The Effect of Diabetes and Hyperglycemia on Horizontal Guided Bone Regeneration: A Clinical Prospective Analysis.

Guided bone regeneration (GBR) is a reconstructive procedure for treating atrophic alveolar ridges. This study aims to assess the correlation between different glycemic control levels and clinical findings in patients undergoing horizontal GBR before implant placement. The study population consisted of all patients requiring horizontal GBR. Patients were divided into three groups based on HbA1c levels: non-diabetic normoglycemic patients (HbA1c < 5.7%), non-diabetic hyperglycaemic patients (HbA1c < 6.5%), and patients with controlled diabetes (HbA1c < 7%). The primary outcomes were the horizontal (mm) and vertical (mm) dimensional changes of the alveolar ridge 6 months after the procedure. The study sample consisted of 54 patients. Sixty-eight implants (95.8%) were classified as "successful," meaning the possibility of inserting a standard-sized implant following the GBR (diameter ≥ 4 mm). There was a statistically significant difference between the three groups in terms of horizontal gain at 6 months: in particular, there was a statistically significant difference between group 1 and group 2 (p = 0.026) and between group 1 and group 3 (p = 0.030). The present investigation showed that patients with HbA1c levels below 7% could undergo GBR and obtain a statistically significant horizontal bone gain.

Implant Placement with Simultaneous Guided Bone Regeneration Using Advanced Platelet-Rich Fibrin and a Deproteinized Bovine Bone Mineral: A 2-Year Retrospective and Comparative Study.

A lack of bone volume may compromise a correct three-dimensional implant placement. This study was designed to evaluate the clinical and radiographic outcomes of simultaneous horizontal guided bone regeneration (GBR) performed using autogenous bone or blood-derived products mixed with a bone xenograft. The study population consisted of patients operated on using one of two clinical protocols for GBR: group A, which used autogenous bone mixed with a bone xenograft, and group B, which used advanced platelet-rich fibrin (A-PRF) mixed with a bone xenograft. The primary outcome was the clinical gain in the peri-implant defect. The secondary outcomes included an analysis of the postoperative healing, periodontal parameters, marginal bone loss, and occurrence of adverse events. All of the surgeries were carried out successfully. One patient in each group experienced a case of early implant loss, and three patients (one in group A and two in group B) presented biologic complications. The mean peri-implant vertical defect heights at baseline in group A and group B were 3.6 ± 0.9 mm and 4 ± 1.5 mm, respectively (P = .382). No statistically significant differences in the mean residual defect heights (P = .521) or in the postoperative wound healing (P = .611) were observed. Stable peri-implant marginal bone levels were recorded after loading in both groups. The use of A-PRF combined with a particulate bone xenograft and covered with a fixed collagen membrane may provide clinical results similar to those obtained via autogenous bone mixed with bone xenograft.

Patient and Operator Centered Outcomes in Implant Dentistry: Comparison between Fully Digital and Conventional Workflow for Single Crown and Three-Unit Fixed-Bridge.

BACKGROUND: Scientific information about the effects of implant therapy following a precise workflow and patient and operators' preferences should be considered to choose which implant treatment protocol to use, and to achieve patient's satisfaction and functional results. The aim of this study was to analyze implant rehabilitations with a fully digital workflow and compare this approach with a conventional one. METHODS: This study comprises 64 patients treated with a fully digital approach and 58 patients treated using a conventional protocol. Patient and operator centered outcomes were assessed through two visual analogue scale (VAS) questionnaires. RESULTS: The VAS questionnaire demonstrated better results for the digital workflow concerning anxiety, convenience, taste, nausea sensation, pain and breathing difficulties (p < 0.0001). The VAS questionnaire administered to the operators showed better scores for the digital approach in relation to anxiety, convenience, difficulties of the impression procedure and the workflow (p < 0.0001). A significant reduced mean time for the digital workflow as well as a reduced number of required visits were recorded. CONCLUSION: The analysis of a fully digital and a conventional protocol showed better results according to patient and operators' preferences when a fully digital approach was used.

The Effectiveness of Chlorhexidine and Air Polishing System in the Treatment of Candida albicans Infected Dental Implants: An Experimental In Vitro Study.

Background: Peri-implantitis is an inflammatory disease with an increasing diffusion rate which can affect the long-term survival of a prosthetic rehabilitation. The present study focused on the decontaminating efficacy of chlorhexidine and air polishing system with sodium bicarbonate powder against Candida albicans, a microorganism which seems to have a superinfecting opportunistic role in the pathology. The aim of the authors was to investigate and compare the effectiveness of these treatments, commonly used in clinical practice. Methods: An in vitro study was conducted to analyze the effects of two widely used therapeutic aids for the disinfection of affected titanium implants: chlorhexidine (CHX) and air polishing with sodium bicarbonate powder (P). A qualitative and quantitative comparative analysis of the residual biofilm was carried out using a colorimetric assay (XTT) and scanning electron microscopy (SEM) observation. The experiment was conducted both on machined titanium surfaces and on rough sandblasted ones with the aim of bringing out differences in the therapeutic outcomes concerning the superficial texture of the implant. The null hypothesis was that no difference could be detected between the samples, regarding both the treatments performed and the nano-structural features of titanium. Results: The best results (on both types of implant surfaces) were obtained when combining the use of chlorhexidine and air polishing (C + P). A linear decrease in the optical density (OD) values recorded at three different time points (30 s, 1 min, 5 min) was also observed passing from the first to the last one. When observed under scanning electron microscope rough surfaces showed an extensive and highly structured biofilm, more complex if compared to the one encountered when analyzing machined implants. Conclusions: the present pilot study showed that rough surfaces can promote fungal adhesion and eventually hinder the outcome of a decontaminating treatment. For this purpose, the physio-chemical technique is always more efficient if compared to a single-technique approach regardless of the surface characteristics.

Reasons for Tooth Extractions and Related Risk Factors in Adult Patients: A Cohort Study.

Background: The aim of this study was to evaluate oral status, the reasons for tooth extractions and related risk factors in adult patients attending a hospital dental practice. Methods: 120 consecutive patients ranging from 23 to 91 years in age (mean age of 63.3 ± 15.8) having a total of 554 teeth extracted were included. Surveys about general health status were conducted and potential risk factors such as smoking, diabetes and age were investigated. Results: a total of 1795 teeth were missing after extraction procedures and the mean number of remaining teeth after the extraction process was 16.8 ± 9.1 per patient. Caries (52.2%) was the most common reason for extraction along with periodontal disease (35.7%). Males were more prone to extractions, with 394 of the teeth extracted out of the total of 554 (71.1%). Male sex (ß = 2.89; 95% CI 1.26, 4.53; p = 0.001) and smoking habit (ß = 2.95; 95% CI 1.12, 4.79; p = 0.002) were related to a higher number of teeth extracted. Age (ß = -0.24; 95% CI -0.31, -0.16; p < 0.001) and diabetes (ß = -4.47; 95% CI -7.61, -1.33; p = 0.006) were related to a higher number of missing teeth at evaluation time. Moreover, periodontal disease was more common as a reason of extraction among diabetic patients than among non-diabetic ones (p = 0.04). Conclusions: caries and periodontal disease were the most common causes of extraction in a relatively old study population: further screening strategies might be required for the early interception of caries and periodontal disease.