Expression of Wnt signaling agonists and antagonists in periodontitis and healthy subjects, before and after non-surgical periodontal treatment: A systematic review.

Periodontitis is a preventable and treatable multifactorial chronic inflammatory disease that can lead to irreversible periodontal destruction and tooth loss. Wnt signaling and its regulators play an important role in periodontal inflammation, destruction, regeneration, and reconstruction. This systematic review aimed at investigating the involvement of Wnt signaling agonists and antagonists in periodontitis and healthy subjects, before and after periodontal treatment. Electronic searches were carried out using MEDLINE/PubMed, EMBASE, and Cochrane Library databases in addition to hand searches. Studies having different designs assessing the levels of Wnt signaling antagonist and agonist levels in gingival crevicular fluid, serum, and tissue in patients diagnosed with periodontitis or gingivitis, compared with healthy individuals were included. In addition, studies compared these levels in periodontitis patients before and after non-surgical periodontal therapy were also eligible. Sixteen studies met the eligibility criteria. Sclerostin (SOST) has been mainly investigated in the literature (8 publications). Sclerostin (5 studies), Wnt-5a (2 studies), secreted frizzled-related protein 1 (SFRP1) (3 studies), and ß-catenin (3 studies) show increased levels in periodontitis compared with periodontal health. Strong correlations between marker levels and periodontal clinical parameters were identified for SOST (5 studies), SFRP1 (2 studies), and ß-catenin (2 studies). SOST (3 studies) and SFRP1 (1 study) levels significantly decrease following non-surgical periodontal treatment. The present systematic review demonstrated an association between Wnt signaling agonist and antagonist levels and periodontitis. Wnt agonists and antagonists may serve as valuable diagnostic and prognostic markers for periodontitis onset and progression. Further case-control and longitudinal studies should be conducted for different Wnt signaling agonists and antagonists.

Postextraction ridge preservation by using dense PTFE membranes: A systematic review and meta-analysis.

STATEMENT OF PROBLEM: The use of dense polytetrafluoroethylene (dPTFE) membranes in alveolar ridge preservation may help reduce the risk of bacterial contamination and infection, maintaining the soft-tissue anatomy. However, systematic reviews on their efficacy in postextraction sites are lacking. PURPOSE: The purpose of this systematic review and meta-analysis was to assess the efficacy of alveolar ridge preservation with dPTFE membranes when used alone or in combination with bone grafting materials in postextraction sites. MATERIAL AND METHODS: An electronic search up to February 2021 was conducted by using PubMed, Embase, and the Cochrane library to detect studies using dPTFE membranes in postextraction sites. An additional manual search was performed in relevant journals. Clinical and radiographic dimensional changes of the alveolar ridge, histomorphometric, microcomputed tomography, implant-related findings, and rate of complications were recorded. One-dimensional meta-analysis was performed to calculate the overall means and 95% confidence intervals (α=.05). RESULTS: A total of 23 studies, 14 randomized controlled trials, 4 retrospective cohort studies, 3 case series, and 2 prospective nonrandomized clinical trials, met the inclusion criteria. Five studies were included in the quantitative analysis. The meta-analysis revealed that the use of dPTFE membranes resulted in a statistically significant (P=.042) increase in clinical keratinized tissue of 3.49 mm (95% confidence interval [CI]: 0.16, 6.83) when compared with extraction alone. Metaregression showed that the difference of 1.10 mm (95% CI: -0.14, 2.35) in the radiographic horizontal measurements was not significant (P=.082), but the difference of 1.06 mm (95% CI: 0.51, 1.62) in the radiographic vertical dimensional change between dPTFE membranes+allograft and extraction alone was statistically significant (P<.001). CONCLUSIONS: The use of dPTFE membranes was better than extraction alone in terms of keratinized tissue width and radiographic vertical bone loss.

Local Oral Delivery Agents with Anti-Biofilm Properties for the Treatment of Periodontitis and Peri-Implantitis. A Narrative Review.

Despite many discoveries over the past 20 years regarding the etiopathogenesis of periodontal and peri-implant diseases, as well as significant advances in our understanding of microbial biofilms, the incidence of these pathologies continues to rise. For this reason, it was clear that other strategies were needed to eliminate biofilms. In this review, the literature database was searched for studies on locally delivered synthetic agents that exhibit anti-biofilm properties and their potential use in the treatment of two important oral diseases: periodontitis and peri-implantitis.

