Evaluation of the Co-Go-Me angle as a predictor in Class II patients treated with Herbst appliance and skeletal anchorage: a retrospective cohort study.

Introduction: A condylion-gonion-menton (Co-Go-Me) angle threshold of 125.5° has been introduced as a predictive parameter of cephalometric mandibular response in the orthopedic treatment of growing Class II patients with functional appliances, despite some contradictions in the literature. Considering the lack of studies evaluating the role of skeletal anchorage, this study aims to reassess the threshold of 125.5° in the Co-Go-Me angle as a useful predictor in growing skeletal Class II patients treated with acrylic splint Herbst appliance and two mini-screws in the lower arch (STM2). Methods: Thirty-five consecutively treated patients (20 males, 15 females; mean age, 11.37 years) with mandibular retrusion were classified into two groups according to their Co-Go-Me baseline values (Group 1, <125.5°; Group 2, >125.5°). The STM2 protocol involved the use of the MTH Herbst appliance with an acrylic splint in the lower arch and two interradicular mini-screws as anchorage reinforcement. Cephalometric analysis was performed by the same operator for each patient at baseline (T0) and at the end of the Herbst phase (T1). The effects of time and group on the variables were assessed by a repeated-measures analysis of variance. The primary research outcome was the difference between the groups in terms of mandibular responsiveness to treatment referred to as the relative difference (T1-T0) in Co_Gn. Results: The mean duration of the treatment was 9.5 months. No statistically significant differences between groups were detected at baseline, except from the expected SN/GoMe° (p < 0.001) and Co-Go mm (p = 0.028). No statistically significant changes between groups, which were caused by the treatment, were found considering the mandibular sagittal and vertical skeletal parameters. Similarly, no statistically significant differences were found in the dental changes between the high-angle and low-angle patients, apart from the upper molar sagittal position (p = 0.013). Discussion and conclusions: The 125.5° threshold in the Co-Go-Me value was not a reliable predictive parameter for the mandibular response in growing patients treated with the MTH Herbst appliance and lower skeletal anchorage. Due to its effective control in the sagittal and vertical planes, the STM2 technique might be an appropriate protocol to use in treating skeletal Class II patients, regardless of the growth pattern.

Accuracy of orthodontic movements with 3D printed aligners: A prospective observational pilot study.

Objective: Owing to the availability of 3D software, scanners, and printers, clinicians are encouraged to produce in-office aligners. Recently, a new directprinting resin (Tera Harz TC-85DAC) has been introduced. Studies on its mechanical characteristics and biological effects have been published; however, evidence on its efficacy in orthodontic treatment remains scarce. This pilot study aimed to investigate the accuracy of teeth movement achieved with directprinted aligners. Methods: Seventeen patients (eight males and nine females) with a mean age of 27.67 ± 8.95 years, presenting with dental rotations < 30° and spaces/crowding < 5 mm, were recruited for this study. The teeth movement was planned starting from a T0 digital dental cast. The 3D direct-printed aligners were produced using Tera Harz TC-85DAC resin. Once the orthodontic treatment was completed, a final digital cast was obtained (T1). The planned teeth positions were then superimposed onto the T0 and T1 digital models. The differences between the programmed movements and the achieved overall torque, tip, rotation, and transverse dimensions were assessed using the paired t test or Wilcoxon's signed rank test. Results: The overall accuracies for torque, tip, and rotation were 67.6%, 64.2%, and 72.0%, respectively. The accuracy of the change in transverse diameter was 99.6%. Conclusions: Within the limits of the present pilot study (difficulties with abnormally shaped teeth and use of attachments), it can be concluded that 3D printed aligners can be successfully printed in-house and utilized for mildly crowded cases, with a comparable accuracy of tooth movement to that of other aligners.

Is significant mandibular advancement possible after the peak of puberty? Dento-osseous palatal expansion and the STM4 technique (Skeletal Therapy Manni Telescopic Herbst 4 miniscrews): A case report.

