Gas Plasma Treatment Improves Titanium Dental Implant Osseointegration-A Preclinical In Vivo Experimental Study.

Recent technological advancements led to the development of various plasma-based technologies for post-packaging modifications. The purpose of the present preclinical in vivo study was to assess the safety and efficacy of a novel chairside nonthermal gas plasma treatment for enhancing osseointegration of titanium implants. Six male mixed foxhounds underwent extraction of mandibular premolars and first molars, and the sockets healed for 42 days. Canine mandibles were randomized to receive either plasma-treated (test) or non-plasma-treated (control) dental implants. A total of 36 implants were placed in six animals, and they were sacrificed at 2 weeks (two animals), 4 weeks (two animals), and 6 weeks (two animals) after the implant surgery. When the radiographic analysis was performed, the changes in bone level were not statistically significant between the two groups at 2 weeks and 4 weeks. The difference became significant at 6 weeks (p = 0.016), indicating more bone loss from baseline to 6 weeks for the control group. The bone-to-implant contact (BIC) appeared to be higher for the test groups at all time points, and the BIC was significantly higher for the test group at 4 weeks (p = 0.046). In conclusion, this study underscored the potential of nonthermal plasma treatment in enhancing implant osseointegration.

Effect of Selective Serotonin Reuptake Inhibitor (Paroxetine) on Newly Formed Bone Volume: Real-Time In Vivo Micro-computed Tomographic Analysis.

INTRODUCTION: Selective serotonin reuptake inhibitors (SSRIs) are commonly used to treat depression and anxiety. The purpose of this study was to assess in real time the effect of paroxetine, an SSRI, on newly formed bone volume (NFBV) in standardized calvarial defects (SCDs) in rats. METHODS: Fourteen Wistar albino female rats with a mean age of 7.5 months and a mean weight of 275 g were used. The animals were randomly divided into 2 groups. The experimental group was given paroxetine 8 weeks before the surgical procedure and throughout the experiment, and the control group was given a placebo 8 weeks before the surgical procedure and throughout the experiment. In each group, 14 SCDs measuring 4.6 mm in diameter were created on the parietal bone. In both groups, a Bio-Oss + collagen membrane was placed. All defects showed primary closure. The volume of the newly formed bone (NFBV) was measured using in vivo micro-computed tomographic imaging. Measurements were taken at days 0, 14, 28, 42, and 56 after surgery using real-time assessment with micro-computed tomographic imaging. RESULTS: The mean NFBV was 17.12 ± 4.52 mm3 and 12.52 ± 4.78 mm3 for the control and experimental groups, respectively, at day 56. The differences between the 2 groups were statistically significant (P < .05) at all time intervals. CONCLUSIONS: Paroxetine intake significantly reduced the amount of regenerated NFBV and the rate of new bone formation.

Histologic Evidence of Oral and Periodontal Regeneration Using Recombinant Human Platelet-Derived Growth Factor.

Human histology provides critical information on the biological potential of various regenerative protocols and biomaterials, which is vital to advancing the field of periodontal regeneration, both in research and clinical practice. Outcomes of histologic studies are particularly valuable when interpreted considering additional evidence available from pre-clinical and clinical studies. One of the best-documented growth factors areproven to have positive effects on a myriad of oral regenerative procedures is recombinant human platelet-derived growth factor-BB (rhPDGF-BB). While a systematic review of clinical studies evaluating rhPDGF in oral regenerative procedures has been recently completed, a review article that focuses on the histologic outcomes is needed. Hence, this communication discusses the histologic effects of rhPDGF-BB on oral and periodontal regenerative procedures, including root coverage and soft tissue augmentation, intrabony defects, furcation defects, peri-implant bone augmentation, and guided bone regeneration. Studies from 1989 to 2022 have been included in this review.

A Novel Surgical Approach to Modify the Periodontal Phenotype for the Prevention of Mucogingival Complications Related to Orthodontic Treatment.

Certain bone morphologies and soft tissue thickness (ie, phenotype) are considered to be risk factors for the development of gingival recessions following orthodontic tooth movement. Preoperative evaluation of the periodontal phenotype, in the frame of orthodontic treatment plan, identify teeth at high risk for mucogingival complications related to orthodontic therapy. The new surgical technique is illustrated in a clinical case. A patient with a thin phenotype without visible gingival recession had bone dehiscences in the anterior mandible. Prior to orthodontic treatment, simultaneous bone and soft tissue augmentation was performed using the combination of a highly cross-linked ribose porcine type I collagen membrane and a subepithelial palatal connective tissue graft. Two years after augmentation surgery and initiation of orthodontic treatment, a thick buccal tissue with a wide band of attached gingiva was observed without any clinical signs of root prominences, indicating a substantial change in periodontal phenotype. The clinical findings were corroborated by the 3D analysis, demonstrating substantial bone apposition on the buccal aspect of all roots in the treated area. The described surgical technique offers a valuable approach for regenerating hard and soft tissues in deficient areas prior to orthodontic therapy, thus preventing the development of gingival recessions.

