Protein Adsorption, Calcium-Binding Ability, and Biocompatibility of Silver Nanoparticle-Loaded Polyvinyl Alcohol (PVA) Hydrogels Using Bone Marrow-Derived Mesenchymal Stem Cells.

Several approaches have evolved to facilitate the exploration of hydrogel systems in biomedical research. In this sense, poly(vinyl alcohol) (PVA) has been widely used in hydrogel (HG) fabrication for several therapeutic applications. The biological properties of PVA hydrogels (PVA-HGs) are highly dependent on their interaction with protein receptors and extracellular matrix (mainly calcium) deposition, for which there is not enough evidence from existing research yet. Thus, for the first time, the functional properties, like protein and mineral interactions, related to the proliferation of mesenchymal stem cells (MSCs) by silver nanoparticle (AgNP)-loaded PVA hydrogels (AgNPs-PVA-HGs) were investigated in the present study. The UV absorption spectrum and TEM microscopic results showed a maximum absorbance of synthesized AgNPs at 409 nm, with an average particle size of 14.5 ± 2.5 nm, respectively. The functional properties, such as the calcium-binding and the protein adsorption of PVA-HG, were accelerated by incorporating AgNPs; however, the swelling properties of the HGs were reduced by AgNPs, which might be due to the masking of the free functional groups (hydroxyl groups of PVA) by AgNPs. SEM images showed the presence of AgNPs with a more porous structure in the HGs. The proliferative effect of MSCs increased over culture time from day 1 to day 7, and the cell proliferative effect was upregulated by HGs with more pronounced AgNPs-PVA-HG. In addition, both HGs did not produce any significant cytotoxicity in the MSCs. The histological (bright light and H&E staining) and fluorescence microscopic images showed the presence of a cytoskeleton and the fibrillar structure of the MSCs, and the cells adhered more firmly to all HGs. More fibrillar bipolar and dense fibrillar structures were seen in the day 1 and day 7 cultures, respectively. Interestingly, the MSCs cultured on AgNPs-PVA-HG produced extracellular matrix deposition on day 7. Accordingly, the present results proved the biocompatibility of AgNPs-PVA-HG as a suitable system for culturing mammalian stem cells for regenerative tissue applications.

Ozonized Hydrogels vs. 1% Chlorhexidine Gel for the Clinical and Domiciliary Management of Peri-Implant Mucositis: A Randomized Clinical Trial.

Peri-implant mucositis consists of a reversible inflammation of peri-implant tissues characterized by bleeding on gentle probing in the absence of bone loss. Ozone therapy is being extensively studied for its efficacy in treating different dental conditions. To date, few studies have evaluated ozone as an adjunct to the oral hygiene measures of peri-implant mucositis patients. The aim of the present study is to assess the efficacy of an ozonized gel (Trial group) compared to chlorhexidine (Control group) after a domiciliary protocol of oral hygiene in a 6-month study. According to a split-mouth study design, patients were divided into Group 1 for the application of chlorhexidine gel in peri-implant mucositis sites of quadrants Q1 and Q3, whereas in quadrants Q2 and Q4, the ozonized gel was in-office administered. For Group 2, the quadrants were inverted. At baseline (T0), and after 1 (T1), 2 (T2), and 3 (T3) months, Probing Depth (PD), Plaque Index (PI), SI Suppuration Index (SI), Bleeding Score (BS) and Marginal Mucosa Condition (MMC) were measured. A statistically significant decrease was found for all the variables assessed in each group (p < 0.05), whereas significant intergroup differences were found only for PI, BoP, and BS. Accordingly, both agents tested in this study showed an efficacy in treating peri-implant mucositis. The ozonized gel deserves particular attention, considering the better outcome than chlorhexidine on specific clinical periodontal parameters, as well as its lesser shortcomings.

Prospective Clinical Study with New Materials for Tissue Regeneration: A Study in Humans.

