Non-invasive oral implant position assessment: An ex vivo study using a 3D industrial scan as the reference model to mimic the clinical situation.

AIM: To introduce an objective method to evaluate the accuracy of implant position assessment in partially edentulous patients by comparing different techniques (conventional impression, intraoral scan, CBCT) to a reference 3D model obtained with an industrial scanner, the latter mimicking the clinical situation. MATERIALS AND METHODS: Twenty-nine implants were placed in four human cadaver heads using a fully guided flapless protocol. Implant position was assessed using (a) a conventional impression, (b) an intraoral scan, and (c) CBCT and compared to an industrial scan. Three-dimensional models of intraoral scan body and implant were registered to the arch models and the deviation at implant shoulder, apex, and the angle of deviation were compared to each other as well as to the reference model. RESULTS: The three assessment techniques showed statistically significant deviations (p < .01) from the industrial scan, for all measurements, with no difference between the techniques. The maximum deviation at the implant shoulder was 0.16 mm. At the implant apex this increased to 0.38 mm. The intraoral scan deviated significantly more than the CBCT (0.12 mm, p < .01) and the conventional impression (0.10 mm, p = .02). The maximum implant angle deviation was 1.0°. The intraoral scan deviated more than the conventional impression (0.3°, p = .02). CONCLUSION: All assessment techniques deviated from the reference industrial scan, but the differences were relatively small. Intraoral scans were slightly less accurate than both conventional impressions and CBCT. Depending on the application, however, this inaccuracy may not be clinically relevant.

The accuracy of probing, ultrasound and cone-beam CT scans for determining the buccal bone plate dimensions around oral implants - A systematic review.

OBJECTIVE: The objective of this review was to assess the accuracy of available means of determining the BBT (buccal bone thickness) and/or BBL (buccal bone level). This was translated into the following research question: What is the accuracy of the available means of visualizing the BBP (buccal bone plate) to establish the BBT and/or the BBL, when compared to control measurements? As control measurements histomorphometric measurements, direct measurements and cone-beam computed tomography (CBCT) measurements in the absence of metal are accepted. BACKGROUND DATA: METHODS: The literary search was performed by searching the databases of MEDLINE, Embase, and Web of Science, up to July 13, 2021. Types of studies included were clinical, in vitro and animal trials, specifically looking into the bone level and/or bone thickness of the buccal bone plate at oral implants. Reference lists were hand searched for relevant articles. Two reviewers performed the data extraction and analysis. Only studies using reliable control measurements to evaluate the accuracy of the tested means of visualizing BBT and/or BBL were included for analysis. The QUADAS-2 tool was used to perform bias analysis on the relevant studies. Extracted data was tabulated to show the differences between test and control measurements for BBT and BBL. For in vitro studies on CBCT measurements of BBT meta-analysis could be performed. RESULTS: A total of 1176 papers were identified in the search. Twenty-two articles were used for data extraction and qualitative analysis. Of these studies nine were animal studies, 9 were in vitro studies and four were human studies. Six animal studies and three human studies provided data on probing. CBCT and sonography as techniques for visualizing the buccal bone plate. Probing at implant sites seems to provide data that correlates with a consistent distance from the BBP. Meta-analysis for probing studies could not be performed due to heterogeneity in the setups of these studies. Eleven studies on CBCT were eligible for inclusion. Of these three were animal studies, the remaining 8 studies were all in vitro studies. Meta-analysis was performed on the accuracy of CBCT for in vitro studies, finding a significant underestimation of the BBT when compared to control measurements by a mean difference of -0.15 mm with 95%CI [-0.26,-0.03]. Three studies were identified on measurement of BBT and/or BBL by sonography. This included one human study and two in vitro studies. The identified studies show a low error when determining the buccal bone level or thickness using sonography. All included studies possess a high risk of bias according to risk of bias analysis, mostly due to selection of the patient. CONCLUSION: A strong limitation of this systematic review is the inclusion of different studies with heterogeneous designs. Within the limits of this analysis it cannot be concluded that probing is an accurate way of visualizing the BBP. CBCT cannot yet be recommended as a standard diagnostic tool for follow-up of the BBP at oral implants. The application of sonography as a diagnostic tool to visualize the BBP needs further scientific validation.

