Six-year extension results of a randomized trial comparing transcrestal and lateral sinus floor elevation at sites with 3-6 mm of residual bone.

OBJECTIVES: To comparatively evaluate the 6-year outcomes of transcrestal and lateral sinus floor elevation (tSFE and lSFE, respectively). METHODS: The 54 patients representing the per-protocol population of a randomized trial comparing implant placement with simultaneous tSFE versus lSFE at sites with a residual bone height of 3-6 mm were invited to participate in the 6-year follow-up visit. Study assessments included: peri-implant marginal bone level at the mesial (mMBL) and distal (dMBL) aspects of the implant, proportion of the entire implant surface in direct contact with the radiopaque area (totCON%), probing depth, bleeding on probing, suppuration on probing, and modified plaque index. Also, the conditions of the peri-implant tissues at 6-year visit were diagnosed according to the case definitions of peri-implant health, mucositis, and peri-implantitis from the 2017 World Workshop. RESULTS: Forty-three patients (21 treated with tSFE and 22 treated with lSFE) participated in the 6-year visit. Implant survival was 100%. At 6 years, totCON% was 96% (IR: 88%-100%) in tSFE group and 100% (IR: 98%-100%) in lSFE group (p = .036). No significant intergroup difference in patient distribution according to the diagnosis of peri-implant health/disease was observed. Median dMBL was 0.3 mm in tSFE group and 0 mm in lSFE group (p = .024). CONCLUSIONS: At 6 years following placement concomitantly with tSFE and lSFE, implants showed similar conditions of peri-implant health. Peri-implant bone support was high in both groups and was slightly but significantly lower in tSFE group.

Gingival pedicle with split-thickness tunnel technique: A retrospective case series for single mandibular anterior recessions.

INTRODUCTION: Gingival recessions in the mandibular anterior sextant are a common clinical finding, but mucogingival treatment in this location is particularly challenging, due to several anatomical and surgical difficulties. In the present case series, a novel technique, called gingival pedicle with split-thickness tunnel (GPST), was retrospectively evaluated. CASE SERIES: Fifteen patients presenting with a single buccal RT1 or RT2 gingival recession of a depth of ≥3 mm in the mandibular anterior sextant were treated by means of the GPST technique. Clinical periodontal parameters at baseline and at the last follow-up evaluation visit (6-84 months) were compared. Early healing was uneventful in all cases, and no complications such as flap dehiscence or loss of connective tissue graft were observed. Mean root coverage (mRC) was 98.1% ± 7.38%, corresponding to a statistically significant recession reduction (ΔRD) of 4.53 ± 1.19 mm. Complete root coverage was achieved in 14 of 15 cases. The gain in keratinized tissue width amounted to 3.13 ± 0.99 mm and was statistically significant, whereas no significant change in periodontal probing depth was observed after treatment. CONCLUSION: In conclusion, treatment with GPST technique seems to achieve a favorable and predictable clinical improvement in gingival recessions on mandibular anterior teeth. Why are these cases new information? Limited information is available about the management of isolated deep labial recessions in the mandibular anterior teeth. A novel surgical approach, called GPST technique, is described in a case series to specifically address this type of defect. What are the keys to successful management of these cases? Horizontal incision ≥ RECwidth Cut-back preparation helps to mobilize the flap without tension. CTG width ≥ 3 times RECwidth CTG height ≥ RECdepth Proper graft and flap stabilization need to be achieved. What are the primary limitations to success in these cases? Limited mesio-distal dimensions, which do not allow to obtain a pedicle with adequate horizontal width Very thin biotype may not be suitable because of the risk of inadequate flap vascularization.

Peri-implant tissue conditions following transcrestal and lateral sinus floor elevation: 3-year results of a bi-center, randomized trial.

