Evaluation of periodontal indices among non-smokers, tobacco, and e-cigarette smokers: a systematic review and network meta-analysis.

OBJECTIVES: The detrimental effect of tobacco smoking on periodontal health is well known, while the effect of electronic cigarette on periodontal parameters has been less investigated. The aim of the present systematic review was to compare periodontal indices in three categories of patients: traditional cigarette smokers (TS), e-cigarette smokers (ES), and non-smokers (NS). MATERIALS AND METHODS: An electronic search was conducted for studies published until December 2021 on MEDLINE (PubMed), ISI Web of Science, and Scopus. A hand search was additionally conducted. Clinical observational and cross-sectional trials investigating periodontal indices among tobacco smokers (TS), electronic cigarette smokers (ES) and non-smokers (NS) were included and selected by 2 independent reviewers. Data on probing depth (PD), plaque index (PI), and bleeding on probing (BOP) were collected. The risk of bias was evaluated according to the NIH quality assessment tool and a network meta-analysis (NMA) was undertaken. RESULTS: Five relevant studies, from 707 identified, were included. Overall, 512 patients were included, of them 170 were NS, 176 were TS, and 166 were ES. A significant difference in the comparison among TS vs NS: effect size (ES) = 3.297 (95%CI: [2.142-4.454], p = 0.001) and TS and ES ES = 2.507 (95%CI: [1.351-3.663], p = 0.001) was identified for PD. A significant difference in the comparison among TS and NS, ES = 21.34 (95%CI: [13.41-29.27], p = 0.001) and between TS and ES ES = 15.67 (95%CI: [7.73-23.62], p = 0.001) was identified for PI. The analysis of BOP values shows a significant difference in the comparison among ES and NS: ES = - 16.22 (95%CI: [- 22.85 to - 9.59], p < 0.001) and between TS and NS: ES = - 14.47 (95%CI: [- 21.103 to - 7.848], p < 0.001). Based on the SUCRA ranking, NS showed the most favorable outcome for PD and PI, followed by ES. Tobacco smokers were clearly in the last position. Dealing with BoP ES showed the most favorable outcome, followed by TS. NS were in the last position. CONCLUSIONS: Periodontal parameters were similar among NS and ES, while TS presented the worst indices. BoP was reduced both in ES and in TS. CLINICAL RELEVANCE: Results of the present review suggest a reduced effect on periodontal tissue of e-cig smoking compared to traditional cigarettes, despite recent studies proved that e-cig smoking increases oxidative stress, inflammatory responses, change in pulmonary cellular behavior, and stimulates DNA injury.

Tissue-level versus bone-level single implants in the anterior area rehabilitated with feather-edge crowns on conical implant abutments: An up to 5-year retrospective study.

STATEMENT OF PROBLEM: Limited information is available on the differences between tissue-level implants with an ultrathin threaded microsurface conical transmucosal portion and bone-level implants rehabilitated with conical custom abutments. PURPOSE: The purpose of this retrospective study was to assess the outcomes of crowns designed as per the biologically oriented preparation technique (BOPT) cemented on conical titanium abutments on tissue-level and bone-level implants. MATERIAL AND METHODS: Patients consecutively rehabilitated with a delayed loading protocol with anterior implant-supported single crowns with a feather-edge margin, in function for at least 4 years, were recruited and divided into 2 groups based on the implant type they had received: tissue-level implants with a conical transmucosal portion or bone-level implants rehabilitated with a conical abutment by following the platform switching concept. Bone resorption, pink esthetic score (PES), and white esthetic score (WES) were collected and analyzed. The nonparametric Mann-Whitney test was performed to analyze all parameters (α=.05 for all tests). RESULTS: A total of 43 participants (48 implants) were included in the present study. The mean follow-up period was 4.5 years (range 52-64 months). A statistically significant difference (P=.004) was found in the mean ±standard deviation bone resorption between tissue-level implants (0.38 ±0.46 mm) and bone-level implants (0.83 ±0.58 mm). Higher values for both PES and WES were obtained in the tissue-level implant group. CONCLUSIONS: Within the limitations of the present retrospective study, tissue-level implants with a conical transmucosal portion seem to provide a suitable alternative to bone-level implants in the anterior area.

Peri-implant Tissue Health and Bone Resorption in Implant- Supported Fixed Partial Rehabilitations.