INTRODUCTION: Treatment of skeletal class II growing patients often requires the use of functional appliances, aimed at promoting mandibular advancement. Among these, Herbst appliance is recommended for its effectiveness, efficiency, and reduced need for compliance. Despite its skeletal favourable effects, well-known dental compensations can occur, especially when the appliance is not used close to the pubertal peak: upper incisors retroclination, lower incisors proclination, upper molars distalization and lower molars mesialization could reduce the overjet needed for a proper mandibular advancement. To counteract these unfavourable effects skeletal anchorage could be crucial. AIM: The aim of this case report is to describe and evaluate the effects of using a skeletally anchored Herbst appliance in an 18-year-old (CVM5) male patient with skeletal Class II malocclusion and a convex profile. TREATMENT PROTOCOL: The treatment started with a tooth-bone-borne palatal expansion, then the upper arch was bonded with pre-adjusted ceramic brackets. After 2months, a Manni Telescopic Herbst (MTH) supported by 4 miniscrews (two in the maxilla and two in the mandible) was applied. To avoid anchorage loss, TADs were connected with elastic chains to the arches. Nine months later, the Herbst was removed, the lower teeth were bonded and the patient wore class 2 elastics to stabilise the occlusion. RESULTS AND CONCLUSIONS: After 24months the treatment goal was achieved with a considerable improvement of the profile and a clinically significant mandibular advancement (Pogonion moved forward 7mm). A one-year follow-up lateral X-rays showed a good stability of the result.

Accuracy of 3-dimensional-printed customized transfer tray using a flash-free adhesive system in digital indirect bonding: An in vivo study.

INTRODUCTION: This paper evaluated the accuracy of a computer-aided design and manufacturing indirect bonding technique using a new customized 3D-printed transfer tray and a flash-free adhesive system for orthodontic bonding. METHODS: This in vivo study analyzed 106 teeth selected from 9 patients undergoing orthodontic treatment. Quantitative deviation analysis was performed to evaluate the bonding positioning errors, assessing the differences between the virtually planned and the clinically transferred bracket position after indirect bonding procedures by superimposing 3-dimensional dental scans. Estimated marginal means were evaluated for individual brackets and tubes, arch sectors, and overall collected measurements. RESULTS: A total of 86 brackets and 20 buccal tubes were analyzed. Among individual teeth, mandibular second molars showed the highest positioning errors, whereas maxillary incisors reported the lowest values. Considering arch sectors, the posterior areas showed greater displacements than the anterior areas, as the right side compared to the left side, with a higher error rate reported for the mandibular arch than the maxillary arch. The overall bonding inaccuracy measurement was 0.35 mm, below the clinical acceptability limit of 0.50 mm. CONCLUSIONS: The accuracy of a 3-dimensional-printed customized transfer tray using a flash-free adhesive system in computer-aided design and manufacturing indirect bonding was generally high, with greater positioning errors for posterior teeth.

Comparison of Lasers and Desensitizing Agents in Dentinal Hypersensitivity Therapy.

The main objective of this review is to verify the validity of laser therapy in the treatment of dentin hypersensitivity, an extremely common problem in patients, with Nd: YAG lasers or high- and/or low-power diode lasers to obtain a definitive protocol for the treatment of hypersensitivity, given the multiplicity of laser treatments proposed by the numerous authors evaluated. The authors performed an electronic search on PubMed, favouring it as a search engine. Lasers represent a means of treating dentin hypersensitivity, used alone and/or in conjunction with specific products for the treatment of such a pathology. The selected articles that examined diode lasers were divided according to the wattage (w) used: low-level laser therapy protocols, i.e., those using a wattage of less than 1 W, and high-level laser therapy protocols, i.e., those using a wattage of 1 W or more. Regarding the Nd: YAG laser, it was not necessary to subdivide the studies in this way, as they used a wattage of 1 W or more. A total of 21 articles were included in the final selection. Laser therapy was found to be effective in the treatment of dentin hypersensitivity. However, the level of effectiveness depends on the laser used. The results obtained from this review show that both the Nd: YAG laser and the diode laser (high and low power) are effective in the treatment of dentin hypersensitivity. However, the high-power laser appears to be more effective in combination with fluoride varnish and the Nd: YAG laser achieved greater long-term benefits than the diode laser.

Assessment of the accuracy of imaging software for 3D rendering of the upper airway, usable in orthodontic and craniofacial clinical settings.

