The impact of electronic and conventional cigarettes on periodontal health-a systematic review and meta-analysis.

OBJECTIVES: This systematic review and meta-analysis examined the effects of electronic cigarettes on periodontal health compared to conventional cigarette smoke and a non-smoking population. MATERIALS AND METHODS: MEDLINE, Embase, Web of Science, CENTRAL, and ClinicalTrials.gov were screened for literature. Eligibility criteria included clinical studies published between 2006 and 2022 that compare e-cigarettes and conventional cigarettes on periodontal health (bleeding on probing (BoP), plaque index (PI), probing depth (PD), attachment loss (AL), marginal bone loss (MBL), tooth loss, molecular inflammation markers, salivary flow rate). Meta-regression analysis was used to examine the influence of moderator variables. RESULTS: Sixteen studies were found to be eligible for qualitative synthesis. Individual analyses showed that cigarette smokers had significantly higher PI, PD, AL, and MBL and increased concentrations of proinflammatory mediators than e-cigarette users and non-smokers. Meta-analysis revealed a 0.33-fold lower chance for BoP in e-cigarette users compared to smokers (p = 0.03), whereby meta-regression failed to detect any effects regarding the age of users and frequency of smoking. A 0.01-fold decreased chance for positive BoP in e-cigarette users compared with non-smokers was seen (p < 0.01). CONCLUSIONS: The current findings suggest that that e-cigarette use might be considered a healthier alternative to cigarette smoking concerning periodontal health. Even so, harmful effects of electronic nicotine delivery system (ENDS) usage on periodontal health were seen as well. However, a definitive decision on this research question remains elusive due to the absence of randomized controlled trials. CLINICAL RELEVANCE: Electronic cigarettes, marketed as a safer alternative to traditional cigarettes, are becoming increasingly popular. Evidence on the use of electronic cigarettes as a cessation aid and its beneficial impact compared to cigarette smoke remains inconclusive, so the analysis conducted in this review addresses a recent question of high clinical relevance.

Survival Rates of Dental Implants in Autogenous and Allogeneic Bone Blocks: A Systematic Review.

Background and Objectives: Preliminary studies emphasize the similar performance of autogenous bone blocks (AUBBs) and allogeneic bone blocks (ALBBs) in pre-implant surgery; however, most of these studies include limited subjects or hold a low level of evidence. The purpose of this review is to test the hypothesis of indifferent implant survival rates (ISRs) in AUBB and ALBB and determine the impact of various material-, surgery- and patient-related confounders and predictors. Materials and Methods: The national library of medicine (MEDLINE), Excerpta Medica database (EMBASE) and Cochrane Central Register of Controlled Trials (CENTRAL) were screened for studies reporting the ISRs of implants placed in AUBB and ALBB with ≥10 participants followed for ≥12 months from January 1995 to November 2021. The review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The risk of bias was assessed via several scoring tools, dependent on the study design. Means of sub-entities were presented as violin plots. Results: An electronic data search resulted in the identification of 9233 articles, of which 100 were included in the quantitative analysis. No significant difference (p = 0.54) was found between the ISR of AUBB (96.23 ± 5.27%; range: 75% to 100%; 2195 subjects, 6861 implants) and that of ALBB (97.66 ± 2.68%; range: 90.1% to 100%; 1202 subjects, 3434 implants). The ISR in AUBB was increased in blocks from intraoral as compared to extraoral donor sites (p = 0.0003), partially edentulous as compared to totally edentulous (p = 0.0002), as well as in patients younger than 45 as compared to those older (p = 0.044), cortical as compared to cortico-cancellous blocks (p = 0.005) and in delayed implantations within three months as compared to immediate implantations (p = 0.018). The ISR of ALBB was significantly increased in processed as compared to fresh-frozen ALBB (p = 0.004), but also in horizontal as compared to vertical augmentations (p = 0.009). Conclusions: The present findings widely emphasize the feasibility of achieving similar ISRs with AUBB and ALBB applied for pre-implant bone grafting. ISRs were negatively affected in sub-entities linked to more extensive augmentation procedures such as bone donor site and dentition status. The inclusion and pooling of literature with a low level of evidence, the absence of randomized controlled clinical trials (RCTs) comparing AUBB and ALBB and the limited count of comparative studies with short follow-ups increases the risk of bias and complicates data interpretation. Consequently, further long-term comparative studies are needed.

Allogeneic cortical struts and bone granules for challenging alveolar reconstructions: An innovative approach toward an established technique.

