Clinical outcomes and significance of postoperative ultrasound biomicroscopy in patients with Boston type 1 keratoprosthesis

ABSTRACT Purpose: To determine the clinical outcomes in patients after type 1 Boston keratoprosthesis surgery and the significance of ultrasound biomicroscopy imaging for postoperative follow-up. Methods: This retrospective analysis included 20 eyes of 19 patients who underwent corneal transplantation with type 1 Boston keratoprosthesis between April 2014 and December 2021. Data on patient demographics, preoperative diagnosis, visual acuity, and postoperative clinical findings were analyzed. Results: Type 1 Boston keratoprosthesis implantation resulted in intermediate- and long-term positive outcomes. However, blindness and other serious complications such as glaucoma, retroprosthetic membrane formation, endophthalmitis, or retinal detachment also occurred. The use of ultrasound biomicroscopy imaging allowed for better evaluation of the back of the titanium plate, anterior segment structures, and the relationship of the prosthesis with surrounding tissues, which provided valuable postoperative information. Conclusion: Regular lifetime monitoring and treatment are necessary in patients who undergo Boston type 1 keratoprosthesis implantation for high-risk corneal transplantation. ultrasound biomicroscopy imaging can be a valuable imaging technique for the evaluation of patients with Boston type 1 keratoprosthesis, providing important information on anterior segment anatomy and potential complications. Further studies and consensus on postoperative follow-up protocols are required to optimize the management of patients with Boston type 1 keratoprosthesis.

Clinical and radiographic changes following transcrestal sinus augmentation: A scoping review of the last 25 years.

INTRODUCTION: Maxillary sinus floor elevation is a surgical procedure intended to increase the volume of the bone vertically to accommodate dental implant placement. This intervention is frequently required for implant installation in the posterior maxilla, where the bone may be insufficient for securing implants of necessary length and stability. Sinus floor elevation can be completed either through a direct approach with a "window" through the lateral wall of the alveolar ridge or an indirect "transcrestal/transalveolar" sinus floor elevation (TSFE), which accesses the sinus floor through the crest of the edentulous ridge. Our study aims to provide a comprehensive scoping review of research conducted over the past 25 years on TSFE, specifically. METHODS: A literature search aimed at identifying pertinent literature for the purpose of this PRISMA-ScR-compliant scoping review was conducted. Only randomized controlled trials, non-randomized controlled trials, prospective cohort studies, and case series that met the eligibility criteria were selected. Relevant data from these studies were extracted. Primary outcome measures included radiographic bone levels and implant failure >5 years. Secondary outcome measures included implant stability at time of placement and complications. Interventions reported in the selected studies were grouped based on treatment modality, which were then compared with the control therapy (traditional osteotome technique) after a minimum of 12 months healing period. RESULTS: Our search yielded 633 records, and after deduplication, 574 of these were screened. Application of the eligibility criteria led to the inclusion of 37 articles in the final selection. Case selection for included studies enrolling subjects: Four different transcrestal sinus elevation treatment modalities were identified: (a) osteotome, (b) piezoelectric surgery, (c) osseodensification, and (d) hydraulic techniques. Due to the heterogeneity of the studies, no superior approach for TSFE could be identified. Overall, all techniques demonstrated high implant survival rates. CONCLUSION: Comprehensive understanding of the patient's medical history, available armamentarium, and post-operative complications/management strategies are all essential to the completion of a successful TSFE approach for implant placement in the posterior maxilla, regardless of the treatment modality used.

Retrospective study on the clinical and radiographic outcomes of 2.8 mm diameter implants supporting fixed prostheses up to 11 years.

