Preoperative assessment of bone density for dental implantation: a comparative study of three different ROI methods.

BACKGROUND: Dental cone beam computed tomography (CBCT) is commonly used to evaluate cancellous bone density before dental implant surgery. However, to our knowledge, no measurement approach has been standardized yet. This study aimed to evaluate the relationship between three different regions of interest (ROI) methods on cancellous bone density at the dental implant site using dental CBCT images. METHODS: Patients' dental CBCT images (n = 300) obtained before dental implant surgery were processed using Mimics (Materialise, Leuven, Belgium). At the potential implant sites, the rectangle, cylinder, and surrounding cylinder ROI methods were used to measure bone density. Repeated measures one-way analysis of variance was performed to compare the three ROI methods in terms of measurement results. Pearson correlation analysis was performed to identify the likely pair-wise correlations between the three ROI methods. RESULTS: The density value obtained using the surrounding cylinder approach (grayscale value [GV],523.56 ± 228.03) was significantly higher than the values obtained using the rectangle (GV, 497.04 ± 236.69) and cylinder (GV,493 ± 231.19) ROI methods in terms of results. Furthermore, significant correlations were noted between the ROI methods (r > 0.965; p < 0.001). CONCLUSIONS: The density measured using the surrounding cylinder method was the highest. The choice of method may not influence the trends of measurement results. TRIAL REGISTRATION: This study was approved by the Institutional Review Board of China Medical University Hospital, No. CMUH111-REC3-205. Informed consent was waived by the Institutional Review Board of China Medical University Hospital, CMUH111-REC3-205, owing to the retrospective nature of the study.

The role of the general dental practitioner in the implant journey.

The relationship between referring dentist and implantologist can be crucial in making the treatment journey as efficient and effective as possible for patients. There are a number of considerations to discuss to allow effective communication of options with the patient, as well as the long-term management of these cases once returned to general practice.

Selected osteointegration markers in different timeframes after dental implantation: findings and prognostic value.

The study aimed to determine the osteointegration markers after dental implantation and evaluate their predictive value. The study was performed on 60 practically healthy persons who needed teeth rehabilitation using dental implants. The conical-shaped implants (CI) and hexagonal implants (HI) were used. The content of Osteopontin (OPN), Osteocalcin (OC), Alkaline Phosphatase (ALP), Osteoprotegerin (OPG), and nitric oxide (NO) was determined in patients' gingival crevicular fluid (GCF) and peri-implant sulcular fluid (PISF), collected 1, 3, and 6 months after implantation. During the 3-6 months of observation level of OPN increased in patients with CIs (<50 years > 50 years) and HIs (<50 years) (CI: <50 years F = 36.457, p < 0.001; >50 years F = 30.104, p < 0.001; HI < 50 years F = 2.246, p < 0.001), ALP increased in patients with CIs (<50 years: F = 19.58, p < 0.001; >50 years: F = 12.01; p = 0.001) and HIs (<50 years) (F = 18.51, p < 0.001), OC increased in patients <50 years (CI: F = 33.72, p < 0.001; HI: F = 55.57, p < 0.001), but in patients >50 years - on the 3 days month (CI: F = 18.82, p < 0.001; HI: F = 26.26, p < 0.001), but sharply decreased at the end of sixth month. OPG increased during 1-3 months of the observation in patients <50 years (CI: F = 4.63, p = 0.037; HI: F = 2.8927, p = 0.046), but at the end of the sixth month returned to the initial level; NO content in PISF increased in patients with CI (>50 years) during 1-6 months of the observation (F = 27.657, p < 0.001). During the post-implantation period, age-related differences in osteointegration were observed. Patients <50 years old had relatively high levels of OPN, ALP, OC, and OPG in PISF, resulting in less alveolar bone destruction around dental implants and more intensive osteointegration. These indicators may be used as biological markers for monitoring implant healing. The process of osseointegration was more intense in CIs due to their comparatively high mechanical loading.

[Effects and techniques of soft tissue augmentation in immediate implant treatment].