WNT-5a and SOST Levels in Gingival Crevicular Fluid Depend on the Inflammatory and Osteoclastogenic Activities of Periodontal Tissues.

Background and Objectives: Wnt signaling leads to stimulation of osteoblasts and it reduces osteoclastogenesis and bone resorption via the regulation of the osteprotegrin and receptor activator of nuclear factor kappa-Β ligan (RANKL). Wnt signaling pathways are regulated by their physiological antagonists such as sclerostin (SOST) as well as WNT-5a. The aim of this study was to determine the total amount of Sclerostin and WNT-5a in the gingival crevicular fluid (GCF) in sites with a continuum from a healthy to diseased periodontium. Materials and Methods: In this cross-sectional study, a total of 20 patients with generalized periodontitis, 10 subjects with gingivitis as well as 14 individuals with a healthy periodontium were recruited upon clinical and radiographic periodontal examination. In patients diagnosed with periodontitis, GCF samples were collected from periodontitis, gingivitis and healthy sites, while gingivitis patients provided samples from gingivitis and healthy sites. In healthy patients, only healthy sites were sampled. Protein total amount of SOST and WNT-5a were quantified by sandwich enzyme-linked immunosorbent assay (ELISA). Results: A total of 108 GCF samples were collected from a total of 44 individuals. When all periodontitis (n = 51), gingivitis (n = 12) and healthy (n = 45) sites were analyzed regardless of the patient diagnosis, periodontitis sites demonstrated significantly elevated WNT-5a total amounts (p = 0.03) when compared to gingivitis sites. Gingivitis sites demonstrated a trend of more total SOST (p = 0.09) when compared to periodontitis and healthy sites. Within each patient diagnostic category, sites showed similar SOST and WNT-5a total amounts (p > 0.05). Conclusions: WNT-5a levels in GCF depend on the stage of periodontitis sites. SOST trended higher in the GCF of gingivitis sites but similar in chronic periodontitis and healthy sites. WNT-5a and SOST play a crucial role in periodontal tissue remodeling and depend on the inflammatory and osteoclastogenic activities.

Sclerostin and WNT-5a gingival protein levels in chronic periodontitis and health.

BACKGROUND AND OBJECTIVE: Wnt signaling pathways regulate osteoblast differentiation and bone formation and are associated with inflammatory responses driven by innate and adaptive immunity via the NF-κB pathway. The aim of this study was to compare the levels of sclerostin (SOST), WNT-5a, and TNF-α between chronic periodontitis and periodontally healthy sites and determine their value as diagnostic markers of chronic periodontitis. MATERIAL AND METHODS: In a cross-sectional assessment 25 chronic periodontitis cases and 25 periodontally healthy controls were selected upon clinical and radiographic periodontal evaluation. Gingival crevicular fluid (GCF) was collected cross-sectionally from diseased and healthy sites in periodontitis patients and from healthy sites in each control subject. In a subgroup analysis, ten patients with generalized moderate and severe chronic periodontitis and ten generalized periodontally healthy individuals were included. The protein levels of SOST, WNT-5a, and TNF-α in GCF were measured by sandwich ELISA. The Shapiro-Wilk test was utilized to assess the normality of the distribution and non-parametric comparisons were performed. RESULTS: The protein levels of SOST were significantly higher in the generalized moderate and severe chronic periodontitis subgroup when compared to the generalized healthy (P = 0.002), while the WNT-5a and TNF-α GCF total amounts were similar (P > 0.05). Diseased sites in the periodontitis patients exhibited significantly higher total protein levels of WNT-5a than in healthy sites (P = 0.017), whereas no differences were detected for SOST and TNF-α (P > 0.05). The total protein levels of SOST, WNT-5a, and TNF-α in GCF were similar in periodontitis and non-periodontitis patients (P > 0.05). CONCLUSIONS: Sclerostin and WNT-5a gingival protein levels demonstrated a high diagnostic value for generalized moderate and severe chronic periodontitis, while a low accuracy was detected for localized chronic periodontitis.