PURPOSE: To evaluate peri-implant tissue health and bone resorption in patients with implant-supported fixed partial rehabilitations. In particular, possible correlations between plaque accumulation and bone loss, as well as other periimplant health parameters, were investigated. MATERIALS AND METHODS: A total of 44 patients rehabilitated with fixed implant-supported partial rehabilitations were included. The following parameters were recorded: spontaneous bleeding (SB), suppuration, bleeding on probing (BOP), plaque index (PI), and probing depth (PD). Periapical radiographs were taken to measure crestal bone loss (BL). A nonparametric test (Spearman rank coefficient; rs) was used to identify possible correlations between the clinical parameters recorded. RESULTS: A total of 121 implants were analyzed. Global PI and BOP were 49.58% and 20.25%, respectively. There were no cases of suppuration, and only 2 implants showed spontaneous bleeding. Mean BL was 1.53 mm (SD: 0.98). No implants showed peri-implantitis. There was a weak, statistically significant correlation between PI and BL (rs = 0.27, P [2-tailed] = .99) and between PI and the other peri-implant parameters (BOP: rs = 0.14, P = .14; PD: rs = 0.04, P = .65; SB: rs = -0.08, P = .34). A very weak correlation was also found between BL and BOP (rs = 0.1, P = .2) and between BL and PD (rs = 0.02, P = .7). Correlation was found between BL and age (rs = 0.13, P = .81) and between the other peri-implant parameters and age using dichotomization (> or < 65 years; PI: rs = -0.14, P = .11; PD: rs = -0.21, P = .01; BOP: rs = -0.21, P = .01; SB: rs = 0.05, P = .53). No statistically significant correlations were found between the clinical parameters evaluated and the sex or the dental arch treated (maxilla vs mandible). In contrast, the correlation between periodontal parameters and years elapsed since surgery (follow-up) was significant. CONCLUSIONS: The present research suggests that in implant-supported fixed partial rehabilitations, dental implants with greater plaque accumulation are more likely to present augmented probing depth, peri-implant inflammation, and bone loss, although the correlation is statistically very weak. Patient age and time of follow-up also significantly affected peri-implant health parameters.

Antimicrobial Activity of Glycine Air Polishing: A Clinical Split- Mouth Study on Full-Arch Implant-Supported Rehabilitations.

PURPOSE: To investigate the possible antimicrobial activity of glycine air polishing by comparing peri-implant microbiota before and after treatment. MATERIALS AND METHODS: A total of 15 patients who received implant-supported full-arch fixed rehabilitations were included. After prosthesis removal (T0), Plaque Index (PI), probing depth (PD), and bleeding on probing (BOP) were recorded. In each hemiarch, the implant with the highest PD score was selected for microbiologic sample collection from the peri-implant sulcus (T0). All patients received two different hygienic protocols (randomly administered, one per each hemiarch): glycine air-polishing (G) and cleansing with cotton pellets soaked in saline (C). At 7 days (T1) and 3 months (T2) after the intervention, PI and BOP were recorded, and new microbiologic samples were taken. Traditional polymerase chain reaction (PCR) and quantitative PCR real-time were employed for microbiologic analysis to investigate how the presence of different bacterial species varied according to the hygienic treatment performed. RESULTS: Treatment G provided a significantly higher PI score reduction around implants compared to treatment C (P = .015). No statistical difference was found in the microbial population around G and C implant sites, with Tannerella forsythia being the most commonly detected bacterial species in both G and C groups. No statistical differences were found between the antimicrobial activity of treatments C and G. CONCLUSIONS: Glycine powder air polishing is a valid method for professional hygienic care of implants and was more effective in PI reduction compared to the control treatment. However, its antimicrobial efficacy cannot be confirmed by the outcomes of the present study.

Dental Implants with External Hex Inclined Shoulder in Full-Arch Immediate Loading Rehabilitations of the Maxilla.