Immediate implant placement can reduce the number of treatments and the time without teeth, but it carries a higher aesthetic risk. Soft tissue augmentation can reduce the risk of gingival recession to a certain extent, improve the predictability and long-term stability of immediate implant aesthetics, and is currently a hot research topic. A comprehensive understanding of the evidence-based medicine and surgical techniques using soft tissue augmentation in immediate implant surgery can assist in clinical diagnosis, treatment decisions and improve treatment outcomes. This article elucidates the changes in soft and hard tissues after immediate implant placement, aesthetic risks, and risk factors. It also discusses the advantages, timing, material selection, and commonly used clinical techniques of soft tissue transplantation in immediate implantation, aiming to provide reference for clinical doctors to improve the effectiveness of immediate implantation.

Free flap jaw reconstruction with dental implantation: A single-institution experience.

BACKGROUND: We sought to review our institution's experience with dental implant placement in free flap jaw reconstruction to determine factors impacting restoration of dental occlusion. METHODS: Exactly 48 patients underwent free flap jaw reconstruction with or without dental restoration from 2017 to 2022. Primary outcome was achievement of restored dental occlusion after jaw free flap reconstruction. RESULTS: A total of 48 patients with a mean age of 59.8 ± 16.4 years underwent jaw reconstruction from 2017 to 2022. Ten patients (20.8%) received osteointegrated dental implants. Two patients received a temporary dental prosthesis, 12 ± 4 months after initial reconstruction. Three patients received a final prosthesis, with a mean time to final prosthesis of 17.7 ± 12.4 months. Five patients did not receive any prosthesis despite placement of implants. CONCLUSION: A minority of patients received dental implant placement with free flap jaw reconstruction and only a small subset of these received a definitive dental prosthesis.

Soft tissue dimensional change using customized titanium healing abutment in immediate implant placement in posterior teeth.

BACKGROUND: The morphologic and dimensional alveolar bone is significant for resorption in the first 3 months after tooth removal because they restrict treatment outcomes with respect to function and esthetic. Following teeth extraction, the width and height of the alveolar ridge contour are reduced in both the horizontal and vertical dimensions. Following implant placement, the gingival morphology should be changed minimally compared to pre-extraction. Surrounding natural-like tissue is also an ultimate goal of the dental implant treatment, which is correlated with the cervical third contour on the anatomical tooth, for comfortable cleansing, food impaction avoidance, and esthetics. PURPOSE: To evaluate the peri-implant soft tissue changes after immediate implant placement (IIP) with the use of a customized titanium healing abutment in the posterior teeth. METHOD: Digital impressions using the intraoral scanner (MEDIT i500) were taken from 30 patients. Customized titanium healing abutments were designed and milled before extraction. Flapless extractions were done using surgical guides, 32 immediate implants placement were done in posterior areas, and healing abutments were placed. Soft tissues were scanned during pre-operation, and post-surgery during the 1st, 3rd, and 6th months. A 3D analysis program (Final Surface) evaluated the gingival margin distance, height, contour width, and volume in each period. SPSS was used to analyze the data with a p-value = 0.05. The between-time interval comparisons were done and the analysis was done using a Multivariate test. RESULTS: Customized titanium healing abutments used in immediate implantation maintained optimal peri-implant mucosa. In intermittent periods, there was no significant reduction in all aspects of the margin distances and heights. During the entire period, the margin height reduction on the buccal, lingual, mesial, and distal was 0.63 mm, 0.93 mm, 0.08 mm, and 0.24 mm, respectively, and contour width reduction on the buccal, lingual, and buccolingual was 0.59 mm, 0.43 mm, and 1.03 mm, respectively. There was a significant reduction in the total buccolingual contour width in the 1st month and total volume in the 3rd to 6th months. CONCLUSIONS: Immediate implant placement with customized titanium healing abutment can achieve the optimal peri-implant mucosa and this protocol is an alternative for soft tissue management.

Outcome measures and methods of assessment of soft tissue augmentation interventions in the context of dental implant therapy: A systematic review of clinical studies published in the last 10 years.