Gingival crevicular blood as a source to screen for diabetes control in a dental office setting.

UNLABELLED: screen for diabetes control, this study compared glycosylated hemoglobin (HbAlc) levels found in GCB and serum. Methods: Patients diagnosed (n= 29), with diabetes received a venipuncture on the finger and serum blood (METHODS) obtained was tested for HbAlc status chair-side. GCB (test) was collected at site(s) with evidence of bleeding after probing and the HbAlc value was determined in the same manner as with the serum blood. Results: There was a significant correlation between serum blood and GCB using the HbAlc test. The Pearson RESULTS: tion was 0.98 (P< 0.0001). The Altman-Bland bias was -0.21 (P= 0.0095), indicating that on average, the GCB method slightly underestimated the venipuncture serum (control) method for determining HbA1c values. The Altman-Bland 95% agreement interval ranged from -1.02 to 0.6. Furthermore, the HbAlc values were independent of the gingival sites used for collection with intra-patient GCB values exhibiting a correlation value between sites of 0.91 (P< 0.0001).

Diabetes and periodontal disease.

With the increasing incidence of diabetes in our patient population, the dental professional needs to be vigilant in recognizing the oral manifestations of diabetes and also be prepared to monitor and treat the diabetic patient who presents to their office for dental care.

Survival rate of implants performed at sites of previously failed implants and factors associated with failure: A retrospective investigation.

Background/purpose: Although reimplantation is currently a common treatment procedure, little information on reimplantation success or failure is available in the literature. The purpose of the present investigation was to evaluate the survival rate of dental implants that were performed in sites of previously failed implants and identify factors associated with the treatment outcome. Materials and methods: This retrospective study is based on a cohort of patients rehabilitated with dental implants in the dental clinics of the universities contributing data to the BigMouth network between 2011 and 2022. Implants replacing a previously failed implant at the same site were included. Cases of first and second reimplantations were included Information regarding patients' characteristics including age, gender, ethnicity, race, tobacco use, and systemic medical conditions were extracted from patients' files. Results: Records of 50,333 dental implants placed in 20,842 patients over a 12-year period were screened. Three hundred seventy implants placed in 284 patients were replaced by another implant at the same site. The cumulative survival rates of implants inserted for the first time was 98.6 %, for the first replacements was 96.1 % and for the second replacements was 91.7 %. First reimplants exhibited a significantly higher risk of failure than initial implantation (P < 0.001). Similarly, second reimplants demonstrated significantly greater risk of failure (P = 0.05) when compared to initial implants. No significant associations were detected between replaced implant failures with any of the patient related parameters evaluated (P > 0.05). Conclusion: Within the limitations of the present study, dental implants replacing failed implants exhibited lower survival rates than the rates reported for the previous attempts of implant placement. No risk indicators for implant failure were identified. Additional factors should be examined in future studies.

Periodontal Disease, Tooth Loss, and Systemic Conditions: An Exploratory Study.

BACKGROUND: Although systemic medical conditions are associated with periodontitis and tooth loss, large-scale studies that include less prevalent systemic conditions are needed. The purpose of the study was to investigate the link between periodontal disease and tooth loss with systemic medical conditions in a large and diverse population. METHODS: Dental charts of adult patients who had attended the dental clinics seeking dental therapy of the universities contributing data to the BigMouth network and accepted the protocol of the study were included. Dental Procedure Codes and Current Procedural Terminology procedures were utilised to identify patients with and without periodontitis. Data were extracted from patients' electronic health records including demographic characteristics, dental procedural codes, and self-reported medical conditions as well as the number of missing teeth. RESULTS: A total of 108,307 records were ultimately included in the analysis; 42,377 of them included a diagnosis of periodontitis. The median age of the included population was 47.0 years, and 55.2% were female. Older and male individuals were significantly more likely to be in the periodontitis group and have higher number of missing teeth. A number of systemic conditions are associated with periodontitis and a higher number of missing teeth. High blood pressure, smoking, drug use, and diabetes were all found to be significant. Other significant conditions were anaemia, lymphoma, glaucoma, dialysis, bronchitis, sinusitis hepatitis, and asthma. CONCLUSIONS: Within the limitations of this retrospective study that utilised the BigMouth dental data repository, the association of a number of systemic conditions such as smoking, diabetes, and hypertension with periodontitis and tooth loss has been confirmed. Additional connections have been highlighted for conditions that are not commonly reported in the literature.