Background: Coaxial implants with an inclined neck might overcome some problems related to angulation of the implant axis when using tilted implants. Therefore, the aim of the present work was to conduct a narrative review of the current literature and to present a case series comparing traditional and coaxial external hex implants in full-arch immediate loading rehabilitations of the maxilla. Methods: A total of 13 external hex tapered implants (Southern Implants) was inserted in the upper jaw of 3 patients. Each patient received two tilted implants in distal sites. In one randomly selected quadrant, the tilted implant was a standard implant, while a Co-Axis® implant with a 24° inclination of the implant shoulder was inserted on the other hemi-arch. Straight conical abutments were screwed on coaxial implants while multiunit abutments of appropriate inclination were screwed as needed on the other implants to correct their axes. Peri-implant bone level was recorded radiographically at T0 (delivery of the immediate loading prosthesis), and at 3, 6, 12, and 24 months of healing and then annually. Plaque index, probing depth, and bleeding on probing were also evaluated. Cumulative implant survival rate (CSR) was calculated, and biological or technical complications were recorded as well as the operator satisfaction towards the use of coaxial implants. Results: The preliminary data collected did not show significant differences in peri-implant tissues health and maintenance over time between the two implant types. No implants failed, and both implant types proved to be favorable for full-arch rehabilitation using tilted implants. Coaxial implants facilitated the prosthodontic procedures. However, a learning curve is required in order to optimize their insertion. Conclusions: Both implants proved to be reliable and suitable for achieving clinical success in full-arch immediate loading rehabilitations, but further research with longer follow-up and larger sample size is needed to confirm these preliminary outcomes.

Shock Absorption Capacity of High-Performance Polymers for Dental Implant-Supported Restorations: In Vitro Study.

BACKGROUND: Restorative materials might significantly affect load transmission in peri-implant bone. The aim of the present study is to evaluate the shock absorption capacity of two different polymeric materials to be used for implant-supported prostheses. METHODS: A masticatory robot was used to compare the shock absorption capacity of veneered and non-veneered polyetherketoneketone (PEKK), Pekkton®ivory (Cendres+Mètaux), and the glass fiber-reinforced composite (GFRC), TRINIATM (Bicon). Five identical sample crowns for each of the three groups were tested. Forces transmitted at the simulated peri-implant bone were recorded and statistically analyzed. RESULTS: The statistical analysis of forces transmitted at the simulated dental implant revealed significant differences between the materials tested and between these materials and zirconia, glass ceramic, composite resin, and acrylic resin. Only differences between PEKK and veneered PEKK and between PEKK and one of the previously tested composite resins were not statistically significant. PEKK samples demonstrated significantly greater shock absorption capacity compared to GFRC. CONCLUSIONS: PEKK revealed optimal shock absorption capacity. Further studies are needed to evaluate its efficacy in the case of long-span prostheses with reduced prosthetic volume.

Outcomes of Zygomatic Implants Combined with Anterior Regular Implants: A Retrospective Analysis with a Mean Follow-up Time of 36 Months.

Purpose: To retrospectively evaluate the clinical outcomes of immediately loaded zygomatic implants combined with anterior regular implants (hybrid zygoma) for the fixed rehabilitation of atrophic maxillae. Materials and Methods: A total of 18 patients were enrolled in this study and treated with the hybrid zygoma concept by an experienced surgeon. Follow-up visits were planned after 1 week, 3 weeks, 4 months, 6 months, then annually. At the last follow-up appointment (mean: 36 months after surgery; range: 24 to 52 months), the prostheses were unscrewed and the implants and peri-implant tissues were examined. The primary outcome evaluated was implant success. Following the criteria proposed by Aparicio et al, implant success was classified in five grades, with grade I representing the best condition and grade V representing a failure. At the annual check-up, patients were asked to fill out a questionnaire to evaluate their satisfaction with their oral rehabilitation. Results: A total of 80 implants (34 zygomatic and 46 regular) were inserted. One zygomatic implant was lost in one patient, and two regular implants failed in two other patients. Of the zygomatic implants, 24 (70.6%) presented a success grade I, 9 (26.5%) a success grade II, and 1 (2.9%) a grade V. Sinusitis was the most common biologic complication, occurring in two patients (5.6%). Two patients showed unilateral upper lip paresthesia that was persistent at the last follow-up appointment. According to the annual follow-up visit questionnaire data, 72%, 89%, and 94% of patients declared that they were satisfied with their phonetic ability, chewing ability, and esthetics, respectively. Conclusion: Although zygomatic implants combined with anterior regular implants present a higher risk of complications than traditional implantology, they allow for immediately loaded full-arch fixed rehabilitation of patients with advanced atrophy of the posterior maxilla, which provides satisfactory chewing ability, esthetics, and phonetics.