BACKGROUND: Several semi-automatic software are available for the three-dimensional reconstruction of the airway from DICOM files. The aim of this study was to evaluate the accuracy of the segmentation of the upper airway testing four free source and one commercially available semi-automatic software. A total of 20 cone-beam computed tomography (CBCT) were selected to perform semi-automatic segmentation of the upper airway. The software tested were Invesalius, ITK-Snap, Dolphin 3D, 3D Slicer and Seg3D. The same upper airway models were manually segmented (Mimics software) and set as the gold standard (GS) reference of the investigation. A specific 3D imaging technology was used to perform the superimposition between the upper airway model obtained with semi-automatic software and the GS model, and to perform the surface-to-surface matching analysis. The accuracy of semi-automatic segmentation was evaluated calculating the volumetric mean differences (mean bias and limits of agreement) and the percentage of matching of the upper airway models compared to the manual segmentation (GS). Qualitative assessments were performed using color-coded maps. All data were statistically analyzed for software comparisons. RESULTS: Statistically significant differences were found in the volumetric dimensions of the upper airway models and in the matching percentage among the tested software (p < 0.001). Invesalius was the most accurate software for 3D rendering of the upper airway (mean bias = 1.54 cm3; matching = 90.05%) followed by ITK-Snap (mean bias = - 2.52 cm3; matching = 84.44%), Seg 3D (mean bias = 3.21 cm3, matching = 87.36%), 3D Slicer (mean bias = - 4.77 cm3; matching = 82.08%) and Dolphin 3D (difference mean = - 6.06 cm3; matching = 78.26%). According to the color-coded map, the dis-matched area was mainly located at the most anterior nasal region of the airway. Volumetric data showed excellent inter-software reliability (GS vs semi-automatic software), with coefficient values ranging from 0.904 to 0.993, confirming proportional equivalence with manual segmentation. CONCLUSION: Despite the excellent inter-software reliability, different semi-automatic segmentation algorithms could generate different patterns of inaccuracy error (underestimation/overestimation) of the upper airway models. Thus, is unreasonable to expect volumetric agreement among different software packages for the 3D rendering of the upper airway anatomy.

Rare case of skeletal third class in a subject suffering from Solitary Median Maxillary Central Incisor syndrome (SMMCI) associated to panhypopituitarism.

BACKGROUND: The median solitary maxillary central incisor syndrome (SMMCI) is a rare malformative syndrome consisting of multiple defects, mainly found on the body midline. It can be correlated to the etiopathological and phenotypic pattern of panhypopituitarism. This case-report describes the rare case of a patient suffering from SMMCI and panhypopituitarism, showing an unusual craniofacial morphology. CASE PRESENTATION: From the cephalometric analysis, a skeletal class III was identified (despite the other cases described in literature described as skeletal class II), derived from hypomaxillia and mandibular protrusion. A convex lip profile, with tendency to mandibular hyper-divergency, airway patency, anterior and posterior cross-bite were observed. At the clinical examination, a maxillary cant was evident on the frontal plane that appeared asymmetric, with the prevalence of the third lower part of the face. There were some dysmorphic signs such as: small nose, rectilinear eyelid line and reduced interocular distance. CONCLUSIONS: The present clinical case shows how, despite the literature, SMMCI can be associated with a III skeletal class, with maxillary hypoplasia and mandibular protrusion. The interdisciplinary collaboration between dentist and pediatrician is therefore important for the early interception of the malocclusions associated with these syndromes.

Cocaine-Induced Midline Destructive Lesions: A Real Challenge in Oral Rehabilitation.

Cocaine abuse is associated with severe local effects on mucosal and osteocartilaginous structures, with a centrifugal spreading pattern from the nose, a condition known as cocaine-induced midline destructive lesions (CIMDL). When the soft or hard palate is affected, a perforation may occur, with subsequent oro-nasal reflux and hypernasal speech. Both diagnosis and therapy (surgical or prosthetic) constitute a serious challenge for the physician. The cases of three patients affected by cocaine-induced palatal perforation and treated with a palatal obturator at San Raffaele Dentistry department between 2016 and 2019 are presented. In addition, the literature was reviewed in search of papers reporting the therapeutic management in patients affected by cocaine-induced palatal perforation. All the patients in our sample suffered from oro-nasal reflux and hypernasal speech, and reported a significant impact on interpersonal relationships. The results at the delivery of the obturator were satisfactory, but the duration of such results was limited in two cases, as the progression of the disease necessitated continuous modifications of the product, with a consequent increase in costs and a reduction in patient satisfaction. In conclusion, the therapy for palatal defects in CIMDL includes both reconstructive surgery and prosthetic obturators, the latter being the only possibility in the event of active disease. It successfully relieves symptoms, but the long-term efficacy is strongly related to the level of disease activity.