An improved freeze-dried PRP-coated biodegradable material suitable for connective tissue regenerative therapy.

We previously published an investigation indicating freeze-dried platelet-rich plasma (PRP)-coated polyglactin mesh was a promising wound-dressing material. However, one of its disadvantages was the inflammatory nature due to degradation of the polyglactin. Therefore, in this study, we investigated the use of a collagen sponge as the carrier for PRP. When implanted subcutaneously in nude mice, the PRP-coated sponge alone rapidly induced angiogenesis and infiltration of surrounding connective tissue without inducing appreciable inflammation. Moreover, addition of periosteal fibroblastic cells substantially augmented the angiogenic response. With in vitro studies, the PRP-coated sponge provided various major growth factors at high levels to stimulate the proliferation of cells cultured on plastic dishes, but did not stimulate the proliferation of cells inoculated into the PRP-coated sponge. Cells were embedded in the fibrin mesh and maintained their spherical shape without stretching. The atomic force microscopic analysis demonstrated that the fibrin gel formed on the PRP-coated sponge was much softer (approx. 22 kPa) than the cross-linked collagen that formed the sponge base (appox. 1.9 MPa). Because insoluble matrices have recently and increasingly been considered important regulatory factors of cellular behavior, as are soluble growth factors, it is suggested that this soft fibrin mesh possibly suppresses cell survival. Overall, our investigation has successfully demonstrated improved wound-healing and regenerative potential of the PRP-coated mesh by combining it with the collagen sponge. In the clinical setting, this PRP-coated collagen sponge is a promising material for connective tissue regenerative therapy, such as periodontal therapy, burn victim treatment and in cosmetic or plastic surgery.

Retrospective analysis of 50,333 implants on implant failure and associated patient-related factors.

PURPOSE: The aim of this investigation was to retrospectively evaluate the long-term implant loss rates and to identify associations between implant failure and patient-related factors in a sample of patients who had consecutively received implant therapy in ten dental universities in the United States using a large database. METHODS: Dental records of adult patients who had attended the dental clinics of the universities contributing data to the BigMouth network between 2011 and 2022 seeking dental therapy were evaluated. Information regarding patients' characteristics including age, gender, ethnicity, race, tobacco use and systemic medical conditions were extracted from patients' files. RESULTS: A total of 20,842 patients who received 50,333 dental implants over a 12-year period (2011-2022) were included. The mean age of the cohort was 57.50±14.27 years which consisted of 51.8% females, 91.1% non-Hispanic, 66.3% white individuals and 8% tobacco users. In the univariate analysis, ethnicity, race and marijuana use were significantly associated with implant treatment outcome. Race and ethnicity were significantly associated with implant loss in the multivariate analysis. The implant failure rate was estimated to be 2.7% at the patient level and 1.4% at the implant level. CONCLUSION: Within the limitations of this retrospective study that utilized records of 50,333 dental implants placed in ten institutions contributing data to the BigMouth network, the implant failure rate was estimated to be 2.7% at patient level and 1.4% at implant level. Ethnicity and race were significantly associated with implant failure, while none of the examined systemic conditions were associated with implant loss.

Dental implant failure and factors associated with treatment outcome: A retrospective study.

