Early implant placement in sites with ridge preservation or spontaneous healing: histologic, profilometric, and CBCT analyses of an exploratory RCT.

PURPOSE: The aim of this study was to compare changes in soft and hard tissue and the histologic composition following early implant placement in sites with alveolar ridge preservation or spontaneous healing (SH), as well as implant performance up to 1 year after crown insertion. METHODS: Thirty-five patients with either intact buccal bone plates or dehiscence of up to 50% following single-tooth extraction of incisors, canines, or premolars were included in the study. They were randomly assigned to undergo one of three procedures: deproteinized bovine bone mineral with 10% collagen (DBBM-C) covered by a collagen matrix (DBBM-C/CM), DBBM-C alone, or SH. At 8 weeks, implant placement was carried out, and cone-beam computed tomography scans and impressions were obtained for profilometric analysis. Patients were followed up after the final crown insertion and again at 1 year post-procedure. RESULTS: Within the first 8 weeks following tooth extraction, the median height of the buccal soft tissue contour changed by -2.11 mm for the DBBM-C/CM group, -1.62 mm for the DBBM-C group, and -1.93 mm for the SH group. The corresponding height of the buccal mineralized tissue changed by -0.27 mm for the DBBM-C/CM group, -2.73 mm for the DBBM-C group, and -1.48mm for the SH group. The median contour changes between crown insertion and 1 year were -0.19 mm in the DBBM-C/CM group, -0.09 mm in the DBBM-C group, and -0.29 mm in the SH group. CONCLUSIONS: Major vertical and horizontal ridge contour changes occurred, irrespective of the treatment modality, up to 8 weeks following tooth extraction. The DBBM-C/CM preserved more mineralized tissue throughout this period, despite a substantial reduction in the overall contour. All 3 protocols led to stable tissues for up to 1 year.

Polydioxanone Dome Technique for Guided Bone Regeneration: Surgical Technique and Results up to 72 Months of Follow-up.

This study aimed to describe the step-by-step procedure of the polydioxanone dome technique associated with guided bone regeneration (GBR) and to report the results up to 72 months after implant loading. Patients with maxillary horizontal bone defects (< 5 mm residual width, confirmed by CBCT scan) were treated with the proposed intervention. During the GBR procedure, four bone perforations were strategically prepared in a roughly square configuration. Segments of polydioxanone suture material were introduced in the perforations, forming a dome-shaped structure. Six months after bone augmentation, a new CBCT was performed. After implant restoration, periapical radiographs were taken, which were then repeated annually. The following outcomes were analyzed: implant survival, horizontal bone gain, marginal bone level, and complications. Twenty implants were placed in 11 patients with a survival rate of 100% in a mean follow-up of 38.18 ± 19.65 months after loading. Mean horizontal bone gain was 3.82 ± 1.67 mm and mean marginal bone level was -0.12 ± 1.17 mm. Only minor complications were observed. The present results suggest that the polydioxanone dome technique may represent a promising approach during horizontal GBR, alone or in combination with implant placement. Int J Periodontics Restorative Dent 2023;43:223-230. doi: 10.11607/prd.6087.

Minimal invasiveness at dental implant placement: A systematic review with meta-analyses on flapless fully guided surgery.