AIM: To identify and report outcome measures and methods of assessment on soft tissue augmentation interventions in the context of dental implant therapy reported in clinical studies published in the last 10 years. MATERIALS AND METHODS: The protocol of this Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) 2020-compliant systematic review was registered in PROSPERO (CRD42021252214). A literature search was conducted to identify articles that met the pre-established eligibility criteria. Data of interest, with an emphasis on outcome measures, were extracted. For each outcome, specific methods and timing of assessment were described in detail. Following a critical qualitative analysis of the data, outcome measures were categorized. Primary outcomes were identified, and the frequency of reporting in the selected articles was calculated. Additionally, risk-of-bias assessments were performed for individual articles and primary outcomes. RESULTS: Ninety-two articles, of which 39 reported randomized controlled trials (RCTs), 20 non-RCTs, and 33 case series studies, were selected. Outcome measures were categorized into either investigator-evaluated outcome measures (i.e., clinical, digital imaging, aesthetic, histological, biomarker, and safety) or patient-reported outcome measures (PROMs). Clinical outcomes were the most frequently reported type of outcome. Considering all categories, the most frequently reported primary outcomes were facial mucosa thickness assessed with clinical methods (22.83%), facial keratinized mucosa width assessed with clinical methods (19.57%), facial mucosal margin position/recession assessed with clinical methods (18.48%), facial mucosa thickness assessed with digital imaging methods (11.96%), facial soft tissue volume assessed with digital imaging methods (9.78%), and supracrestal tissue height assessed with clinical methods (9.78%). No distinguishable patterns of association between specific types or quality (level of bias) of clinical studies and the choice of primary outcomes were observed. CONCLUSIONS: Clinical research on peri-implant soft tissue augmentation has progressively increased in the last 10 years. Although clinical outcome measures were the most frequently reported outcomes in the selected literature, trends in the field are indicative of a shift from traditional clinical assessment methods to the use of digital technologies. PROMs were generally under-reported but should be considered an integral methodological component in future clinical studies.

The impact of cone beam computer tomography field of view on the precision of digital intra-oral scan registration for static computer-assisted implant surgery: A CBCT analysis.

OBJECTIVES: Registration of intra-oral surface scans to cone beam computer tomography (CBCT) is critical in the digital workflow for static computer-aided implant surgery (sCAIS). This study aimed to assess the impact of CBCT field of view (FoV) on the precision of digital intra-oral scan registration. MATERIALS AND METHODS: Cone beam computer tomography data and intra-oral scans from 20 patients were included. Small FoV CBCT's were created by digitally segmenting a large FoV into three sextants. Virtual implant planning was performed. Digital intra-oral scans were repeatedly registered onto their corresponding large and small FoV CBCT datasets. The distances and angulations between the matching implant positions of each repeated registration were used to determine the precision of the registration process. Wilcoxon Signed Rank Paired Tests were used to compare the differences between large FoV and small FoV. The threshold for statistical significance was set at p = .05. RESULTS: Differences in 3D implant position based on the registration precision between small FoV and large FoV present at both the implant entry point (0.37 ± 0.25 mm vs 0.35 ± 0.23 mm, p = .482) and implant tip (0.49 ± 0.34 mm vs 0.37 ± 0.24 mm, p < .001). Differences in overall angular precision were observed between small FOV and large FoV (1.43 ± 1.36° vs 0.51 ± 0.38°, p < .001). CONCLUSION: CBCT with a small FoV is accompanied by greater precision errors in intra-oral scan registration. However, when sufficient well-distributed teeth are visible in small FoV CBCT, the precision of digital intra-oral scan registration appears to be within clinically acceptable limits for sCAIS.

