Qualitative and Semi-Quantitative Assessment of Processing-Related Surface Contamination of One- and Two-Piece CAD/CAM Abutments before and after Ultrasonic Cleaning.

Manufacturing processes of custom implant abutments may contaminate their surfaces with micro wear deposits and generic pollutants. Such particulate debris, if not removed, might be detrimental and provoke inflammatory reactions in peri-implant tissues. Although regulatory guidelines for adequate cleaning, disinfection, or sterilization exist, there does not appear to be a consistent application and data on the amount and extent of such contaminants is lacking. The aim of the present in vitro study was to evaluate the quality and quantity of processing-related surface contamination of computer-aided design/computer-aided manufacturing (CAD/CAM) abutments in the state of delivery and after ultrasonic cleaning. A total of 28 CAD/CAM monotype and hybrid abutments were cleaned and disinfected applying a three-stage ultrasonic protocol (Finevo protocol). Before and after cleaning, the chemical composition and the contamination of the abutments were assessed using scanning electron microscopy (SEM), dispersive X-ray spectroscopy (EDX), and computer-aided planimetric measurement (CAPM). In the delivery condition, monotype abutments showed a significantly higher amount of debris compared to hybrid abutments (4.86 ± 6.10% vs. 0.03 ± 0.03%, p < 0.001). The polishing process applied in the laboratory after bonding the hybrid abutment components reduces the surface roughness and thus contributes substantially to their purity. The extent of contamination caused by computer-aided manufacturing of custom abutments can be substantially minimized using a three-stage ultrasonic protocol.

Assessment of routine diet (garlic consumption) as a pre- and postoperative protocol in oral and maxillofacial surgical interventions: An evidence-based literature review.

BACKGROUND: It was hypothesized that pathological bleeding (PB) during and/or after oral surgical procedures is higher in systemically healthy patients who have a history of garlic intake compared to controls (patients without a history of garlic consumption). AIM: The aim of the present review article was to identify studies in which garlic consumption was included as a patient management protocol before and after oral and maxillofacial surgery (OMFS). METHODS: A review of pertinent indexed literature was performed. The focused question that was addressed was "Has diet (garlic consumption) been considered as a patient management protocol before and after OMFS?" The inclusion criteria were: (a) studies published in indexed databases, (b) original studies, (c) studies on OMFS, and (d) studies that considered diet (garlic consumption) as a patient management protocol before and after OMFS. Literature review, commentaries, letters to the editor, and studies published in non-indexed resources were excluded. The pattern of the present review was customized to summarize the pertinent information. RESULTS: The initial search using the terms "oral," maxillofacial," "protocol," and "surgery" yielded 1478 studies. The addition of the term "diet" to this search strategy reduced the number of studies to five. Further filtration of these studies using the terms "garlic" and/or "Allium sativum" showed no studies. CONCLUSIONS: Garlic intake predisposes patients to PB. However, there are no studies in the indexed literature that have considered the inclusion of garlic consumption in patient management protocols before and after OMFS.

Midfacial Tissue Assessment of the Effect of Amount of Keratinized Mucosa on Immediate Temporarization of Fresh Socket Implants: 8-Year Follow-up.

The aim of the present study was to consider the long-term midfacial mucosal outcome around final prosthetic restorations on dental implants placed and loaded immediately after tooth extractions. A total of 42 patients requiring tooth extractions were recruited, and 142 teeth were extracted. Based on the amount of keratinized mucosa (KM), implants were categorized into group A (KM ≥ 2 mm; n = 61) or group B (KM < 2 mm; n = 62). In both groups, all patients received temporary prosthetic restorations immediately after the surgical procedure. Baseline levels were measured at placement of the final prosthetic restoration and patients were followed for 8 years. After the 8-year follow-up, a survival rate of 98.37% was reported. Two implants were lost due to peri-implantitis after 6 and 7 years of function, respectively. Peri-implantitis occurred at 9 implants (3 from group A and 6 from group B) in 8 patients (7.32%). At the 8-year follow-up for group A, an increase in midfacial tissue level of 0.14 ± 0.13 mm (screwed restorations) and 0.16 ± 0.09 mm (cemented restorations) was measured. For group B, a decrease in midfacial tissue level of 0.15 ± 0.09 mm (screwed restorations) and 0.17 ± 0.12 mm (cemented restorations) was reported. Statistically significant differences between groups were measured at 2, 5, and 8 years of follow-up (P < .01). The results demonstrated that the presence of KM is significantly associated with less mucosal inflammation and less gingival recession, regardless of the type of prosthetic restoration (screwed vs cemented).

A detailed decision tree to create, preserve, transfer, and support the emergence profile in anterior maxillary implants using custom abutments.