PURPOSE: The purpose of the present study was to retrospectively 1) investigate the association between implant-, patient- and bone-related parameters with the risk of implant failure; 2) analyze the survival rates of dental implants placed in a university clinical setting. METHODS: Data were retrieved from patient charts from the University of Minnesota School of Dentistry to identify patients older than 18 years of age who received dental implant treatment by faculty, residents or students in the university dental clinics. Implant-, patient- and bone-related parameters such as implant system, length, diameter, jaw, region, installation protocol, gender, smoking, medical history, history of periodontal disease, self-reported oral parafunctions, type of bone, and operator were manually retrieved and analyzed. RESULTS: Five hundred and fifty-three implants were randomly selected from a total of 4,424. Of these 553 implants, 440 (79.6%) were associated with a >10 mm length, 371 (67.1%) with a >4 mm diameter and 431 (77.9%) had replaced a single tooth. Submerged healing mode was followed in 363 (65.6%) of the implants with the mean healing time being 3.2 months. History of periodontal disease was identified in 294 (53.2%) of these cases. A total of 17 implants failed after a mean time of 6.29 ± 6.75 months, resulting in an overall survival rate of 96.9%. Based on a univariate analysis, implant system, operator, time between extraction and implant surgery, time between bone grafting and implant placement, tobacco use as well as clenching and grinding were considered potential implant failure predictors and were further included in the multivariate logistic regression analysis. Tobacco use (p < 0.001) was significantly associated with implant failure. CONCLUSION: Within the limitations of this retrospective randomly selected university-treated sample tobacco use increased the risk for implant failure. Failure occurred in 17 implants representing a 3.1% failure rate.

Dental implant failure and bone augmentation: A retrospective study.

Background: To retrospectively assess the failure rate of implants placed in augmented and non-augmented sites and to investigate whether the time of implant and bone placement are associated with the risk of implant failure in a university setting. Material and Methods: In this retrospective study, data were retrieved from the electronic patient database of the University of Minnesota School of Dentistry, USA to identify patients older than 18 years of age who received dental implant treatment. Patient characteristics and the adequacy of available bone were retrieved from the patients' dental records and analyzed. Performing sinus lift and/or alveolar ridge augmentation in stages or simultaneously with implant placement and the need for multiple bone regeneration procedures were recorded. Kaplan-Meier plots and Cox regression models were created to analyze the data. Results: Data from 553 implants were analyzed in the study. More than half of the implants were placed in the maxilla (56.8%) and posterior regions (74.3%). The overall survival rate was 96.9%. Sinus augmentation was performed in 19.5% of the cases, while in 12.1% of the included treatments an implant was placed simultaneously. Staged and simultaneous ridge augmentation occurred in 45.2% and 18.8% of the cases, respectively. Implants placed in an area following (p=0.018) or simultaneously (p=0.025) with sinus augmentation showed a significantly reduced survival. Cox regression analysis showed that smoking and simultaneous ridge augmentation and implant placement increased failure rates. Conclusions: Within the limitations of this study, implants placed in tobacco users as well as in augmented maxillary sinuses, simultaneously or in stages, and in augmented ridges lead to higher implant failure rates. Key words:Bone grafting, dental implant, osseointegration, risk factor, survival rate, treatment outcome.

Association between Periodontitis Extent, Severity, and Progression Rate with Systemic Diseases and Smoking: A Retrospective Study.

BACKGROUND: The aim of this study was to analyze the relationship between extent, severity (stage), and rate of progression (grade) of periodontitis with systemic diseases as well as smoking using a large database. METHODS: Patients' records identified in the BigMouth Dental Data Repository with a periodontal diagnosis based on the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions were evaluated. Patients were further categorized based on extent, severity, and rate of progression. Data were extracted from patients' electronic health records including demographic characteristics, dental procedural codes, and self-reported medical conditions, as well as the number of missing teeth. RESULTS: A total of 2069 complete records were ultimately included in the analysis. Males were more likely to have generalized periodontitis and stage III or IV periodontitis. Older individuals were more likely diagnosed with grade B and stage III or IV periodontitis. Individuals with generalized disease, grade C, and stage IV demonstrated a significantly higher number of missing teeth. Higher numbers of tooth loss reported during supportive periodontal treatment were noted in generalized disease and stage IV periodontitis. Multiple sclerosis and smoking were significantly associated with grade C periodontitis. CONCLUSIONS: Within the limitations of this retrospective study that utilized the BigMouth dental data repository, smokers were significantly associated with rapid progression of periodontitis (grade C). Gender, age, number of missing teeth, and number of tooth loss during supportive periodontal treatment were associated with disease characteristics.

Relationship of Medication Intake and Systemic Conditions with Periodontitis: A Retrospective Study.