OBJECTIVES: The present study was performed to comparatively evaluate the peri-implant bone stability and conditions of marginal tissues at 3 years following transcrestal and lateral sinus floor elevation (tSFE and lSFE, respectively). MATERIALS AND METHODS: Patients included in a parallel-arm randomized trial comparatively evaluating tSFE and lSFE were recalled at 3 years post-surgery. Twenty-one and 24 patients in tSFE and lSFE groups, respectively, participated in the follow-up visit. Peri-implant bone support was evaluated as the proportion of the entire implant surface in direct contact with the radiopaque area (totCON%) on 3-year periapical radiographs. The conditions of the marginal peri-implant tissues at 3-year visit were classified as peri-implant health, peri-implant mucositis, or peri-implantitis. RESULTS: At 3 years, both groups showed an implant survival rate of 100%. Median totCON% was stable at 3 years, being 100% in both groups (p = 0.124). Peri-implant health and mucositis were diagnosed in 10 (47.6%) and 11 (52.4%) patients, respectively, in the tSFE group, and in 8 (33.3%) and 16 (66.7%) subjects, respectively, in the lSFE group (p = 0.502). CONCLUSIONS: At 3 years following surgery, implants placed concomitantly with tSFE and lSFE fully maintain peri-implant bone support. Peri-implant mucositis was the most prevalent condition, with a similar prevalence between groups. CLINICAL RELEVANCE: Based on 3-year data on peri-implant bone support and prevalence of peri-implant diseases, the study suggests that tSFE and lSFE represent two equally valid options for the rehabilitation of the posterior maxilla. CLINICALTRIALS: gov ID: NCT02415946.

Immediate Loading of Four Guided Unsplinted Narrow Implants Supporting a Maxillary Overdenture: A Minimally Invasive Approach.

INTRODUCTION: Little evidence is available on the loading protocols for implant-supported overdentures in the treatment of the edentulous maxilla. There are only a few case-reports available to document the feasibility of immediate loading for maxillary overdenture, and the majority of the publications include the use of splinted implants. This paper presents a case report of immediately loaded narrow diameter implants supporting a maxillary overdenture using Locator abutments. CASE PRESENTATION: A 64-year-old, fully edentulous patient presented with a maxillary complete removable denture. A dual cone beam computed tomography scan was obtained, and the surgical planning was performed. Four 3.3 mm diameter implants were placed at the lateral incisor and second premolar positions, using a guided and flapless approach. Locator abutments were placed, and the denture was connected immediately. The patient was instructed not to remove the prosthesis for 1 week and to follow a soft diet regimen for 2 weeks. Clinical and radiographic evaluation showed positive results at 12 months, with neither prosthetic nor implant complications. CONCLUSION: This is a proof of principle case report, which demonstrates the possibility of immediately loading four guided narrow diameter implants supporting a maxillary overdenture using a Locator retention system.

Computer-Guided Surgery Using Human Allogenic Bone Ring With Simultaneous Implant Placement: A Case Report.

INTRODUCTION: The allogenic bone ring technique allows for horizontal and vertical bone augmentation with simultaneous implant placement in severely compromised sites. The aim of this report is to present a modified protocol for simultaneous placement of implant and allogenic bone ring graft using a computer-guided surgery technique. CASE PRESENTATION: Patient's chief complaint was to replace a missing lateral incisor. The implant site presented both vertical and horizontal tissue deficiencies. Study models and wax-ups were digitally scanned to stl files and merged with the existing CBCT data in the implant planning software. A 3D representation of an allogenic bone ring was developed, and two digitally designed guides were created: a 5 mm sleeve guide for the implant site and a 7 mm sleeve guide for the allogenic bone ring trephine. Both the implant site and the allogenic bone ring recipient site were prepared using the computer-generated guides. Once the ring was adapted into the recipient site, the implant was inserted through the allogenic bone ring. The healing was monitored and the implant was restored at 12 months. The accuracy of implant placement was measured and the difference in the final positioning was as follows: 0.6 mm at entry point, 0.55 mm vertical displacement, 1.94 mm at the apex, and angle discrepancy 6.1°. CONCLUSION: The use of computer-guided technology for planning and placement of an allograft bone block with simultaneous implant insertion allows for a prosthetically driven team approach to compromised site grafting in addition to improving precision and accuracy when compared with non-guided techniques.

Novel Surgical Approach for Root Coverage of Single Deep Recessions on Mandibular Incisors: Gingival Pedicle With Split-Thickness Tunnel Technique.

