Intraoperative complications and early implant failure after transcrestal sinus floor elevation with residual bone height ≤5 mm: A retrospective multicenter study.

OBJECTIVE: Clinical indications for maxillary sinus floor elevation with transcrestal techniques have increased in recent years even in sites with minimal residual bone height (RBH). Nevertheless, limited information is currently available on incidence of intraoperative complications and early implant failure in these cases. MATERIAL AND METHODS: This retrospective multicenter study was performed on anonymized clinical and radiographic records of patients who underwent transcrestal sinus floor elevation in seven clinical centers. Influence of different factors related to patient, and sinus anatomy and surgical technique on the incidence of intraoperative complications and early implant failure rate after transcrestal sinus lift were investigated. RESULTS: A total of 430 patients treated with transcrestal sinus floor elevation for single-implant insertion in sites with RBH ≤5 mm were included in the final analysis. After 1 year of loading, 418 implants of 430 were satisfactorily in function. Early implant failure was recorded in 12 cases (2.8%); results were significantly associated with the presence of large sinus cavities and with the occurrence of membrane perforation. The following adverse events were recorded: membrane perforation (7.2%), acute sinusitis (0.9%), implant displacement into the sinus cavity (0.7%), oro-antral fistula (0.2%), and benign paroxysmal positional vertigo (0.5% of osteotome cases). A strong direct correlation between sinus membrane perforation and bucco-palatal sinus width (p = .000) was demonstrated. CONCLUSIONS: Early implant failure after transcrestal sinus elevation showed significant direct correlation with bucco-palatal maxillary sinus width and the presence of membrane perforation. Sinus membrane perforation was strongly associated with bucco-palatal sinus width (extremely low perforation rate in narrow and much higher incidence in wide sinuses).

Influence of Modified Titanium Abutment Surface on Peri-implant Soft Tissue Behavior: A Systematic Review of In Vitro Studies.

PURPOSE: Abutment soft tissue integration in the transmucosal area supports the peri-implant tissues, improves esthetics, ensures a soft tissue seal against microorganisms, and preserves crestal bone level. The aim of this systematic review was to systematically analyze the cellular response of fibroblasts on different abutment materials and surface modifications in in vitro studies with a score-based reliability evaluation. MATERIALS AND METHODS: A protocol aiming to answer the following focused question was developed: "What is the effect of different abutment materials and different surface modifications on in vitro cellular response of fibroblasts?" A search through three electronic databases (Medline/PubMed, EMBASE, and Web of Science) was performed using the following search terms: fibroblast, implant, abutment used as the main keywords, with AND/OR as Boolean operators. Only in vitro studies using machined titanium as control surface were included. A quality assessment of the selected studies was performed following the SciRAP method. RESULTS: Out of a preliminary pool of 97 articles, 21 relevant articles were identified for final evaluation. Cellular response evaluation was investigated as follows: 10 studies compared two or more different materials, 7 assessed mechanical surface modification, 14 weighed chemical or biochemical surface modification, and 3 evaluated surfaces modified by a biophysical procedure. Rather than abutment bulk material, external surface features (collagen coating, electropolishing, plasma cleaning, and laser dimpling) were demonstrated to positively affect cell response (cell attachment, morphology and proliferations, expression of adhesion-related proteins and cytokines), mostly at the early stage. While sandblasting, acid etching, composite coating, nitride coating, and vitamin D presented lower results compared with machined, controversial results were demonstrated by anodization. The mean reporting quality SciRAP score was 78.17 ± 11.89, while the mean methodologic quality SciRAP score was 84.13 ± 12.35. Intrastudy comparison highlighted that the time after seeding chosen to evaluate the fibroblast response varies significantly and seems to deeply influence the response. In fact, due to heterogeneity in the study designs, statistical methods, and reported results, meta-analysis of the data was not possible. CONCLUSION: Within the limitation due to the design and heterogeneity of the included studies, it can be speculated that abutment material and its mechanical, physical, and chemical modification influence fibroblast response in vitro, especially in the earlier phases of contact with the abutment surface.

Insertion torque values and success rates for paramedian insertion of orthodontic mini-implants : A retrospective study.

OBJECTIVES: Orthodontic mini-implants (OMIs) are a reliable method to provide temporary orthodontic anchorage. We hypothesized that there is an optimal insertion torque (<10 Ncm) that can be used to ensure the success of self-drilling OMIs in the paramedian region. PATIENTS AND METHODS: Included were 40 (26 females, 14 males) consecutive patients requiring palatal skeletal anchorage. Mean age was 17.3 years (range 11.0-44.6 years) for female patients and 15.7 years (range 10.6-36.9 years) for male patients. A total of 22 patients received a Beneslider according to Wilmes for the distalization of maxillary first molars, 10 patients received a Mesialslider for the mesialization of maxillary first molars, and 8 patients received a bone-borne rapid palatal expansion (RPE) appliance. Torque values of 10-15 Ncm were recorded in 46.3% of the OMIs and 15-20 Ncm in 35% of OMIs. OMIs that endured the orthodontic force applied for ≥6 months were considered as success. RESULTS: The overall success rate was 98.8%. No significant differences were found between insertion torque values with respect to the right and left sides, Jarabak's ratio, facial axis, and Frankfort to mandibular plane angle. There were no significant differences in the OMIs insertion torques with regard to the different appliances. No association was found between insertion torque and vertical skeletal morphology. CONCLUSION: With an overall success rate of 98.8%, the study hypothesis that greater insertion torque (>10 Ncm) will decrease the success rate and increase palatal OMI failure was rejected.

Bruxism is unlikely to cause damage to the periodontium: findings from a systematic literature assessment.

BACKGROUND: This paper systematically reviews the MEDLINE and SCOPUS literature to answer the following question: Is there any evidence that bruxism may cause periodontal damage per se? METHODS: Clinical studies on humans, assessing the potential relationship between bruxism and periodontal lesions (i.e., decreased attachment level, bone loss, tooth mobility/migration, altered periodontal perception) were eligible. Methodologic shortcomings were identified by the adoption of the Critical Appraisal Skills Program quality assessment, mainly concerning the internal validity of findings according to an unspecific bruxism diagnosis. RESULTS: The six included articles covered a high variability of topics, without multiple papers on the same argument. Findings showed that the only effect of bruxism on periodontal structures was an increase in periodontal sensation, whereas a relationship with periodontal lesions was absent. Based on the analysis of Hill criteria, the validity of causation conclusions was limited, mainly owing to the absence of a longitudinal evaluation of the temporal relationship and dose-response effects between bruxism and periodontal lesions. CONCLUSIONS: Despite the scarce quantity and quality of the literature that prevents sound conclusions on the causal link between bruxism and the periodontal problems assessed in this review, it seems reasonable to suggest that bruxism cannot cause periodontal damage per se. It is also important to emphasize, however, that because of methodologic problems, particularly regarding sleep bruxism assessment, more high-quality studies (e.g., randomized controlled trials) are needed to further clarify this issue.