Autotransplantation with Adjunctive Application of Enamel Matrix Derivatives Using a Digital Workflow: A Prospective Case Series.

OBJECTIVES: Digital protocols and bioactive materials may reduce complications and improve tooth autotransplantation (ATT) success and survival rates. This prospective study assesses the performance of a fully digital autotransplantation protocol of close-apex molars with the adjunctive application of Enamel Matrix Derivatives (EMD). METHODS: Twelve adult patients with 13 hopeless molar teeth were replaced with autotransplantation of closed apex third molars. Outcomes, including success and survival rates, clinical, endodontic, radiographic, patient-reported outcome measures (PROMs), and digital image assessments, were conducted over a two-year follow-up period. RESULTS: Survival and success rates were 100% and 91.2%, respectively, with no progressive inflammatory or replacement root resorption (ankylosis) except for one tooth presenting radiographic furcation involvement. A significant probing depth reduction of 2.4 ± 2.58 mm and CAL gains of 2.8 ± 3.03 mm were observed in transplanted teeth compared to the hopeless receptor teeth. Radiographic bone levels remained stable throughout the study period (-0.37 ± 0.66 mm), and digital image assessments showed minimal alveolar ridge width changes (-0.32 to -0.7 mm) and gingival margin changes (-0.95 to -1.27 mm) from baseline to last visit. PROMs indicated very high patient satisfaction. CONCLUSION: The use of a digital ATT protocol with adjunctive use of EMD in closed-apex third molars demonstrated promising short-term high success and survival rates. Additionally, this type of therapy adequately preserves the dimensions of the alveolar ridge in the receptor site.

Effect of one-time placement of the definitive abutment versus multiple healing abutment disconnections and reconnections during the prosthetic phase on radiographic and clinical outcomes: A 12-month randomized clinical trial.

OBJECTIVE: The aim of this investigation was to evaluate the effect on clinical and radiological outcomes of the one-abutment, one-time protocol (test) versus placing the definitive abutment on the day of functional loading after having disconnected and connected three times the healing abutment during the prosthetic phase (control). MATERIALS AND METHODS: Forty patients with 80 implants were randomly allocated to either the test or the control group. Changes in the radiographic marginal bone levels (MBLs), clinical outcomes, prosthetic-related outcomes, and patient-reported outcomes measures (PROMs) were assessed and compared 6 and 12 months after functional loading. RESULTS: Thirty-seven patients with 74 implants were followed at 12 months. A statistically significant bone remodeling was observed in both groups following implant placement. MBLs were significantly greater in the control group at the 6- (-0.13 mm vs. -0.61 mm) and 12-month visits (-0.01 mm vs. -0.53 mm). Bone loss was significantly greater in the control group from surgery to 6 and 12 months and from loading to 6 and 12 months. The abutment height was significantly greater in the test group, however, there were no significant differences in the restorative angle. Similarly, there were no statistically significant differences between groups for the measured clinical variables (probing depth, plaque, and bleeding index) and PROMs. CONCLUSIONS: Disconnecting and reconnecting the healing abutment was associated with significantly higher bone loss after 12 months, as compared to the placement of the definitive abutment at implant installation.

Calibrated intraoral scan protocol (CISP) for full-arch implant impressions: An in vitro comparison to conventional impression, intraoral scan, and intraoral scan with scan-aid.

OBJECTIVE: To assess a newly developed intraoral scan protocol in enhancing the accuracy of complete-arch implant impressions. MATERIALS AND METHODS: Four impression approaches were applied to the same maxillary edentulous model with 6 implants: (1) intraoral scan (IOS), (2) intraoral scan with scan aid (IOS-SA), (3) calibrated intraoral scan protocol (CISP), and (4) conventional splinted open-tray impression (CONV). Each approach was repeated 10 times, and a direct scan of the model with a desktop scanner was used as a reference model. The alignment of scans and the reference model was conducted by two methods: (a) aligning all scan bodies to evaluate the overall fit, and (b) aligning the first and second scan bodies to simulate the Sheffield fit test for passive fitting of multiple implant-supported prostheses. Linear deviations from the reference model (trueness) and within each group (precision) were analyzed using Python scripts. RESULTS: When aligned by all scan bodies, the CISP group exhibited comparable mean trueness (38.33 µm) and precision (45.97 µm) to the CONV group (44.30 and 47.92 µm respectively), both of which significantly outperformed the IOS group (86.82 and 83.17 µm, respectively). Furthermore, in the virtual Sheffield fit test, the CISP group achieved the highest levels of mean trueness at the end span (121.7 µm), making a linear deviation reduction of 36.7%, 60%, and 41.4% when compared to the CONV, the IOS, and the IOS-SA groups, respectively. Moreover, the CISP group (104.3 µm) displayed a remarkable 65, 182, and 86 µm advantage in precision over the CONV, IOS, and IOS-SA groups, respectively. CONCLUSION: CISP demonstrated comparable accuracy to the gold standard, the conventional splinted open-tray impression. Furthermore, it excelled in the virtual passive fitting test.

