Digital planning and bone regenerative technologies: A narrative review.

OBJECTIVES: The aim of this narrative review was to explore the application of digital technologies (DT) for the simplification and improvement of bone augmentation procedures in advanced implant dentistry. MATERIAL AND METHODS: A search on electronic databases was performed to identify systematic reviews, meta-analyses, randomized and non-randomized controlled trials, prospective/retrospective case series, and case reports related to the application of DT in advanced implant dentistry. RESULTS: Seventy-nine articles were included. Potential fields of application of DT are the following: 1) the use of intra-oral scanners for the definition of soft tissue profile and the residual dentition; 2) the use of dental lab CAD (computer-aided design) software to create a digital wax-up replicating the ideal ridge and tooth morphology; 3) the matching of STL (Standard Triangulation Language) files with DICOM (DIgital COmmunication in Medicine) files from CBCTs with a dedicated software; 4) the production of stereolithographic 3D models reproducing the jaws and the bone defects; 5) the creation of surgical templates to guide implant placement and augmentation procedures; 6) the production of customized meshes for bone regeneration; and 7) the use of static or dynamic computer-aided implant placement. CONCLUSIONS: Results from this narrative review seem to demonstrate that the use of a partially or fully digital workflow can be successfully used also in advanced implant dentistry. However, the number of studies (in particular RCTs) focused on the use of a fully digital workflow in advanced implant dentistry is still limited and more studies are needed to properly evaluate the potentials of DT.

Minimal invasiveness in vertical ridge augmentation.

Vertical ridge augmentation is one of the most challenging procedures in implant dentistry because of the advanced skills required by the operator and the fact that bone augmentation is aimed outside the bony contour, in an environment of reduced blood supply. What is more, the flap management required to ensure soft tissue closure frequently leads to associated comorbidities in terms of swelling and hematomas. For these reasons, and even if autologous onlay block grafts are still the gold standard, new techniques and biomaterials have favored the development of potentially less invasive approaches. The present work evaluates the most recent strategies in vertical ridge augmentation to reduce invasiveness and complications, including diagnostic/treatment planning considerations, surgical techniques, digital tools (eg, customized titanium meshes/membranes or bone blocks), and future trends in the field of tissue engineering and cell therapy.

Customized CAD/CAM titanium meshes for the guided bone regeneration of severe alveolar ridge defects: Preliminary results of a retrospective clinical study in humans.

OBJECTIVES: To present the results of guided bone regeneration (GBR) of atrophic edentulous ridges with customized CAD/CAM titanium meshes. MATERIAL AND METHODS: Forty-one patients, presenting with 53 atrophic sites, were enrolled between 2018 and 2019. GBR was obtained with titanium meshes filled with autogenous bone chips and bovine bone mineral (BBM). After a mean of 7 months (range: 5-12 months), meshes were removed and 106 implants placed. After a mean of 3.5 months (range: 2-5 months), implants were uncovered and prosthetic restorations started. The outcomes were vertical and horizontal bone augmentation changes, biological complications and implant survival. RESULTS: Out of 53 sites, 11 underwent mesh exposure: eight of them were followed by uneventful integration of the graft, while three by partial bone loss. The mean vertical and horizontal bone gain after reconstruction was 4.78 ± 1.88 mm (range 1.00-8.90 mm) and 6.35 ± 2.10 mm (range 2.14-11.48 mm), respectively. At the time of implant placement, mean changes of initial bone gain were -0.39 ± 0.64 mm (range -3.1 to + 0.80 mm) and -0.49 ± 0.83 mm (range -3.7 to +0.4 mm), in the vertical and horizontal dimensions, respectively. Reduction of bone volume was significantly higher (p < .001 for both dimensions) in the exposed sites. The mean follow-up of implants after loading was 10.6 ± 6.5 months (range: 2-26 months). The survival rate of implants was 100%. CONCLUSION: Customized titanium meshes can represent a reliable tool for GBR of severely atrophic sites, with simplification of the surgical phases.