Human Histologic Evaluations of the Use of Er,Cr:YSGG Laser to Decontaminate an Infected Dental Implant Surface in Preparation for Implant Reosseointegration.

This investigation was designed to evaluate the reestablishment of bone-to-implant contact on infected dental implant surfaces following decontamination with an erbium, chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser and reconstructive therapy. Three patients presenting with at least one failing implant each were enrolled and consented to treatment with the Er,Cr:YSGG laser surface decontamination and reconstruction with a bone replacement allograft and a collagen membrane. The laser treatment was carried out at a setting of 1.5 W, air/water of 40%/50%, and pulse rate of 30 Hz. At 6 months, all three patients returned for the study. En bloc biopsy samples of four implants were obtained and analyzed. Two patients had excellent clinical outcomes, while one patient with two adjacent failing implants experienced an early implant exposure during the follow-up period. There was histologic evidence of new bone formation with two implant specimens and less bone gain with the others. Despite the small sample size, these were optimistic findings that suggested a positive role of Er,Cr:YSGG laser in debridement of a titanium implant surface to facilitate subsequent regenerative treatment. This investigation provides histologic evidence as well as encouraging clinical results that use of the Er,Cr:YSGG laser can be beneficial for treatment of peri-implantitis, but further long-term clinical studies are needed to investigate the treatment outcome obtained.

Human Histologic Evaluations of Implants with a Unique Triangular Neck Design.

The goal of the present study was to evaluate human histologic healing of dental implants with a unique triangular neck design that is narrower than the implant body. Four patients in need of full-mouth reconstruction were recruited and received several implants to support a full-arch prosthesis. In each patient, two additional customized reduced-diameter implants were placed, designated to be harvested after 6 months of submerged healing. The eight harvested implants were all placed in healed edentulous maxillary or mandibular ridges. These implants were Ø 3.5 × 8 mm in size, and the final osteotomy drill allowed for the creation of a gap up to 0.2 mm in size between the coronal aspect of the triangular implant neck and the surrounding bone. At the end of the healing period, the implants were retrieved with the surrounding bone. Microcomputed tomography (µCT) was performed before processing the biopsy samples for undecalcified histologic exampination. Bone-to-implant contact (BIC) was measured from the µCT data and from buccolingual/buccopalatal and mesiodistal central histologic sections. All implant gaps were filled by mature remodeled bone. The mean BICs of the BL/BP and MD sections were 64.45% ± 6.86% and 65.39% ± 10.44%, respectively, with no statistically significant difference. The mean 360-degree 3D BIC measured all over the implant surface was 68.58% ± 3.76%. The difference between the BIC measured on the µCT and on the histologic sections was not statistically significant. The positive histologic results of the study confirmed the efficacy of this uniquely designed dental implant.

Piezoelectric bone surgery compared with conventional rotary instruments in oral surgery and implantology: Summary and consensus statements of the International Piezoelectric Surgery Academy Consensus Conference 2019.

PURPOSE: Piezoelectric bone surgery was introduced into clinical practice almost 20 years ago as an alternative method for cutting bone in dental surgical procedures, in an attempt to reduce the disadvantages of using conventional rotary instruments. The aim of this Consensus Conference was to evaluate the current evidence concerning the use of piezoelectric surgery in oral surgery and implantology. MATERIALS AND METHODS: Three working groups conducted three meta-analyses with trial sequential analysis, focusing on the use of piezoelectric surgery in impacted mandibular third molar extraction, lateral sinus floor elevation and implant site preparation. The method of preparation of the systematic reviews, based on comprehensive search strategies and following preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, was discussed and standardised. RESULTS: Moderate/low evidence suggests that piezoelectric surgery is significantly associated with a more favourable postoperative course (less pain, less trismus) after impacted mandibular third molar extraction than conventional rotary instruments. Moderate evidence suggests that implants inserted with piezoelectric surgery showed improved secondary stability during the early phases of healing compared with those inserted using a drilling technique. Strong/moderate evidence suggests that piezoelectric surgery prolongs the duration of surgery in impacted mandibular third molar extraction, sinus floor elevation and implant site preparation, but it is unclear whether the slight differences in duration of surgery, even if statistically significant, represent a real clinical advantage for either operator or patient. Weak evidence or insufficient data are present to draw definitive conclusions on the other investigated outcomes. CONCLUSIONS: Further well-designed trials are needed to fully evaluate the effects of piezoelectric surgery, especially in implant site preparation and sinus floor elevation.