Surgical guides for guided bone augmentation: An in vitro study.

AIM: To validate in vitro the accuracy of a novel method for bone augmentation of horizontal alveolar bone defects with the help of a surgical guide. MATERIAL AND METHODS: Six cone-beam computed tomography scans of patients requiring horizontal bone augmentation were segmented and 3D printed. Two surgeons performed the bone augmentation surgery twice for each case on 3D-printed models, using either a conventional or guided protocol. Each surgeon virtually planned the desired graft shape beforehand. The resulting grafts were compared linearly and volumetrically to the plan; graft density and surgical time were also analyzed. RESULTS: There was significantly less graft volume outside the planned volume with the guided protocol (36.8% ± 14.1 vs. 19.6% ± 12.3, p < .01). The use of a guide increased graft accuracy at several measurement points, resulting in less overfill when using the guided protocol (1.7 ± 1.7 mm at the most coronal point, 0.2 mm ± 1.4 at 25%, 0.0 mm ± 0.9 at 50%, 0.1 mm ± 1.1 at 75%, and 0.4 mm ± 1.4 apically). Graft thickness was increased 1 mm coronally from the planned graft (2.8 mm ± 2.3 vs. 1.8 mm ± 2.2, p = .04). Surgical time increased significantly when using a guide (a difference of 2 m 26 s). CONCLUSION: The technique, tested here in vitro, allows surgeons to improve the accuracy of the resulting graft shape, to better compact material in the coronal portion of the graft, and to reduce the amount of graft material placed outside the planned volume.

The impact of implant-related characteristics on dental implant blooming: An in vitro study.

AIM: To assess, in vitro, variables potentially influencing implant blooming using a human-like imaging phantom and 3D-printed mandibles. MATERIAL AND METHODS: Sixty implants were inserted in 3D-printed mandibles in 26 different configurations in order to examine the impact of implant diameter, presence of a cover screw, implant design/material, implant position, and the presence of additional implants on implant blooming using two cone-beam computed tomography (CBCT) devices (Accuitomo [ACC] and NewTom [NWT]). Two observers measured the amount of implant blooming in both buccolingual and mesiodistal directions. Inter-rater agreement and descriptive statistics, grouped by implant characteristic and CBCT device, were calculated. RESULTS: Both CBCT devices increased implant diameter (a mean increase of 9.2% and 11.8% for titanium, 20.3% and 24.4% for zirconium, for ACC and NWT, respectively). An increase in implant diameter did not increase the amount of blooming, whereas placing a cover screw did (from 8.0% to 10.9% for ACC, and from 10.0% to 15.6% for NWT). Moreover, implant design, anatomical region, and the presence of another implant also affected the extent of the blooming. CONCLUSIONS: Dental implants show a clear diameter increase on CBCT, with the effect being more pronounced for zirconium than for titanium implants. Similar effects are likely to occur in the clinical setting, potentially masking nonosseointegration, reducing the dimensions of peri-implant defects, and/or causing underestimation of the buccal bone thickness.

The effect of choline-stabilized orthosilicic acid in patients with peri-implantitis: an exploratory randomized, double-blind, placebo controlled study.