A retrospective 10-year mean follow-up of implants placed in ridges grafted using autogenous mandibular blocks covered with bovine bone mineral and collagen membrane.

OBJECTIVES: To report the clinical and radiographic outcomes of patients presenting with edentulous and atrophic ridges and treated with autogenous mandibular bone blocks and rehabilitated with implant-supported prostheses. MATERIALS AND METHODS: From 1997 to 2015, 75 patients presenting with bone defects of the jaws were grafted with autogenous mandibular bone blocks. One-hundred eighty-two implants were placed 4 to 12 months later and loaded 3 to 10 months later: the mean follow-up was 10 years (range: 3-16 years). The following outcomes were recorded: (a) complication rate of the reconstructive procedure; (b) bone graft resorption before implant placement; (c) peri-implant bone resorption; (d) implant-related complications; and (e) implant survival and success rates. RESULTS: Postoperative recovery was uneventful in the majority of patients. An early dehiscence occurred in three patients, but with no significant bone loss, while 3 experienced temporary paraesthesia. The mean vertical and horizontal bone resorption before implant placement was 0.18 mm (standard deviation [SD] = 0.43) and 0.15 mm (SD = 0.42), respectively. The mean peri-implant bone loss ± standard deviation was 1.06 ± 1.19 (range: 0.00-5.05) at patient level and 1.11 ± 1.26 (range: 0.00-5.20) at implant level. Two implants in 2 patients lost integration and were removed; 10 implants in 7 patients developed peri-implantitis, but healed after surgical treatment. The cumulative implant survival and success rates were 98.11% and 85.16%, respectively. CONCLUSION: Implants placed in areas reconstructed with mandibular bone blocks presented survival rates consistent with those obtained for implants placed in native bone.

Odontogenic rhinosinusitis and sinonasal complications of dental disease or treatment: prospective validation of a classification and treatment protocol.

PURPOSE: Odontogenic sinusitis and sinonasal complications of dental disease or treatment (SCDDT) represent a heterogeneous group of conditions that often require multidisciplinary care. The present study aims to prospectively validate a classification and treatment protocol for SCDDT patients. METHODS: One hundred twenty-eight consecutive patients (73 females and 45 males, mean age 52.4 years) affected by SCDDT not responding to dental and medical therapy were classified and surgically treated according to the proposed protocol. The protocol classified patients into three aetiology-based groups (preimplantologic, implantologic, and related to traditional dental diseases and procedures, respectively). The groups were further divided into classes according to the presence of oro-antral communications and/or dislocated dental hardware. Each condition was treated according to the class-related, protocol-defined treatment, by either a transnasal or combined transnasal/transoral approach. All patients were successfully classified according to our protocol. None of the proposed classes were redundant, and no condition fell outside the definitions. RESULTS: The surgical treatment protocol proved to be adequate and effective, in that 125 of the 128 patients completely recovered after surgical treatment. CONCLUSIONS: The term SCDDT and the consequent classification proposed by the authors appear, therefore, to be nosologically correct. Furthermore, the protocol-related proposed treatment appears to be clinically sound, with a success rate nearing 98%.

Horizontal bone-augmentation procedures in implant dentistry: prosthetically guided regeneration.

The rehabilitation of partially or totally edentulous patients with implant-supported prostheses has become routine, with excellent long-term outcome. A proper implant position is mandatory to achieve good functional and esthetic outcome and may require an adequate amount of alveolar bone and surrounding soft tissue. When this is lacking because of atrophy, sequelae of periodontal disease, traumas or congenital malformations, increased bone volume and/or keratinized mucosa can be obtained by guided bone regeneration, bone-grafting techniques and alveolar bone expansion. This article presents an evidence-based, prosthetically driven approach for the treatment of edentulous ridges with horizontal defects. The classification of bony defects, the main augmentation techniques, the selection criteria among different surgical procedures for different types of bony defects, and the advantages, disadvantages and limitations of each technique, are described in detail.