OBJECTIVE: The shell technique is a well-established procedure for GBR with which extensive osseous defects can be predictably restored by using cortical bone struts harvested from various intraoral aspects. Recent publications have demonstrated comparable results for autologous and allogeneic bone grafts, whereas the evidence on allogeneic cortical struts remains limited. CLINICAL CONSIDERATIONS: In this case series, we demonstrate the regeneration of five complex alveolar bone defects in four patients with subsequent insertion of fixed dental implants. In all cases, cortical struts made from human donor bone were applied in combination with allogeneic bone granules and collagen membranes. CONCLUSIONS: Similar to autologous cortical shells, the allogeneic struts functioned by creating an immobile container with which the osseous defects in all patients could be successfully restored, enabling placement of dental implants in accordance with the treatment plan. Even when the containers were solely filled with allogeneic granules, vascularized healthy tissue was present at re-entry, demonstrating the vast potential of these materials for applications in dentistry. CLINICAL SIGNIFICANCE: Especially when it comes to regeneration of complex alveolar bone defects, autologous bone grafts are often outlined as the only treatment modality. Here we show that innovative biomaterials like allogeneic bone grafts hold the potential to mimic the functions of autologous bone transplants and provide excellent clinical results without the requirement of a second surgical side for bone harvesting and no risk of donor-site morbidity.

Reconstruction of a Unilateral Alveolar Cleft Using a Customized Allogenic Bone Block and Subsequent Dental Implant Placement in an Adult Patient.

Cleft lip and palate is the most common congenital deformity with severe effects on the quality of life of affected patients. The deformity often includes an alveolar cleft (AC). In most cases, osteoplasty will be performed using autogenous bone transplants harvested from the iliac crest. Thus, this treatment represents a highly invasive procedure. With freeze-dried bone allografts (FDBAs) becoming an increasingly accepted alternative to autogenous bone grafting for several indications, their application might also be suitable for AC reconstruction. We present the use of a customized allogenic bone block in a guided bone regeneration procedure for reconstruction of a unilateral AC and the successful insertion of dental implants after a healing period of 6 months. The use of FDBA seems to represent a successful treatment option for AC reconstruction. The allogenic bone block demonstrated high volume stability with ideal integration and revascularization, resulting in functional bone tissue suitable for implantation and esthetic rehabilitation. Nevertheless, further investigations, especially concerning the long-term stability of the augmented bone and dental implants, are needed to draw definite conclusion regarding the performance of allogenic bone blocks in orofacial cleft osteoplasty.

Bilateral maxillary augmentation using CAD/CAM manufactured allogenic bone blocks for restoration of congenitally missing teeth: A case report.

OBJECTIVE: Various biomaterials have been successfully applied in alveolar bone regeneration, however, the reconstruction of extensive osseous defects remains challenging and is often unfeasible with granular grafting materials. Several studies have outlined allogenic bone blocks as valid alternative to autologous block grafting. CLINICAL CONSIDERATIONS: In this report, we demonstrate the regeneration of two large osseous defects in the maxilla with allogenic bone blocks made from human donor bone. The bone blocks were customized using the CAD/CAM technology in order to enable the insertion of four dental implants. CONCLUSIONS: Both blocks perfectly matched the defect geometry, showed limited resorption, led to the formation of sufficient amounts of mineralized bone in both horizontal and vertical dimensions and enabled the installation of implants according to the treatment plan. The implementation of innovative technologies for individualization of allogenic bone blocks simplifies the restoration of complex and extensive osseous defects and poses great benefits for both practitioners and patients. CLINICAL SIGNIFICANCE: The here presented procedure demonstrates the successful regeneration of two extensive osseous defects in a patient suffering from hypodontia using two CAD/CAM manufactured allogenic bone blocks, rendering the procedure far less invasive as compared to guided bone regeneration carried out with autologous transplants. Furthermore, to the best of our knowledge, this is the first case report that radiographically demonstrates the new formation of a cortical bone layer following block grafting with solely cancellous bone blocks.

Vertical bone augmentation in a single-tooth gap with an allogenic bone ring: Clinical considerations.

OBJECTIVE: The main objective of this case report is to introduce a one-stage bone block augmentation with a cylindrical freeze-dried bone allograft (FDBA) and simultaneous implantation for the reconstruction of a single-tooth bone defect. CLINICAL CONSIDERATIONS: The report describes this method on the basis of radiographical and clinical images derived from a single patient. CONCLUSIONS: The report demonstrates the time-saving and successful application of this treatment concept, which has the potential to increase patient satisfaction and comfort. CLINICAL SIGNIFICANCE: The application of the presented technique enabled a prosthetic rehabilitation of the extracted tooth about 3 months earlier as compared to the conventional procedure, while demonstrating no compromises regarding clinical outcome, functionality and esthetics.

Applications of Metals for Bone Regeneration.