Evaluation of the Effectiveness of the Use of the Diode Laser in the Reduction of the Volume of the Edematous Gingival Tissue after Causal Therapy.

AIM: The aim of this study was to evaluate and compare two different techniques for the treatment of plaque-induced gingivitis, demonstrating whether the causal therapy supported by diode laser can allow a resolution of the edema caused by gingivitis in less time compared to the single traditional causal therapy. MATERIALS AND METHODS: Twenty-five patients between 20 and 60 years of age with a specific diagnosis of gingivitis were evaluated at the CLID-HSR oral hygiene department. Once the clinical parameters (bleeding index, plaque index, recession, and clinical attack level) were recorded, each of them was subjected to a professional oral hygiene session and instructed in correct home hygiene procedures. Through a split-mouth protocol for each individual patient, hemi-arches were treated by simple randomization to be treated with causal therapy supported by the action of the diode laser (experimental therapy) and which with traditional causal therapy (control therapy). A first intraoral scan was performed before therapy (T0), which was repeated 20 min after rinsing with CHX. The intraoral scans were repeated at a control 7 (T1) and 14 days (T2) after the session. For each intraoral scan, a volumetric value was calculated, proportional to the edema of the gingival tissues, using special digital software. The operator who carried out the volumetric measurements on the software was not aware of the therapy implemented on each half-arch. The operator who carried out the statistical analysis was not aware of the therapy applied to each group. The collected data were statistically compared in order to detect any differences between the volumetric variations between the two therapy groups and within the therapy groups over time. After evaluating the distribution of data by means of the Kolmogorov-Smirnov statistical test, the appropriate nonparametric tests were chosen to carry out the statistical comparisons. RESULTS: Based on the analysis of the gingival-periodontal health parameters and the volumetric value of the treated areas, no statistically significant differences were detected between the areas treated with the adjuvant action of the diode laser compared to those treated with causal therapy alone. CONCLUSIONS: With the limitations of this study, in accordance with the statistical results obtained, diode laser therapy does not allow a faster resolution of gingival edema compared to traditional therapy; the two treatment techniques for plaque-induced gingivitis, therefore, have the same efficacy.

Development of a Prediction Model for Short-Term Success of Functional Treatment of Class II Malocclusion.

(1) Background: The nature of the changes that contribute to Class II correction with functional appliances is still controversial. A broad variation in treatment responses has been reported. The purpose of this study was to find cephalometric predictors for individual patient responsiveness to twin-block treatment in patients with Class II Division 1 malocclusion; (2) Methods: The study was performed on a sample of 39 pubertal patients (21 females, 18 males) treated with the twin block appliance. Lateral cephalograms were available at the start of the treatment (T1) and at the end of functional therapy (T2). The outcome variable was the T2-T1 change in the sagittal position of the soft tissue pogonion with respect to the vertical line perpendicular to the Frankfort plane and passing through point subnasale. The predictive variables were age, gender at T1, and all the cephalometric parameters measured T1. Forward stepwise linear regression with p value to enter 0.05 and p value to leave 0.10 was applied; (3) Results: The only significant predictive variable that was selected was the Co-Go-Me angle (p = 0.000); (4) Conclusions: A greater advancement of the soft tissue chin on the profile is expected with smaller pretreatment values of Co-Go-Me angle.

An fMRI Study on Self-Perception of Patients after Aesthetic Implant-Prosthetic Rehabilitation.

OBJECTIVES: In this functional magnetic resonance (fMRI) study, we investigated the activation of cerebral pathways involved in the elaboration of self-retracting photos (SELF) and the same pictures of others (OTHER). Each of the photographs showed one of the participants during different stages of the rehabilitation: pre-treatment (PRE), virtual planning using "Smile-Lynx" smile design software (VIR), and post-rehabilitation (POST). METHODS: We selected eighteen volunteers, both male and female, between 22 and 67 years of age, who previously underwent prosthetic rehabilitation. Each of them was subjected to an fMRI acquisition. Various stimuli were then shown to the subjects in the form of self-retracting photographs and photographs of other participants, all in pseudo-randomized order. We then carried out a two- stage mixed-effects group data analysis with statistical contrast targeting two main effects: one regarding the main effect of Identity (SELF vs. OTHER) and the other regarding the effect of the prosthetic rehabilitation phase (PRE vs. VIR vs. POS). All the effects mentioned above survived a peak-level of p < 0.05. RESULTS: For the effect of identity, results reported the involvement of dorsolateral frontoparietal areas bilaterally. For the phase by identity effect, results reported activation in the supplementary motor area (SMA) in the right hemisphere. A stronger activation in observing self-retracting photos (SELF) post-treatment (POST) was reported compared to the other phases considered in the experiment. CONCLUSIONS: All the collected data showed differences regarding the main effect of Identity (SELF vs. OTHER). Most importantly, the present study provides some trend-wise evidence that the pictures portraying the subject in their actual physiognomy (POST) have a somewhat special status in eliciting selectively greater brain activation in the SMA. This effect was interpreted as a plausible correlate of an empathic response for beautiful and neutral faces. The present research suggests a possible way to measure self-perception of the subject after an appearance-altering procedure such an implant-prosthetic rehabilitation. However, future clinical studies are needed to investigate this matter further.