Piezoelectric bone surgery for lateral sinus floor elevation compared with conventional rotary instruments: A systematic review, meta-analysis and trial sequential analysis.

AIMS: To evaluate whether piezoelectric bone surgery (PBS) for lateral maxillary sinus floor elevation reduces risk of intraoperative complications, requires prolonged surgical time and improves the survival rate of dental implants in comparison with conventional rotary instruments. MATERIALS AND METHODS: This meta-analysis followed PRISMA guidelines and was registered in the PROSPERO database (CRD42019122972). The PubMed, Embase, Scopus and Open Grey databases were screened for articles published from 1 January 1990 to 31 December 2018. The selection criteria included randomised controlled trials (RCTs) and case-control studies (CCTs) comparing PBS with rotary instruments in lateral sinus augmentation and reporting intraoperative and postoperative outcomes (e.g. sinus membrane perforations, surgical time and implant failure rate). The risk of bias assessment was performed using the Cochrane Collaboration's tool for RCTs. A meta-analysis was performed, and the power of the meta-analytic findings was assessed via trial sequential analysis (TSA). RESULTS: Four RCTs met the inclusion criteria and were included in the review. The meta-analysis showed that, although a lower incidence of membrane tearing occurred when using PBS, the difference between the two groups was not significant. However, the power of evidence for this outcome, as determined by the TSA, was weak. Moreover, there was moderate evidence suggesting that PBS prolongs the surgery duration (mean difference of 3.43 minutes), whilst insufficient data was present to assess if PBS improves the survival rate of implants inserted in augmented sinuses. CONCLUSIONS: The power of the evidence was too weak to confirm the above-mentioned findings and further well-designed randomised clinical trials are needed to draw definitive conclusions.

Clinical Outcomes of Maxillary Anterior Postextraction Socket Implants with Immediate Provisional Restorations Using a Novel Macro-Hybrid Implant Design: An 18- to 24-Month Single-Cohort Prospective Study.

Extraction and immediate implant placement/restoration in the esthetic zone is clinically challenging; benefits include fewer surgical appointments and maintenance of peri-implant soft tissues throughout the treatment period, and limitations include gingival recession and bone dehiscence during surgery. Macro-hybrid implants (large-diameter apical/narrow-diameter occlusal) were placed in 19 patients immediately following the extraction of hopeless maxillary anterior teeth. Immediate restorations were fabricated without occlusal contacts. Pre- and postplacement cone beam computed tomography (CBCT) scans were taken. Nineteen implants were available for recall 13 to 25 months postoperatively. The overall implant cumulative survival rate was 100% (range: 13 to 25 months, mean: 19 months), and mean insertion torque value was 65 Ncm. Mean Pink Esthetic Score was 12.63 at 6 months, and was 13 at the 18- to 24-month follow-up. Mean mesial and distal tooth-to-implant distances immediately after implant placement were 2.55 ± 1.29 mm and 2.29 ± 0.82 mm, respectively. Interproximal bone crest width, distance, and height were maintained at implant platforms, mesially and distally, 18 to 24 months postoperative. The results of this study indicated that the macro-hybrid implant geometry for this immediate surgical/restorative protocol provided excellent and stable 2-year results relative to implant survival (100%), labial plate thickness via CBCT evaluations, tooth-to-implant distances immediately post-implant placement, PES, and interproximal bone crest width, distance, and heights, which were maintained at the implant platforms.

Human Clinical and Histologic Evaluations of Laser-Assisted Periodontal Therapy with a 9.3-µm CO² Laser System.