OBJECTIVE: This study was performed to evaluate the clinical, radiographic, and histomorphometric outcomes of novel bone grafting materials and dental membranes and to compare the results with current data from the literature. MATERIALS AND METHODS: New synthetic bone substitutes, consisting of biphasic calcium phosphate in the ratio of 60% hydroxyapatite and 40% ß-tricalcium phosphate, were applied in bony defects and covered by either a novel synthetic poly(lactic-co-glycolic) acid (PLGA) or porcine collagen membrane. A sample of 51 biomaterials was placed in a total of 20 patients during different surgical protocols. Implants were simultaneously inserted, and in the case of sinus floor elevations 6 months later. Pre- and postoperative cone-beam computed tomographies were taken. Bone biopsies were harvested from augmented sides and processed for histomorphometric evaluation. STATISTICAL ANALYSIS: Averages and ranges were calculated for the percentage of newly formed bone, residual biomaterial, and connective tissue. Data were submitted to analyze the radiological mean differences in length, width, and density. Paired t-tests were deployed for the analysis of differences within each group between the baseline (preoperative) and the final (postoperative) measurements. RESULTS: The mean bone gain in length and width were 0.96 ± 3.33 mm (+27.59%) and 1.22 ± 1.87 mm (+30.48%), respectively. The bone density was increased by a factor of 4, reaching an average of 387.47 ± 328.86 HU. Histomorphometric evaluations revealed new bone formation of 41.44 ± 5.37%, residual biomaterial of 24.91 ± 7.31%, and connective tissue of 33.64 ± 4.81%. The mean healing period was 8.32 ± 3.00 months. CONCLUSIONS: Data from this study confirmed the suitability of the tested materials in dental surgery. The biomaterials may be recommended for various clinical procedures. A satisfactory level of increase of new bone was reported in augmented sides. No significant differences were observed between the tested membranes. PLGA membranes might be superior to collagen membranes for their easier handling.

The Molecular Interaction of Collagen with Cell Receptors for Biological Function.

Collagen, an extracellular protein, covers the entire human body and has several important biological functions in normal physiology. Recently, collagen from non-human sources has attracted attention for therapeutic management and biomedical applications. In this regard, both land-based animals such as cow, pig, chicken, camel, and sheep, and marine-based resources such as fish, octopus, starfish, sea-cucumber, and jellyfish are widely used for collagen extraction. The extracted collagen is transformed into collagen peptides, hydrolysates, films, hydrogels, scaffolds, sponges and 3D matrix for food and biomedical applications. In addition, many strategic ideas are continuously emerging to develop innovative advanced collagen biomaterials. For this purpose, it is important to understand the fundamental perception of how collagen communicates with receptors of biological cells to trigger cell signaling pathways. Therefore, this review discloses the molecular interaction of collagen with cell receptor molecules to carry out cellular signaling in biological pathways. By understanding the actual mechanism, this review opens up several new concepts to carry out next level research in collagen biomaterials.

Antibacterial and Proliferative Effects of NaOH-Coated Titanium, Zirconia, and Ceramic-Reinforced PEEK Dental Composites on Bone Marrow Mesenchymal Stem Cells.

Several metallic and polymer-based implants have been fabricated for orthopedic applications. For instance, titanium (Ti), zirconia (Zr), and polyetheretherketone (PEEK) are employed due to their excellent biocompatibility properties. Hence, the present study aimed to compare the functional and biological properties of these three biomaterials with surface modification. For this purpose, Ti, Zr, and ceramic-reinforced PEEK (CrPEEK) were coated with NaOH and tested for the biological response. Our results showed that the surface modification of these biomaterials significantly improved the water contact, protein adhesion, and bioactivity compared with uncoated samples. Among the NaOH-coated biomaterials, Ti and CrPEEK showed higher protein absorption than Zr. However, the mineral binding ability was higher in CrPEEK than in the other two biomaterials. Although the coating improved the functional properties, NaOH coating did not influence the antibacterial effect against E. coli and S. aureus in these biomaterials. Similar to the antibacterial effects, the NaOH coating did not contribute any significant changes in cell proliferation and cell loading, and CrPEEK showed better biocompatibility among the biomaterials. Therefore, this study concluded that the surface modification of biomaterials could potentially improve the functional properties but not the antibacterial and biocompatibility, and CrPEEK could be an alternative material to Ti and Zr with desirable qualities in orthopedic applications.

Clinical Performance of Zygomatic Implants-Retrospective Multicenter Study.

The main objective of this analysis was to evaluate (1) implant survival, (2) biologic complications, and (3) demographics associated with zygomatic implants placed according to the zygomatic anatomy-guided approach (ZAGA). This retrospective multicenter study reviewed data from the charts of 82 consecutive patients who had received 182 zygomatic implants. Patients were fully edentulous (62.2%), partially edentulous (22.0%), or had failing dentition (15.9%). Most patients (87.5%) did not have previous sinusitis and 11.3% had been previously treated for it. Additionally, about half of the patients (53.8%) did not present periodontal pathology, and one-third (36.3%) did, but were subsequently treated. Most implants (93.8%) were loaded immediately, i.e., within 48 h of placement. Implants were followed for 10.5 ± 7.2 months, and all were recorded as surviving and stable at last follow-up. Post-operative complications were infrequent and included sinusitis (10.1%) and peri-implant hyperplasia (0.8%). The low complication rate and 100% implant survival and stability indicate that zygomatic implants offer a viable treatment option when performing graftless restoration of severely resorbed maxilla, including immediate loading protocols.