OBJECTIVES: This study aimed to report the clinical and radiographic results of 2.8 mm two-piece narrow diameter implant (NDI) supporting fixed restorations. MATERIALS AND METHODS: Clinical and radiographic data of 54 NDIs in 32 patients were retrospectively assessed after 2 to 11 (mean 8.17) years of follow-up. Clinical and radiographic measurements were taken. Survival rate, implant and prosthesis failure, pink aesthetic scores (PES), white aesthetic scores (WES), bleeding on probing (BOP), probing depth (PD), marginal bone loss (MBL), and mechanical and biological complications were evaluated. RESULTS: An implant failed during the follow-up period, resulting in a cumulative survival rate of 98.15% at the implant level and 96.88% in the patient. The total mean values of PES and WES for 2.8 mm NDIs were 7.09 ± 1.15 (range: 3.33-9.00) and 7.42 ± 1.03 (range: 3.67-9.33). The prevalence of sites with positive BOP was 38.14 ± 29.77%. The mean PD value was 2.46 ± 0.62 mm. The average MBL was 1.15 ± 0.74 mm (range: 0.25-4.03 mm). No implant or abutment fracture was detected. A veneer chipping was present in one patient, and a loose crown appeared in another patient. Two implants (3.7%) and two patients (6.3%) were diagnosed with peri-implantitis. CONCLUSION: Within the limitation of the study, the results indicate that the use of two-piece 2.8 mm NDI for the fixed prosthetic rehabilitation of edentulous regions with reduced interdental and/or buccal-lingual width is viable.

Osseodensification technique in crestal maxillary sinus elevation-A narrative review.

Osseodensification is a novel approach that has significantly advanced the field of implant dentistry, particularly in the context of transcrestal maxillary sinus floor elevation. This technique involves the use of specially designed burs that compact and densify bone along the osteotomy walls, thereby enhancing implant primary stability and facilitating osseointegration in low-density bone. This article reviews the historical evolution of implant site preparation, and the biomechanical, histological, and clinical evidence of osseodensification with a special focus on its application in sinus floor augmentation. The integration of this technique into contemporary practice represents a paradigm shift, offering a minimally invasive and efficient solution for addressing the challenges of posterior maxilla, with improved patient-reported outcomes and low complication rate. Three different protocols for sinus lift and implant placement using osseodensification burs are proposed based on available literature, and risk factors for Schneiderian membrane perforation based on residual bone height are discussed, along with implant-related outcomes and patient-reported outcome measures. The potential for osseodensification to become a standard practice in sinus floor augmentation is emphasized, highlighting key aspects such as surgical protocol and patient selection.

Evaluation of Maxillary Sinus Septa Using Cone Beam Computed Tomography (CBCT): A Retrospective Study.

BACKGROUND: Maxillary sinus septa, which are bony structures dividing the sinus cavity, can pose challenges during sinus lift or implant surgeries by potentially causing perforation of the Schneiderian membrane. This study aimed to estimate the prevalence, height, location, orientation, and risk of perforation of the maxillary sinus septa using cone beam computed tomography (CBCT). MATERIALS AND METHODS: This retrospective, cross-sectional study utilized CBCT (NewTom CBCT machine, of which the scan parameters were 90 KvP, 8 mAs, and 14 s exposure with a field of view (FOV) of 8×8 cm and a 0.2 mm3 voxel size) images of 300 maxillary sinuses from patients aged >18 years, obtained from Swami Devi Dyal Hospital and Dental College in Panchkula, India. Scans were analyzed for the presence, height, location, orientation, and risk of septal perforation. The data were categorized based on age, sex, and dentition status. Statistical analyses were performed to assess the prevalence, configuration, and risk factors. RESULTS: The prevalence of maxillary sinus septa was 21.33%, with the majority showing a single septum (90.63%). Septa were predominantly found in the middle region (48.44%), with bucco-palatal orientation (93.75%) being more common than anteroposterior. The mean septa height was 6.16 mm. The perforation was classified as moderate (48.4%), low (46.8%), or high (4.6%). Class III septa were associated with the highest risk of perforation. CONCLUSION: This study highlights a significant prevalence of maxillary sinus septa with variations in height, orientation, and location. The risk of perforation varies with the septa configuration and orientation. CBCT is essential for identifying these anatomical features to minimize surgical complications and to guide preoperative planning.

Immediate implant placement in damaged extraction sockets: a systematic review and meta-analysis of randomized controlled trials.