OBJECTIVES: To examine the potential relationship of medication intake and systemic conditions with periodontitis. METHODS AND MATERIALS: A total of 1985 patient records with a diagnosis of periodontal health and stage III and IV periodontitis were included in the analysis. Demographic characteristics, the number of missing teeth, patient-reported medical conditions and medication intake as well as smoking habits were recorded. Regression models were performed to explore the outcomes. RESULTS: Older individuals, Hispanic ethnic groups, Black and Hispanic or Latino racial groups and non-White individuals in general were significantly more frequently diagnosed with periodontitis than health. Hypertension, glaucoma, anxiety and depression were significantly associated with periodontitis, while cancer, alcohol use, kidney problems, asthma, sleep apnea and gastrointestinal disorders were associated with periodontal health. Patients who reported taking anticoagulants, statins and ACE inhibitors demonstrated 3.546 (95% CI: 1.982, 6.343), 2.771 (95% CI: 1.877, 4.09) and 4.847 (95% CI: 2.785, 8.434) times higher odds of having periodontitis, respectively. CONCLUSION: Within the limitations of this retrospective study that utilized the BigMouth dental data repository, there is a possible relationship between systemic medications including anticoagulants, ACE inhibitors and statins as well as systemic medical conditions including hypertension, glaucoma, anxiety and depression with periodontitis.

Bioactivity of freeze-dried platelet-rich plasma in an adsorbed form on a biodegradable polymer material.

Owing to the necessity for the immediate preparation from patients' blood, autologous platelet-rich plasma (PRP) limits its clinical applicability. To address this concern and respond to emergency care and other unpredictable uses, we have developed a freeze-dried PRP in an adsorbed form on a biodegradable polymer material (Polyglactin 910). On the polymer filaments of PRP mesh, which was prepared by coating the polymer mesh with human fresh PRP and subsequent freeze-drying, platelets were incorporated, and related growth factors were preserved at high levels. This new PRP mesh preparation significantly and reproducibly stimulated the proliferation of human periodontal ligament cells in vitro and neovascularization in a chorioallantoic membrane assay. A full-thickness skin defect model in a diabetic mouse demonstrated the PRP mesh, although prepared from human blood, substantially facilitated angiogenesis, granulation tissue formation, and re-epithelialization without inducing severe inflammation in vivo. These data demonstrate that our new PRP mesh preparation functions as a bioactive material to facilitate tissue repair/regeneration. Therefore, we suggest that this bioactive material, composed of allogeneic PRP, could be clinically used as a promising alternative in emergency care or at times when autologous PRP is not prepared immediately before application.

A proposed protocol for the standardized preparation of PRF membranes for clinical use.

Upon clinical application, thick platelet-rich fibrin (PRF) is usually compressed to fit the implantation site. However, it is speculated that the preservation of platelets and plasma content depends on the compression methods used. To accurately evaluate the clinical outcome of PRF, the preparation protocol should be standardized. Freshly prepared PRF clots were compressed into a thin membrane by our novel PRF compression device. The localization of platelets was examined by SEM and immunostaining. Growth factor levels were evaluated by bioassays and cytokine-antibody array techniques. The angiogenic activity was examined by the chick chorioallantoic membrane assay and the scratch assay using HUVEC cultures. Platelets were concentrated on the surface of the region adjacent to the red thrombus and this region was subjected to the experiments. Compared to the PRF membrane compressed by dry gauze (G-PRF), the preservation of the plasma content, 3D-fibrin meshwork, and platelets was more intact in the compressor-prepared PRF membrane (C-PRF). Among the growth factors tested, C-PRF contained PDGF isoforms at higher levels, and significantly stimulated cell proliferation and neovascularization. C-PRF may be useful for grafting while minimizing the loss of bioactive factors. This C-PRF preparation protocol is proposed as a standardized protocol for PRF membrane preparation.

Survival Rates and Factors Affecting the Outcome Following Immediate and Delayed Implant Placement: A Retrospective Study.