Flapless and fully guided implant placement has the potential to maximize efficacy outcomes and at the same time to minimize surgical invasiveness. The aim of the current systematic review was to answer the following PICO question: "In adult human subjects undergoing dental implant placement (P), is minimally invasive flapless computer-aided fully guided (either dynamic or static computer-aided implant placement (sCAIP)) (I) superior to flapped conventional (free-handed implant placement (FHIP) or cast-based/drill partially guided implant placement (dPGIP)) surgery (C), in terms of efficacy, patient morbidity, long-term prognosis, and costs (O)?" Randomized clinical trials (RCTs) fulfilling specific inclusion criteria established to answer the PICO question were included. Two review authors independently searched for eligible studies, screened the titles and abstracts, performed full-text analysis, extracted the data from the published reports, and performed the risk of bias assessment. In cases of disagreement, a third review author took the final decision during ad hoc consensus meetings. The study results were summarized using random effects meta-analyses, which were based (wherever possible) on individual patient data (IPD). A total of 10 manuscripts reporting on five RCTs, involving a total of 124 participants and 449 implants, and comparing flapless sCAIP with flapped FHIP/cast-based partially guided implant placement (cPGIP), were included. There was no RCT analyzing flapless dynamic computer-aided implant placement (dCAIP) or flapped dPGIP. Intergroup meta-analyses indicated less depth deviation (difference in means (MD) = -0.28 mm; 95% confidence interval (CI): -0.59 to 0.03; moderate certainty), angular deviation (MD = -3.88 degrees; 95% CI: -7.00 to -0.77; high certainty), coronal (MD = -0.6 mm; 95% CI: -1.21 to 0.01; low certainty) and apical (MD = -0.75 mm; 95% CI: -1.43 to -0.07; moderate certainty) three-dimensional bodily deviations, postoperative pain (MD = -17.09 mm on the visual analogue scale (VAS); 95% CI: -33.38 to -0.80; low certainty), postoperative swelling (MD = -6.59 mm on the VAS; 95% CI: -19.03 to 5.85; very low certainty), intraoperative discomfort (MD = -9.36 mm on the VAS; 95% CI: -17.10 to -1.61) and surgery duration (MD = -24.28 minutes; 95% CI: -28.62 to -19.95) in flapless sCAIP than in flapped FHIP/cPGIP. Despite being more accurate than flapped FHIP/cPGIP, flapless sCAIP still resulted in deviations with respect to the planned position (intragroup meta-analytic means: 0.76 mm in depth, 2.57 degrees in angular, 1.43 mm in coronal, and 1.68 in apical three-dimensional bodily position). Moreover, flapless sCAIP presented a 12% group-specific intraoperative complication rate, resulting in an inability to place the implant with this protocol in 7% of cases. Evidence regarding more clinically relevant outcomes of efficacy (implant survival and success, prosthetically and biologically correct positioning), long-term prognosis, and costs, is currently scarce. When the objective is to guarantee minimal invasiveness at implant placement, clinicians could consider the use of flapless sCAIP. A proper case selection and consideration of a safety margin are, however, suggested.

Clinical performance of short versus standard dental implants in vertically augmented bone: an overview of systematic reviews.

OBJECTIVE: To answer the question: What do we know so far about the clinical performance of short implants (≤ 7 mm) when compared to standard length implants in vertically augmented bone, as well as which is the overall confidence of the systematic reviews (SRs) about this topic? MATERIALS AND METHODS: An overview of SRs was conducted. The searches were performed in six electronic databases and grey literature. SRs about short (≤ 7 mm) versus standard dental implants performance in vertically augmented bone were included. The assessed outcomes were marginal bone loss (MBL), implant survival (IS), prosthetic (PC) and biological complications (BC), costs, surgical time, and patient satisfaction. AMSTAR 2 was used to evaluate the overall confidence of included SRs. RESULTS: Thirteen SRs were included. Nine of twelve SRs reported a lower MBL for the short implant group. All the included SRs showed no difference in the IS between groups. A higher rate of BC was reported for standard-length implants in four out of five SRs. No differences regarding PC were reported in four of five SRs. Information related to patient preference, cost, and surgery time were underreported. The confidence evaluation of the SRs was stratified as low for five SRs and critically low for eight SRs. CONCLUSIONS: In an overall low-to-very low confidence levels, short implants appear to perform better in the mid-term (up to 5 years) than standard dental implants associated with vertical bone augmentation regarding MBL and BC, but they have a similar performance regarding IS rates and PC. There is an imperative need to improve the methodological quality of SRs, and efforts should focus on conducting RCTs to broaden the knowledge on this topic. CLINICAL RELEVANCE: Short implants could represent a viable, simpler, and less invasive treatment when available bone height is limited.

Optical Behavior of Zirconia-Based Restorations Over Teeth and Implants in the Esthetic Zone: A Clinical Report.

While various zirconia-based alternatives are available today for the restoration of teeth and implants in the esthetic zone, each treatment approach could result in different optical behavior. To clinically demonstrate these differences, this case report describes a rehabilitation in the esthetic zone using several options of teeth- and implant-supported restorations. Conventional veneered zirconia crowns, high-translucent monolithic zirconia crowns, and minimally veneered high-translucent zirconia crowns were proposed and assessed under different light sources before cementation. The patient and clinical team achieved consensus on the minimally veneered high-translucent zirconia crowns, which were then cemented and have performed well over both tooth and implant substrates.

Employment of U-Shape Technique at Reentry Surgery for Papillae Coronal Migration on the Rehabilitation of Anterior Single Implant: 3-Year Follow-Up Case Report.