Elevación de seno maxilar sin injerto y colocación simultánea de implante dental / Graftless maxillary sinus lift with simultaneous dental implant placement

Introducción: La elevación de seno maxilar con implante dental simultáneo, sin el uso de substitutos óseos, ha retomado la teoría del potencial de neoformación ósea, que el coágulo de sangre alojado bajo la membrana de Schneider por sí solo presenta. Excluyendo así la necesidad de materiales exógenos. Objetivo: Exponer la efectividad de la elevación de seno maxilar con implante dental simultáneo, sin el uso de injerto, mediante la evaluación de la cantidad de ganancia ósea vertical. Presentación de casos: Caso 1: Paciente de 62 años, género femenino, que fue sometida a una elevación de seno maxilar sin injerto e implante dental simultáneo, con técnica de ventana lateral debido a altura ósea reducida de 5,24 mm. Luego del período de seguimiento tomográfico de 12 meses, después de la carga protésica, se logró una altura ósea vertical de 10,2 mm, lo que dio como resultado una ganancia ósea vertical de 4,96 mm. Caso 2: Paciente de 48 años, género femenino, que fue sometida a una elevación de seno maxilar sin injerto e implante dental simultáneo, con técnica transalveolar, mediante el uso de piezoeléctrico debido a una altura ósea reducida de 8,33 mm. Luego del período de seguimiento radiográfico de 4 meses, antes de la carga protésica, se logró una altura ósea vertical de 11,55 mm, lo que dio como resultado una ganancia ósea vertical de 3,19 mm. Conclusiones: Con base en estos 2 informes de casos, la elevación de seno maxilar e implante dental simultáneo sin injerto se asocian con la reducción de la morbilidad quirúrgica, menor probabilidad de procesos infecciosos y menor costo de la cirugía. Por lo tanto, puede considerarse una alternativa quirúrgica para la colocación de implantes en el maxilar posterior superior debido a deficiencias óseas verticales, independientemente de la técnica (lateral o transalveolar(AU)

Introduction: Maxillary sinus lift with simultaneous dental implantation without using bone substitutes, reapproaches the theory about the bone neoformation potential of the blood clot housed under the Schneider membrane, all by itself, thus excluding the need to use exogenous materials. Objective: Discuss the effectiveness of graftless maxillary sinus lift with simultaneous dental implant placement through an evaluation of the amount of vertical bone gain. Case presentation: Case 1: Female 62-year-old patient undergoing graftless maxillary sinus lift with simultaneous dental implantation by lateral window technique due to a reduced bone height of 5.24 mm. After a 12-month tomographic follow-up period subsequent to prosthetic loading, a 10.2 mm vertical bone height was achieved, resulting in 4.96 mm vertical bone gain. Case 2: Female 48-year-old patient undergoing graftless maxillary sinus lift with simultaneous dental implantation by transalveolar technique using a piezoelectric generator due to a reduced bone height of 8.33 mm. After a 4-month radiographic follow-up period, before prosthetic loading, an 11.55 mm vertical bone height was achieved, resulting in 3.19 mm vertical bone gain. Conclusions: According to these two case reports, graftless maxillary sinus lifting with simultaneous dental implantation is associated to reduced surgical morbidity, a lesser probability of infectious processes and lower surgical costs. It may therefore be considered to be a surgical alternative for implant placement in the posterior maxilla due to vertical bone deficiencies, regardless of the technique used (lateral or transalveolar(AU)

On-Bone Fixation of Free Gingival Graft Induces an Osteoinductive Effect in Human Alveolar Bone.

We examined alveolar bone samples in the area of on-bone fixation of a free gingival graft performed during surgery in patients aged 37-55 years with a diagnosis of secondary partial adentia of the upper and lower jaws. Six months after fixation of the graft in the alveolar bone, foci of neoosteogenesis were found in the contact zone. They were characterized by the appearance of appositional lines, cords of basophilic osteoblasts, and growing osteons. An immunohistochemical study revealed an increase in the number of CD44+, CD29+, and osteocalcin+ cells in the layer of the outer circumferential lamellae, primary osteons, and the lining of the Haversian canals. TGF-ß1+ cells were located in the intertrabecular reticular tissue and wall of microvessels. The results indicate activation of mesenchymal stem cells in the area of localization of the graft and differentiating osteoblasts. The observed osteoinductive effect of free gingival graft is associated with its participation in reorganization in MSC and induction of morphogenetic molecules.

Classical Dichotomy of Macrophages and Alternative Activation Models Proposed with Technological Progress.