Correction to: Influence of surface treatment on osseointegration of dental implants: histological, histomorphometric and radiological analysis in vivo.

Dear Professor Dr. Matthias Hannig. Editor-in-Chief Clinical Oral Investigations. Following the publication of our paper by Calvo Guirado et al, 2015 [1] in Clinical Oral Investigations, it came to light that a certain part of the text at the materials and methods and results sections were similar.

Socket-shield technique: the influence of the length of the remaining buccal segment of healthy tooth structure on peri-implant bone and socket preservation. A study in dogs.

OBJECTIVE: The aim of this study was to evaluate the influence of the location and length of root pieces on buccal peri-implant bone width and socket preservation in socket shield technique. MATERIAL AND METHODS: Forty-eight dental implants (24 narrow and 24 regular platform internal hex implants) were placed in six dogs. The clinical crowns of teeth P2, P3, P4 and M1 were detached horizontally and removed from the underlying roots. Then the mesial root of each tooth was extracted and the distal root was degraded using a high-speed hand-piece with round bur, creating a concave shell of dentin cementum and periodontal ligament (PDL) connected to the buccal aspect of the socket. Remaining root fragments of different lengths were created: coronal (1/3); middle and coronal (2/3); full length (3/3). These were positioned all around the bone crest. Implants were placed at the center of the root sockets, 1-3mm deeper than the original root apex. RFA and histological evaluations were made at 4 and 12 weeks. Data underwent statistical analysis (p<0.05). RESULTS: All 48 implants osseointegrated satisfactorily. On both buccal and lingual sides, the coronal (1/3) radicular fragment was attached to the buccal bone plate by physiologic periodontal ligament with less crestal bone resorption compared with middle (2/3) and whole root (3/3) groups for narrow and standard implants. CONCLUSIONS: Within the limitations of this study, the results demonstrate that a small piece of root in the coronal part of the alveolus can protect the buccal, mesial and distal bone crest following the immediate placement of NeO narrow or NeO Standard Internal Hex implants. The thickness of peri-implant bone and the remaining root fragment together will provide a total thickness of >2mm. The technique would appear to be highly predictable, maintaining bone volume and reducing the risk of crestal bone resorption.

Influence of Implant Neck Design on Peri-Implant Tissue Dimensions: A Comparative Study in Dogs.

This in vivo study assessed (hard and soft) peri-implant tissue remodeling around implants with micro-ring and open-thread neck designs placed in a dog model. Twenty histological sections corresponding to four different implant designs that were placed in America Foxhound dogs were obtained from previous studies. All the implants had been placed under identical conditions and were divided into four groups: Group A, micro-rings on implant neck plus 0.5 mm refined surface; Group B, micro-rings on implant neck; Group C, open-thread neck; and, Group D, double-spiral neck. Eight weeks after surgery, the integrated implants were removed and processed for histological examination. Crestal bone loss and bone-to-implant contact was greater for micro-ring necks than open-thread necks. Soft tissues showed significant differences on both buccal and lingual aspects, so that the distance from peri-implant mucosa to the apical portion of the barrier epithelium was smaller in the micro-ring groups. So, in spite of generating greater bone-to-implant contact, implants with micro rings produced more bone loss than open-thread implants. Moreover, the outcomes that were obtained IPX implants smooth neck design produced less bone loss in the cervical area, following by Facility implants when compared with the other open thread and microthreaded implant designs. Implant thread design can influence on bone remodeling in the cervical area, related to bundle bone preservation.

Evaluation of the Surrounding Ring of Two Different Extra-Short Implant Designs in Crestal Bone Maintanence: A Histologic Study in Dogs.