Comparison of Milled Full-Arch Implant-Supported Frameworks Realised with a Full Digital Workflow or from Conventional Impression: A Clinical Study.

BACKGROUND: The aim of the present study was to investigate the accuracy of a new digital impression system, comparing it to the plaster impression technique in the realization of full-arch implant-supported metal frameworks. METHODS: We took 11 scans (8 of the upper maxilla and 3 of the lower jaw) on a sample of nine patients previously rehabilitated with fixed full-arch screw-retained prostheses following the Columbus Bridge Protocol (CBP) with four to six implants (total: 51) since at least 4 months. Two impressions were taken for each dental arch: one analogic plaster impression using pick-up copings and an open tray technique and a second one using an intra-oral scanner. Two milled metal substructures were realised. The precision and passivity of the substructures were clinically analysed through the Sheffield test and endo-oral radiographs. Laboratory scans of the plaster casts obtained from an intra-oral scanner (IOS) and of the plaster casts obtained from traditional impression were compared with the intraoral scans following Hausdorff's method and an industrial digital method of optical detection to measure discrepancies. A Mann-Whitney test was performed in order to investigate average distances between surfaces after the superposition. RESULTS: The Sheffield test demonstrated an excellent passivity of the frameworks obtained through both the digital and the analogic method. In 81.81% of cases (n = 9) both substructures were found to have a perfect fit with excellent passivity, while in 18.18% (n = 2) of cases the substructures were found to have a very slight discrepancy. From the radiographic examination, no gaps between the frameworks and the implant heads or multiunit abutments were observed, with 100% accuracy. By superimposing digital files of scans according to Hausdorff's method, a statistically significant discrepancy (p = 0.006) was found between the digital scans and the digital models obtained from plaster impressions. Three-dimensional optical detection found a mean discrepancy of 0.11 mm between the analogic cast and the cast derived from the digital impression. CONCLUSIONS: The present study clinically demonstrates that milled implant-supported full-arch frameworks obtained through a digital scan and the herein described technique have an accuracy comparable to those obtained with traditional plaster impression.

Zirconia Crowns and FDPs with Feather-Edge Margins on Conical Implant Abutments-Up-To-5-year Clinical Retrospective Study.

PURPOSE: To retrospectively evaluate the survival rate and technical and biologic complications of feather-edge zirconia and metal-ceramic implant restorations cemented on conical titanium abutments. MATERIALS AND METHODS: Patients rehabilitated with implant-supported single crowns or fixed dental prostheses (FDPs) were divided into four groups: ZR-TL = tissue-level implant with a convergent collar and zirconia restoration; ZR-BL = bone-level implant and zirconia restoration; MC-TL = tissue-level implant with a convergent collar and metal-ceramic restoration; MC-BL = bone-level implant and metal-ceramic restoration. All of the restorations were cemented onto conical titanium abutments and had feather-edge margins, following the biologically oriented preparation technique (BOPT). Crown-level survival rates, technical and biologic complications, and bone resorption were registered. Chi-square test was performed to analyze all evaluated parameters among the groups. Nonparametric Mann-Whitney test was performed to analyze changes in bone level. RESULTS: A total of 85 patients (133 implants, 66 single crowns, and 28 FDPs) were included in the present study with a mean follow-up time of 4.98 years. The overall survival rate was 98.2% for zirconia and 97.5% for metal-ceramic restorations at the crown level. No significant differences were found between the zirconia (ZR-BL and ZR-TL) and the metal-ceramic (MC-BL and MC-TL) groups for technical complications (P > .05). Bone resorption was 0.33 (0.37) mm in MC-TL; 0.61 (0.52) mm in MC-BL; 0.39 (0.51) mm in ZR-TL; and 0.77 (0.64) mm in ZR-BL, showing significantly greater bone loss in bone-level implants (P = .011). CONCLUSION: Zirconia implant restorations with feather-edge margins seem to be a viable alternative in cases of both tissue-level and bone-level implants.

Efficacy of air-polishing devices without removal of implant-supported full-arch prostheses.