OBJECTIVES: The aim of this study was to observe whether immediate implant placement (IIP) into damaged extraction sockets is a successful modality for treating hopeless teeth that require extraction. DATA SOURCE: An electronic search was carried out through four databases (PubMed/MEDLINE, Web of Science, Scopus, and ScienceDirect) to identify randomized controlled trials (2013-2023) to understand whether IIP in damaged sockets is a successful treatment. The focus question was, 'In a patient with a hopeless tooth that needs extraction with the indication for dental implant treatment, is IIP in damaged extraction sockets, compared to undamaged sockets or healed sites, an effective method for the replacement of hopeless teeth and achieving a favorable clinical result?' The risk of bias was appraised and a meta-analysis using random effect was applied. Five studies with 135 patients and 138 implants were included. The implant survival rate was 100% for all studies and period evaluated; the pink esthetic score (PES) scores had no statistically significant result for all articles that evaluated this parameter; the soft tissue changes was reported by two studies: one found no significant differences and the other showed that the test group experienced reduced soft tissue loss at the 1-year evaluation (measured with digital intraoral scanners); other two studies assessed the marginal bone loss, presenting no differences between groups. The meta-analysis showed homogeneity between the studies. There was an equilibrium among the groups in the various studies included, and age tended to be lower in the test group. The buccal bone tissue and pink esthetic score showed favoritism for the test group but without statistical significance. CONCLUSION: This study suggests that IIP in the presence of buccal bone defects can achieve comparable clinical and radiological outcomes to traditional methods in the short term of the limited studies available. The buccal aspect is not possible to be evaluated through radiographs. Bone regeneration was essential to reach optimal results. It is important to emphasize that IIP requires adherence to rigorous criteria to ensure functionally acceptable results.

Personalized subperiosteal implant­supported obturator for the rehabilitation of rhino­orbit­cerebral mucormycosis sequela: A case report.

Severe atrophy of the maxilla occasionally renders it impossible to place standard endosseous implants to replace absent teeth. For such cases, personalized subperiosteal implants (PSI) are presented as a treatment alternative. Due to novel design and manufacturing technologies, PSIs are fitted closely to the bone structure of the patient, after defining the anchorage areas where the bone is of higher quality and allowing a passive dental prosthesis to be attached to restore function and aesthetics to the patient. The present case report documents a patient with severe bone defects as a sequela of rhino-orbit-cerebral mucormycosis. After a failed microvascular fibula flap reconstruction, the patient was treated with a removable implant-supported prosthesis attached to a PSI, which provided occlusion with the mandible of the patient and closed the oronasal-antral communication defect. At 18 months after treatment, the patient felt well, with no biological complications and the prosthesis was well adjusted and with good function. Consequently, we consider that in some cases such as this, a customized solution of this type can avoid complex reconstruction treatments.

Crafting Confidence: A Comprehensive Case Study of Full-Mouth Reconstruction Utilizing Implant-Supported Computer-Aided Design/Computer-Aided Manufacturing (CAD/CAM) Zirconia Restorations.

A 67-year-old male patient reported to the department with a chief complaint of tooth mobility. The patient presented with a medical history of diabetes for which he was on medication, and he also reported a history of chronic periodontitis. After a thorough assessment of the patient, a proper treatment plan was designed, which included full-mouth rehabilitation, prior to which the patient was advised full-mouth extraction. Six implants were inserted into the mandibular and maxillary arches as part of the treatment. After the implant was placed, zirconia was the preferred choice for the restoration because of its superior aesthetic results. Polyvinyl siloxane impression material was used to make implant impressions after an eight-week healing period. The case report provides the technique for the current approach to full-mouth rehabilitation with all six concepts of implant placement. In these situations, it is crucial to plan and insert implants correctly and adhere to the entire treatment plan. Restorations were performed using the latest computer-aided design/computer-aided manufacturing (CAD/CAM) technologies for a more aesthetically pleasing result. The case study highlights the significance of meticulous preparation and implementation for the accomplishment of successful full-mouth rehabilitation.

3D-printed aerogels as theranostic implants monitored by fluorescence bioimaging.