The effect of one-time abutment placement on clinical and radiographic outcomes: A 5-year randomized clinical trial.

OBJECTIVE: The aim of this study was to evaluate the long-term (5 years) clinical efficacy of the one-abutment one-time protocol (test) versus the standard of care by placing the definitive abutment on the day of the prosthetic delivery (control). MATERIALS AND METHODS: In this study, 39 subjects with 60 implants were randomly allocated to either the test or the control group. Changes in the radiographic interproximal bone levels (DIB), modified sulcus bleeding index, probing depth, modified plaque index, papilla fill (Jemt score), incidence of peri-implantitis and peri-implant mucositis as well as patient-reported outcomes measures (PROMs) were collected and compared at 1, 3 and 5 years. RESULTS: At 5 years, the control group showed a greater, although not statistically significant, change in mean DIB values (0.97 mm vs. 0.53 mm). Regarding the other clinical parameters evaluated, no statistically significant differences were observed between groups at any time point. At 5 years, 51% of the implants presented peri-implant mucositis (25.5% in the control and 23.5% in the test), and only one implant in the test group developed peri-implantitis. CONCLUSIONS: The connection and disconnection of healing abutments during the healing period was not associated with higher long-term bone loss. Clinical outcomes and PROMs were similar between groups.

Multifunctional anatomical prototypes (MAPs): Treatment of excessive gingival display due to altered passive eruption.

OBJECTIVE: To describe a strategy using digital technologies for improving the diagnosis, treatment planning, and surgical execution of patients with excessive gingival display (EGD) due to altered passive eruption (APE). CLINICAL CONSIDERATIONS: An important component for successful patient's management is to fulfill their esthetic expectations whilst delivering predictable and long-term therapeutic outcomes. To achieve this goal in patients with excessive gingival display due to altered passive eruption, it is essential to perform an accurate diagnosis and to communicate to the patient the expected customized results using digital technologies. Computer-aided designed and manufactured multifunctional anatomical prototypes (MAPs) may contribute to these purposes. Additionally, they can guide the surgical crown lengthening procedure or serve as a reference during the surgical guide fabrication providing information of the required anatomical landmarks. CONCLUSIONS: This novel strategy protocol for diagnosis, communication, and treatment management of patients with excessive gingival display follows functional and biological principles within the frame of a digital workflow, which improves the diagnostic capabilities, enhances communication, and guides the surgical treatment as shown in the 12 months follow-up of the reported case. CLINICAL SIGNIFICANCE: Developing a virtual patient by combining multiple digital data sets including cone-beam computed tomography (CBCT), intra-oral scans and digital photography, supports the clinician and the patient to achieve a comprehensive diagnosis and to better communicate the expected results to the patient. Furthermore, this digital treatment exercise based on anatomical and biological principles will facilitate the surgical precision and the achievement of successful outcomes, thus fulfilling the patient needs and expectations.

The role of desalinisation to address aquifer overdraft in SE Spain.

Aquifer overdraft is a major environmental and water management problem in Southeast Spain. In some areas, availability of desalinised seawater resources is being expanding, which provides an opportunity to address this problem at a lower social and economic cost. We analyse the economic impact of using several instruments to address the problem of non-renewable groundwater pumping in the aquifers of the Guadalentín basin: an environmental tax on groundwater use, the buyback of groundwater rights and the subsidization of desalinised resources. Their impact is assessed using a mathematical programming model that maximises the farm net margin resulting from the use of the available water resources for irrigation in the area. Our results show that, in the current situation of water availability, all the alternatives have significant economic impacts. Moreover, the first two alternatives would be unfeasible from a political point of view. The existence of abundant, though expensive, desalinised water resources in the foreseen future would reduce, but not eliminate, the negative economic impact of such instruments. Furthermore, water demand is so high in this area that even strongly subsidising desalinised water in exchange for reducing the use of groundwater would not allow to eliminate aquifer overdraft.

Using pruning residues as mulch: analysis of its adoption and process of diffusion in Southern Spain olive orchards.

This paper analyses both the processes of adoption and diffusion of the practice of using the chopped residues of pruning as mulch in the olive orchards of the Southern Spanish province of Granada, one of the major olive-producing areas in the world. Many olive groves in the area are located on steep areas where the risk of soil erosion is high. A majority of farmers have adopted no tillage, as an alternative to traditional tillage, combined with either vegetation soil covers or, more frequently, using the chopped pruning residues as mulch. The data used comes from a survey carried out in 2005 to 215 olive farmers. From farmers' responses we estimate a binomial probit model to identify some socio-economic and institutional factors related to the decision to use the practice of mulching on a regular basis. We also estimate several diffusion models that describe the spatial and temporal spread of mulching among farmers. Our results show that mulching using the pruning residues is adopted by 43% of the surveyed farmers. The diffusion process of this practice has been very intense since the middle nineties, and seems to have been based on the interactions among farmers in the area of study rather than in other external source of information. Some of the relevant identified factors that affect the probability of adoption of this practice are farmer's experience, the level of soil degradation in the farm or the continuity of farming by some relative.