INTRODUCTION: Gingival recession is a very common mucogingival defect in the adult population, with mandibular central and lateral incisors being the most frequently affected teeth. Limited information is available about the management of isolated deep recession lesions in the mandibular anterior area, where the predictability of the root coverage is reduced by unfavorable anatomical conditions. The purpose of this case report is to present a novel surgical technique for deep labial recessions on mandibular incisors, based on a gingival pedicle with split-thickness tunneling (GPST), in combination with connective tissue graft (CTG). CASE PRESENTATION: A 25-year-old female patient presented with a Class II Miller isolated buccal recession on #24, 5 × 3 mm. The recipient site design consisted of a laterally positioned flap with a width of 4 mm, in combination with a split-thickness tunnel preparation that reached the mesial line angle of #25 and extended beyond the mucogingival junction. A CTG (13 × 7 mm) was harvested from the palate and properly adapted over the root surface. Graft and flap were secured with internal mattress and single-interrupted sutures. Complete root coverage was obtained and maintained at 6 months with excellent esthetic outcomes. CONCLUSION: This novel surgical approach, based on the combination of laterally displaced pedicle flap and tunneling in addition to CTG, seems to lead to promising results for the treatment of single deep mandibular anterior recessions.

Radiographic outcomes of transcrestal and lateral sinus floor elevation: One-year results of a bi-center, parallel-arm randomized trial.

OBJECTIVES: To comparatively evaluate the radiographic outcomes of transcrestal and lateral sinus floor elevation (tSFE and lSFE, respectively) when applied concomitantly with implant placement. MATERIALS AND METHODS: Patients with at least 1 edentulous site with residual bone height (RBH) of 3-6 mm were enrolled in a bi-center, parallel-arm, randomized trial. Both tSFE and lSFE were associated with a bovine-derived xenograft, and implants were inserted concomitantly. In lSFE group, the antrostomy was covered with a resorbable collagen membrane. Marginal bone loss and the maturation of the grafted area were evaluated on periapical radiographs at 6 and 12 months. Twelve-month CT/CBCT was used to assess the effect of grafting procedures circumferentially around the implant. A per-protocol analysis was performed. RESULTS: The per-protocol study population consisted of 26 patients in the tSFE group and 28 patients in the lSFE group. At 12 months, the median proportion of the implant surface in contact with the peri-implant radiopaque area was 100% in both groups, with no significant inter-group difference. Suboptimal bone-to-implant contact was observed in 13% and 3.6% of tSFE and lSFE cases, respectively. In both groups, marginal bone loss was minimal (≤1 mm) and infrequent, and the radiographic aspect was suggestive of an advanced stage of maturation. CONCLUSIONS: At sites with RBH of 3-6 mm where implants are placed concomitantly with sinus floor elevation, tSFE and lSFE are both highly predictable in obtaining an implant surface completely embedded in a radiopaque area at 12 months post-surgery. (ClinicalTrials.gov ID: NCT02415946).

Immediate versus delayed loading of mandibular implant-retained overdentures: A 60-month follow-up of a randomized clinical trial.

AIM: The purpose of this observational, post-trial follow-up study was to evaluate 60-month outcomes of a randomized controlled clinical trial that compared immediately and delayed loaded two unsplinted implants, supporting a locator-retained mandibular overdenture. MATERIALS AND METHODS: Patients from a randomized controlled clinical trial, treated with either immediate or delayed loading of two implants, supporting a locator-retained mandibular overdenture, were recalled for 60-month evaluation. Patients underwent a clinical and radiographic examination to evaluate the peri-implant soft tissue parameters and bone. Prosthetic maintenance needs and complications were also recorded. RESULTS: Twenty three of the 30 patients were available for the 60-month follow-up. The mean radiographic bone level change measured using standardized periapical radiographs from baseline to 60 months was 0.89 mm (±0.74) and 0.18 (±0.41) for delayed loading and immediate loading groups, respectively. A statistically significant difference was observed at 60 months with a smaller radiographic bone level change in the immediate loading group. No implants were lost between 12 and 60 months. At 60 months, per-protocol implant survival rate was 100% for both the groups. No difference was found in the peri-implant soft tissue parameters and prosthetic needs between the groups. CONCLUSION: Both immediately and delayed loaded implants supporting a locator-retained mandibular overdenture showed similar clinical outcomes.

Alveolar ridge dimensions in mandibular posterior regions: a retrospective comparative study of dentate and edentulous sites using computerized tomography data.

