ridge dimension.

Can computer-assisted implant surgery improve clinical outcomes and reduce the frequency and intensity of complications in implant dentistry? A critical review.

Computer-assisted implant surgery (CAIS), either static or dynamic, is well documented to significantly improve the accuracy of implant placement. Whether the increased accuracy leads to a corresponding improvement in clinical outcomes has not yet been systematically investigated. The aim of this critical review was to investigate whether the use of CAIS can lead to reduction of complications as well as improved clinical and patient-reported outcomes (PROs) when compared with conventional freehand implant surgery. A comprehensive online search was conducted to identify studies where implants were installed with static computer-assisted implant surgery (s-CAIS)or dynamic computer-assisted implant surgery(d-CAIS) or combinations of the two, either compared with conventional free-hand implant placement or not. Seventy-seven studies were finally included in qualitative analysis, while data from three studies assessing postsurgical pain were suitable for a meta-analysis. Only a small number of the available studies were comparative. The current evidence does not suggest any difference with regard to intraoperative complications, immediate postsurgical healing, osseointegration success, and survival of implants placed with CAIS or freehand protocols. Intraoperative and early healing events as reported by patients in randomized clinical trials (RCTs) did not differ significantly between CAIS used with flap elevation and conventional implant placement. There is limited evidence that increased accuracy of placement with CAIS is correlated with superior esthetic outcomes. Use of CAIS does not significantly reduce the length of surgeries in cases of single implants and partially edentulous patients, although there appears to be a more favorable impact in fully edentulous patients. Although CAIS alone does not seem to improve healing and the clinical and PRO, to the extent that it can increase the utilization of flapless surgery and predictability of immediacy protocols, its use may indirectly lead to substantial improvements in all of the above parameters.

Influence of interproximal peri-implant tissue and prosthesis contours on food impaction, tissue health and patients' quality of life.

PURPOSE: To investigate tissue features and interproximal contour of posterior implant-supported single crowns (ISSC), which correlate with food impaction. 2) To evaluate the influence of food impaction on the health of the adjacent peri-implant tissue and patients' oral health-related quality of life (OHRQoL). MATERIALS AND METHODS: Patients with posterior ISSC under maintenance between July 2019 and July 2020 were recruited. OHRQoL of patients who self-reported food impaction between ISSC and teeth was evaluated by Oral Impacts on Daily Performance questionnaire and reported at patient level. Interproximal prosthesis contours and periodontal/peri-implant tissue conditions were assessed by clinical and radiographic examination. Differences between food impaction (FI) and non-food impaction (NFI) sites were analysed. RESULTS: Totally, 178 patients (286 ISSC and 410 interproximal spaces) were included. Among 119 patients who self-reported food impaction, 84 (70.6%) reported their OHRQoL to be affected with minor-to-severe intensity. The most commonly affected daily performance was the ability to clean the teeth. Plaque accumulation at ISSC, deeper probing depth, complete interdental papilla fill, loose contact, longer contact length, lower contact point level, closer distance between ISSC and tooth, lesser embrasure surface area, tissue-level implant and cement-retained restoration were found significantly more in the FI group than the NFI group (p < .05). CONCLUSION: Interproximal features of the implant prosthesis were associated with food impaction between the ISSC and the adjacent tooth, which might affect periodontal and/or peri-implant tissue health conditions. Patients' OHRQoL was commonly affected by food impaction, but the intensity was low.

Chitosan-Based Scaffold for Mineralized Tissues Regeneration.

Conventional bone grafting procedures used to treat bone defects have several limitations. An important aspect of bone tissue engineering is developing novel bone substitute biomaterials for bone grafts to repair orthopedic defects. Considerable attention has been given to chitosan, a natural biopolymer primarily extracted from crustacean shells, which offers desirable characteristics, such as being biocompatible, biodegradable, and osteoconductive. This review presents an overview of the chitosan-based biomaterials for bone tissue engineering (BTE). It covers the basic knowledge of chitosan in terms of biomaterials, the traditional and novel strategies of the chitosan scaffold fabrication process, and their advantages and disadvantages. Furthermore, this paper integrates the relevant contributions in giving a brief insight into the recent research development of chitosan-based scaffolds and their limitations in BTE. The last part of the review discusses the next-generation smart chitosan-based scaffold and current applications in regenerative dentistry and future directions in the field of mineralized tissue regeneration.

