Esthetically driven immediate provisionalization in the anterior zone: 5-year results from a prospective study evaluating 3.0-mm-diameter tapered implants.

OBJECTIVES: Evaluate the 5-year safety and efficacy of a narrow-diameter (3.0 mm) implant that was immediately provisionalized with a single crown in the maxillary lateral incisor or mandibular central or lateral incisor area. MATERIALS AND METHODS: An open, prospective, single-cohort, multicenter study was conducted, in which narrow-diameter implants were placed in fresh, healed extraction, or congenitally missing sites. All patients were required to meet strict criteria for immediate loading. The primary endpoints were marginal bone levels (MBL) and MBL changes (MBLC) from implant placement to 5-year follow-up. Secondary endpoints included cumulative 5-year survival and success rates, soft tissue health, and esthetic parameters. RESULTS: A total of 91 implants were placed in 77 patients. The mean MBL remained stable from the 1-year (- 0.79 ± 0.73 mm, n = 75) to 5-year (- 0.74 ± 0.87 mm, n = 65) follow-up. A marginal bone gain of 0.11 ± 0.83 mm was observed from the 1-year to 5-year follow-up. The cumulative 5-year survival rate was 96.5%, and the cumulative 5-year success rate was 93%. The clinical parameters, including the modified plaque index, modified sulcus bleeding index, Jemt's papilla index, and pink esthetic score improved throughout the 5-year study. CONCLUSIONS: The study demonstrated that narrow-diameter implants represent a safe and predictable treatment option for subjects suitable for immediate loading and with limited bone volume or limited inter-dental space. CLINICAL RELEVANCE: Narrow-diameter implants with immediate provisionalization can be considered for use to restore missing or damaged teeth with predictable functional and esthetic outcomes. This trial was registered with ClinicalTrials.gov (NCT02184845).

Systemic Antibiotic Use in Acute Irreversible Pulpitis: Evaluating Clinical Practices and Molecular Insights.

This scoping review systematically evaluates the use of systemic antibiotics in treating acute irreversible pulpitis, integrating clinical practice patterns with recent molecular insights. We analyzed clinical evidence on antibiotic prescription trends among dental professionals and examined molecular research advancements in relation to pulpitis. This review is intended to bridge the gap between clinical practice and molecular research, guiding more evidence-based approaches to treating acute irreversible pulpitis. Electronic databases were searched for relevant articles published in English based on the objective of the review. A second search using all identified keywords and index terms was undertaken across all the included databases. In addition, a reference list of identified articles was searched. Studies including original research, systematic reviews, meta-analyses, clinical trials, and observational and retrospective studies, all written in English and published from 2010 onwards, were included, and an analysis of the text words contained in the titles and abstracts of the retrieved papers and of the index terms used to describe the articles was performed. A total of N = 53 articles were selected. Altogether, N = 43 (76.79%) articles were cross-sectional studies, N = 4 (11.11%) were systematic reviews, and N = 3 (5.36%) were guidelines. The most frequent level of evidence was level VI (N = 43 (76.79%). The mean percentage of dentists who prescribed antibiotics to treat acute irreversible pulpitis was 23.89 ± 23.74% (range: 0.05-75.7). Similarly, for specialists, it was 22.41 ± 15.64 (range 2.2-50.4), and the percentage for undergraduates was 17.52 ± 20.59 (range 0-62.6). The significant developments in research models for pulpitis research and the characterisation of biomarkers have led to better management strategies. Concurrently, significant advancements in molecular research provide new understandings of pulpitis, suggesting alternative therapeutic approaches. Although there are guidelines available, increased rates of antibiotic prescription are still prevalent around the globe.

Immediate provisionalization in the esthetic zone: 1-year interim results from a prospective single-cohort multicenter study evaluating 3.0-mm-diameter tapered implants.