The aim of this study was to compare the implant stability and bone resorption and formation of two different extra-short implant designs with different diameter rings placed in a dog´s maxilla. Thirty-six extra-short, 5 mm diameter × 4 mm length (Short DM®, Bioner Sistemas Implantológicos, Barcelona, Spain), delayed implants were placed in each hemimaxilla of six dogs at the bone crest level. Eighteen implants of each design (wide and narrow ring) were installed. After 8 and 12 weeks of healing, histomorphometric analyses of the specimens were carried out to measure the crestal bone level values and the tissue thickness around the wide and narrow ring implant designs. In the microscopic analysis, less buccal bone resorption was observed in the narrow ring implants with a statistical significance (p < 0.001). For the peri-implant tissue thickness, the distance from the implant shoulder to the external portion of the epithelium was significantly higher for the implants installed with a wide ring with statistical significance (p < 0.001). Our findings suggest that the amount of peri-implant tissues (crestal bone loss) after remodeling over a period of 12 weeks was smaller in the narrow ring extra-short implant installed in the healed maxilla, compared with the wide ring extra-short implants.

The Use of Tooth Particles as a Biomaterial in Post-Extraction Sockets. Experimental Study in Dogs.

Objectives: The objective of this study was to evaluate new bone formation derived from freshly crushed extracted teeth, grafted immediately in post-extraction sites in an animal model, compared with sites without graft filling, evaluated at 30 and 90 days. Material and Methods: The bilateral premolars P2, P3, P4 and the first mandibular molar were extracted atraumatically from six Beagle dogs. The clean, dry teeth were ground immediately using the Smart Dentin Grinder. The tooth particles obtained were subsequently sieved through a special sorting filter into two compartments; the upper container isolating particles over 1200 μm, the lower container isolated particles over 300 μm. The crushed teeth were grafted into the post-extraction sockets at P3, P4 and M1 (test group) (larger and smaller post-extraction alveoli), while P2 sites were left unfilled and acted as a control group. Tissue healing and bone formation were evaluated by histological and histomorphometric analysis after 30 and 90 days. Results: At 30 days, test site bone formation was greater in the test group than the control group (p < 0.05); less immature bone was observed in the test group (25.71%) than the control group (55.98%). At 90 days, significant differences in bone formation were found with more in the test group than the control group. No significant differences were found in new bone formation when comparing the small and large alveoli post-extraction sites. Conclusions: Tooth particles extracted from dog’s teeth, grafted immediately after extractions can be considered a suitable biomaterial for socket preservation.

Evaluation of a New Dental Implant Cervical Design in Comparison with a Conventional Design in an Experimental American Foxhound Model.

The aim of this study was to evaluate osseointegration and crestal bone height in implants with a triangular cervical design in comparison with a standard rounded cervical design. The control group consisted of 24 implants with a standard cervical design, and the test group of 24 implants with a triangular cervical design. The implants were inserted in healed bone in six American Foxhounds. Crestal bone height and tissue thickness in the cervical portion were measured after 12 weeks healing. Data analysis found mean crestal bone loss of: 0.31 ± 0.24 mm on the buccal side, 0.35 ± 0.14 mm on the lingual in the test group, and 0.71 ± 0.28 mm buccal loss, and 0.42 ± 0.30 mm lingual in the control group; with statistically significant differences on the buccal aspect (p = 0.0019). Mean tissue thickness in the test group was 1.98 ± 0.17 mm on the buccal aspect, and 2.43 ± 0.93 mm in the lingual; in the control group it was 2.48 ± 0.61 mm buccal thickness, and 2.88 ± 0.14 mm lingual, with significant differences on both aspects (p = 0.0043; p = 0.0029). The results suggest that greater thickness of peri-implant tissue can be expected when the triangular cervical implant design is used rather than the standard cervical design.

Peri-implant bone loss clinical and radiographic evaluation around rough neck and microthread implants: a 5-year study.

OBJECTIVE: To evaluate marginal bone loss over 5 years around microthreaded implants placed in the maxillary anterior/esthetic zone and immediate restored with non-occlusal loading. MATERIALS AND METHODS: Seventy-one implants (with microthreads up to the platform-rough surface body and neck, internal connection and platform switching) were placed in healed bone in the maxillary arches of 30 men and 23 women (mean age 37.85 ± 7.09 years, range 27-60). All subjects had at least 3 mm of soft tissue to allow the establishment of adequate biologic width and to reduce bone resorption. Each patient received a provisional restoration immediately after implant placement with slight occlusal contact. Mesial and distal bone height was evaluated using digital radiography on the day following implant placement (baseline) and after 1, 2, 3, 4 and 5 years. Primary stability was measured with resonance frequency analysis. RESULTS: No implants failed, resulting in a cumulative survival rate of 100% after 3 years. Marginal bone loss from implant collar to bone crest measured at baseline (peri-implant bone defect at the fresh extraction socket) and after 5 years was 0.90 mm ± 0.26 mm. Mesial and distal site crestal bone loss ranged from 3.42 ± 1.2 mm at baseline to 3.51 ± 1.5 mm after 5 years and from 3.38 ± 0.9 mm at baseline to 3.49 ± 0.9 mm after 5 years, respectively (P = 0.086). CONCLUSIONS: The results of this study showed limited implant crestal bone loss 0.90 mm ± 0.26 mm and 100% of implant survival rate at 5-year follow-up of immediate restored implants with rough surface neck and microthreads.

