Aesthetic outcomes of non-functional immediately restored single post-extraction implants with and without connective tissue graft: A multicentre randomized controlled trial.

OBJECTIVES: To compare the 1-year aesthetic results of flapless single implants, placed in fresh extraction sockets with bone replacement and immediate provisional restoration with or without a connective tissue graft (CTG). MATERIAL AND METHODS: The present study proposes a partially blinded multicentre parallel randomized controlled trial, where computer-generated tables were used for central randomization to allocate treatments. A total of 59 of the 60 patients screened by eight private practices in Northern Italy fulfilled the inclusion criteria. Immediate implants were placed in a fresh extraction socket with a non-functional immediate provisional restoration with (Test group) or without (Control group) a CTG. The primary outcome variable was the implant Crown Aesthetic Index (ICAI) at the 1-year follow-up. RESULTS: ICAI for the 59 randomized patients (Test group = 31, Control group = 28) at the 1-year follow-up was 4.69 (95% CI = 3.16-6.22) for the Test group and 3.45 (95% CI = 1.83-5.08) for the Control group, without statistically significant difference between the two groups (p = .086). One implant failure was recorded in each group, resulting in an implant survival rate of 96.8% [95% CI = 83.3-99.9] for the Test group and 96.4% [95% CI = 81.7-99.9] for the Control group. Other secondary outcome variables and complication rates were comparable across the two groups. CONCLUSIONS: Within the limitations of the present clinical trial, the results suggested that the adjunct use of CTG is not mandatory to achieve successful aesthetic outcomes for a well-planned immediate implant placement with immediate non-functional provisional restoration in a fresh extraction socket.

Salinity and sensitivity to endocrine disrupting chemicals: A comparison of reproductive endpoints in small-bodied fish exposed under different salinities.

The influence of salinity on toxicity outcomes has been demonstrated for various contaminants, but has received limited attention for endocrine disrupting chemicals (EDCs). Short-term laboratory tests using small-bodied fish are an important tool for evaluating impacts of EDCs on reproduction. Tests have been developed for both freshwater and estuarine/marine species, providing an opportunity to assess whether concentrations at which small-bodied fish respond to EDCs may be influenced by salinity. We conducted a semi-quantitative review of short-term laboratory tests with small-bodied fish exposed to EDCs, including 59 studies under freshwater conditions (7 species) and 23 studies conducted under saline conditions (5 species). We focused on two model estrogens [17α-ethinylestradiol and 17ß-estradiol (E2)], and three androgens (17ß-trenbolone, 5α-dihydrotestosterone and 17α-methyltestosterone). The lowest observed adverse effect concentration (LOAECLOW) for key reproductive endpoints was recorded, including sex-steroid and vitellogenin (VTG) levels, fecundity and fertilization. In 65.2% of cases, responses occurred at lower doses under freshwater compared to saline conditions, compared to only 4.3% of cases where fish responded to lower doses under saline conditions. The potential influence of salinity was more pronounced when estrogenic compounds were considered separately, with fish responding to lower doses under fresh compared to saline conditions in 90.5% of cases. Fecundity and E2 level were identified as the most sensitive endpoints for evaluating EDCs regardless of salinity. Interestingly, female VTG levels were a sensitive endpoint under freshwater but not saline conditions. Overall, our results suggest that salinity may be an important factor influencing how small-bodied fish respond to environmental EDCs.

Tissue Integration of a Volume-Stable Collagen Matrix in an Experimental Soft Tissue Augmentation Model.

Reducing the need for a connective tissue graft by using an efficacious biomaterial is an important task for dental professionals and patients. This experimental study aimed to test the soft tissue response to a volume-stable new collagen matrix. The device demonstrated good stability during six different time points ranging from 0 to 90 days of healing with no alteration of the wound-healing processes. The 90-day histologic specimen demonstrates eventual replacement of most of the matrix with new connective tissue fibers.

Combined Regenerative and Mucogingival Treatment of Deep Intrabony Defects Associated with Buccal Gingival Recession: Two Case Reports.

The case reports presented in this article describe a surgical approach for improving root coverage and regenerative parameters in deep intrabony defects associated with buccal gingival recession. A mandibular canine and a maxillary premolar were treated. The surgical technique consisted of a connective tissue graft (CTG) that was placed and sutured at the inner surface of a coronally advanced envelope flap (CAF), thickening the buccal soft tissue wall of the most coronal extension of the intrabony defect and treated with biomaterials as scaffold. No palatal/lingual flap was elevated. Two years after the surgery, clinically significant root coverage, increased buccal keratinized tissue height and thickness, some minor improvement in the position of the interdental papilla, and clinical attachment level gain were achieved. The radiographs showed bone fill of the intrabony components of the defects. This report encourages a novel application of CAF + CTG + biomaterials to improve both esthetic and regenerative parameters in deep intrabony defects associated with gingival recessions.