Dental implants placed in severely atrophic jaws reconstructed with autogenous calvarium, bovine bone mineral, and collagen membranes: A 3- to 19-year retrospective follow-up study.

OBJECTIVES: To present the clinical, radiographic, and patient-related outcomes of patients presenting with severely resorbed ridges reconstructed with autogenous calvarial bone blocks and rehabilitated with implant-supported prostheses. MATERIAL AND METHODS: From 1998 to 2014, 72 patients presenting with severe bone defects were reconstructed with autogenous calvarial bone blocks covered with bovine bone mineral granules and collagen membranes. Four to 9 months later, 330 implants were placed and loaded 3-9 months later. The follow-up ranged from 3 to 19 years (mean: 8.1 years). The following parameters were recorded: (a) complication rate of the reconstructive procedure; (b) bone resorption before implant placement; (c) implant survival rate and implant-related complications; (d) peri-implant bone resorption; and (e) patient's satisfaction inquired with a dedicated questionnaire. RESULTS: No patients developed severe complications, such as complete loss or resorption of the grafts. A dehiscence occurred in six patients, which developed a mild graft resorption. The mean peri-implant bone resorption before implant placement was 0.13 mm (SD ± 0.71). All patients received the planned number of implants. Three patients were lost during the follow-up. The survival rate of implants at the end of the observation period was 98.5%. The mean peri-implant bone resorption ranged from 0.00 to 4.87 mm (mean: 1.11 mm). At last, 90% of the patients were very satisfied as regards the treatment received. CONCLUSIONS: Results from this study suggested that: (a) bone volume in the areas reconstructed with calvarial grafts was stable over time; (b) survival rates of implants were consistent with those reported for implants placed in native bone; (c) patient's satisfaction was high.

Iliac Crest Fresh-Frozen Allografts Versus Autografts in Oral Pre-Prosthetic Bone Reconstructive Surgery: Histologic and Histomorphometric Study.

PURPOSE: The aim of this work was to compare histologically bone biopsies obtained during dental implant placement in atrophic jaws reconstructed with fresh-frozen bone (FFB) or autologous bone blocks. MATERIALS AND METHODS: Twenty partially or totally edentulous patients were treated either with iliac crest FFB grafts (14 patients; group A) or with iliac crest autografts (6 patients; group B). Seven to 9 months later, dental implants were placed in the reconstructed jaws and bone biopsies were harvested. RESULTS: The reconstructive procedure was uneventful in 9 patients of group A and in all patients of group B. Samples from both groups did not show relevant differences concerning the proportion of lamellar bone, newly formed bone, and bone marrow. In group A, the decreasing proportion of blood vessels from the apical to the coronal portion, the larger amount of lacunae in the apical portion, and the fewer vessels in the coronal portion than in group B evoke an effort of the host bone to "integrate" the graft from the apical portion. CONCLUSIONS: FFB cannot be considered as successful and safe in alveolar bone reconstruction as autogenous bone grafting.

An easy access to retrieve dental implants displaced into the maxillary sinus: the bony window technique.

AIM OF THE STUDY: To present the authors' experience concerning the removal of dental implants displaced in the maxillary sinus via an intraoral approach consisting of the creation of a bony window pedicled to the maxillary sinus membrane. MATERIALS AND METHODS: Thirty-six systemically healthy patients, presenting with oral implants displaced into the maxillary sinus, but with no signs of acute or chronic sinusitis, were consecutively treated between 2002 and 2012 via an intraoral approach with the bony window technique. RESULTS: Removal of oral implants from the maxillary sinus was achieved in all patients, and postoperative recovery was uneventful in all of them. Computed tomographies performed after surgery showed no signs of residual sinus infection in all patients and a complete ossification of the bony window margins. Twelve of the 36 treated patients were treated with a sinus grafting procedure 12-18 months after in the same areas previously treated with the bone lid technique. Seventeen implants were placed in the grafted areas 6-9 months later and, after a further waiting period needed for osseointegration, the treated patients were rehabilitated with implant-supported prostheses. The survival rate of implants was 100%, and no complications related to the sinuses and implants were recorded. CONCLUSION: Results from this study seem to demonstrate that the bony window technique is a safe and easy way to remove oral implants from the maxillary sinus under local anesthesia. The surgical access is hardly visible 6-12 months after surgery, and maxillary sinuses appeared free from residual pathology in all treated patients. Finally, this procedure allows a second-stage sinus grafting procedure via a lateral approach as in a previously untreated maxillary sinus, thus allowing an implant-supported prosthetic restoration.