The accuracy of single-tooth implants placed using fully digital-guided surgery and freehand implant surgery.

AIM: This randomized controlled clinical trial (RCT) aimed to compare the accuracy of implant positions between static computer-assisted implant surgery (CAIS) and freehand implant surgery in a single edentulous space. MATERIALS AND METHODS: Sites with single edentulous spaces and neighbouring natural teeth were randomized into static CAIS or freehand implant surgery groups. In both groups, digital implant planning was performed using data from cone beam computed tomography (CBCT) and surface scans. In the static CAIS group, a surgical guide was produced and used for fully guided implant surgery, while in the freehand group, the implants were placed in a freehand manner. Postoperative CBCT was used for nine measurements representing the deviations in angles, implant shoulders and apexes between planned and actual implant positions. RESULTS: Fifty-two patients received 60 single implants. The median (IQR) deviations in angles, shoulders and apexes were 2.8 (2.6)°, 0.9 (0.8) mm and 1.2 (0.9) mm, respectively, in the static CAIS group, and 7.0 (7.0)°, 1.3 (0.7) mm and 2.2 (1.2) mm, respectively, in the freehand group. Statistically significant differences were found in 6 out of nine measured parameters using Mann-Whitney U test (p < 0.05). CONCLUSION: Static CAIS provided more accuracy in implant positions than freehand placement in a single edentulous space.

The accuracy of static vs. dynamic computer-assisted implant surgery in single tooth space: A randomized controlled trial.

OBJECTIVES: The aim of this RCT was to compare the accuracy of implant placement between static and dynamic computer-assisted implant surgery (CAIS) systems in single tooth space. MATERIALS AND METHODS: A total of 60 patients in need of a single implant were randomly assigned to two CAIS groups (Static n = 30, Dynamic n = 30) and implants were placed by one surgeon. Preoperative CBCT was transferred to implant planning software to plan the optimal implant position. Implants were placed using either stereolithographic guide template (Static CAIS) or implant navigation system (Dynamic CAIS). Postoperative CBCT was imported to implant planning software, and deviation analysis with the planned position was performed. Primary outcomes were the deviation measurements at implant platform, apex, and angle of placement. Secondary outcome was the distribution of the implant deviation into each 3D direction. RESULTS: The mean deviation at implant platform and implant apex in the static CAIS group was 0.97 ± 0.44 mm and 1.28 ± 0.46 mm, while that in the dynamic CAIS group was 1.05 ± 0.44 mm and 1.29 ± 0.50 mm, respectively. The angular deviation in static and dynamic CAIS group was 2.84 ± 1.71 degrees and 3.06 ± 1.37 degrees. None of the above differences between the two groups reached statistical significance. The deviation of implants toward the mesial direction in dynamic CAIS group was significantly higher than that of the static CAIS (p = 0.032). CONCLUSIONS: Implant placement accuracy in single tooth space using dynamic CAIS appear to be the same to that of static CAIS. (Thai Clinical Trials Registry TCTR20180826001).

Post-treatment patient-reported outcome measures in a group of Thai dental implant patients.

OBJECTIVE: The aims of this study were to evaluate and analyze the factors affecting patients' perceptions and satisfaction after receiving implant treatment. MATERIAL AND METHODS: Questionnaires were mailed to 691 patients who had completed implant treatment for at least 6 months. The questionnaire consisted of 23 items, including demographic data, seven items on perceptions, and nine items on satisfaction. RESULTS: Of the returned 382 questionnaires, 188 and 194 were from patients treated by postgraduate students and specialists, respectively. Dentists were the most common main source of implant information (55.8%). Although 90% of the patients felt that they were well informed about implant treatment, some inaccurate perceptions remained: 18% believed that "Dental implants require less care than natural teeth," 35.6% that "Dental implants last longer than natural teeth," and 75% that "Treatment with dental implants has no risks or complications." Approximately 90% of the patients were satisfied with their chewing, phonetics, aesthetic outcome, and dental implant treatment; however, some were dissatisfied with the cost. Although gender, age, educational level, main source of information, implant number, and implant position had some impact on patients' perceptions and satisfaction; monthly income did not. The clinicians' expertise affected patients' perceptions, but not satisfaction. CONCLUSIONS: Although most patients had accurate perceptions with regards to implant treatment, some misperceptions about the need for a maintenance care still exist after treatment. Most patients were satisfied with their treatment outcome regardless of monthly income and the clinicians' expertise level.