Influence of hydroxyapatite granule size, porosity, and crystallinity on tissue reaction in vivo. Part B: a comparative study with biphasic synthetic biomaterials.

OBJECTIVE: The aim of this study was to compare the influence of the physical-chemical properties of synthetic hydroxyapatite (HA) and biphasic commercial materials on the biological behavior of study materials through material characterization and SEM analysis before and after application in rabbit tibias. MATERIALS AND METHODS: Two defects were performed in each tibiae for a total of 180 defects: Group I HA granules (2000-4000 µm), Group II HA granules (1000-2000 µm), Group III HA granules (600-1000 µm), Group IV Ossceram® nano (Bredent medical GmbH & Co. KG, Senden, Germany), Group V 4Bone® granules (MIS Implants Technologies Ltd, Shlomi, Israel), and Group VI: empty defect acted as control. Comparison was performed by mean of material characterization, SEM, and EDX. RESULTS: 4Bone: Pores between 300 µm and 100 µm with intra- and interparticle spaces. Ossceram show also interparticle and intraparticle pores, between 100 µm and 26 µm, but the proportion of interparticles in the 4Bone is clearly minor than in the Ossceram. Related with pure HA, Group III has the greatest porosity (69.3%). For Group I, the intraparticle pores (0.71 µm) are about 8 times larger than those of the other two samples. The analysis of the images of in vivo SEM shown as biphasic groups has presented a more gradual resorption of the material. CONCLUSION: HA-based biomaterials, both pure and biphasic, are an effective means for bone regeneration processes; of these, materials with higher initial and secondary porosimetry allow greater cell colonization and therefore more effective substitution by new bone. The two-phase materials have a higher ion release to the environment in the early stages and thus allow greater colonization by collagen fibers that can be matured into new bone.

Effects on the osseointegration of titanium implants incorporating calcium-magnesium: a resonance frequency and histomorphometric analysis in rabbit tibia.

OBJECTIVE: This study assessed the bone formation around titanium surface incorporating the calcium-magnesium (CaMg) deposited by blasted in rabbit tibia bone to determine whether this surface would further enhance bone healing compared with commercially available implant surface. MATERIAL AND METHODS: The deposition of CaMg on the titanium SLA surface were obtained by blasting formed the experimental group (EX group), while implants with traditional SLA surface were used as control group (CO group), in this study. Fifty cylindrical threaded implants with a length of 8 mm were used (P = 25 per group). Five implants of each group were used to surface characterization by scanning electron microscopy, energy dispersive spectrometry, and optical profilometry. Ten New Zealand white rabbits received 40 implants (n = 20 per group). Resonance frequency analysis was performed three times (0, 4, and 6 weeks). Histomorphometric analysis was performed 4 and 6 weeks after implantation. Statistical significance was set at P < 0.05. RESULTS: Blasted CaMg deposition on SLA implant surface displayed almost identical surface morphologies and R(a) values at the micron scale. In comparing the implant stability quotient at the three time points, highly significant statistic differences were found (P < 0.001). Histomorphological analysis showed higher degrees of bone organization in the samples of test implant surfaces at both implantation times. CONCLUSION: Within the limitations of this study, the results indicate that the deposition of CaMg on the SLA titanium surface may be effective in enhancing the osseointegration of moderately rough grit-blasted implants by increasing the degree of bone-implant contact.

Biological effects of compressive forces exerted on particulate bone grafts during socket preservation: animal study.