Surgical treatment of vascular malformations of the facial bones.

PURPOSE: To characterize intraosseous vascular malformations and describe the most appropriate approach for treatment according to clinical experience and a review of the published data. MATERIALS AND METHODS: We performed a retrospective review of 11 vascular malformations (7 venous and 4 arteriovenous) of the facial bones treated during a 10-year period using en bloc resection or intraoral aggressive curettage alone or preceded by endovascular embolization. Corrective surgery was planned to address any residual bone deformities. The cases were reviewed at a mean follow-up point of 6 years. RESULTS: Facial symmetry was restored in the cases requiring reconstruction. Tooth sparing was possible in the case of jaw and/or maxillary localization. Recanalization occurred in 14% of the venous and 33% of the arteriovenous malformations. CONCLUSIONS: Facial intraosseous venous malformations can be successfully treated using surgery alone. Facial intraosseous arteriovenous malformations will be better addressed using combined approaches. Aggressive curettage will obviate the need for extensive surgical resection in selected cases.

Comprehensive surgical management of cocaine-induced midline destructive lesions.

PURPOSE: This article presents a review of the literature and proposes a protocol for managing acute and chronic midfacial cocaine-induced injuries. MATERIALS AND METHODS: This report describes a series of 4 patients affected by cocaine-induced midline destructive lesions. Three patients came to the authors' attention after 18 months of drug withdrawal and underwent surgical treatments to restore nasal and palatal morphology and function, and the fourth patient was referred because of acute cocaine-induced destructive lesions and was treated by aggressive debridement. An 18-month drug-free period is planned before beginning any reconstructive procedures in this latter patient. RESULTS: Long-term follow-up showed stable results without relapse of palatal fistulas and good esthetic nasal appearance in all 3 patients undergoing reconstruction. The fourth patient did not show any disease progression and will be monitored for drug withdrawal. CONCLUSION: Chronic cocaine consumption may cause multiple types of damage to the soft and hard tissues of the midface. Acute lesions must be addressed with aggressive debridement. As a result of chronic injury, the palate and nose are deformed in a very complex way and the vascularity of the remaining local tissues may be compromised or inadequate for flap harvesting. Palatal and nasal reconstructions are very delicate operations and should be addressed separately to maximize the predictability of the result.

Management of Oral Surgery-Related Complications.

This article reviews the optimal management of oroantral fistulas, implants protruding into the maxillary sinus, implants completely displaced into the sinus(es), and infected bone grafts used for sinus augmentation. For each scenario, multidisciplinary management strategies will be considered based on whether there is concurrent infectious odontogenic sinusitis. A multidisciplinary approach with oral surgeons and otolaryngologists is often mandatory to ensure optimal therapeutic outcomes.

Indications for implant-supported rehabilitation of the posterior atrophic maxilla: A multidisciplinary consensus among experts in the field utilising the modified Delphi method.