In Vivo Bone Regeneration Induced by a Scaffold of Chitosan/Dicarboxylic Acid Seeded with Human Periodontal Ligament Cells.

Chitosan/dicarboxylic acid (CS/DA) scaffold has been developed as a bone tissue engineering material. This study evaluated a CS/DA scaffold with and without seeded primary human periodontal ligament cells (hPDLCs) in its capacity to regenerate bone in calvarial defects of mice. The osteogenic differentiation of hPDLCs was analyzed by bone nodule formation and gene expression. In vivo bone regeneration was analyzed in mice calvarial defects. Eighteen mice were divided into 3 groups: one group with empty defects, one group with defects with CS/DA scaffold, and a group with defects with CS/DA scaffold and with hPDLCs. After 6 and 12 weeks, new bone formation was assessed using microcomputed tomography (Micro-CT) and histology. CS/DA scaffold significantly promoted in vitro osteoblast-related gene expression (RUNX2, OSX, COL1, ALP, and OPN) by hPDLCs. Micro-CT revealed that CS/DA scaffolds significantly promoted in vivo bone regeneration both after 6 and 12 weeks (p < 0.05). Histological examination confirmed these findings. New bone formation was observed in defects with CS/DA scaffold; being similar with and without hPDLCs. CS/DA scaffolds can be used as a bone regenerative material with good osteoinductive/osteoconductive properties.

Patient-based outcomes following surgical implant placements.

OBJECTIVES: To assess the postoperative oral health-related quality of life (OHRQoL), pain and swelling after surgical implant placement and to investigate their association with socio-demographic and clinical variables. MATERIALS AND METHODS: A total of 85 partial edentulous patients requiring implant-supported fixed prostheses were enrolled. Standard surgical practice for implant placement was employed. Interviews were conducted to assess the OHRQoL based on the oral impact on daily performances (OIDP) index preoperatively as well as 2 weeks and 1 month postoperatively in addition to the degree of pain and swelling at 2 weeks postoperatively. The socio-demographic and clinical variables of interest were also assessed. RESULTS: Patient's OHRQoL was reduced at 2 weeks followed by a return to baseline levels 1 month postoperatively. The median OIDP scores were 5.0, 12.0 and 3.5 preoperatively, 2 weeks and 1 month postoperatively, respectively. Eating and teeth cleaning were affected after surgery. Overall, 50.6% of the patients perceived no to mild pain, whereas 36.5%, 49.4% and 14.1% reported no, localized or extensive facial swelling, respectively. No association was found between pain and any variable, but anterior implantation and bone augmentation were more commonly associated with facial swelling. Oral health-related quality of life worsened in patients with more pain or facial swelling as well as in cases involving multiple implant placement or bone augmentation procedures. CONCLUSIONS: Oral health-related quality of life deteriorated shortly after surgery based on eating and teeth cleaning difficulties. A high degree of pain, extensive swelling, multiple implant placement and bone augmentation procedures were all associated with oral impacts.

Oral health-related quality of life and esthetic outcome in single anterior maxillary implants.