Milled versus moulded mock-ups based on the superimposition of 3D meshes from digital oral impressions: a comparative in vitro study in the aesthetic area.

BACKGROUND: Aesthetic porcelain veneers proved to be a long-term reliable prosthetic solution, ensuring minimal invasiveness. The use of veneers requires an adhesive cementation technique, so maintaining as much enamel as possible is to ensure lasting success. A diagnostic mock-up is a key tool that allows a preview of the outcome of the aesthetic restoration: it is obtainable both in an analog and digital way. With the recent developments in impression technology and the ever so fast growing use of CAD-CAM technologies it is useful to understand the pros and cons of either one of these techniques (analog and digital) in order to identify the easier and more convenient workflow in aesthetic dentistry. METHODS: After taking pictures and impressions of the dental arcs of a patient in need of aesthetic rehabilitation, 52 resin models were produced and a digital drawing of the smile was outlined. Both an analog and a digital wax-up were obtained from two of the 52 models: the latter was obtained using digital impressions and a dedicated software. The analog wax-up was then used to produce 25 matrices that have later been used to mould 25 resin mock-ups using a traditional moulding protocol (Control Group - CG). The digital wax-up was used to mill 25 PMMA mock-ups. Each mock-up, both milled and moulded (total 50), was then laid on the other 50 resin models as a digital impression of it was taken. The STL. files of the milled mock-ups were compared with the 3D CAD wax-up made using a specific software. The STL. files of the analog printed mock-ups were compared with the traditional wax-up design. A statistical analysis was carried out to evaluate the difference between the groups. RESULTS: The statistical analysis showed a significant difference (P > 0.01) between the mean value of the distance between the points of the overlapping STL. meshes in GC (0.0468 mm) and in TG (Test Group - TG) (0,0109 mm). CONCLUSIONS: The study showed a difference in accuracy between traditional moulded and milled mock-ups compared to their original wax-up. The data analysis reports that the digital method allows for greater accuracy. Within the limitations of this study, a fully digital workflow is to considered more reliable when it come to creating an esthetic mockup: the digital procedure has been shown to be more accurate than the one made manually which is much more operator dependent and it brings an increase to the chance of error, and that could ultimately affect the final result.

Point-of-care testing for hepatitis C virus infection at an Italian dental clinic: portrait of the pilot study population.

The dental clinic is an appropriate place to promote the prevention of hepatitis C virus (HCV) infection and fast access for care of HCV-positive subjects with new-generation anti-HCV drugs. This study aimed to determine the socio-demographic profile of subjects screened for HCV virus in a dental clinic to acquire useful information for future campaigns of prevention. An easy, free-of-charge, screen salivary test was offered to patients referred to the dental clinic of San Raffaele Scientific Research Hospital in Milan, Italy for dental procedures. These patients were also asked to complete an anonymous questionnaire on demographics and risk behaviours. A total of 1388 of 2097 (66.19%) questionnaires were evaluable. The demographics of the population responding to this initiative was primarily Italians citizen (96.47%), homogeneous gender distribution (55.55%), age over 50 (609 subjects; 43.88%), with high-level education and stable professional positions. 905 subjects (65.20%) were never tested for HCV before. The test showed positive reactivity in 22 cases (1.05%); of these, 21 subjects were known to be HCV-positive, and the test confirmed their status. One subject was newly diagnosed as HCV-positive. The percentage of subjects who were never tested for HCV infection appears too high (905 subjects, i.e., 65.20%), especially among subjects with high level of education and professions, and among adults over 40 or young people (18-25). The easy screening test in dental clinic can help raise awareness, promote early diagnosis and prevention, and provide a fast link to care for HCV infection.