Equine-derived bone mineral matrix for maxillary sinus floor augmentation: a clinical, radiographic, histologic, and histomorphometric case series.

The objective of this proof-of-principle multicenter case series was to examine the bone regenerative potential of a newly introduced equine-derived bone mineral matrix (Equimatrix) to provide human sinus augmentation for the purpose of implant placement in the posterior maxilla. There were 10 patients requiring 12 maxillary sinus augmentations enrolled in this study. Histologic results at 6 months demonstrated abundant amounts of vital new bone in intimate contact with residual graft particles. Active bridging between residual graft particles with newly regenerated bone was routinely observed in intact core specimens. A mean value of 23.4% vital bone formation was observed at 6 months. This compared favorably with previous results using xenografts to produce bone in the maxillary sinus for the purpose of dental implant placement. Both the qualitative and quantitative results of this case series suggest comparable bone regenerative results at 6 months to bovine-derived xenografts.

Establishment of the epithelial attachment and connective tissue adaptation to implants installed under the concept of "platform switching": a histologic study in minipigs.

AIM: To validate the "platform switching" concept at oral implants with respect to the preservation of the alveolar crestal bone levels in an animal model. MATERIAL & METHODS: Five minipigs received three implants each with a 0.25 mm implant/abutment mismatch and were placed flush (T(0)), 1 mm below (T(1)) and 1 mm above (T(+1)) the alveolar bony crest, and as a control, one conventionally restored implant placed at the bone level. The implants were randomly inserted flapless into the mandible. Four months after implant insertion, the animals were sacrificed, and undecalcified block sections were obtained and used for histological analyses. RESULTS: The mean values for peri-implant bone resorption were 1.09 ± 0.59 mm (Control), 0.51 (± 0.27 mm, T(0)), 0.50 (± 0.46 mm, T(+1)) and 1.30 (± 0.21 mm, T(-1)), respectively. Statistically significant differences (P<0.05) were found among the test (T(0), T(-1)) and the control sites. Control implants presented an average biologic width length of 3.20 mm (± 0.33), with a connective tissue adaptation compartment of 1.29 mm (± 0.53) and an epithelial attachment of 1.91 mm (± 0.71). T(0), T(+1) and T(-1) implants presented with a mean biologic width of 1.97 mm (± 1.20), 2.70 mm (± 1.36) and 2.84 mm (± 0.90), respectively, with a connective tissue adaptation compartment of 1.21 mm (± 0.97), 1.21 mm (± 0.65) and 1.50 mm (± 0.70) and an epithelial attachment of 0.84 mm (± 0.93), 1.66 mm (± 0.88) and 1.35 mm (± 0.44), respectively. Differences between the configurations were mainly associated with the length of the epithelial attachment. The epithelial attachment was significantly longer in the C sites than in T(0) (P=0.014). However, no other differences between configurations were detected. CONCLUSION: If the implants are positioned at the level of the alveolar bony crest, the platform-switching concept may have a minor impact on the length of the epithelial attachment (0.84 vs. 1.91 mm), while the connective tissue adaptation compartment remains relatively unaffected. Moreover, platform switching resulted in less resorption of the alveolar crest (0.58 mm).

Rare bilateral nasopalatine duct cysts: a case report.

The nasopalatine duct cyst (NPDC) is the most common of the non-odontogenic cyst of the jaws. This cysts are usually central or unilateral with no prevalence of side occurrence. The NPDC is the most frequent developmental, nonodontogenic cyst of the jaws. This cyst originates from epithelial remnants from the nasopalatine duct. The cells could be activated spontaneously during life, or are eventually stimulated by the irritating action of various agents (infection, etc.). Generally, patients present without clinical signs and symptoms. Therefore, the tentative diagnosis "nasopalatine duct cyst" is often based on a coincidental radiological finding on a routine panoramic view or occlusal radiograph. The definite diagnosis should be based on clinical, radiological and above all histopathologic findings. The therapy of nasopalatine duct cysts consists of an enucleation of the cystic tissue, only in rare cases a marsupialization needs to be performed. This report describes the appearance and treatment of a rare case of bilateral nasopalatine duct cyst.

Orthodontic surgical treatment on an upper central dilacerated incisor in an adult patient.

This study describes how a dilacerated upper central incisor was repositioned in the dental arch in an adult patient with proper surgical and orthodontic management avoiding use of prosthetic implants. The results were sustainable long term in both periodontal and aesthetic terms.