PURPOSE: To establish consensus-driven guidelines that could support the clinical decision-making process for implant-supported rehabilitation of the posterior atrophic maxilla and ultimately improve long-term treatment outcomes and patient satisfaction. MATERIALS AND METHODS: A total of 33 participants were enrolled (18 active members of the Italian Academy of Osseointegration and 15 international experts). Based on the available evidence, the development group discussed and proposed an initial list of 20 statements, which were later evalu-ated by all participants. After the forms were completed, the responses were sent for blinded ana-lysis. In most cases, when a consensus was not reached, the statements were rephrased and sent to the participants for another round of evaluation. Three rounds were planned. RESULTS: After the first round of voting, participants came close to reaching a consensus on six statements, but no consensus was achieved for the other fourteen. Following this, nineteen statements were rephrased and sent to participants again for the second round of voting, after which a consensus was reached for six statements and almost reached for three statements, but no consensus was achieved for the other ten. All 13 statements upon which no consensus was reached were rephrased and included in the third round. After this round, a consensus was achieved for an additional nine statements and almost achieved for three statements, but no consensus was reached for the remaining statement. CONCLUSION: This Delphi consensus highlights the importance of accurate preoperative planning, taking into consideration the maxillomandibular relationship to meet the functional and aesthetic requirements of the final restoration. Emphasis is placed on the role played by the sinus bony walls and floor in providing essential elements for bone formation, and on evaluation of bucco-palatal sinus width for choosing between lateral and transcrestal sinus floor elevation. Tilted and trans-sinus implants are considered viable options, whereas caution is advised when placing pterygoid implants. Zygomatic implants are seen as a potential option in specific cases, such as for completely edentulous elderly or oncological patients, for whom conventional alternatives are unsuitable.

The role of pericranium grafts in the reduction of postoperative dehiscences and bone resorption after reconstruction of severely deficient edentulous ridges with autogenous onlay bone grafts.

PURPOSE: To compare: (i) the incidence of soft tissue dehiscences; (ii) bone resorption before and after implant placement; and (iii) the survival and success rates of implants placed in two groups of patients with severe bone defects of the jaws reconstructed with autogenous onlay bone grafts alone (control group) or in association with autogenous pericranium coverage (study group). MATERIAL AND METHODS: Forty-four patients affected by severe atrophy of the alveolar ridges underwent bone reconstruction with vertical/tridimensional autogenous onlay grafts harvested from the calvarium or the mandibular ramus. In 23 patients (study group), grafts were covered with autogenous pericranium before suturing, while in 21 patients (control group) no coverage of the grafts before suturing was performed. After a 4-7 month waiting period, 199 implants were placed (105 in the study group, 94 in the control group) and 3-4 months afterward prosthetic rehabilitation was carried out. The mean follow-up after the start of prosthetic loading was 23.9 months (range: 12-48 months). RESULTS: The incidence of soft tissue dehiscences was 5,7% in the study group and 16% in the control group. The mean graft resorption before implant placement was 0.12 mm (SD ± 0.32) in the study group and 0.98 mm (SD ± 2.79) in the control group. The mean peri-implant bone resorption at the end of the follow-up period was 0.21 mm (SD ± 0.48) in the study group and 0.43 mm (SD ± 0.83) in the control group. The survival rate of implants was 99.1% in the study group and 100% in the control group, while success rate was 96.2% in the study group and 93.6% in the control group. CONCLUSIONS: The use of pericranium as an autogenous membrane for the coverage of onlay bone grafts seems to reduce the risk of soft tissue dehiscences after the reconstruction of atrophic edentulous ridges to reduce peri-implant bone resorption over time, while it seems to have no significant effect in reducing bone resorption in the reconstructed areas before implant placement.

Behaviour of soft tissues healing around single bone-level-implants placed immediately after tooth extraction A 1 year prospective cohort study.