Influence of Intra-Oral Scanner (I.O.S.) on The Marginal Accuracy of CAD/CAM Single Crowns.

The aim of this in vitro study was to compare the quality of digital workflows generated by different scanners (Intra-oral digital scanners (I.O.S.s)) focusing on marginal fit analysis. A customized chrome-cobalt (Cr-Co) implant abutment simulating a maxillary right first molar was fixed in hemi-maxillary stone model and scanned by eight different I.O.S.s: Omnicam® (Denstply Sirona, Verona, Italy) CS3500®, CS3600®, (Carestream Dental, Atlanta, GA, USA), True Definition Scanner® (3M, St. Paul, MN, USA), DWIO® (Dental Wings, Montreal, Quebec, Canada), PlanScan® (Planmeca Oy, Helsinki, Finland), 3D PROGRESS Plus® (MHT, Verona, Italy), TRIOS 3® (3Shape, Copenhagen, Denmark). Nine scans were performed by each tested I.O.S. and 72 copings were designed using a dental computer-assisted-design/computer-assisted-manufacturing (CAD/CAM) software (exocad GmbH, Darmstadt, Germany). According to CAD data, zirconium dioxide (ZrO2) copings were digitally milled (Roland DWX-50, Irvine, CA, USA). Scanning electron microscope (SEM) direct vision allowed for marginal gap measurements in eight points for each specimen. Descriptive analysis was performed using mean, standard deviation, and median, while the Kruskal⁻Wallis test was performed to determine whether the marginal discrepancies were significantly different between each group (significance level p < 0.05). The overall mean marginal gap value and standard deviation were 53.45 ± 30.52 µm. The minimum mean value (40.04 ± 18.90 µm) was recorded by PlanScan®, then 3D PROGRESS Plus® (40.20 ± 21.91 µm), True Definition Scanner® (40.82 ± 26.19 µm), CS3500® (54.82 ± 28.86 µm) CS3600® (59,67 ± 28.72 µm), Omnicam® (61.57 ± 38.59 µm), DWIO® (62.49 ± 31.54 µm), while the maximum mean value (67.95 ± 30.41 µm) was recorded by TRIOS 3®. The Kruskal⁻Wallis tests revealed a statistically significant difference (p-value < 0.5) in the mean marginal gaps between copings produced by 3D PROGRESS Plus®, PlanScan, True Definition Scanner, and the other evaluated I.O.S.s. The use of an I.O.S. for digital impressions may be a viable alternative to analog techniques. Although in this in vitro study PlanScan®, 3D PROGRESS Plus® and True Definition Scanner® may have showed the best performances, all I.O.S.s tested could provide clinically encouraging results especially in terms of marginal accuracy, since mean marginal gap values were all within the clinically acceptable threshold of 120 µm.

Midfacial Tissue Assessment of the Effect of Amount of Keratinized Mucosa on Immediate Temporarization of Fresh Socket Implants: 8-Year Follow-up.

The aim of the present study was to consider the long-term midfacial mucosal outcome around final prosthetic restorations on dental implants placed and loaded immediately after tooth extractions. A total of 42 patients requiring tooth extractions were recruited, and 142 teeth were extracted. Based on the amount of keratinized mucosa (KM), implants were categorized into group A (KM ≥ 2 mm; n = 61) or group B (KM < 2 mm; n = 62). In both groups, all patients received temporary prosthetic restorations immediately after the surgical procedure. Baseline levels were measured at placement of the final prosthetic restoration and patients were followed for 8 years. After the 8-year follow-up, a survival rate of 98.37% was reported. Two implants were lost due to peri-implantitis after 6 and 7 years of function, respectively. Peri-implantitis occurred at 9 implants (3 from group A and 6 from group B) in 8 patients (7.32%). At the 8-year follow-up for group A, an increase in midfacial tissue level of 0.14 ± 0.13 mm (screwed restorations) and 0.16 ± 0.09 mm (cemented restorations) was measured. For group B, a decrease in midfacial tissue level of 0.15 ± 0.09 mm (screwed restorations) and 0.17 ± 0.12 mm (cemented restorations) was reported. Statistically significant differences between groups were measured at 2, 5, and 8 years of follow-up (P < .01). The results demonstrated that the presence of KM is significantly associated with less mucosal inflammation and less gingival recession, regardless of the type of prosthetic restoration (screwed vs cemented).