Rehabilitation with implants in the esthetic zone is one of the most demanding tasks due to the importance of obtaining an optimum esthetic result. The aim of this article was to present a workflow to create, preserve, transfer and support the emergence profile in anterior maxillary implants. Different methods are used surgically as well as prosthetically to construct an ideal restoration. When immediate loading can be applied in cases of increased primary stability, a provisional restoration is placed with occlusal contacts. In cases not permitting the above procedure and requiring extensive augmentation, a resin-bonded partial coverage fixed partial denture can be a predictable and reliable treatment option until the final restoration is delivered. Creating or preserving the emergence profile at immediate post-extraction and delayed implants, respectively, is achieved through customized provisional, healing abutments, a combination of prefabricated healing abutments and partial coverage provisional restoration, or utilization of the patient's own tooth crown. Transferring the individualized soft tissue contour to the final restoration can be achieved by modifying the impression coping intraorally with composite resin, fabricating a cast mimicking the soft tissue contour in the laboratory, or by the use of CAD/CAM technology. A customized abutment is necessary in order to maintain the emergence profile that has been created during the previous stages. The objective of this paper was to present a detailed workflow for the restoration of anterior maxillary implants focused on the creation, preservation, support, and transfer of the emergence profile of the soft tissues through a series of clinical cases.

Comparative assessment of the interfacial soft and hard tissues investing implants and natural teeth in the macaque mandible.

OBJECTIVES: The aim of this study was to conduct a comparative qualitative and quantitative assessment of the interfacial soft and hard tissues investing implants and natural teeth. MATERIALS AND METHODS: The test sample consisted of six adult healthy male Macaca fascicularis with three-unit splinted crowns, each crown supported by an Ankylos screw-shaped titanium implant. These implants were placed in the mandibular premolar-second molar region, one side by an immediate-loading (IL) and the other by delayed-loading (DL) protocol. The animals were sacrificed after 3 months of functional loading. Another two monkeys with natural dentition served as controls. Nondecalcified sections were prepared for assessment of optical intensities (OI) under a confocal laser scanning microscope. RESULTS: In both the test (IL and DL) and control, the soft tissue complexes demonstrated a highly fluorescent keratinized layer and diminished cytoplasmic and enhanced membranous fluorescence in the remaining epithelium. Peri-implant mucosa was further characterized by an intense fluorescence at the junctional epithelium-implant interface and in the stromal mononuclear infiltrate. Connective tissue contact and periodontal ligament were weakly fluorescent. In hard tissues, a high fluorescence was observed in peri-implant woven bone and along the implant-bone interface. Mean OI was significantly higher in peri-implant woven bone than around teeth (P < 0.05). In the remaining soft and hard tissue complexes, no significant differences in mean OI between the test and control were observed (P > 0.05). CONCLUSIONS: Present findings suggest that peri-implant woven bone is highly mineralized, while the peri-implant and gingival mucosa share structural similarities. CLINICAL RELEVANCE: Optical intensities of interfacial tissues investing implants and teeth are related to their biological properties.

In vitro assessment of primary stability of Straumann® implant designs.

BACKGROUND: Primary implant stability (PS) is one of the main factors influencing implant survival rate. Several methods to determine the PS have been used, such as Periotest values (PVs) and resonance frequency analysis (RFA) with implant stability quotient (ISQ) values. PURPOSE: The aim of this study was to compare different implant designs in regard to PS assessed by Periotest and RFA in vitro. MATERIALS AND METHODS: A total of 90 implants were placed in freshly slaughtered cow ribs. The implants (Straumann®, Institute Straumann AG, Basel, Switzerland; length 10 mm, ø3.3 mm) had the following three designs: Bone Level (BL, 30 implants), Standard Plus (SP, 30 implants), and Tapered Effect (TE, 30 implants). Before implant placement, the investigator was calibrated for every design according to the manufacturer's instructions. An independent observer, blinded to the study, assessed the accuracy of placement. RFA based on the Osstell device and PVs were performed after abutment connection. One-way analysis of variance and Tukey's post hoc test were used for statistical evaluation. RESULTS: All implants were mechanically stable. The mean PV for BL was -4.67(± 1.18), for SP, -6.07(± 0.94), and for TE, -6.57(± 0.57). The mean ISQ values were 75.02(± 3.65), 75.98(± 3.00), and 79.83(± 1.85), respectively. The one-way ANOVA showed significant difference among three implant designs in PV (p < .0001) and for the ISQ between BL/TE or SP/TE implants (p < .0001). In addition, the Tukey's (pair-wise comparison) test showed significant differences in PV and RFA between the BL/T (p < .0001). CONCLUSION: Within the limitations of this study, higher implant stability was found for tapered designed implants.