This investigation was designed to evaluate the healing response of 9.3-µm CO2 laser-assisted periodontal therapy. Five patients presenting with moderate to severe periodontitis, with an initial pocket depth (PD) ≥ 5 mm and with teeth predetermined to be surgically extracted, were enrolled and consented to treatment with full-mouth CO2 laser-assisted therapy. The laser treatment was carried out in the Ultraguide Mode at a setting of 0.25-mm spot size, with an average power of 0.65 to 1.15 watts and 20% mist. The laser tip was passed from the gingival margin and down apically to the base of the pocket with a sweeping L motion. The teeth were intensely scaled with piezoultrasonic instrumentation afterwards. A second pass of the laser tip was performed for the study teeth. At 9 months, all patients were clinically reevaluated. For sites with an initial pocket depth of ≥ 7 mm, a mean PD reduction of 3.97 ± 1.36 mm and a mean clinical attachment level gain of 3.54 ± 1.54 mm were achieved, resulting in a mean PD of 3.91 ± 0.77 mm. En bloc biopsy samples of four teeth were obtained and analyzed; two demonstrated histologic evidence of new bone formation while the other two healed with a long junctional epithelium with minimal inflammatory infiltrate. Further long-term clinical studies are needed to investigate the treatment stability obtained with a 9.3-µm CO2 laser compared to conventional surgical therapy. Nevertheless, the encouraging clinical results indicated that adjunctive use of the 9.3-µm CO2 laser-assisted periodontal therapy can be beneficial for treatment of periodontally compromised patients.

Laser De-epithelialization of Autogenous Gingival Graft for Root Coverage and Soft Tissue Augmentation Procedures.

The purpose of this case report was to introduce a novel technique for de-epithelializing autogenous gingival graft that can be combined with coronally advanced flap for root coverage and soft tissue augmentation. This technique allows for easier, predictable harvesting of connective tissue of excellent quality and quantity without inclusion of undesirable submucosa or adipose tissues. Reduced surgical chair time and double protection of the donor site using the combination of cyanoacrylate and periodontal dressing allowed for uneventful postoperative healing.

Immediate Palatal Molar Implants: A Simple, Safe, Minimally Invasive Technique.

The purpose of this study was to determine whether a single immediate implant placed into the postextraction palatal socket of a maxillary molar would be as efficacious as a single implant placed centrally in a staged approach. A total of 61 immediate implants were placed in 52 patients and restored after 6 months. Periotest and Osstell were used to determine implant stability, and cone beam computed tomography was used for marginal bone level assessment. During the 2-year follow-up, implant survival was 100%. It was concluded that immediate palatal implants can safely restore extracted molars in the maxilla.

Tissue Engineering Therapy for Atrophic Maxilla Using Minimally Manipulated CD90 and CD105 Bone Marrow Stem Cells: A Case Report.

Bone deficiencies in the jaws of edentulous patients limit the possibility of successful placement and osseointegration of endosseous implants. Bone resorption is defined as a vertical and horizontal loss of quality and quantity in the residual bone ridges; lack of bone structure requires bone grafting procedures to enable implant placement and to improve the function, predictability, and longevity of implants. The objective of this case study was to demonstrate the feasibility of a novel cell therapy treatment for localized jaw bone defects with tissue repair cells composed of a mixture of bone marrow-derived cells, including CD90+ mesenchymal stem cells and CD105+ monocytes/macrophages, and xenograft blocks, in what would be a safe and efficacious approach to the regeneration of localized craniofacial bone defects. The use of stem cells represents an alternative that could offer improved results, better quality histologically, and greater quantity in millimeters of tissue in bone regeneration.

Clinical and Histologic Evaluations of SLA Dental Implants.

The goal of this investigation was to evaluate the efficacy of dental implants with a surface that was sandblasted with large grit and acid etched in a human model. Seven patients volunteered to allow the biopsy of a small implant in exchange for complete dental rehabilitation at no cost. All biopsy sites received soft and hard tissue reconstruction, and this report provides observation of successful bone-to-implant contact and successful prosthesis construction for the patient. The patients enthusiastically reported improved quality of life as a result of participation in this study. The surgeons' confidence in this implant was reflected by the clinical and histologic result of the study.

Arrangement of Peri-implant Connective Tissue Fibers Around Platform-Switching Implants with Conical Abutments and Its Relationship to the Underlying Bone: A Human Histologic Study.

The objective of this study was to clarify and evaluate the orientation of the collagen fibers around platform-switching (PS) implants with conical abutments in humans after 8 weeks of healing, and to determine how this orientation would help stabilize the soft tissue and prevent bone resorption. On PS implants, circular orientation of collagen fiber was observed as the main arrangement in a cross-sectional view. The circular collagen fibers might be the key factor in stabilizing the soft tissues around the rehabilitation, inhibiting apical migration of the soft tissues and, in turn, protecting the underlying bone.