PURPOSE: Long-term success of titanium dental implants is influenced by various factors, including the maintenance of good oral hygiene. The present study aimed to evaluate cleaning effectiveness and patient satisfaction with glycine powder air polishing and traditional professional oral hygiene treatments when applied to implant-supported full-arch restorations without removal of the fixed prosthesis. MATERIALS AND METHODS: A total of 85 patients with 357 implants supporting full-arch fixed restorations were included. After removal of the prosthesis (T0), the following parameters were recorded: Plaque Index, peri-implant spontaneous bleeding, probing depth and bleeding on probing. The prosthesis was then reinserted. The patients were divided into three groups, each of which received two hygiene therapies randomly administered in each hemiarch using a split-mouth design. The possible treatments were glycine powder air polishing and use of sponge floss vs sponge floss only in group 1; glycine powder air polishing vs use of an ultrasonic device with a polyetheretherketone fibre tip coating in group 2; and glycine powder air polishing vs use of carbon fibre curettes and sponge floss in group 3. After instrumentation, the prostheses were removed to assess the Plaque Index and peri-implant spontaneous bleeding. Questionnaires were used to record patients' levels of comfort and satisfaction in relation to the various treatments. RESULTS: Glycine powder air polishing resulted in a significantly higher reduction in plaque around implants compared to control treatments (sponge floss only, ultrasonic device with polyetheretherketone fibre tip coating, and manual scaling with carbon fibre curettes and use of sponge floss) (P = 0.020). Glycine powder air polishing followed by application of sponge floss provided the greatest reduction of plaque deposits on the prosthetic surfaces. On average, 80% of patients rated glycine powder air polishing highest with regard to satisfaction. CONCLUSIONS: Glycine powder air polishing is a highly effective and comfortable treatment to maintain good oral hygiene in clinical practice, and could be used as an alternative to manual and mechanical instrumentation when dealing with implant-supported restorations.

Evaluation of internal and external hexagon connections in immediately loaded full-arch rehabilitations: A within-person randomized split-mouth controlled trial with a 3-year follow-up.

BACKGROUND: Although full-arch immediately loaded rehabilitations are widely used nowadays, little information is available on which implant/abutment connection is the most suitable in this type of treatment. PURPOSE: The aim of the present multicentric split-mouth clinical trial was to compare the clinical outcomes of two different implant-abutment connections applied in full-arch immediate loading rehabilitations: external hexagon connection (EHC) versus internal hexagon connection (IHC). MATERIALS AND METHODS: Twenty patients were rehabilitated with immediately loaded fixed full-arch rehabilitations. All the implants presented the same macro- and micro-topography but different implant/abutment connection. IHC were used in one randomly selected side of the jaw and EHC in the other side. Outcome measures were implant survival rate, peri-implant marginal bone loss (MBL), plaque index (PI), probing depth (PD), and bleeding on probing (BoP) evaluated at 3, 6, 12, and 36-month post-loading. Any technical and biological complication was recorded. Kaplan-Meier procedure and linear mixed model were used to perform statistical analysis. RESULTS: Forty-three EHC and 40 IHC implants were inserted. No patients dropped out and two implants failed in the first 6 months. The CSR was 97.7% for EHC and 97.5% for IHC implants. No statistically significant differences were found among the two groups for any of the parameters at any time point. At the 36-month follow-up visit a slight difference was found in MBL with a mean value of 1.7 mm in the EHC and of 1.9 mm in the IHC group (p = 0.355). No biologic complications were identified. Seven loosed abutment screws were identified in the entire follow-up period, two in the EHC, and five in the IHC group without a statistically significant difference (p = 0.394). CONCLUSIONS: After 36 months in function, both internal and external hexagon connections provided good clinical outcomes and were not associated with any significant difference.

Framework Materials for Full-Arch Implant-Supported Rehabilitations: A Systematic Review of Clinical Studies.

The purpose of this systematic review was to investigate the clinical outcomes of frameworks made of different materials in patients with implant-supported full-arch prostheses. A literature search was conducted on MEDLINE, Scopus and Cochrane Library, until the 1st of March 2021, with the following search terms: framework or substructure combined with "dental implants". The outcomes evaluated were: implant and prosthesis survival, bone resorption, biological and technical complications. The Cochrane Handbook for Systematic Reviews of Interventions was employed to assess the risk of bias in randomized clinical trials. The Newcastle-Ottawa quality assessment scale was used for non-randomized studies. In total, 924 records were evaluated for title and abstract, and 11 studies were included in the review: 4 clinical randomized trials and 7 cohort studies. The framework materials investigated were: gold alloy, titanium, silver-palladium alloy, zirconia and polymers including acrylic resin and carbon-fiber-reinforced composites. High implant and prosthetic cumulative survival rates were recorded by all included studies. Various materials and different fabrication techniques are now available as alternatives to traditional cast metal frameworks, for full-arch implant-supported rehabilitations. Further long-term studies are needed to validate the use of these materials and clarify their specific clinical indications and manufacturing protocols to optimize their clinical outcomes.