INTRODUCTION: The rehabilitation of a maxillary single dental implant represents a great challenge at clinical practice. Harmony among the implant-supported crown and adjacent teeth is required in which concerns pink and white esthetics. The aim of the present case report is to depict a multidisciplinary treatment in which the U-shape flap technique for papillae preservation at second stage surgery was used. CASE PRESENTATION: One female patient presenting an un-rehabilitated dental implant at the left central incisor position sought treatment at the Centre of Education and Research on Dental Implants (CEPID). Alterations of color, shape, and position were observed on the anterior maxillary teeth. For proper treatment planning, radiograph, wax-up, and mock-up were performed. Second stage surgery was performed by the U-shape flap technique. A trunnion abutment was installed at the implant and a provisional subcontoured cemented crown was manufactured. Dental bleaching, feldspathic veneers, and a ceramic crown were performed. Oral hygiene instructions were recommended. Follow-up appointments were set at 1.5 and 3 years after restoration placement. After 3-year follow-up, soft tissue stability and health were preserved and papillae coronal migration around the single dental implant was observed. A complication-free treatment was reached, and patient demonstrated satisfaction towards esthetic and function. CONCLUSIONS: The use of U-shape technique at second stage surgery associated to adequate prosthetic contour improved soft tissue esthetic outcomes, while the multidisciplinary treatment planning provided adequate solutions, refining harmony between dental and implant-supported components.

Peri-implant tissue management after immediate implant placement using a customized healing abutment.

OBJECTIVE: The unavoidable extraction of teeth in the esthetic area can be overcome through different treatment modalities. Recently, immediate implants appeared as a minimally invasive approach to resolving these cases; however, immediate implant loading is not always possible or indicated. In these cases, an innovative approach through customized healing abutments could be used to preserve the soft tissue contour, eliminating the need for reopening surgery and the use of provisional restorations to condition the mucosal contour. CLINICAL CONSIDERATIONS: The present cases describe a simplified chairside approach to use customized healing abutments for immediate implants placed after tooth extraction in the anterior and posterior areas in order to maintain the soft tissue contours while reducing the clinical steps until delivering the final restorations. CONCLUSIONS: This technique seems to be effective to guide the soft tissue healing around dental implants allowing a natural emergence profile with implant-supported restorations, reducing the number of treatment steps. CLINICAL SIGNIFICANCE: The use of customized healing abutments prepares soft tissue for the prosthetic stage preserving its contours and eliminating the need for reopening surgery.

Adhesion behavior of conventional and high-translucent zirconia: Effect of surface conditioning methods and aging using an experimental methodology.

OBJECTIVE: Evaluate the adhesive behavior of conventional and high-translucent zirconia after surface conditioning and hydrothermal aging. MATERIALS AND METHODS: Conventional (ZrC) and high-translucent zirconia (ZrT) specimens were divided into six groups: without surface treatment (ZrC and ZrT), air-borne particle abrasion with 50-µm Al2 O3 sized particles (ZrC-AO and ZrT-AO), and tribochemical treatment with 30-µm silica modified Al2 O3 sized particles (ZrC-T and ZrT-T). Zirconia specimens were treated using an MDP-containing universal adhesive and bonded to two resins blocks with an adhesive luting cement. Microbar specimens with cross-sectioned areas of 1 mm2 were achieved. Half of the microbars were subjected to hydrothermal aging. Bond strength was evaluated by microtensile bond strength test and statistically evaluated by the Weibull analysis. RESULTS: Roughness of the ZrC-AO and ZrT-AO groups were statistically higher. Bond strength analysis revealed higher bond strength for ZrC-AO and ZrC-T groups compared to ZrT-AO and ZrT-T, respectively. Mixed failure was the most frequent for the mechanically treated groups, while no cohesive failures were obtained. CONCLUSION: Lower values of bond strength were obtained for the mechanically treated high-translucent zirconia groups when compared to their conventional zirconia counterparts. Mechanical surface treatment significantly improved the bond strength to conventional and high-translucent zirconia. CLINICAL SIGNIFICANCE: Mechanical surface treatment (air-borne particle abrasion or tribochemical treatment) associated with the use of universal adhesives containing MDP could provide a durable bonding to conventional and high-translucent zirconia.

Fixed and Removable Full-Arch Restorations Supported by Short (≤ 8-mm) Dental Implants In the Mandible: A Systematic Review and Meta-Analysis.