PURPOSE: To evaluate ridge dimensions at edentulous, mandibular posterior sites, and contralateral dentate sites. METHODS: Computerized tomography scans of 24 patients with one fully edentulous and one fully dentate mandibular posterior region were retrospectively selected. Relative ridge position (rRP), bone height (BH), alveolar canal height (ACH), basal bone height (BBH), and bone width (BW) at 1, 3, and 5 mm apically to the most coronal point of the alveolar crest (BW1mm, BW3mm, and BW5mm, respectively) were measured at posterior dentate sites and contralateral edentulous sites. The proportion of edentulous sites with BH ≥ 9 mm and BW1mm ≥ 6 mm and/or BH ≥ 11 mm and BW3mm ≥ 6 mm was calculated. RESULTS: When compared to dentate sites, edentulous sites showed lower BH, a more apical position of the ridge, lower BW1mm, lower ACH, and similar BBH. The difference in rRP, BH, ACH, BBH, BW1mm, BW3mm, and BW5mm between edentulous and contralateral dentate sites was not significantly different between females and males. The prevalence of edentulous sites with BH ≥ 9 mm and BW1mm ≥ 6 mm and/or BH ≥ 11 mm and BW3mm ≥ 6 mm was higher in females (83.3%) compared to males (58.3%) at second premolar, while was higher in males compared to females at the first molar (83.3 vs 66.6%) and second molar (83.3 vs 75.0%). CONCLUSIONS: In the posterior mandible, edentulous sites show a reduced height and bucco-lingual ridge width compared to contralateral dentate sites. Gender seems to have a limited impact on the extent of ridge resorption following the loss of posterior mandibular teeth.

Morbidity following transcrestal and lateral sinus floor elevation: A randomized trial.

AIM: To comparatively evaluate the morbidity following maxillary sinus floor elevation according to either transcrestal (tSFE) or lateral (lSFE) approach with concomitant implant placement. MATERIALS & METHODS: Patients with ≥1 edentulous maxillary posterior site with residual bone height (RBH) of 3-6 mm were enrolled. tSFE was performed in association with a xenograft and a collagen matrix. For lSFE, the sinus was grafted with the xenograft, and the antrostomy was covered with a membrane. Implants were inserted concomitantly. The postoperative course was assessed through questionnaires. Pain level (VASpain ) was recorded using a 100-mm visual analogue scale. RESULTS: Twenty-nine and 28 patients were included in tSFE and lSFE group, respectively. On the day of surgery, VASpain was significantly higher for tSFE compared to lSFE, and similar from day 1 to 14. tSFE was characterized by significantly lower incidence of swelling, bruising and nasal discharge/bleeding. Significantly less severe limitation in swallowing, continuing daily activities, eating, speaking, opening the mouth and going to school/work was found for tSFE only at specific postsurgery intervals. CONCLUSIONS: lSFE was associated with lower pain on the day of surgery, and tSFE revealed lower postoperative morbidity as well as more tolerable postoperative course.

Osteogenesis During Early Healing Around Titanium and Roxolid Implants: Evaluation of Bone Markers by Immunohistochemistry and RT-PCR Analysis in Miniature Pigs: A Pilot Study.

PURPOSE: A novel approach for the study of early bone formation around dental implants in the miniature pig was evaluated. In addition to the traditional histologic and histomorphometric analysis, the expression of the osteogenic genes was analyzed both at the messenger ribonucleic acid (mRNA) and protein level. MATERIALS AND METHODS: Mandibular premolars and the first molar were extracted in six miniature pigs. After 3 months of healing, 36 specially designed bone chamber implants were placed. Three different implant surface configurations were used: titanium SLA, titanium SLActive, and titanium zirconium SLActive (Roxolid). Each hemi-mandible received three randomly allocated implants (one for each surface type) on both sides of the arch, in a split-mouth design. Three animals were sacrificed after 3 days and another three after 2 weeks of healing post-implant insertion. For each animal the right hemi-mandible underwent qualitative histologic and quantitative histomorphometric analysis. The left hemi-mandible underwent immunohistofluorescence (IHF) analysis. ß-catenin, Runx2, osteopontin, and osteocalcin were analyzed by IHF; osterix, and osteocalcin mRNA expression was also evaluated by quantitative reverse transcription polymerase chain reaction (qRT-PCR). RESULTS: At 3 days after the implantation, all implants were surrounded by blood clot. No provisional matrix or bone was observed inside the chamber. Infection or degenerative lesions were absent. At 2 weeks, the histomorphometric analysis showed no significant difference between the groups concerning the bone area. qRT-PCR showed that Ti SLActive had the highest osteocalcin mRNA expression followed by Ti SLA and Roxolid SLActive. Osterix mRNA expression was higher on Ti SLA and Roxolid SLActive compared to Ti SLActive. The differences were not statistically significant. IHF was only found positive for osteocalcin at 2 weeks. At 3 days, osteocalcin was detected only on native bone. At 2 weeks, osteocalcin was expressed highest by Ti SLActive followed by Roxolid SLActive and TiSLA; however, there was no statistically significant difference between the groups in the osteocalcin expression level. CONCLUSION: The present methodology allowed evaluation of changes in gene expression during the early phase of osteogenesis that seem to be related to the quality of the surface. Further studies with higher power and more specific antibodies are needed to confirm these preliminary findings.