MicroRNA in Implant Dentistry: From Basic Science to Clinical Application.

Specific microRNA (miRNA) expression profiles have been reported to be predictive of specific clinical outcomes of dental implants and might be used as biomarkers in implant dentistry with diagnostic and prognostic purposes. The aim of the present narrative review was to summarize current knowledge regarding the use of miRNAs in implant dentistry. The authors attempted to identify all available evidence on the topic and critically appraise it in order to lay the foundation for the development of further research oriented towards the clinical application of miRNAs in implant dentistry.

Photo and Plasma Activation of Dental Implant Titanium Surfaces. A Systematic Review with Meta-Analysis of Pre-Clinical Studies.

BACKGROUND: Ultraviolet (UV) and non-thermal plasma functionalization are surface treatment modalities that seem able to improve osseointegration. The aim of this systematic review and meta-analysis is to assess the effect of the two methods and possible differences. MATERIALS AND METHODS: The systematic research of pre-clinical animal studies was conducted up to May 2020 in the databases PubMed/Medline, Scopus and the Cochrane Lybrary. A meta-analysis was performed by using the DerSimonian-Laird estimator in random-effects models. RESULTS: Through the digital search, 518 articles were identified; after duplicate removal and screening process 10 papers were included. Four studies evaluating UV treatment in rabbits were included in the meta-analysis. The qualitative evaluation of the included studies showed that both UV photofunctionalization and non-thermal plasma argon functionalization of titanium implant surfaces might be effective in vivo to improve the osseointegration. The meta-analysis on four studies evaluating UV treatment in rabbits showed that bone to implant contact values (expressed as standardized mean differences and raw mean differences) were significantly increased in the bio-activated groups when follow-up times were relatively homogeneous, although a high heterogeneity (I2 > 75%) was found in all models. CONCLUSIONS: The present systematic review and meta-analysis on pre-clinical studies demonstrated that chair-side treatment of implants with UV or non-thermal plasma appear to be effective for improving osseointegration. This systematic review supports further clinical trials on this topic.

Analysis of the Subgingival Microbiota in Implant-Supported Full-Arch Rehabilitations.

BACKGROUND: The etiology of peri-implantitis is multifactorial, and it is not directly linked to the quantitative amount of plaque. The aim of this study was to evaluate the influence of subgingival microbiota around implants supporting full-arch restorations on clinical indexes of peri-implant health. METHOD: 47 patients (54 full-arch fixed rehabilitations) were included. Based on the highest value of probing depth (PD), 47 implants (in the test arch), 40 natural teeth and 7 implants (in the antagonist arch) were selected for microbiological sampling (traditional PCR and real-time PCR). Periodontal indexes (plaque index, PlI; probing depth, PD; bleeding on probing, BOP; peri-implant suppuration, PS) and marginal bone loss were also recorded. RESULTS: Despite abundant plaque accumulation, the peri-implant parameters were within normal limits. No statistical difference was found in the microbial population around the test implants and antagonist natural teeth. Treponema denticola was present in a significantly higher amount around implants with increased PlI. Implants with increased BOP showed a significant increase in Treponema denticola and Tannerella forsythia. A significantly higher presence of Porphyromonas gingivalis, Treponema denticola and Tannerella forsythia was identified around the implants affected by peri-implantitis and in smokers. CONCLUSIONS: Peri-implantitis is characterized by a complex and polymicrobial disease, that might be influenced by the qualitative profile of plaque. Smoking might also favor implant biological complications in full-arch fixed prosthesis.

Angled implant brush for hygienic maintenance of full-arch fixed-implant rehabilitations: a pilot study.