Macrophages are important immune cells that participate in the regulation of inflammation in implant dentistry, and their activation/polarization state is considered to be the basis for their functions. The classic dichotomy activation model is commonly accepted, however, due to the discovery of macrophage heterogeneity and more functional and iconic exploration at different technologies; some studies have discovered the shortcomings of the dichotomy model and have put forward the concept of alternative activation models through the application of advanced technologies such as cytometry by time-of-flight (CyTOF), single-cell RNA-seq (scRNA-seq), and hyperspectral image (HSI). These alternative models have great potential to help macrophages divide phenotypes and functional genes.

A new inertial navigation system for guiding implant placement. An in-vitro proof-of-concept study.

The aim of this study was to assess the potential use of a new advanced inertial navigation system for guiding dental implant placement and to compare this approach with standard stereolithographic template guiding. A movement processing unit with a 9-axis absolute orientation sensor was adapted to a surgical handpiece and wired to a computer navigation interface. Sixty implants were placed by 10 operators in 20 jaw models. The 30 implants of the test group were placed in 10 models guided by the new inertial navigation prototype. The 30 implants of the control group were placed in another 10 models using a CAD-CAM template. Both groups were subdivided into experienced and non-experienced operators. Pre- and postoperative computer tomography images were obtained and matched to compare the planned and final implant positions. Four deviation parameters (global, angular, depth, and lateral deviation) were defined and calculated. The primary outcome was the angular deviation between the standard stereolithographic approach and the new inertial navigation system. Results showed no significant differences between both groups, suggesting that surgical navigation based on inertial measurement units (IMUs) could potentially be useful for guiding dental implant placement. However, more studies are still needed to translate this new approach into clinical practice.

Primary stability and PES/WES evaluation for immediate implants in the aesthetic zone: a pilot clinical double-blind randomized study.

The use of immediate implants in the aesthetic area is a technique widely used in modern implantology. The characteristics of the patient, the implant, and the surgical procedure used may influence the final results. The aim was to assess whether the implant design affects primary (P.S.) and secondary stability (S.S.), bone level (B.L.), and PES/WES evaluation. Twenty implants with two different designs (n = 10) were immediately placed and randomly located in the upper anterior maxilla with no grafting material. Implant-Stability-Quotient (ISQ), B.L., and Pink-Esthetic-Score/White-Esthetic-Score (PES/WES) were evaluated. Shapiro-Wilk normality test was performed to determine the sample normality, as the data did not follow a normal distribution, the Wilcoxon-Mann-Whitney test was applied (p < 0.05). ISQ was determined at placement (PS): control 59.1 (C.I.54.8-63.3); experimental 62.2(C.I.60.1-64.2) and three months after placement (SS): control 62.2.1 (C.I.53.3-71.0); experimental 67.2(C.I.65.8-68.5). The BL was measured at three months after placement: control 0.38 mm (C.I.- 0.06 to + 0.83); experimental 0.76 mm (C.I.0.33-1.19) and at 12 months post-loading: control 0.07 mm (C.I.- 0.50-0.65); experimental 0.90 mm (C.I.0.38-1.42). PES/WES values were evaluated for the control group: 15 (C.I.12.68-17.32), and for the experimental group 15.20 (C.I.11.99-18.41). No significant differences were shown between both implant designs. A good grade of osseointegration and primary/secondary stability was achieved, as well as proper maintenance of crestal bone and adequate PES/WES scores. The criteria for selection for the ideal patient for immediate implant placement is essential.ClinicalTrials Protocol ID: NCT04343833.

Whole-Process Digitalization-Assisted Immediate Implant Placement and Immediate Restoration in the Aesthetic Zone: A Prospective Study.