OBJECTIVES: The aim of this interim analysis of a 5-year prospective multicenter study is to evaluate clinical and radiological performance of immediately provisionalized 3.0-mm-diameter tapered implants. MATERIALS AND METHODS: Patients needing implant rehabilitation of maxillary lateral incisors or mandibular lateral and central incisors were treated with 3.0-mm-diameter implants placed in extraction or healed sites and immediately provisionalized. Clinical and radiographic examinations were performed at implant insertion, 6 months thereafter, and are ongoing. Marginal bone levels and changes, complications, the papilla, plaque, and bleeding indices, and the pink esthetic score (PES) were evaluated at each follow-up visit. RESULTS: Of 112 enrolled patients, 77 patients (91 implants) met the inclusion criteria. Seventy-one patients with 82 implants completed the 1-year follow-up. Three implants failed yielding a CSR of 96.7%. All failures occurred within the first 3 months after implant insertion. Marginal bone level changes from insertion to 6 months was - 0.57 ± 1.30 mm (n = 75) and from insertion to 12 months - 0.25 ± 1.38 mm (n = 72). Fifteen non-serious complications were recorded. Papilla index score and PES improved at the 1-year follow-up. Plaque formation and bleeding-on-probing showed no statistically significant differences between the 6-month and the 1-year visit. CONCLUSIONS: This 1-year analysis demonstrated high survival, stable bone levels, and healthy soft tissue with 3.0-mm-diameter implants. CLINICAL IMPLICATIONS: Narrow diameter implants are a safe and predictable treatment option in patients with limited bone volume and/or limited interdental space and eligible for immediate loading protocols.

Short-term effect of regular vs mini curettes on periodontal tissue according to phenotype: a randomized control clinical trial.

AIM: The aim of this randomized control clinical trial was to compare the soft tissue response to mechanical root instrumentation procedures performed using periodontal curettes with different-sized working parts. MATERIALS AND METHODS: Twenty patients affected by Stage 3 Grade B periodontitis - a total of 109 teeth - were treated with either Mini-Five Gracey Curettes (MFC) or Conventional Gracey Curettes (CGC). Measurements were performed by a blinded examiner at baseline and at 6 weeks. Outcome measurements included pocket depth (PD), recession depth (RD), and difference in RD (∆RD). RESULTS: The use of MFC significantly reduced soft tissue shrinkage (1.5 ± 1 vs 2.4 ± 1.3; difference: -0.9 mm; P < 0.001). Patients in the MFC (test) group experienced lower gingival recession (GR), especially in both thin (2 ± 0.4 mm vs 3.1 ± 0.5 mm; difference: -1.1; P < 0.001) and medium (1.6 ± 0.5 mm vs 2.6 ± 0.6; difference: -1 mm; P = 0.010) periodontal phenotypes. Severe periodontal pockets (PD ≥ 7 mm) of patients in the MFC group experienced significantly lower soft tissue shrinkage than those in the CGC (control) group, regardless of periodontal phenotype. CONCLUSION: The use of MFC resulted in a greater PD reduction and lower rate of GR in the short term. Nonsurgical periodontal treatment performed with CGC led to more soft tissue shrinkage, particularly when performed in patients with a thin periodontal phenotype.

Multilayered Connective Tissue Grafting Technique to Improve Aesthetics after Failed GBR: A Clinical Case Report of 16 Months Follow-Up.

OBJECTIVE: This case report describes soft-tissue management after a failed GBR procedure to enhance the soft-tissue quality, quantity, and aesthetic outcomes. Case Presentation. A 38-year-old patient visited the Dental Clinic of the Ospedale Maggiore Policlinico, University of Milan, Milan, Italy, for a chief complaint of unsatisfactory aesthetics of the anterior maxillary area. Dental history disclosed failed preimplant vertical bone augmentation with GBR procedure in the area of the left maxillary central incisor resulting in a severe gingival recession of adjacent teeth and compromised soft-tissue quantity and quality and severe ridge atrophy (class III). Multilayered connective tissue grafting technique, in a two-step mucogingival surgery, was used to cover the gingival recessions, reach even gingival margin, and reconstruct the defect. Frenectomy was done after the second mucogingival surgery to relieve the muscle attachment. A definitive cantilever bridge was placed to restore the left and right maxillary central incisors, and a satisfactory aesthetic outcome was reached. CONCLUSIONS: Multilayered connective tissue grafting technique might be successful in correcting soft-tissue quantity and quality in class III ridge defects.

Preaugmentation Soft Tissue Expansion: A Report of Four Pilot Cases.

This pilot study aimed at investigating the safety and feasibility of pre-augmentation soft tissue expansion (STE). Tissue expanders of different sizes (from 240 to 1300 mm3) were implanted subperiosteally in four patients requiring vertical and/or horizontal bone augmentation, and left in situ for 20-60 days, according to the expander size. Guided bone regeneration was carried out after STE completion. Horizontal and vertical bone gains were analyzed through CBCT. Optical scanning and superimposition of cast models were used for volumetric analysis. The mean soft tissue volume increase was 483.8 ± 251.7 mm3. Horizontal bone gain averaged 3 mm in two successfully expanded sites while one case had a vertical bone gain of 8 mm. Despite promising outcomes in bone and soft tissue gain, the present technique needs improvement before being applied routinely in everyday dental practice.