PURPOSE: This pilot study was conducted to evaluate the cleaning efficacy of an angled implant brush for home oral hygiene of full-arch fixed-implant prostheses. METHODS: Forty-one patients treated with a full-arch implant rehabilitation in the maxilla or mandible (164 implants) for at least 4 months were enrolled. The screw-retained fixed prostheses were removed and baseline (T0) parameters were recorded, including plaque index (PI), probing depth (PD), and bleeding on probing (BOP). All patients completed a 5-item questionnaire on hygiene maintenance and received an implant brush for home hygiene. After 1 month (T1) PI, PD, and BOP were recorded again and patients completed a 7-item questionnaire to evaluate their satisfaction with the implant brush. One-way repeated-measures analysis of variance was conducted to evaluate the significance of changes in PI, PD, and BOP. A P value <0.05 was considered to indicate statistical significance. RESULTS: A statistically significant reduction of BOP (0.62±0.6 at T0 vs. 0.5±0.5 at T1; P=0.032) was found, while no statistically significant changes in PD (1.74±0.5 mm at T0 vs. 1.77±0.5 mm at T1; P=0.050) or PI (1.9±0.7 at T0 vs. 1.7±0.7 at T1; P=0.280) occurred. According to the 7-item questionnaire, patients reported no difficulty in using the angled brush (63.4%) and deemed it highly (46.3%) or very highly (4.8%) effective in improving their home oral hygiene. CONCLUSIONS: Within the limits of the present pilot study, the patients experienced a reduction of BOP 1 month after being instructed to use the angled implant brush. The angled implant brush appeared to be a well-accepted device for home-care hygiene of full-arch fixed-implant rehabilitations.

Influence of Implant Thread Morphology on Primary Stability: A Prospective Clinical Study.

OBJECTIVES: The purpose of this study was to evaluate the primary stability of two implants with the same macro- and micromorphology but different thread design and analyze their clinical outcomes over a one-year period. MATERIALS AND METHODS: 14 patients needing a partial rehabilitation with a delayed loading approach (DEL group: 9 patients) or a full-arch rehabilitation treated with immediately loaded fixed prostheses supported by 4 implants following the Columbus Bridge Protocol (CBP) (IL group: 5 patients) were included. In each patient, at least one SY (implant with standard threads) and one SL implant (implant with an augmented depth of the threads) were randomly inserted. Primary outcome measures were the number of threads exposed at a torque of 30 Ncm and 50 Ncm and final insertion torque. Secondary outcome measures were implant and prosthetic failure, peri-implant bone resorption, and periodontal parameters: bleeding on probing (BoP), plaque index (PI), and probing depth (PD) evaluated at 3, 6, and 12 months of healing. RESULTS: Nineteen SY and 19 SL implants were inserted in 14 patients. Twenty implants (10 SL and 10 SY) were inserted in the IL group, while 18 (9 SL and 9 SY) were inserted in the DEL group and followed-up for 12 months. No patients dropped out. No implants and prostheses failed. No biological complications were identified. No significant differences were found between SY and SL implants comparing the number of exposed threads when inserting the implant with a torque insertion of 30 N (T student test p = .142 and U test p = .164). At 50 N, no threads were visible in either groups. Final torque insertion values were higher for SL (mean: 48.42 Ncm) compared to SY implants (mean: 43.42 Ncm) without a statistically significant difference. All the implants showed good clinical outcomes at the 1-year-in-function visit. CONCLUSIONS: After 12 months of function, both implant types provided good clinical outcomes without statistically significant differences between the two groups. A difference in insertion torque (even if not statistically significant) was found with higher insertion torque values for SL implants with a larger thread depth.

Brånemark Novum Immediate Loading Rehabilitation of Edentulous Mandibles: Case Series with a 16-Year Follow-up.

The aim of the present report was to evaluate the clinical outcomes of edentulous jaws rehabilitated with the Brånemark Novum protocol over a 16-year period. Between April and November 2001, four patients (three males, one female) were rehabilitated with fixed full-arch rehabilitations supported by three immediately loaded implants following the Brånemark Novum protocol. Cumulative survival rates (CSRs) of the implants and prosthesis, bleeding on probing (BOP), Plaque Index (PI), probing depth (PD), implant stability quotient (ISQ; as measured through resonance frequency analysis [RFA]), and peri-implant bone resorption were evaluated over time, up to the 16-year follow-up. At 16 years of follow-up, no implant failed (CSR 100%) and no prosthesis needed to be substituted (CSR 100%). During the period between the 11th and 16th year of follow-up, bone level (mean: 2.2 mm at 16 years) and RFA values remained stable. At the 16-year follow-up, the implants presented high PI (79.2%) but low BOP (10.4%) values. Mean PD was 3.30 mm (range: 2 to 6 mm). One biologic complication was detected on a central implant (crater-form bone destruction), and several prosthodontic complications occurred during the 16 years (fractures of resin or teeth), the majority of which were registered on the same parafunctional patient. This is the first description of the Brånemark Novum protocol rehabilitation with a 16-year follow-up. The outcomes demonstrated very good long-term outcomes for this protocol.

