Horizontal and Vertical Defect Management with a Novel Degradable Pure Magnesium Guided Bone Regeneration (GBR) Membrane-A Clinical Case.

Background and objectives: In guided bone regeneration (GBR), large defects comprising both horizontal and vertical components usually require additional mechanical support to stabilize the augmentation and preserve the bone volume. This additional support is usually attained by using non-resorbable materials. A recently developed magnesium membrane presents the possibility of providing mechanical support whilst being completely resorbable. The aim of this case report was to describe the application and outcome of the magnesium membrane in combination with a collagen pericardium membrane for GBR. Materials and methods: A 74 year old, in an otherwise good general health condition, was presented with stage 2 grade A periodontitis and an impacted canine. After extraction of the impacted canine, a defect was created with both vertical and horizontal components. The defect was augmented using the magnesium membrane to create a supportive arch to the underlying bone graft and a collagen pericardium membrane was placed on top to aid with the soft tissue closure. Results: Upon reentry at 8 months, complete resorption of the magnesium devices was confirmed as there were no visible remnants remaining. A successful augmentation outcome had been achieved as the magnesium membrane in combination with the collagen membrane had maintained the augmented bone well. Two dental implants could be successfully placed in the healed augmentation. Conclusions: In this case, the magnesium membrane in combination with a collagen pericardium membrane presented a potentially viable alternative treatment to titanium meshes or titanium-reinforced membranes for the augmentation of a defect with both horizontal and vertical components that is completely resorbable. It was demonstrated that it is possible to attain a good quality and quantity of bone using a resorbable system that has been completely resorbed by the time of reentry.

Periimplant Bone Response in Human-Retrieved, Clinically Stable, Successful, and Functioning Dental Implants After a Long-Term Loading Period: A Report of 17 Cases From 4 to 20 Years.

OBJECTIVE: This study aimed at a histologic and histomorphometric analysis of the periimplant tissues and bone-titanium interface reactions in successfully osseointegrated, clinically stable, and immobile human titanium dental implants retrieved after a long loading period. MATERIALS AND METHODS: In the last 30 months (2013-2015), 21 implants, retrieved from individuals for different causes after a loading period ranging from 4 to 20 years, were sent to the Implant Retrieval Center, University of Chieti-Pescara, Italy. In 4 cases, almost all the bone had been lost during the retrieval, whereas in the remaining 17 cases, mineralized bone was still present. RESULTS: Around the majority of the implants, mature compact bone with few marrow spaces was found. The trabecular bone, constituted by a few thin bone trabeculae, was in a periimplant location around only a few implants. A high percentage of bone-implant contact (BIC) (comprised between 32 ± 4.1% and 83 ± 2.9%) was present. In almost all implants, the space within the threads was almost completely filled by compact lamellar bone or by a thin layer of bone. Close and tight contact between bone and implant surface was observed in all specimens with no gaps or connective tissue at the interface. CONCLUSIONS: All implants appeared to be well integrated in the surrounding mineralized bone, and all of them showed adequate bone-to-implant contact percentages.

Peri-implant bone tissues around retrieved human implants after time periods longer than 5 years: a retrospective histologic and histomorphometric evaluation of 8 cases.

Only rarely, it is possible to find in the literature histological reports of human retrieved implants, especially after several years of functional loading. These implants can help us in understanding the reactions of peri-implant bone. The aim of this study was to perform a histologic and histomorphometric analysis of the peri-implant tissues behavior and of the bone-titanium interface in titanium dental implants retrieved from patients after time periods longer than 5 years. The archives of the Implant Retrieval Center of the Dental School of the University of Chieti-Pescara, Italy were searched for human dental implants, retrieved after a loading period of more than 5 years. A total of 8 implants were found: 3 of these had been retrieved after 5 years, 1 after 6 years, one after 10 years, 1 after 14 years, 1 after 18 years, 1 after 22 years. Only the bone to implant contact in the three best threads was evaluated. Compact, mature, lamellar bone, with few and small marrow spaces, was present around the implants. Osteons with Haversian canals were present inside some threads, in close proximity to the interface, at both cortical and trabecular regions. Other osteons had a direction perpendicular to the direction of the long axis of the implants. Numerous reversal lines were present. At higher magnification, no gaps or fibrous, connective tissues were present at the interface. The BIC of the three best threads for all implants varied from 94 to 100 %.In conclusion, within the limitations of the present report histology showed that implants with different surfaces all presented the potential to maintain osseointegration over a long period, with a continuous remodeling at the interface, as indicated by the presence of reversal lines.