Background: Immediate implant placement into extraction sockets has become a widely acceptable treatment option to decrease treatment time and enhance esthetics. The objectives of this study were to assess and compare the survival rates of immediate and delayed implant treatment as well as to investigate the effect of patient- and site-related variables on the treatment outcome in a large-scale population-based study. Methods: Dental records of patients who received implant therapy were retrieved from the electronic records of the University of Minnesota School of Dentistry. Demographic characteristics, dental insurance status, socioeconomic status as well as medical history and tobacco use were recorded. The treatment outcome was included as a binary variable (survival/failure). Time to failure (date of procedure to date of visit with failure) was compared between immediate and delayed implant treatment in Cox regression models. Kaplan−Meier plots for the survival of both treatment modalities were created. Patient-sites without failure were censored at the last follow-up visit. Results: A total of 4519 records of implants were included. The sample mean age was 60.27 years and included 50.7% males and 12.9% tobacco users. High socioeconomic status was characterized for 82.3% of the included population and 63.0% of them were self-payers. Immediate implants were significantly more frequently placed in the maxillary arch (p < 0.001) than in the mandible. Tobacco users received more often a delayed rather than an immediate implant placement (p = 0.001). The survival rate analysis revealed there were no significant differences between immediate and delayed implant placements (p = 0.48). The mean follow-up time was 32.27 months during which 1.5% immediate and 1.1% delayed implants were removed. The estimated mean survival time for immediate implants was 68.90 months, while delayed implants placed in healed sockets showed a mean survival time of 75.11 months. A statistically significant association was found between gender (p = 0.03) and osteoporosis (p = 0.001) with treatment outcome. Conclusions: The placement of immediate implants achieved similarly high survival rates when compared to delayed implants placed in healed sites. Males and osteoporotic individuals showed significantly higher implant failure than females and non-osteoporotic patients. This study demonstrated that both immediate and delayed implant placements are sound options with predictable treatment outcome.

The Use of Biocompatible Membranes in Oral Surgery: The Past, Present & Future Directions. A Narrative Review.

The use of biocompatible membranes in periodontal and oral surgery is an important part of regeneration. Over the years, several different membranes have been developed, ranging from non-resorbable membranes that have to be removed in a separate procedure, to collagen membranes that completely resorb on their own, thus avoiding the need for a second surgery. Autogenous membranes are becoming increasingly popular in more recent years. These membranes can be used with a great variety of techniques in the four main hard tissue regenerative procedures: guided tissue regeneration, alveolar ridge preservation, guided bone regeneration and sinus floor augmentation. A review of the literature was conducted in order to identify the most commonly used membranes in clinical practice, as well as the most promising ones for regeneration procedures in the future. The information provided in this review may serve as a guide to clinicians, in order to select the most applicable membrane for the clinical case treated as the correct choice of materials may be critical in the procedure's success.

Clinical performance of hydrophilic, titanium-zirconium dental implants in patients with well-controlled and poorly controlled type 2 diabetes: One-year results of a dual-center cohort study.

BACKGROUND: This study assessed the clinical performance of hydrophilic dental implants in a patient cohort with type 2 diabetes mellitus (T2DM). METHODS: Subjects with T2DM of ≥2-years duration were allocated to either the well-controlled (WC; HbA1c ≤ 7.0%,) or poorly-controlled (PC; 7.5 < HbA1c < 10%) groups in a dual-center, prospective cohort study. Each subject received a single, titanium-zirconium (Ti-Zr) dental implant with a chemically-modified, hydrophilic (modSLA) surface in a posterior mandibular site. Postoperatively, subjects were followed at 1, 2, 4, 8, and 12-week intervals. Post-loading, subjects were followed at 3, 6, and 12-months. Clinical and radiographic parameters of implant success, and dental patient-reported outcomes were collected. RESULTS: Twenty-one dental patients (NWC  = 11; NPC  = 10; mean age: 66.8 ± 7.5 years) were enrolled and the 1-year implant success rate was 100%. Peri-implant bone levels were stable with 0.15 ± 0.06 mm mean marginal loss at 1 year without significant inter-group differences (P = 0.79). Postoperative pain was minimal at 1-week, and OHIP-5 scores decreased significantly over time as compared with preoperative levels (P < 0.001) suggesting significant improvement in patient-perceived oral health following implant therapy. CONCLUSIONS: Elevated HbA1c levels > 7.5% did not compromise 1-year success rates, or oral health-related quality of life in PC patients receiving modSLA, Ti-Zr implants. Given that implant placement up to 10% HbA1c significantly enhanced oral health-related quality of life without complications or morbidity, the safety and efficacy of implants to improve oral function in T2DM is supported, even without ideal glycemic control.