Aerogel scaffolds are nanostructured materials with beneficial properties for tissue engineering applications. The tracing of the state of the aerogels after their implantation is challenging due to their variable biodegradation rate and the lack of suitable strategies capable of in vivo monitoring the scaffolds. Upconversion nanoparticles (UCNPs) have emerged as advanced tools for in vitro bioimaging because of their fluorescence properties. In this work, highly fluorescent UCNPs were loaded into aerogels to obtain theranostic implants for tissue engineering and bioimaging applications. 3D-printed alginate-hydroxyapatite aerogels labeled with UCNPs were manufactured by 3D-printing and supercritical CO2 drying to generate personalize-to-patient aerogels. The physicochemical performance of the resulting structures was evaluated by printing fidelity measurements, nitrogen adsorption-desorption analysis, and different microscopies (confocal, transmission and scanning electron microscopies). Stability of the aerogels in terms of physicochemical properties was also tested after 3 years of storage. Biocompatibility was evaluated in vitro by different cell and hemocompatibility assays, in ovo and in vivo by safety and bioimaging studies using different murine models. Cytokines profile, tissue index and histological evaluations of the main organs unveiled an in vivo downregulation of the inflammation after implantation of the scaffolds. UCNPs-decorated aerogels were first-time manufactured and long-term traceable by fluorescence-based bioimaging until 3 weeks post-implantation, thereby endorsing their suitability as tissue engineering and theranostic nanodevices (i.e. bifunctional implants).

Cationic homopolypeptides: A versatile tool to design multifunctional antimicrobial nanocoatings.

Postoperative infections are the most common complications faced by surgeons after implant surgery. To address this issue, an emerging and promising approach is to develop antimicrobial coatings using antibiotic substitutes. We investigated the use of polycationic homopolypeptides in a layer-by-layer coating combined with hyaluronic acid (HA) to produce an effective antimicrobial shield. The three peptide-based polycations used to make the coatings, poly(l-arginine) (PAR), poly(l-lysine), and poly(l-ornithine), provided an efficient antibacterial barrier by a contact-killing mechanism against Gram-positive, Gram-negative, and antibiotic-resistant bacteria. Moreover, this activity was higher for homopolypeptides containing 30 amino-acid residues per polycation chain, emphasizing the impact of the polycation chain length and its mobility in the coatings to deploy its contact-killing antimicrobial properties. However, the PAR-containing coating emerged as the best candidate among the three selected polycations, as it promoted cell adhesion and epithelial monolayer formation. It also stimulated nitric oxide production in endothelial cells, thereby facilitating angiogenesis and subsequent tissue regeneration. More interestingly, bacteria did not develop a resistance to PAR and (PAR/HA) also inhibited the proliferation of eukaryotic pathogens, such as yeasts. Furthermore, in vivo investigations on a (PAR/HA)-coated hernia mesh implanted on a rabbit model confirmed that the coating had antibacterial properties without causing chronic inflammation. These impressive synergistic activities highlight the strong potential of PAR/HA coatings as a key tool in combating bacteria, including those resistant to conventional antibiotics and associated to medical devices.

Characterisation of 3D-printed acetabular hip implants.

Three-dimensional printing is a rapidly growing manufacturing method for orthopaedic implants and it is currently thriving in several other engineering industries. It enables the variation of implant design and the construction of complex structures which can be exploited in orthopaedics and other medical sectors. In this review, we develop the vocabulary to characterise 3D printing in orthopaedics from terms defined by industries employing 3D printing, and by fully examining a 3D-printed off-the-shelf acetabular cup (Fig. 1). This is a commonly used 3D-printed implant in orthopaedics, and it exhibits a range of prominent features brought about by 3D printing. The key features and defects of the porous and dense regions of the implant are clarified and discussed in depth to determine reliable definitions and a common understanding of characteristics of 3D printing between engineers and medical experts in orthopaedics. Despite the extensive list of terminology derived here, it is clear significant gaps exist in the knowledge of this field. Therefore, it is necessary for continued investigations of unused implants, but perhaps more significantly, examining those in vivo and retrieved to understand their long-term impact on patients and the effects of certain features (e.g. surface-adhered particles). Analyses of this kind will establish an understanding of 3D printing in orthopaedics and additionally it will help to update the regulatory approach to this new technology.