Evaluation of internal and external hexagon connections in immediately loaded full-arch rehabilitations: A within-person randomised split-mouth controlled trial.

PURPOSE: To evaluate if a different morphology of the implant-abutment connection (internal vs. external hexagon) is able to condition the behaviour of hard and soft peri-implant tissues. MATERIALS AND METHODS: Twenty patients with significantly unfavourable prognoses for their residual maxillary or mandibular dentitions were selected and rehabilitated with immediately loaded fixed full-arch rehabilitations in two different centres. Four to six implants with identical macro- and micro-topography were inserted in each arch: external hexagon implants (EHC) in one randomly selected side of the dental arch and internal hexagon implants (IHC) in the other side. Primary outcome measures were the success rates of the implants and prostheses. Any technical and biological complication was recorded. Secondary outcome measures were: peri-implant marginal bone level (MBL) changes, Plaque Index (PI), probing depth (PD) and bleeding on probing (BoP), evaluated at implant insertion and at 3, 6 and 12 months post-loading. RESULTS: Forty-three EHC and 40 IHC implants were inserted in 20 patients. No patients dropped out. Two implants failed; one IHC after 3 months and one EHC after 6 months in two different patients (difference IHC vs. EHC at patient level: 0.06%; 95% CI: -1.9 to 2.1; P = 0.99). No prosthesis failed. No biological complications were identified and three loose prosthetic abutment screws were identified in three different patients (two EHC and one IHC); difference at patient level IHC vs. EHC: 2.1% (95% CI: -0.8 to 5; P = 0.43). Overall marginal bone loss was not significantly different between the two treatment groups (EHC vs. IHC) at any time point. The mean difference of bone levels between EHC and IHC was 0.25 mm (95% CI: -0.18 to 0.69) at implant placement. Mean difference between IHC and EHC was -0.01 mm (95% CI: -0.34 to 0.36) at 3 months, 0.13 mm (95% CI: -0.48 to 0.22) at 6 months and 0.11 mm (95% CI: -0.45 to 0.25) at 12 months. All the implants showed good periodontal health at the 1-year-in-function visit, with no statistically significant differences between groups. At 12 months mean (± standard deviation) PI was 2 (± 1.5) for the EHC and 1.85 (± 1.58) for the IHC group (P = 0.57) with a mean difference between the two groups of 0.15 (95% CI: -0.56 to 0.85). Mean PD was 2.23 mm (± 0.52) for the EHC and 2.10 mm (± 0.39) for the IHC group (P = 0.39), with a mean difference between the two groups of 0.12 mm (95% CI: -0.08 to 0.33). At 12 months 41.4% of EHC and 43.6% of IHC implants presented no BoP (mean difference: -2.2%, 95% CI: -24.0 to 19.3; P = 0.51). No significant effect of centres over all outcomes was identified (P = 0.71 for MBL, P = 0.14 for PI, P = 0.14 for PD and P = 0.20 for BoP). CONCLUSIONS: On the basis of the present trial the two types of implant connections were clinically reliable. After 12 months in function, both implants provided good clinical outcomes, without statistically significant differences between the two groups.

Evaluation of Adhesion Between Carbon Fiber Frameworks and Esthetic Veneering Materials.

PURPOSE: To assess bond strength and failure patterns of carbon fiber-reinforced composite (CFRC) and veneering materials. MATERIALS AND METHODS: A total of 20 samples were prepared: 10 veneered with polymethylmethacrylate (group A) and 10 with composite resin (group B). Shear bond strength (SBS) was measured, and failed samples were microscopically observed. RESULTS: The mean ± standard deviation (SD) SBS of specimens in group A was slightly higher (7.39 ± 0.24 MPa) than specimens in group B (5.68 ± 0.29 MPa). Microscopic observation showed an adhesive fracture pattern at the CFRC-adhesive interface in both groups. CONCLUSION: Adhesion between CFRC and veneering material is reliable and predictable, although a specific protocol needs to be developed to improve adhesion.