BACKGROUND: Choline-stabilized orthosilicic acid (CS-OSA) was previously found to stimulate bone collagen formation in osteopenia and to improve biomarkers of cartilage degradation in knee osteoarthritis. The aim of the present study was to investigate the effect of oral administration of CS-OSA on clinical symptoms of peri-implantitis and the associated bone loss. METHODS: Twenty-one patients with peri-implantitis were randomized in CS-OSA or placebo groups. After initial clinical and cone beam computed tomography (CBCT) measurements [probing pocket depth (PPD), bleeding on probing (BOP), mucosal recession (REC), distance from implant shoulder to alveolar crest (IS-AC) and distance from implant shoulder to first bone-to-implant contact (IS-BIC)], flap operations were performed at the peri-implantitis sites. All patients were instructed to use either placebo or CS-OSA capsules twice a day for 1 year. Measurements were repeated 6 and 12 months after randomization. RESULTS: The data of 18 patients (36 implants) were used in the per protocol analysis. PPD and BOP improved significantly (p < 0.05) compared to baseline for both groups after 6 and 12 months. However, REC significantly increased in the placebo group but not in the CS-OSA group. The change in REC over 6 and 12 months was significantly different between groups (p < 0.01). IS-BIC and IS-AC measurements remained stable in the CS-OSA group whereas in the placebo group, both parameters increased significantly after 6 and 12 months. The change in IS-BIC over 12 months was significantly different between groups (p < 0.05). CONCLUSION: The results of this preliminary study suggest that CS-OSA may stabilize and even prevent further bone loss after surgical peri-implantitis treatment and support mucosal tissue healing. Trial registration The trial was retrospectively registered at ISRCTN registry, registration number: ISRCTN14348802, registration date: 24/06/2020.

Inaccuracy of buccal bone thickness estimation on cone-beam CT due to implant blooming: An ex-vivo study.

AIM: The aim of this article was to evaluate the accuracy of buccal bone thickness measurements around implants on CBCT. MATERIAL AND METHODS: Forty-four Osseospeed EV implants (3.6 in Ø) were placed guided and flapless in five fresh frozen human cadaver heads. The buccal peri-implant bone was measured clinically via guided bone sounding. Post-op CBCTs were taken with two different CBCT scanners (NewTom® and Accuitomo® ) on which the buccal bone was measured. Consequently, after implant removal, a new CBCT was made without implant artefacts (image reference standard) on which the real buccal bone thickness was scored. RESULTS: Due to an average blooming (artificial increase of implant diameter) percentage of 12%-15%, the buccal peri-implant bone thickness was underestimated by 0.3 mm on both CBCT devices. Immediately adjacent to the implant blooming area, a doubtful zone of about 0.45 mm was observed in which the buccal bone was not always visible. Buccal bone that was thick enough to fall outside this doubtful zone could always be visualized. CONCLUSION: The findings in this study may help the clinician in the decision-making process whether or not to intervene surgically in areas with ambiguous CBCT results.

Artificial intelligence serving pre-surgical digital implant planning: A scoping review.

OBJECTIVES: To conduct a scoping review focusing on artificial intelligence (AI) applications in presurgical dental implant planning. Additionally, to assess the automation degree of clinically available pre-surgical implant planning software. DATA AND SOURCES: A systematic electronic literature search was performed in five databases (PubMed, Embase, Web of Science, Cochrane Library, and Scopus), along with exploring gray literature web-based resources until November 2023. English-language studies on AI-driven tools for digital implant planning were included based on an independent evaluation by two reviewers. An assessment of automation steps in dental implant planning software available on the market up to November 2023 was also performed. STUDY SELECTION AND RESULTS: From an initial 1,732 studies, 47 met eligibility criteria. Within this subset, 39 studies focused on AI networks for anatomical landmark-based segmentation, creating virtual patients. Eight studies were dedicated to AI networks for virtual implant placement. Additionally, a total of 12 commonly available implant planning software applications were identified and assessed for their level of automation in pre-surgical digital implant workflows. Notably, only six of these featured at least one fully automated step in the planning software, with none possessing a fully automated implant planning protocol. CONCLUSIONS: AI plays a crucial role in achieving accurate, time-efficient, and consistent segmentation of anatomical landmarks, serving the process of virtual patient creation. Additionally, currently available systems for virtual implant placement demonstrate different degrees of automation. It is important to highlight that, as of now, full automation of this process has not been documented nor scientifically validated. CLINICAL SIGNIFICANCE: Scientific and clinical validation of AI applications for presurgical dental implant planning is currently scarce. The present review allows the clinician to identify AI-based automation in presurgical dental implant planning and assess the potential underlying scientific validation.