Comparison of stress distribution around splinted and nonsplinted implants with different crown height space in posterior mandible: A finite element analysis study.

PURPOSE: The purpose of this finite element analysis (FEA) study was to analyze the stress distribution on prosthetic components of splinted and nonsplinted prostheses, bone, and implants with different crown height space (CHS). MATERIALS AND METHODS: Mandibular posterior segment was modeled with no resorption at the second premolar site and various amounts of resorption (0, 3, 6, and 9 mm) at the first molar site. Two adjacent implants (Straumann bone level implants, 4.1 mm×8 mm) were placed; at the second premolar site, the crown height was 8 mm and at the first molar site, the crown height varied (8, 11, 14, and 17 mm), depending on the amount of resorption. Both splinted and nonsplinted crowns were designed. Vertical and oblique loads of 400 N were applied to the crowns. von Mises stress was used to evaluate the stress distribution in the implant complex and maximum principal stress was used to evaluate the stress in the bone. RESULTS: When oblique forces were applied, the highest von Mises stresses were observed for nonsplinted crowns in the 17 mm CHS group. The maximum principal and minimum principal stresses observed in bone under oblique loading increased with increased CHS for nonsplinted restorations. CONCLUSIONS: Crown height affected the amount of stress in bone and implant components. When the crown height difference between two adjacent implants increases, splinting may be crucial.

Modified Surgical Guide for Root Sectioning in the Socket Shield Technique-In Vitro Study.

OBJECTIVE: This in vitro study aimed to evaluate the effectiveness of a printed surgical guide for root sectioning in the socket-shield technique. MATERIALS AND METHODS: A typodont model of the maxilla with augmented filler was used for the upper right central incisor, and CBCT images were obtained. Two types of vertical root sectioning guides were tested: one with a buccal sleeve (Group A, n = 10) and another with a buccal orientation slit (Group B, n = 10). Control group (n = 10) performed freehand cuts on printed models. After crown cutting with diamond burs, root sectioning was conducted using an ultrasonic tip with the guides. Mean and standard deviation were calculated for the remaining root length, width, and volume. Data were analyzed using the Kruskal-Wallis test and Dunn's post hoc test. RESULTS: Statistical analysis showed significant differences in root width between the control group (2.0 mm) and both Groups A (2.655 mm; p < 0.0001) and B (2.460 mm; p < 0.0001). Group B (5.585 mm) also showed a significant difference in root remnant compared with the control (13.880 mm; p < 0.0043). Groups A and B did not differ significantly from each other. CONCLUSIONS: The socket shield technique is safe and effective, this study aimed to add improvements through the introduction of surgical guides, facilitating the root section, which is the critical phase so that the parameters that are requisite for success are achieved in terms of width, length, and volume of the root remnant. Both guided techniques effectively facilitated root sectioning, maintaining satisfactory root thickness and length. CLINICAL SIGNIFICANCE: Sectioning the root is challenging for the correct angulation to remove the palatal portion in the socket shield technique. Therefore, modifying this technique with the use of the presented guides, it is possible to prevent damage to the soft tissues and to plan the surgery with the help of cone beam computed tomography (CBCT) scans to remove the root apex and maintain the root remnant with a thickness greater than 1.5 mm, making the socket-shield technique more predictable.

Clinical report of the immediate placement implants in patients aged 80 and over: Five cases and a short review.