AIM: The aim of this study was to verify if the three-dimensional implant position in fresh alveolar socket may influence the maintenance of stable gingival margins around single premolar restorations with immediate implant placement. METHODS: After 16 weeks of healing, implants were loaded with single crowns. Documentation consisted in peri-apical radiographs taken: before treatment; at the time of implant placement; at the time of prosthetic rehabilitation and 12 months after the start of prosthetic function. Parameters assessed were: the presence/absence of inter-proximal papilla; the inter-implant-tooth distance (ITD); the distance from the base of the crown contact-point to the inter-dental bone crest (CPB); and the buccal-gingival tissue modifications. ITD, CPB values and the modification of buccal-gingival tissue were determined using an image processing software. RESULTS: Twenty-one healthy patients with thick gingival biotype, with a total of 21 maxillary premolars scheduled for extractions were enrolled. Following extraction, implants were immediately positioned. A 100% of implant survival rate was observed after 12 months of function. The presence of the mesial papilla was significantly correlated with the mean mesial CPB value (P = 0.0519 by means of two-tailed Mann-Whitney U-test). No significant correlation was found between the mesial papilla presence and the mean mesial ITD score (P = 0.7722 by means of two-tailed Mann-Whitney U-test). Furthermore, the presence of the distal papilla was not significantly correlated with the mean distal ITD and CPB values: scores of 0.7195 and 0.8225 were calculated respectively. CONCLUSION: In the premolar area, the relationship between the presence of a complete inter-proximal papilla and ITD parameter was not significant (P > 0.05). The relationship between the presence of a complete inter-proximal papilla and CPB parameter still remain unclear. Nevertheless, a more large sample size is required to confirm this trend. Moreover, it was observed that the buccal-gingival tissue withdrew in the range 0-1 mm after 1 year of prosthetic function.

Patient-reported outcome measures of leucocyte- and platelet-rich fibrin (L-PRF) or hemostatic agent application at palatal donor sites after free gingival graft harvesting: a randomized controlled clinical trial.

OBJECTIVE: The aim of this study was to evaluate the patient's morbidity and postsurgical complications after treatment of palatal donor sites after free gingival graft harvesting using leucocyte- and platelet-rich fibrin (L-PRF) membranes or a hemostatic agent with oxidized and regenerated cellulose. METHOD AND MATERIALS: Forty-two palatal donor sites after free gingival graft harvesting in 42 patients were randomly assigned to experimental (L-PRF membrane) or control procedure (hemostatic agent). The primary outcome was postoperative pain related to the wound located at the palatal area, and the secondary outcomes were postoperative discomfort, inability to chew, postoperative stress, surgical chair time, thickness of the palatal fibromucosa, and thickness of the free gingival graft. The patient-reported outcome measures were recorded after 1 week. RESULTS: After 1 week, a statistically significant difference was found between groups in terms of postoperative stress (P = .008). No statistically significant differences in terms of postoperative pain (P = .326), patient discomfort (P = .509), inability to chew (P = .936), or surgical chair time (P = .932) were recorded between the test and the control group. No statistically significant differences were recorded in terms of thickness of the palatal fibromucosa (P = .647) and thickness of the free gingival graft (P = .756) between groups. Postsurgical wound healing complications (ie, necrosis or infections) were not observed in both groups. CONCLUSION: Within their limitations, the present outcomes indicated that the application of L-PRF membrane at palatal donor sites after FGG harvesting did not produce significant advantages for the patients.

Evaluation of peri-implant bone resorption around Straumann Bone Level implants placed in areas reconstructed with autogenous vertical onlay bone grafts.

AIM OF THE STUDY: To evaluate the survival and success rate of Straumann Bone Level implants placed in vertically atrophied edentulous jaws previously reconstructed with autogenous onlay bone grafts taken from the calvarium or the mandibular ramus. MATERIALS AND METHODS: From 2007 to 2009, 18 patients presenting with vertical deficits of the edentulous ridges were treated with autogenous cortical bone grafts harvested from the mandibular ramus or the calvarium. Four to seven months afterward, 60 Straumann Bone Level implants were placed in the reconstructed areas. After a further waiting period of 2-3 months, patients were rehabilitated with implant-supported fixed prostheses. Follow-up ranged from 12 to 36 months (mean: 19 months) after the start of prosthetic loading. Graft resorption before implant placement, as well as survival and success rates of implants, were recorded. RESULTS: The mean bone resorption prior to implant placement was 0.18 mm for calvarial grafts and 0.42 mm for ramus grafts. Survival rate was 100% either for implants placed in calvarial grafts or implants placed in ramus grafts, while success rate was 90.3% for implants placed in calvarial grafts, and 93.1% for implants placed in ramus grafts. CONCLUSION: Results from this study seem to demonstrate that implants with a platform-switching design may predictably integrate in edentulous areas reconstructed with autogenous bone grafts, with survival rates consistent with those reported in recent literature reviews on the same topic, and also with implants placed in native bone. Conversely, this study was not able to demonstrate that implants with platform-switching design may reduce bone resorption around implants placed in reconstructed areas.