Immediate Postextractive Implants With and Without Bone Graft: 3-year Follow-up Results From a Multicenter Controlled Randomized Trial.

PURPOSE: To evaluate the outcome of single postextraction immediate implants placed with and without bone grafts in the esthetic maxillary premolar area for 3-year follow-up after loading. MATERIAL AND METHODS: After tooth extraction, 102 patients received 115 immediate dental implants. Patients were randomly allocated to immediate implant placement with (group A: 51) or without (group B: 51) anorganic bovine bone and resorbable collagen barrier. RESULTS: After 3 years (T36), 1 implant failed in each group. Thirty-seven patients showed inflammation and bleeding, 19 mucositis, and 2 periimplantitis. Statistical significant association was found between BOP and mucositis at T12 (P < 0.0005) and T36 (P < 0.0005). The mesial bone level was -0.61 mm in group B and -1.01 mm in group A (P < 0.001). The group B distal bone level was -0.71 mm and -1.12 mm in group A (P < 0.005). Group B's buccal mean probing was increased (+0.40 mm) than group A (+0.36 mm). Group B's palatal mean value was higher (+0.54 mm) than group A (+0.38 mm). No statistically significant differences were found between the 2 groups. However, the Pink Esthetic Score and patient satisfaction were higher in group B than A (P < 0.001). CONCLUSIONS: The use of anorganic bovine bone substitute with a resorbable collagen barrier in immediate postextractive implants seems to improve the esthetic outcomes after a 3-year follow-up.

Prefabricated Bar System for Immediate Loading in Edentulous Patients: A 5-Year Follow-Up Prospective Longitudinal Study.

OBJECTIVES: The aim of this clinical study was to evaluate a new type of prefabricated bar system, supported by axial and tilted implants at 5-year follow-up. MATERIALS AND METHODS: Twenty-nine consecutive participants (19 females, 10 males) (mean age 61.4 years), edentulous in one or both jaws, with severe atrophy of the posterior regions, were treated according to the All-on-four® protocol with immediately loaded axial (64) and tilted (64) implants supporting complete-arch screw-retained prostheses (12 maxillary, 20 mandibular) featuring a prefabricated bar as framework. Follow-up visits were performed at 3, 6, 12, 24, 48, and 60 months after implant insertion. Radiographic assessments were made using panoramic radiographs obtained immediately after surgery and at each follow-up visit. Bone level measurements around the axial and tilted implants were compared by means of the Student's t-test. RESULTS: One axial implant failed in the lower jaw and did not compromise prosthetic function. The 60-month overall implant survival rate was 100% for axially positioned implants and 98.44% for tilted implants. The implant survival rates were 100% in the maxilla and 98.75% in the mandible. None of the 32 fixed prostheses were lost during the observation period, representing a prosthetic survival rate of 100%. No statistically significant differences (P > 0.05) in marginal bone loss between tilted and axial implants were detected in either jaw over time. CONCLUSIONS: The use of the evaluated prefabricated bar for immediately loaded implants placed according to the All-on-four concept may significantly reduce implant failures; however, more long-term prospective clinical trials are needed to affirm the effectiveness of the surgical-prosthetic protocol.

Posterior atrophic jaws rehabilitated with prostheses supported by 5 × 5 mm implants with a nanostructured calcium-incorporated titanium surface or by longer implants in augmented bone. 3-year results from a randomised controlled trial.