Prevention of Dry Socket with Ozone Oil-Based Gel after Inferior Third Molar Extraction: A Double-Blind Split-Mouth Randomized Placebo-Controlled Clinical Trial.

Tooth extraction is followed by a sequence of elaborate local changes affecting hard and soft tissues. Dry socket (DS) can occur as intense pain around and in the extraction site, with an incidence from 1-4% after generic tooth extraction to 45% for mandibular third molars. Ozone therapy has gained attention in the medical field because of its success in the treatment of various diseases, its biocompatible properties and its fewer side effects or discomfort than drugs. To investigate the preventive effect of the sunflower oil-based ozone gel Ozosan® (Sanipan srl, Clivio (VA), Italy) on DS, a double-blind split-mouth randomized placebo-controlled clinical trial was conducted according to the CONSORT guidelines. Ozosan® or the placebo gel were put in the socket, and the gels were washed off 2 min later. In total, 200 patients were included in our study. The patient population comprised 87 Caucasian males and 113 Caucasian females. The mean age of the included patients was 33.1 ± 12.4 years. Ozosan reduced the incidence of DS after inferior third molar extraction from 21.5% of the control to 2% (p < 0.001). Concerning the dry socket epidemiology, the incidence was not significantly correlated with gender, smoking or mesioangular, vertical or distoangular Winter's classification. Post hoc power calculation showed a power of 99.8% for this data, with alpha = 0.001.

Expansion of the Zone of Keratinized Tissue for Healthy Implant Abutment Interface Using De-epithelialized Amnion/Chorion Allograft.

Keratinized tissue around implants is beneficial for soft tissue stability and esthetics. The aim of this investigation is to show the use of amnion/chorion membrane to increase the keratinized tissue. Fifteen patients were grafted with the allograft at the first or second stage of implant surgery. The mean values of keratinized tissue were 1.27 ± 0.46 mm, 2.00 ± 0.38 mm, 2.80 ± 0.78 mm, and 3.27 ± 0.80 mm at the initial evaluation and 7, 15, and 60 days postsurgery (prosthetic delivery was at day 60), respectively (P < .001). Most increase occurred between 7 days up to the prosthetic delivery. Use of the amnion/chorion membrane seems to improve keratinized-tissue expansion.

Guided periodontal surgery: a novel approach for the treatment of gummy smile. A case report.

An excessive gingival display, which commonly influences the appearance of the smile and the social behavior of patients, can be the result of various factors, including vertical maxillary excess, alterated passive eruption (APE), and a short or hyperactive upper lip. Surgical stents and guides have been used more frequently in clinical crown lengthening procedures during recent years to promote a higher level of precision and more predictable results. The aim of this article is to describe a novel approach for treating patients with APE who have high esthetic demands.

New possibilities in soft tissue augmentation around dental implants / Novas possibilidades no aumento do tecido mole ao redor dos implantes dentários

A fim de manter a osseoreintegração a longo prazo e para se proteger de complicações é necessário que se tennha uma quantidade suficiente de tecido ósseo e tecido mole. O transplante do tecido mole tornou-se nos últimos anos um procedimento muito comum, para aumentar a qualidade e quantidade da mucosa em torno dos implantes dentários. Tecido retirado do palato ou da tuber maxilar representam o melhor padrão, mas alguns fatores limitam essas possibilidades em alguns casos: a espessura da quantidade disponível, invasividade, etc. Recentemente foi introduzido um novo biomaterial para o transplante do tecido mole. Esse material é obtido da pele suina e trabalha como material reabsorvível submerso totalmente ou parcialmente dentro do tecido para obter mudanças no volume. Vários estudos foram publicados e muitas aplicações foram descritas em dentes naturais e implantes dentários. No presente trabalho foram descritas as principais aplicações e um caso clinico (AU).

In order to maintain osseointegration in the long term and to protect from complications, it is necessary to have sufficient amount of bone tissue and soft tissue. Soft tissue grafting became in the last years a very common procedure to increase the quality and quantity of mucosa around dental implants. Autologous tissue from palate or maxillary tuberosity represents the gold standard, but some factors limitate this possibility in some cases: thickness of quantity avalilable, invasiveness, etc. A novel biomaterial was recently introduced for soft tissue grafting. This material is obtained from porcine dermis and it works as a reabsorbable material submerged totally or partially into recipient soft tissue to obtain changes in volume. Several studies were published and many applications were described on natural teeth and dental implants. In the present paper main applications were described and a clinical case was presented (AU).