Impacted canine extraction by ridge expansion using air scaler surgical instruments: a case report.

The presence of an impacted tooth interferes with ideal implant placement. In such cases, atraumatic extraction is recommended in order to avoid difficult and complex bone regeneration procedures. In the present case report, a novel surgical approach to extract a horizontally impacted canine using an edentulous ridge expansion (ERE) technique and air scaler surgical devices is described. A 74-year-old female patient had a maxillary left horizontally impacted canine. The tooth was extracted after elevating a partial-thickness flap and performing an ERE technique using air scaler surgical instruments. The impacted tooth was fragmented through the breach created in the expanded ridge, and the fragments were carefully removed. A suitably sized implant was placed at the time of surgery. The treated site healed without complication. The implant was integrated, successfully restored, and stable after a 3-year follow-up period. This case report demonstrates a novel surgical approach to extract an impacted canine through ridge expansion, using air scaler surgical devices that allow implant placement in an ideal position.

Adaptive growth factor delivery from a polyelectrolyte coating promotes synergistic bone tissue repair and reconstruction.

Traumatic wounds and congenital defects that require large-scale bone tissue repair have few successful clinical therapies, particularly for craniomaxillofacial defects. Although bioactive materials have demonstrated alternative approaches to tissue repair, an optimized materials system for reproducible, safe, and targeted repair remains elusive. We hypothesized that controlled, rapid bone formation in large, critical-size defects could be induced by simultaneously delivering multiple biological growth factors to the site of the wound. Here, we report an approach for bone repair using a polyelectrolye multilayer coating carrying as little as 200 ng of bone morphogenetic protein-2 and platelet-derived growth factor-BB that were eluted over readily adapted time scales to induce rapid bone repair. Based on electrostatic interactions between the polymer multilayers and growth factors alone, we sustained mitogenic and osteogenic signals with these growth factors in an easily tunable and controlled manner to direct endogenous cell function. To prove the role of this adaptive release system, we applied the polyelectrolyte coating on a well-studied biodegradable poly(lactic-co-glycolic acid) support membrane. The released growth factors directed cellular processes to induce bone repair in a critical-size rat calvaria model. The released growth factors promoted local bone formation that bridged a critical-size defect in the calvaria as early as 2 wk after implantation. Mature, mechanically competent bone regenerated the native calvaria form. Such an approach could be clinically useful and has significant benefits as a synthetic, off-the-shelf, cell-free option for bone tissue repair and restoration.

Efficacy of growth factor in promoting early osseointegration.

A preclinical study was conducted to evaluate the feasibility of 2 different topical formulations of recombinant human platelet-derived growth factor-BB (rhPDGF-BB) to promote early osseointegration and enhanced bone-to-implant contact (BIC) for dental implants placed in an edentulous ridge. Six female beagle dogs were divided into 3 groups. The control group included 4 implants with no coating; test group A included 10 implants with commercially available rhPDGF-BB formulation coating; and second test group B included 10 implants with prototype viscous rhPDGF-BB coating. Three dogs were sacrificed at 3 weeks (12 implants) and the remaining 3 dogs at 6 weeks after implant placement (12 implants). The specimens were retrieved for histological evaluation, and revealed an uneventful healing of all implants without any sign of an inflammatory response at the different time intervals. Furthermore, the bone was in very close contact with the implants' surfaces with no evidence of intervening fibrous tissue layers. At 3 weeks, new bone formation between most implant threads on rhPDGF-BB coated implants was evident, whereas in the control group only a thin and sparse amount of new bone was noted. At 6 weeks, the commercially available rhPDGF-BB formulation coated implant group (Group A) showed more trabecular bone and higher BIC compared to the other 2 groups. Histologically, the results in this study showed that use of conventionally available rhPDGF-BB formulation as the implant surface treatment may accelerate the process of osseointegration and enhance BIC.

Human histologic assessment of a platform-switched osseointegrated dental implant.

This case report examined crestal bone level maintenance surrounding a platform-switched implant that was retrieved due to prosthetic difficulty. The retrieved platform-switched implant threads demonstrated tight contact with the surrounding bone and demonstrated both radiographic and histologic features that were indicative of successful osseointegration. Very high bone-to-implant contact (BIC) without epithelial downgrowth to the implant thread was noted. The BIC consisted of a combination of newly formed bone and native bone. The buccal and lingual bone levels coincided with the original platform position noted at the time of the surgery, and did not appear to resorb at all. The result of the present investigation confirms the maintenance of the crestal bone level for platform-switched implants.