PURPOSE: To evaluate, through a systematic review of the literature, the published data regarding marginal bone loss, implant failure proportion, biologic and prosthetic complications, and risk factors associated with short (≤ 8-mm) implants supporting fixed or removable full-arch restorations in the edentulous mandible. MATERIALS AND METHODS: Two reviewers performed a search of five databases, with handsearching through the reference lists and grey literature. Controlled clinical trials and prospective cohort studies were selected in a two-phase process. The data were independently gathered for the same two reviewers. Quality assessment of the studies was done using the Cochrane Handbook for Systematic Reviews of Interventions for Randomized Clinical Trials and the Newcastle-Ottawa Scale for Prospective Cohort Studies. Marginal bone loss and Implant failure proportion were meta-analyzed using random (R-Em) and fixed-effects models (FEm), respectively, with a 95% confidence interval. A descriptive analysis was performed of the prevalence of biologic and prosthetic complications. Meta-regression analysis was run as fixed-effect models for risk factors. RESULTS: Six studies met the eligibility criteria and had data extracted. A total of 291 short implants (lengths 5 to 8 mm) were placed in 122 patients (82 females; mean age, 64.7 ± 10.8) supporting 23 fixed and 99 removable full-arch restorations. The pooled marginal bone loss overall was 0.12 mm (0.07 to 0.17 mm). Marginal bone loss for fixed full-arch restorations was 0.11 mm (0.01 to 0.21 mm) and for removable full-arch restorations was 0.14 mm (0.07 to 0.21 mm). The pooled implant failure proportion was 2.0% (1.0% to 5.0%) for the overall studies. Implant failure proportion for fixed and removable restorations was 2.0% with a confidence interval of (0.0% to 9%) and (0.0% to 6%), respectively. The prevalence of prosthetic complications was 34.5% for fixed restorations and 2.6% for removable restorations. No biologic complications were found for fixed restorations, while 13.1% of removable restorations did have biologic complications. Risk factors did not demonstrate statistical differences regarding Implant failure proportion and marginal bone loss. All included studies demonstrated a high methodological quality. CONCLUSION: Findings from this systematic review and meta-analysis suggest that full-arch restorations supported by short implants in atrophic edentulous mandibles might be a viable treatment option, presenting minimal marginal bone loss and implant failure in the short-term. However, further well-performed prospective clinical trials with long-term observation are needed.

Esthetic and functional rehabilitation of bilateral congenital absence of maxillary lateral incisors: Minimally invasive surgical and prosthetic approach.

OBJECTIVE: Congenital absence of maxillary lateral incisors is a frequent clinical challenge which must be solved by a multidisciplinary approach in order to obtain an esthetic and functional restorative treatment. Noninvasive treatments, that are in accordance with the patients' expectations, should be the first therapeutic alternative. If the deciduous tooth is present, minimally invasive dental extraction followed by immediate dental implant placement and provisional restoration is indicated. In this restorative treatment, an adequate emergency profile can be achieved by peri-implant soft-tissue-conditioning techniques. Moreover, the association of restorative materials, such as composite resins and dental ceramics, provides more predictable esthetic results. CLINICAL CONSIDERATIONS: The present case report presents a rehabilitation of bilateral congenital absence of maxillary lateral incisors through a multidisciplinary approach. Dental implants, long-term provisional restoration, tooth bleaching, minimally veneered high-translucent monolithic zirconia crowns, feldspathic veneers, and composite restorations were used by the dental team to achieve the expected functional and esthetic outcomes. CONCLUSIONS: Different treatment modalities are available for the rehabilitation of congenital absence of teeth. However, it is important that a dental team consider performing minimally invasive treatments, as many of these treatments are done on young patients. CLINICAL SIGNIFICANCE: Patient-centered treatments involving minimally invasive approaches in a multidisciplinary environment would be appropriate in order to achieve predictable results.

Effect of different irrigations on the bond strength of self-adhesive resin cement to root dentin.

BACKGROUND: Different disinfectant solutions or medications are indicated prior fiber post bonding procedures.The aim was to evaluate the effect of different pretreatments of root canal on the bond strength of a fiber post luted to dentin with self-adhesive resin cement. MATERIAL AND METHODS: Forty-eight single-rooted mandibular premolars were endodontically treated and prepared to receive fiber posts. Teeth were assigned to four groups (n=12). Root canal walls were subjected to no pretreatment (G1 - control); irrigation with 10 mL of 5% sodium hypochlorite (NaOCl) (G2); 10 mL of 17% ethylenediaminetetraacetic acid (EDTA) associated with 10 mL of 5% NaOCl (G3); or 10 mL of 17% EDTA (G4). Fiber posts were bonded with self-adhesive cement. After the roots were sectioned into slices, a push-out bond strength test was performed using a universal testing machine at crosshead speed of 0.5 mm/min. Bond strength data were recorded and expressed in MPa and analyzed by Anova (5%) and Tukey Test (5%). RESULTS: It was found that G2 (9.36 MPa) and G4 (6.33 MPa) were significantly different among themselves and statistically inferior to G1 (13.93 MPa) while G3 (14.31 MPa) was statistically similar to G1 (control) and superior to G2 and G4. CONCLUSIONS: Irrigation with 17% EDTA associated with 5% NaOCl showed increased bond strength compared with the same solutions used alone. Key words:Self-adhesive, Dentin, Push-out, Bonding.