Statements and Recommendations for Guided Bone Regeneration: Consensus Report of the Guided Bone Regeneration Symposium Held in Bologna, October 15 to 16, 2016.

INTRODUCTION: In the past 10 years, long-term studies have demonstrated that guided bone regeneration (GBR) is a successful and reliable technique for vertical and horizontal ridge augmentation, but strict and rigorous protocols must be adopted. MATERIAL AND METHODS: Because no reports have yet been published with statements and clinical recommendations for GBR, a closed meeting of all authors was organized to discuss this matter during a GBR symposium held in Bologna (Italy) in October 2016. The authors focused on the findings of systematic and narrative reviews, prepared before the meeting, covering aspects of the clinical management of GBR techniques. Successively, a discussion based on the scientific evidence and on the experts' opinions led to the formulation of statements, clinical recommendations, and implications for future research. RESULTS: To avoid complications and to optimize outcomes, the following factors should be considered by clinicians: patient selection; analysis of defect type; blood supply; antibiotic treatment; flap passivation; delayed implant placement; combination of autogenous bone and xenograft or allograft; rigorous fixation of membranes; removal after 6 to 9 months; analysis of complications; soft-tissue management; and high care in scarred sites and in esthetic areas. CONCLUSIONS: The present consensus report reviewed the scientific evidence and provided specific guidelines and recommendations for clinical practice and the different approaches to GBR techniques to ensure surgical success and predictable outcomes.

Periodontal response to two different subgingival restorative margin designs: a 12-month randomized clinical trial.

OBJECTIVES: Subgingival margin placement is sometimes required due to different reasons and is often associated with adverse periodontal reactions. The purpose of this study was to determine if a single restoration with subgingival margin on a tooth, in the maxillary anterior zone, would affect its periodontal soft tissue parameters, and whether or not a deep chamfer preparation has a different influence in the periodontium when compared to a feather edge preparation. MATERIAL AND METHODS: Plaque and gingival indexes, periodontal probing depth, bleeding on probing, and patient's biotype were registered. One hundred six teeth were prepared with a deep chamfer, while 94 were prepared with a feather edge finishing line. Twelve months after the restoration delivery, the same parameters were evaluated. Repeated measure one-way analysis of variance (ANOVA) (α = 0.05) was used. RESULTS: A statistically significant difference between the baseline and the 12-month follow-up is present in regard to plaque index, gingival index, and periodontal probing depth, but no statistically significant difference between chamfer and feather edge finishing lines. There is a statistically significant difference between the baseline and the 12-month follow-up in regard to bleeding on probing. Feather edge preparation presents significantly more bleeding on probing and less gingival recession than the chamfer. CONCLUSIONS: Subgingival margins do influence the periodontal soft tissue response. Statistically significant difference exists between feather edge and chamfer finishing lines in regard to bleeding on probing and gingival recession. CLINICAL RELEVANCE: Subgingival margins should be carefully selected, especially when feather edge finishing line is utilized.

Significance of crown shape in the replacement of a central incisor with a single implant-supported crown.

OBJECTIVE: When utilizing a single implant-supported crown to replace a central incisor, understanding the final shape of the implant restoration is an important factor to help achieve a successful esthetic outcome. In today's dentistry, tooth shape is a critical factor when dental implant prostheses are considered in the esthetic zone. The major esthetic goal for this type of restoration is to achieve the closest possible symmetry with the adjacent tooth, both at the soft and at the hard tissue levels. The goal of this study was to objectively analyze the significance of natural crown shape when replacing a central incisor with a single implant-supported crown. METHOD AND MATERIALS: In this study, we investigated the shape of the crowns of maxillary central incisors in 60 individuals who presented to our clinics with an untreatable central incisor. The presence of a dental diastema, "black triangle," presence or absence of gingival symmetry, and the presence or absence of dental symmetry were recorded in the pre- and postoperative photographs. RESULTS: Out of 60 patients, 33.3% had triangular-shaped crowns, 16.6% square/tapered, and 50% square-shaped crown form. After treatment was rendered, 65% of the triangular group, 40% of the square/tapered group, and 13.3% of the square group required an additional restoration on the adjacent central incisor in order to fulfill the esthetic needs of the patients. CONCLUSION: Data analysis revealed that if there is a "black triangle," a diastema, or presence of dental or gingival asymmetry, an additional restoration on the adjacent central incisor is often required in order to fulfill esthetic goals. The additional restoration is highly recommended in situations with a triangular crown shape, while it is suggested in cases of square/tapered and square tooth shapes in the presence of a dental diastema.

A technique for immediate occlusal implant loading of a completely edentulous mandible: a clinical report.

The protocols described are designed for immediate implant loading of the completely edentulous mandible and to provide the patient with a prosthesis that incorporates structural durability and esthetics in a time efficient manner. Incorporating appropriate diagnostic and surgical procedures, this clinical report describes the use of custom-fabricated transparent devices that help the clinician identify implant position, thereby reducing the procedural time and improving the structural durability and esthetics of the immediate prosthesis.

A prospective, multicenter, randomized-controlled 5-year study of hybrid and fully etched implants for the incidence of peri-implantitis.

BACKGROUND: The dual acid-etched (DAE) implant was commercially introduced in 1996 with a hybrid design incorporating a machined surface in the coronal region from approximately the third thread to the seating surface. This design was intended to reduce the risks of peri-implantitis and other related soft tissue complications that were reported for implants with surface roughness in the coronal region. The objective of this prospective, randomized-controlled clinical trial was to determine the incidence of peri-implantitis for a fully etched implant with the DAE surface extending to the implant platform. METHODS: Patients had implant sites randomly assigned to receive one hybrid control implant and at least one fully etched test implant in support of a short-span fixed restoration to ensure that variables (e.g., demographics, jaw locations, and bone density) were consistent between groups. Prostheses were inserted 2 months after implant placement with follow-up evaluations scheduled annually for 5 years to assess mucosal health based on bleeding on probing, suppuration, and probing depths. Evaluations also included radiographic and mobility assessments. RESULTS: One hundred twelve patients who were enrolled at seven centers received 139 control and 165 test implants (total: 304 implants). With >5 years of postloading evaluations, there was one declaration of peri-implantitis associated with a control implant that was successfully treated later. Clinical probing and radiographic assessments did not reveal differences between groups in mucosal health outcomes or other signs of peri-implantitis. CONCLUSION: Five-year results of this randomized-controlled study showed no increased risk of peri-implantitis for fully etched implants compared to hybrid-designed implants.