The regeneration of bone tissue is the main purpose of most therapies in dental medicine. For bone regeneration, calcium phosphate (CaP)-based substitute materials based on natural (allo- and xenografts) and synthetic origins (alloplastic materials) are applied for guiding the regeneration processes. The optimal bone substitute has to act as a substrate for bone ingrowth into a defect, as well as resorb in the time frame needed for complete regeneration up to the condition of restitution ad integrum. In this context, the modes of action of CaP-based substitute materials have been frequently investigated, where it has been shown that such materials strongly influence regenerative processes such as osteoblast growth or differentiation and also osteoclastic resorption due to different physicochemical properties of the materials. However, the material characteristics needed for the required ratio between new bone tissue formation and material degradation has not been found, until now. The addition of different substances such as collagen or growth factors and also of different cell types has already been tested but did not allow for sufficient or prompt application. Moreover, metals or metal ions are used differently as a basis or as supplement for different materials in the field of bone regeneration. Moreover, it has already been shown that different metal ions are integral components of bone tissue, playing functional roles in the physiological cellular environment as well as in the course of bone healing. The present review focuses on frequently used metals as integral parts of materials designed for bone regeneration, with the aim to provide an overview of currently existing knowledge about the effects of metals in the field of bone regeneration.

Volumetric Changes of a Customized Allogeneic Bone Block Measured by Two Image Matching Tools: Introduction of a Novel Assessment Technique for Graft Resorption.

OBJECTIVE: The purpose of this case report was to present a method for the assessment of volumetric changes of bone blocks during healing and demonstrate its practicability by analysing the resorption of a pre-shaped allogeneic bone block used for the reconstruction of a complex maxillary defect. MATERIALS AND METHODS: CBCT-scans of a 19-year-old male treated with an allogeneic bone block were recorded pre-OP, post-OP, and following six months of healing. Graft shrinkage was assessed via two image matching tools, namely coDiagnostiX® and Slicer. A biopsy specimen was harvested along the implant canal at the time of implantation. RESULTS: The osseous defect was successfully restored and advanced graft remodelling was found upon re-entry as confirmed by the histomorphometric and histologic analysis. The initial volumes of the graft determined via coDiagnostiX® and Slicer were 0.373 mL and 0.370 mL., respectively, while graft resorption after six months of healing was 0.011 mL (3.00%) and 0.016 mL (4.33%). CONCLUSIONS: The avoidance of bone harvesting and reduction of invasiveness display an important issue in dentoalveolar restorations. However, before grafting materials can be considered a safe alternative, understanding their clinical performance, especially resorption stability, is pivotal. The present case report demonstrates a limited resorption of the allogeneic bone block and further emphasizes the practicability of determining bone resorption by the here introduced method. As our investigation comprises solely one subject, the results should be considered with care and substantiated by further studies.

Customized allogeneic bone grafts for maxillary horizontal augmentation: A 5-year follow-up radiographic and histologic evaluation.

We report the histological evaluation of an individualized allogeneic bone block 5 years after alveolar ridge augmentation. The biopsy showed a well-vascularized lamellar bone with fatty incorporations without any avital allograft remnants. The presence of osteocytes, lining cells, macrophages, and blood vessels indicated a healthy and vital bone tissue.

Incidental finding of a degrading zirconia dental implant 29 months after implantation: Histological and histomorphometrical analysis.

With the emerging development and improvement of biomaterials, the application of ceramics in restorative medicine has experienced a renaissance. New production processes have reportedly helped to overcome unfavorable biomechanical characteristics of these materials, which lead to a wide application of zirconia as ground material for dental implants. Zirconia-based implants are biocompatible, demonstrate ability to osseointegrate and have a teeth-like color, rendering them to be an ideal replacement for titanium-based implant systems, which represent the current gold standard in implantology. However, there is a lack of standardized guidelines on production of zirconia-based implants and long-term studies on the stability of this material in vivo are missing. In this study we demonstrate for the first time the accumulation of degradation products of a commercially available one-piece zirconia-based dental implant 29 months after implantation, which was recovered following a traumatic accident. Biopsy specimens from the implant and the surrounding tissue attached to it were processed for histological and histomorphometrical analysis. Although the implant was well integrated into the anchoring bone, degradation particles were observed in tissues adjacent to lower aspects of the implant. The observed implant degradation might seriously compromise implant stability several years after implantation. This incidental finding highlights the requirement of further research on zirconia-based ceramics before they can be advertised as safe alternative to titanium-based implant systems. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 2919-2923, 2018.

Treatment of Severely Resorbed Maxilla Due to Peri-Implantitis by Guided Bone Regeneration Using a Customized Allogenic Bone Block: A Case Report.

The objective of this case report is to introduce a customized CAD/CAM freeze-dried bone allograft (FDBA) block for its use in Guided Bone Regeneration (GBR) procedures for severely deficient maxillary bones. Additionally, a special newly developed remote incision technique is presented to avoid wound dehiscence. The results show optimal integration behavior of the FDBA block after six months and the formation of new vital bone. Thus, the results of the present case report confirm the use of the customized CAD/CAM bone block for augmentation of complex defects in the maxillary aesthetic zone as a successful treatment concept.