OBJECTIVES: The aim of this study is twofold: to assess the esthetic outcome of single dental implant restorations in the anterior maxillary area after up to 3 years of function, and to evaluate the relationship between the esthetic outcome and oral health-related quality of life. MATERIALS AND METHODS: Twenty patients who were treated with an anterior maxillary single implant restoration were recalled for esthetic outcome evaluation using pink and white esthetic scores (PES/WES). All patients completed a questionnaire regarding satisfaction of treatment outcome and quality of life related to the implant restorations. Patient satisfaction was assessed by visual analog scales (VAS) analysis, whereas oral impact on daily life performances (OIDP) was used to evaluate the quality of life of patients. RESULTS: The esthetic outcome assessed by PES/WES showed favorable results. The median PES/WES scores were 16.00 (maximum possible score = 20). The median PES scores and WES scores were 7.50 and 8.00, respectively. Patient satisfaction rated in VAS scale ranged from 8 to 10. OIDP assessment showed an impact on daily life performance in 45% of patients. The most common impacts were eating (n = 5) and cleaning teeth (n = 4). No significant difference in PES/WES scores was found between the patients who perceived and did not perceive oral impacts. CONCLUSIONS: There was some discrepancy between the dentist's evaluation and patient's perception but a strong positive satisfaction was reported from all patients which let suppose that the psychosocial factors that involve patient's perspective should be further investigated.

Comparing Bone Graft Success, Implant Survival Rate, and Marginal Bone Loss: A Retrospective Study on Materials and Influential Factors.

This retrospective study aimed to evaluate success rate of guided bone regeneration (GBR) bone grafting and investigate survival rate of implants, as well as degree of marginal bone loss (MBL) around implants. This study was carried out between January 2007 and December 2016 on treatment outcomes of patients with implants which used various graft materials, including autograft, allograft, and xenograft. The bone graft success rate and implant survival rate were recorded. The influence of confounding factors such as patient characteristics, bone graft properties, and implant conditions was considered. Moreover, MBL up to 3 years after implant installation was evaluated in periapical radiographs. In mean follow-up 70 months (range 3-10 years), overall success rate of bone graft (n=80) was 100% and overall survival rate of implant (n=107) was 97.2% (autograft and allograft 100%, and xenograft 92.9%, respectively; P=.03). The 3-year MBL were similar among bone grafts (autograft 0.84±0.48mm, allograft 0.73±0.42mm and xenograft 1.01±0.59mm, respectively; P=.14). Posterior mandibular location had a significant influence on implant survival (P=.003). Regarding MBL, patients aged >60 years (P=.03), patients with both diabetes and hypertension (P=.02), patients who did not receive adjunctive membrane use (P=.04), patients with <6 months of loading (P<.001) and patients with screw-retained crowns (P=.008) were significantly associated. Our data substantiated that implant rehabilitation with GBR using autograft and allograft provide the most predictable results. With xenograft, aforementioned factors should be carefully considered to enhance long-term clinical outcomes.

Alveolar ridge preservation in rat tooth extraction model by chitosan-derived epigenetic modulation scaffold.

PURPOSE: Alveolar ridge preservation is a surgical technique used to prevent dimensional changes in the alveolar bone by dressing biomaterials in the extraction socket. Recently, a chitosan biphasic calcium phosphate loaded with trichostatin A (CS/BCP/TSA) scaffold was introduced as an excellent bone-regeneration material. This study aimed to explore the biological properties of released trichostatin A (TSA) and evaluate the potential of the CS/BCP/TSA scaffold in preserving the alveolar ridge in a rat tooth extraction model. METHODS: In vitro biocompatibility, histone deacetylase (HDAC) activity, and osteogenic differentiation of MC3T3-E1 cells were tested. For in vivo studies, the maxillary first molars (M1) of Wistar rats were extracted, and alveolar ridge preservation was performed using a CS/BCP/TSA scaffold or commercial bone graft. Micro-Computed Tomography (micro-CT), polyfluorochrome labeling, and histological analysis were used to evaluate the ridge-preservation ability. RESULTS: The released TSA was cytocompatible. Inhibition of histone deacetylase (HDAC) activity and induction of osteogenic differentiation in MC3T3-E1 cells were confirmed. The socket dressing with the CS/BCP/TSA scaffold showed increased socket bone fill and preserved the buccal and middle aspects of the alveolar ridge compared with the conventional graft. Further analysis of the bone regeneration ability by histomorphometric and histological analyses demonstrated that CS/BCP/TSA showed a significantly higher potential to induce bone formation and complete healing in the extraction socket than the other groups. CONCLUSIONS: The CS/BCP/TSA scaffold is a novel candidate for alveolar ridge preservation.