BACKGROUND This study explored the clinical effects of whole-process digitalization (WD)-assisted immediate implant placement (IIP) and immediate restoration (IR) in the aesthetic zone and clarified the clinical procedures. MATERIAL AND METHODS Patients who received maxillary aesthetic region IIP and IR treatment were randomly distributed into WD-assisted and conventional groups. Postoperative assessment included implant accuracy, marginal bone loss, aesthetic evaluation, and patient satisfaction evaluation. The aesthetic evaluation included visual analog score (VAS), pink aesthetic score (PES), and white aesthetic score (WES). Numerical data, measurement data, and grade data were analyzed by χ² test, t test, and Mann-Whitney U test. RESULTS The WD-assisted group exhibited decreased implant accuracy, including coronal deviation, apical deviation, angular deviation, and depth deviation, compared with the conventional group (P<0.05). The marginal bone loss in both the mesiodistal direction and the buccolingual direction were significantly lower in the WD-assisted group than in the conventional group (P<0.05). The VAS, PES, and WES were all significantly higher in the WD-assisted group than in the conventional group at 3, 6, and 12 months after surgery (P<0.05). Patients in the WD-assisted group also reported a higher satisfaction level than those in the conventional group (P<0.05). CONCLUSIONS WD-assisted IIP and IR treatment in the aesthetic zone increased implant accuracy, decreased marginal bone loss, improved aesthetic effect, and increased patient satisfaction compared with conventional treatment. Therefore, WD-assisted IIP and IR treatment constitutes a promising approach in clinical oral implantology.

Influence of different incision designs on bone increment of guided bone regeneration (Bio-Gide collagen membrane +Bio-OSS bone powder) during the same period of maxillary anterior tooth implantation.

Exploring the influence of different incision designs on bone increment of guided bone regeneration [Bio-Gide collagen membrane +Bio-OSS bone powder (carbonate apatite crystal extracted from bovine bones), Bio-OSS bone meal was placed on the surface of the bone defect and then covered with a Bio-Gide membrane to close the wound] during the same period of maxillary anterior tooth implantation. The 99 patients from the stomatology department were divided into 3 groups: small incision (N = 30, group A), wide incision (N = 39, group B), internal gingival sulcus incision (N = 30, group C). At the different time (immediately after surgery, 6 months, 12 months and 24 months), the width and height of labial bone at different implant margin (2 mm, 4 mm, 6 mm) has no significant difference in comparison of any two of the three groups (p > 0.05). The score of esthetic feeling in group A was significant higher than group C (P < 0.05). The PPD, the incidence of SH, BOP in group A were all significant higher than group B (P < 0.05). The PISm, PISd, PPD, the incidence of SH and BOP in group A were all significant higher than group C (P < 0.05). The PISm, PISd, PPD, the incidence of SH and BOP in group B were all significant higher than group C (P < 0.05). The three groups has no significant different on the influence bone increment. The soft tissue condition around the implant after surgery was better in internal gingival crevicular incision than others two incisions, large-scale incision better than small incisions.

Sequential drug delivery of vancomycin and rhBMP-2 via pore-closed PLGA microparticles embedded photo-crosslinked chitosan hydrogel for enhanced osteointegration.

As generally accepted, inhibiting the bacterial invasion at initial stage and promoting the behavior of related osteogenesis cells afterwards is crucial to achieve favorable osteointegration after dental implantation. In this study, a novel combined structured hydrogel composed of chitosan and pore-closed poly(lactic-co-glycolic acid) microparticles was prepared and characterized. In vitro and in-vivo studies have identified that this biocompatible material can rapidly release vancomycin at initial 2 days and then sustainedly release recombinant human bone morphogenetic protein-2 for about 12 days, thus respectively accomplish antibacterial and osteogenesis functions. This sequential drug release system can be used as a promising coating material to improve the surface conditions of dental implant to enhance the osteointegration after surgery.

Which experimental models and explorations to use in regenerative endodontics? A comprehensive review on standard practices.

Since the discovery of dental pulp stem cells, a lot of teams have expressed an interest in dental pulp regeneration. Many approaches, experimental models and biological explorations have been developed, each including the use of stem cells and scaffolds with the final goal being clinical application in humans. In this review, the authors' objective was to compare the experimental models and strategies used for the development of biomaterials for tissue engineering of dental pulp with stem cells. Electronic queries were conducted on PubMed using the following terms: pulp regeneration, scaffold, stem cells, tissue engineering and biomaterial. The extracted data included the following information: the strategy envisaged, the type of stem cells, the experimental models, the exploration or analysis methods, the cytotoxicity or viability or proliferation cellular tests, the tests of scaffold antibacterial properties and take into account the vascularization of the regenerated dental pulp. From the 71 selected articles, 59% focused on the "cell-transplantation" strategy, 82% used in vitro experimentation, 58% in vivo animal models and only one described an in vivo in situ human clinical study. 87% used dental pulp stem cells. A majority of the studies reported histology (75%) and immunohistochemistry explorations (66%). 73% mentioned the use of cytotoxicity, proliferation or viability tests. 48% took vascularization into account but only 6% studied the antibacterial properties of the scaffolds. This article gives an overview of the methods used to regenerate dental pulp from stem cells and should help researchers create the best development strategies for research in this field.