OBJECTIVES: To compare different compressive forces exerted on a particulate graft material during socket preservation and their effects on bone regeneration. MATERIAL AND METHODS: Six male dogs were used. The second, third, and fourth premolars, and the first molar were extracted bilaterally at the lower jaws. A particulate synthetic biphasic grafting material (60% HA and 40% ß-tricalcium phosphate) was used. Three different standardized compressive forces were applied randomly during the socket preservation. The sample was divided into four experimental groups Test A (10 g), Test B (50 g), Test C (200 g), and Control (empty sockets). Collagen membranes were placed, and primary closure was obtained. Two months after the surgery the animals were sacrificed, and histomorphometric analysis of non-decalcified samples was performed at the coronal, middle, and apical thirds. RESULTS: Grafted sockets resulted in higher bony contour (3 ± 0.43 mm2 ; P < 0.05). The particles penetrated up to the apical third in the group C but not in the other test groups and controls (P < 0.05). The percentage of new bone were higher at the coronal and apical thirds for Controls and group C compared to A and B groups (P < 0.05). The residual graft was higher for group C (53 ± 1.4%), followed by group B (45 ± 3.1%) and group A (35 ± 1.9%; P < 0.05). The percentages of connective tissue were higher at the middle third without differences between groups (P > 0.05). CONCLUSIONS: Within the limitations of this experimental animal study, it might be concluded that grafted sockets compressed with 200 g force will have higher bony contours; higher compressive forces facilitate the penetration of the particulate graft material into the apical area of the socket and results in more bone formation at the coronal, middle, and apical thirds.

The influence of drill length and irrigation system on heat production during osteotomy preparation for dental implants: an ex vivo study.

OBJECTIVE: This study aimed to measure the influence of drill length and irrigation system on heat production during osteotomy preparation for dental implants using bovine bone rib as experimental model. MATERIALS AND METHODS: Three groups were created: Group 1: drilling with three consecutive burs with double irrigation (internal and external) for a 4.0 mm conical implant; and Group 2 and Group 3: drilling with three consecutive burs with external irrigation for a 4.1 mm cylindrical implant and for a 4.3 mm conical implant, respectively. Four lengths were tested: 10, 12, 14 and 16 mm; in site prepared on bovine ribs using a surgical unit linked to a testing device, to standardize and simulate implant drilling procedures. Bone temperature variations were recorded using three thermocouples in different positions as of the crestal bone: 2 mm, position (p1); 7 mm, position 2 (p2); and 12 mm, position 3 (p3). RESULTS: The highest temperature changes were invariably recorded during the process of withdrawal. Significantly lower temperature changes (P < 0.02) could be recorded at maximum drilling depths during the shearing process regardless of drilling depth or irrigation method. Double irrigation was associated with significantly lower temperatures compared with external irrigation by the use of implant drills (P < 0.01). CONCLUSIONS: Within the limitations of this ex vivo study was possible concluded that the use a double irrigation system in multiple conventional drill for osteotomy can decrease the heat generation when increase the drill length.

Stability and Crestal Bone Behavior Following Simultaneous Placement of Multiple Dental Implants (Two or More) with the Bone Splitting Technique: A Clinical and Radiographic Evaluation.

PURPOSE: The present study aimed to measure the implant stability quotient (ISQ) values at three different time points after surgical procedures and crestal bone behavior in multiple implants (two or more) installed simultaneously with the bone splitting technique. MATERIALS AND METHODS: For this study, 45 patients with different edentulous areas in the maxilla were selected, and a total of 114 dental implants were installed. Implant stability was measured by resonance frequency analysis immediately following implant placement to assess immediate stability (time 1) and stability at 90 days (time 2), and 150 days (time 3). Crestal bone height was measured in peri-apical radiographs at 90 and 150 days after implantation in relation to each implant shoulder, given that the implants were installed at the level of the crestal bone. RESULTS: Six implants were not osseointegrated. Overall, the means and standard deviations of the ISQ values were 60.3 ± 4.94 (95% confidence interval [CI], 44-69) at baseline, 66.6 ± 5.28 (95% CI, 49-75) at 90 days, and 72.1 ± 4.28 (95% CI, 59-79) at 150 days (p < 0.0001). The mean marginal bone loss of the implants was 1.11 ± 0.61 mm on the mesial side and 1.17 ± 0.61 mm on the distal side at time 2, and 1.73 ± 0.68 mm on the mesial side and 1.79 ± 0.70 mm on the distal side at time 3. A strong positive correlation between implant stability and bone loss was detected (p < 0.0001). CONCLUSIONS: Within the limits of this study, the bone splitting technique with simultaneous implant installation exhibited a good success rate with respect to the osseointegration index but requires attention with respect to crestal bone behavior.