With the population aging, the proportion of elderly individuals is expected to increase, and the proportion of individuals over 80 is also likely to increase. Given that the population is aging and life expectancy is increasing, elderly patients who have lost thei teeth will also increase. Impaired masticatory function caused by tooth loss is a risk factor for cognitive decline and frailty, and neglecting to treat tooth loss is a critical issue. In this report, five patients over 80 requested dental implants for new missing teeth and underwent immediate implant placement. All patients were treated by the same surgeon using the same technique, materials, and dental implants. Five elements were measured for the peri-implant bone from the cone-beam computed tomography images. All patients were followed for three or more years and exhibited good progress without any abnormal findings in their oral cavities or notable radiographic abnormalities such as bone absorption or peri-implantitis. Compared to conventional treatment with delayed placement, combining immediate implant placement and regenerative medicine for fixed superstructures may be the better option for missing tooth replacement if the conditions are suitable. Thus, this treatment modality may improve the quality of life in elderly patients, especially super elderly patients.

Secured Anatomy-driven Flap Extension (SAFE) for Guided Bone Regeneration: A Modified Flap Release Technique Description and Retrospective Study.

INTRODUCTION: Current flap-releasing designs for guided bone regeneration (GBR) emphasize preserving subperiosteal microvasculature by adapting a deep slit approach, separating theperiosteum from the flap. While biologically sound, a biomechanical disadvantage may be encountered. This study aimed to describe a modified design, the Secured Anatomy-driven Flap Extension (SAFE) technique, for effective facial flap release and to preliminarily evaluate the clinical outcomes of this technique retrospectively. MATERIALS AND METHODS: Chart reviews were conducted to identify patients treated by facial flap release in staged GBR procedures between May 2020 and March 2022. The anatomical, biological, and biomechanical rationale of this technique were described. The following clinical data were collected: intraoperative and postoperative complications, initial and final horizontal ridge width before and 5-6 months after the GBR, and implant performance. RESULTS: A total of 10 patients were identified. At baseline, these patients presented with a mean ridge width of 2.05 ± 0.52 mm. No intraoperative and postoperative complications were observed in these patients (bleeding, wound opening, neurosensory disturbance, etc.) at the 2-3-week follow-up visit. At the re-entry, a mean ridge width of 6.50 ± 0.55 mm was measured (p < 0.01), resulting in a mean of 4.45 ± 0.65 mm ridge width gain. Twenty-one implants were successfully placed, integrated, and in function without signs/symptoms of peri-implantitis after a mean 21.5 ± 9.2 months follow-up period. CONCLUSION: Preliminary results suggest that the SAFE technique is a safe and predictable approach for releasing facial flaps during GBR procedures.

Effectiveness of keratinized mucosa augmentation procedures around dental implants based on risk assessment: A 5-year retrospective cohort study.

PURPOSE: To compare the effectiveness of keratinized mucosa (KM) augmentation with different techniques for the treatment of dental implants based on risk assessment. METHODS: Thirty-nine patients who underwent KM augmentation at implant sites in the posterior mandible were included. Three techniques were used based on anatomy-guided risk assessment: an apically positioned flap (APF) alone, an APF plus a free gingival graft (APF plus FGG), and an APF plus a collagen matrix (APF plus CM). Clinically effective KM augmentation was defined as remaining KM ≥ 2 mm after the intervention. The effective rate, implant/prosthesis survival rates, and bone/soft tissue parameters were analyzed. The correlation between local anatomical characteristics and different techniques was also determined. The associations between the effectiveness of KM augmentation and related factors were analyzed using a linear model. RESULTS: Overall, 74 sites received KM augmentation in the posterior mandible, for an effective rate of 94.6% at the 1-year follow-up and 93.2% at the 5-year follow-up. The KM width in the APF plus FGG group (3.85 ± 1.22 mm) was greater than that in the APF alone (3.05 ± 0.90 mm) (P = 0.016) and APF plus CM (3.21 ± 1.17 mm) groups (P = 0.038) at 5 years post-surgery. There was no significant difference in the effective/ineffective outcomes at the 1-year or 5-year follow-up among the three groups. CONCLUSIONS: Comparable effective outcomes were achieved with three KM augmentation techniques following the decision-making criterion based on risk assessment.

Engineering Ga-doped mesoporous bioactive glass-integrated PEEK implants for immunomodulatory and enhanced osseointegration effects.