PURPOSE: To evaluate whether 5.0 × 5.0 mm dental implants with a novel nanostructured calcium-incorporated titanium surface could be an alternative to implants of at least 10.0 mm long placed in bone augmented with bone substitutes in posterior atrophic jaws. MATERIALS AND METHODS: Forty patients with atrophic posterior (premolar and molar areas) mandibles with 5.0 mm to 7.0 mm bone height above the mandibular canal, and 40 patients with atrophic maxillas with 4.0 mm to 6.0 mm below the maxillary sinus, were randomised according to a parallel group design to receive between one and three 5.0 mm implants or one to three at least 10.0 mm-long implants in augmented bone at two centres. All implants had a diameter of 5.0 mm. Mandibles were vertically augmented with interpositional bovine bone blocks covered with resorbable barriers. Implants were placed after 4 months. Maxillary sinuses were augmented with particulated porcine bone via a lateral window covered with resorbable barriers, and implants were placed simultaneously. All implants were submerged and loaded after 4 months with provisional prostheses. Four months later, definitive screw-retained or provisionally cement metal-ceramic or zirconia prostheses were delivered. Patients were followed to 3 years post-loading and the outcome measures were: prosthesis and implant failures, any complication, and peri-implant marginal bone level changes. RESULTS: Seven patients dropped out before the 3-year evaluation (two short mandibles, one short maxilla, two augmented mandibles and two augmented maxillae). In mandibles, two grafted patients were not prosthetically rehabilitated because of multiple complications and two implants failed in the same patient (the second was a replacement implant) vs one patient who lost a short implant and crown 2 years after loading. In maxillas one short implant failed with its provisional crown 3 months post-loading. There were no statistically significant differences in prostheses (difference in proportion = 0.001; 95% CI: -0.12 to 0.13; P = 1.000) and implant failures (difference in proportion = 0.00; 95% CI: -0.13 to 0.13; P = 1.000) up to 3 years after loading. Significantly, more complications occurred at mandibular grafted sites: 17 augmented patients were affected by complications vs eight patients treated with short implants in mandibles (difference in proportion = 0.43; 95% CI: 0.13 to 0.64; P = 0.008). In the maxilla, six sinus-lifted patients vs two patients treated with short implants were affected by complications; the difference not being statistically significant (difference in proportion = 0.21; 95% CI: -0.05 to 0.45; P = 0.232). Patients with mandibular short implants lost on average 1.10 mm of peri-implant bone at 3 years and patients with 10.0 mm or longer mandibular implants lost 1.39 mm. Patients with maxillary short implants lost on average 1.04 mm of peri-implant bone at 3 years and patients with 10 mm or longer maxillary implants lost 1.43 mm. Longer implants showed a greater bone loss up to 3 years after loading than short implants both in maxillae (mean difference: -0.39 mm; 95% CI: -0.70 to -0.07 mm; P = 0.017) and in mandibles (mean difference: -0.29 mm; 95% CI: -0.53 to -0.05 mm; P = 0.020). CONCLUSIONS: Three years after loading, 5.0 mm × 5.0 mm implants achieved similar results than longer implants placed in augmented bone. Short implants might be a preferable choice to bone augmentation especially in posterior mandibles since the treatment is faster, cheaper and associated with less morbidity. However, 5- to 10-year post-loading data are necessary before making reliable recommendations.

Tissue Remodeling in Immediate Versus Delayed Prosthetic Restoration in Fresh Socket Implants in the Esthetic Zone: Four-Year Follow-up.

The aim of this study was to compare midfacial soft tissue assessment and horizontal width changes of fresh socket implants in immediate and delayed prosthetic restorations. Patients requiring extractions in the maxillary esthetic zone were recruited. In one group, 30 implants were placed using an immediate loading approach; in the second group, 30 implants were loaded after a period of 3 months. At the 4-year follow-up, statistically significant differences (P < .001) were found. Immediate implants restored on the day of surgery demonstrated more stable midfacial soft tissue levels and bone volume maintenance than delayed implants.

Treatment of Severe Maxillary Hypoplasia With Combined Orthodontics and Distraction Osteogenesis.

Distraction osteogenesis (DO) is a technique that allows the generation of new bone in a gap between 2 vascularized bone surfaces in response to the application of graduated tensile stress across the bone gap.Distraction osteogenesis has become a routine treatment of choice to correct skeletal deformities and severe bone defects in the craniofacial complex over the past decade. Distraction osteogenesis has been successfully chosen in lengthening the maxilla and the mandible; in the maxilla and recently in the mandible, the jawbones have been distracted and widened transversely to relieve severe anterior dental crowding and transverse discrepancies between the dental arches.Distraction osteogenesis for maxillary advancement started in 1993 and is now widely used, especially in patients with skeletal Class III malocclusion caused by maxillary hypoplasia.The aim of this study was to present the efficiency of combined orthodontic and DO in the severe maxillary hypoplasia.A 35-year-old Italian man presented to our clinical practice with the chief complaint of esthetic and functionally problems because of skeletal Class III malocclusion with anterior crossbite.Considering that the severity of the skeletal discrepancy is remarkable but compensated by the DO potential, the combined orthodontic and DO treatment was considered adequate, like less invasive and equally effective.It was obtained a good alignment with the upper and lower arch dental alveolar maxillary advancement that allowed to correct the sagittal relationships.The patient was satisfied for the treatment results and had considerable improvement in his self-esteem.