Evaluation of plaque removal by a single-headed versus a triple-headed manual toothbrush using different plaque assessment tools.

Background: Dental plaque is a common issue that can be effectively managed with proper oral hygiene practices and regular oral health care. The aim of this crossover study was to assess dental plaque using different methods (digital and clinical plaque scores) and evaluate the effectiveness of toothbrushing with a triple-headed manual toothbrush compared to a single-headed manual toothbrush in removing dental plaque. Methods: Plaque staining was performed to assess dental plaque amounts before and after brushing with the triple-headed (test) and single-headed (control) manual toothbrush in 21 study participants after plaque was allowed to accumulate for 48 hours. Dental plaque was scored both clinically as well as digitally. Results: Toothbrushing with a manual single-headed toothbrush and a triple-headed toothbrush was found to be equally effective when comparing plaque removal ability. Brushing time was shorter when using a triple-headed toothbrush, compared to a single-headed toothbrush. Conclusion: The triple-headed manual toothbrush may be a good alternative to the single-headed manual toothbrush for certain patient groups.

Contexte: La plaque dentaire est un problème courant qui peut être géré efficacement en adoptant de bonnes pratiques d'hygiène buccale et en obtenant régulièrement des soins buccodentaires. L'objectif de cette étude croisée était d'évaluer l'état de la plaque dentaire à l'aide de différentes méthodes (cotes de plaque numériques et cliniques) et d'évaluer l'efficacité du brossage à l'aide d'une brosse à dents manuelle à 3 côtés comparativement au brossage avec une brosse à dents manuelle à 1 côté pour éliminer la plaque dentaire. Méthodes: On a coloré la plaque dentaire pour en évaluer la quantité avant et après le brossage avec une brosse à dents manuelle à 3 côtés (essai) et à 1 côté (contrôle) parmi les 21 participants à l'étude après avoir laissé la plaque s'accumuler pendant 48 heures. On a attribué une cote clinique et numérique à la plaque dentaire. Résultats: Le brossage avec une brosse à dents manuelle à 3 côtés s'est révélé tout aussi efficace que le brossage avec une brosse manuelle à 1 côté sur le plan de l'élimination de la plaque. Le temps de brossage était plus court avec une brosse à dents à 3 côtés qu'avec une brosse à dents à 1 côté. Conclusion: Pour certains groupes de patients, la brosse à dents à 3 côtés peut être une bonne alternative à la brosse à dents ordinaire.

Engineered scaffolds and cell-based therapy for periodontal regeneration.

BACKGROUND: The main objective of regenerative periodontal therapy is to completely restore the periodontal tissues lost. This review summarizes the most recent evidence in support of scaffold- and cell-based tissue engineering, which are expected to play a relevant role in next-generation periodontal regenerative therapy. METHODS: A literature search (PubMed database) was performed to analyze more recently updated articles regarding periodontal regeneration, scaffolds and cell-based technologies. RESULTS: Evidence supports the importance of scaffold physical cues to promote periodontal regeneration, including scaffold multicompartmentalization and micropatterning. The in situ delivery of biological mediators and/or cell populations, both stem cells and already differentiated cells, has shown promising in vivo efficacy. CONCLUSIONS: Porous scaffolds are pivotal for clot stabilization, wound compartmentalization, cell homing and cell nutrients delivery. Given the revolutionary introduction of rapid prototyping technique and cell-based therapies, the fabrication of custom-made scaffolds is not far from being achieved.