With the increasing aging population, the demand for orthopedic implants is also growing. Polyether ether ketone (PEEK) is considered a promising material for orthopedic implants due to its excellent biocompatibility. However, the lack of bioactivity and excessive immune response post-implantation often impair bone integration. Therefore, it is urgent to bio-functionalize PEEK-based implants to promote bone integration. This study employs a simple, economical, and feasible method to coat Ga-ion doped bioactive glass nanoparticles (Ga-MBGs) onto sulfonated PEEK surfaces, constructing a multifunctional PEEK-based orthopedic implant. The resulting bio-functionalized PEEK implants promote macrophage M2 phenotype polarization, thus fostering an anti-inflammatory immune microenvironment. Moreover, the direct osteogenic effect of Ga ions and the immuno-osteogenic effect through promoting macrophage M2 polarization enhance osteogenic differentiation potential in vitro and bone integration in vivo. A sequence of in vivo and in vitro experiments substantiates the essential and intricate function of this innovative orthopedic implants. in regulating normal bone immunity and metabolism. Overall, the application of Ga-MBGs provides a simple, economical, and effective method for developing multifunctional orthopedic implants. This surface bio-functionalized PEEK implant, capable of modulating immunity and bone metabolism, holds significant clinical application potential as an orthopedic implant.

Revision of the Wolford protocol for managing infections in temporomandibular joint prostheses: an updated surgical approach.

The management of infected temporomandibular joint prostheses presents a surgical challenge. In certain instances, an intermediate approach involving biofilm debridement and local antibiotic instillation may obviate the need for prosthesis removal. This technical note describes an update of the technique outlined by Wolford for managing infections, in which improved materials are used to implement the technique.

Engineering of Bioresorbable Polymers for Tissue Engineering and Drug Delivery Applications.

Herein, the recent advances in the development of resorbable polymeric-based biomaterials, their geometrical forms, resorption mechanisms, and their capabilities in various biomedical applications are critically reviewed. A comprehensive discussion of the engineering approaches for the fabrication of polymeric resorbable scaffolds for tissue engineering, drug delivery, surgical, cardiological, aesthetical, dental and cardiovascular applications, are also explained. Furthermore, to understand the internal structures of resorbable scaffolds, representative studies of their evaluation by medical imaging techniques, e.g., cardiac computer tomography, are succinctly highlighted. This approach provides crucial clinical insights which help to improve the materials' suitable and viable characteristics for them to meet the highly restrictive medical requirements. Finally, the aspects of the legal regulations and the associated challenges in translating research into desirable clinical and marketable materials of polymeric-based formulations, are presented.

Tooth- and implant-related prognostic factors in treatment planning.

Following a comprehensive patient examination, including the assessment of periodontal and peri-implant diseases as well as considering the patient's needs, a pretherapeutic prognosis for each tooth and implant is given. Teeth and implants with a secure pretherapeutic prognosis require simple procedures and may be regarded as secure abutments for function and with a doubtful pretherapeutic prognosis usually need a comprehensive therapy. Such teeth and implants must be brought into the category with a secure prognosis by means of additional therapy such as endodontic, restorative, and surgical procedures. Teeth and implants with a hopeless pretherapeutic prognosis should be extracted/explanted during the initial phase of cause-related therapy (i.e., infection control). For example, teeth with vertical root fracture or unrestorable caries and implants with mobility or unrestorable malposition fall into the category of hopeless units. The primary goal of periodontal and peri-implant therapy should be to arrest disease progression. The latest consensus statement highlights that periodontitis can be successfully controlled and treated teeth can be retained for life. Nevertheless, for patients with uncontrolled contributing factors, the endpoints might not always be achievable, and low disease activity may be an acceptable therapeutic goal. Similarly, the management of peri-implantitis frequently requires surgical intervention following nonsurgical therapy due to incomplete treatment outcomes. Different surgical modalities can be effective and lead to significant improvement; however, achieving complete resolution of peri-implantitis is challenging, not always predictable, and can depend on multiple baseline factors. Therefore, this review aims at summarising available evidence on the rationale for incorporating systemic, lifestyle-related, clinical, and radiographic prognostic factors into treatment planning of patients diagnosed with periodontal and peri-implant diseases.