Radiographic protrusion of dental implants in the maxillary sinus and nasal fossae: A multidisciplinary consensus utilising the modified Delphi method.

The aim of the present study was to generate an international and multidisciplinary consensus on the clinical management of implant protrusion into the maxillary sinuses and nasal fossae. A total of 31 experts participated, 23 of whom were experts in implantology (periodontologists, maxillofacial surgeons and implantologists), 6 were otolaryngologists and 2 were radiologists. All the participants were informed of the current scientific knowledge on the topic based on a systematic search of the literature. A list of statements was created and divided into three surveys: one for all participants, one for implant providers and radiologists and one for otolaryngologists and radiologists. A consensus was reached on 15 out of 17 statements. According to the participants, osseointegrated implants protruding radiographically into the maxillary sinus or nasal fossae require as much monitoring and maintenance as implants fully covered by bone. In the event of symptoms of sinusitis, collaboration between implant providers and otolaryngologists is required. Implant removal should be considered only after pharmacological and surgical management of sinusitis have failed.

Long-term outcome of dental implants placed in revascularized fibula free flaps used for the reconstruction of maxillo-mandibular defects due to extreme atrophy.

PURPOSE: the objectives of this study were to evaluate (a) the clinical outcome of revascularized fibula flaps used for the reconstruction of extremely atrophic jaws and (b) the survival rates of dental implants placed in the reconstructed areas. MATERIALS AND METHODS: between 1999 and 2004, 12 patients presenting with extreme atrophy of the edentulous jaws were reconstructed with fibula free flaps. Five to 12 months after the reconstructive procedure, 75 titanium dental implants were placed in the reconstructed areas, while prosthetic rehabilitation was started 4-6 months afterward. The mean follow-up of patients after the start of prosthetic loading was 77 months (range: 48-116). RESULTS: an uneventful healing of the bone transplants occurred in all patients. One out of the 75 dental implants placed was not loaded due to prosthetic reasons. No dental implants failed to integrate before prosthetic loading, while three were removed during the follow-up period. Despite the high survival rate of dental implants (95.8%), a relevant number of them presented relevant peri-implant bone-level loss, ranging from 1 to 7 mm for maxillary dental implants and from 1 to 4.5 mm for mandibular dental implants. CONCLUSION: although no failures of the bone transplants occurred and a high long-term survival rate of dental implants were observed, this study showed that fibula free flaps do not guarantee dimensional stability of peri-implant bone, despite the immediate blood supply delivered by the vascular pedicle. The peri-implant bone resorption was higher when compared with the one related to dental implants placed in native bone.

Wound Closure and Simultaneous Soft Tissue Augmentation at Fresh Extraction Sockets: A Simplified Technique Adopting a Xenogeneic Collagen Matrix.

A simplified surgical technique is presented for closure and soft tissue augmentation of fresh extraction sockets that utilizes a xenogeneic collagen matrix as a substitute for a combined onlay-interpositional connective tissue graft. Ten alveoli receiving a socket preservation procedure (n = 5) or an immediate submerged implant (n = 5) were sealed with a xenogeneic collagen matrix, stabilized under small palatal and buccal full-thickness envelope flaps. Eight weeks after surgery, full wound closure was achieved in 9 out of 10 sites with satisfactory esthetic integration (mean ΔE score: 3.76). Results from this descriptive observational study suggest that this technique may represent a valuable and minimally invasive solution to simplify closure and soft tissue augmentation of fresh extraction sockets.