Integración de tres especialidades estomatológicas en el tratamiento protésico / Integration of three stomatological specialties in the prosthetic treatment

Los implantes dentales son una opción de restauración estética, funcional y armónica, cuya tasa de éxito es superior a 95 %. Se presenta el caso clínico de una paciente de 24 años de edad, atendida en la consulta de Ortodoncia de la Clínica Estomatológica Provincial Docente Mártires del Moncada de Santiago de Cuba, quien fue remitida desde el Servicio de Prótesis Estomatológica, con el fin de lograr el espacio adecuado para colocarle un implante, pues desde los 12 años de edad aproximadamente había perdido un diente a causa de caries. La restauración protésica mediante el implante dental proporcionó un excelente resultado.

Dental implants are an option of cosmetic, functional and harmonic repairs whose rate of success is higher than 95 %. The case report of a 24 years patient is presented. She was assisted in the Orthodontics Service of Mártires del Moncada Teaching Provincial Stomatological Clinic in Santiago de Cuba and was referred from the Stomatological Prosthesis Service, with the purpose of achieving the appropriate space to place an implant, because she had lost a tooth due to dental decay since she was approximately 12 years. The prosthetic repair by means of dental implant provided an excellent result.

Influence of Immediate Implant Placement and Provisionalization with or without Soft Tissue Augmentation on Hard and Soft Tissues in the Esthetic Zone: A One-Year Retrospective Study.

The purpose of this clinical research was to evaluate peri-implant marginal changes around immediate implants placed either with the application of SCTG or XCM or without soft tissue grafting. A total of 48 patients requiring a single implant-supported restoration in the anterior jaw were selected for inclusion. Three surgical procedures were performed, as follows: type 1 implant with subepithelial connective tissue graft (SCTG), type 1 implant with xenogenic collagen matrix (XCM), and type 1 implant without soft tissue augmentation (NG) (control group). The marginal change of peri-implant soft tissue, facial soft tissue thickness (FSTT), peri-implant health status, esthetics, and patient satisfaction were assessed at one year after surgery. All of the placed implants showed a survival rate of 100%. No significant differences in FSTT were recorded between the SCTG group and the XCM group after treatment (P > 0.05), while the NG group presented a significant difference (P < 0.05). Patients in the NG group lost significantly more in the buccal marginal level than did patients in the SCTG group and those in the XCM group (P < 0.05). The favourable success rate recorded in all groups confirmed immediate tooth replacement as a choice of treatment for a missing anterior single tooth. The NG group presented significant changes of FSTT and buccal marginal level, while XCM constituted a viable alternative to SCTG.

Titanium Wear of Dental Implants from Placement, under Loading and Maintenance Protocols.

The objective of this review was to analyze the process of wear of implants leading to the shedding of titanium particles into the peri-implant hard and soft tissues. Titanium is considered highly biocompatible with low corrosion and toxicity, but recent studies indicate that this understanding may be misleading as the properties of the material change drastically when titanium nanoparticles (NPs) are shed from implant surfaces. These NPs are immunogenic and are associated with a macrophage-mediated inflammatory response by the host. The literature discussed in this review indicates that titanium NPs may be shed from implant surfaces at the time of implant placement, under loading conditions, and during implant maintenance procedures. We also discuss the significance of the micro-gap at the implant-abutment interface and the effect of size of the titanium particles on their toxicology. These findings are significant as the titanium particles can have adverse effects on local soft and hard tissues surrounding implants, implant health and prognosis, and even the health of systemic tissues and organs.