Marginal Bone Response Around Immediate- and Delayed-Loading Implants Supporting a Locator-Retained Mandibular Overdenture: A Randomized Controlled Study.

PURPOSE: Implant-supported mandibular overdentures (OVDs) have been proposed as the gold standard for the treatment of edentulous mandibles. There is limited evidence on the clinical outcomes of immediate loading of two unsplinted implants supporting a mandibular OVD. The purpose of this randomized controlled trial was to evaluate the performance of two unsplinted implants supporting a Locator-retained mandibular OVD over 12 months loaded immediately or after a delay. MATERIALS AND METHODS: Each patient received two implants 4.0 mm in diameter and 8 to 15 mm long. Locator-retained mandibular OVDs were connected to the implants either immediately (IL) or 3 months postsurgery (DL). The primary response variable was radiographic bone loss (RBL) at 6 and 12 months postsurgery. Implant length, insertion torque, implant failure, prevalence of maintenance visits, and prosthetic complications were also recorded. RESULTS: Thirty participants (15 in the IL and 15 in the DL groups) were evaluated at 12 months. The implant cumulative survival rates were 100% and 93% for DL and IL, respectively. The mean RBL from baseline to 1 year was 0.54 (± 0.5) mm and 0.25 (± 0.5) mm for DL and IL, respectively. A statistically significant difference was observed at 12 months, with less RBL in the IL group. Insertion torque and implant length were not correlated with RBL. Also, no difference in frequency of maintenance visits and prosthetic complications was reported between the groups. CONCLUSION: Immediate loading of two unsplinted implants supporting a Locator-retained mandibular OVD seems to be a suitable treatment option. Significantly less RBL was observed after 1 year of loading around IL implants than around DL implants. Furthermore, neither implant length nor insertion torque seemed to affect RBL 1 year after surgical placement.

Randomized controlled multicenter study comparing short dental implants (6 mm) versus longer dental implants (11-15 mm) in combination with sinus floor elevation procedures. Part 2: clinical and radiographic outcomes at 1 year of loading.

AIM: To compare, clinically and radiographically, short dental implants (6 mm) to long implants (11-15 mm) placed with sinus grafting. METHODS: Participants with 5-7 mm of bone height in the posterior maxilla were randomly allocated to receive short implants (GS) or long implants with sinus grafting (GG). Implants were loaded with single crowns 6 months after placement (PR). Patients were re-evaluated 12 months after loading (FU-1). Outcome variables included: Implant survival rate (CSR), marginal bone level alteration (MBL), periodontal probing depth (PPD), bleeding on probing (BoP), plaque control record (PCR) and crown-to-implant ratios (C/I). Statistical analysis was performed using parametric tests. RESULTS: In 97 subjects, 132 implants were re-evaluated at FU-1. The CSR was 100%. The MBL from implant placement (IP) to (PR) was -0.22 ± 0.4 mm for GG and -0.3 ± 0.45 mm for GS (p < 0.001). MBL from IP to FU-1 was -0.37 ± 0.59 mm for GG and -0.22 ± 0.3 mm for GS (p < 0.001). Intergroup comparisons showed non-significant differences for MBL (p > 0.05), PPD (p = 1) and PCR (p = 0.09). BoP was higher in the GS (p = 0.04). The C/I was 0.99 ± 0.17 for GG and 1.86 ± 0.23 for GS (p < 0.001). No correlation was observed between C/I and MBL, (GG: p = 0.13; GS: p = 0.38). CONCLUSIONS: Both treatment modalities provided similar outcomes.

Radiographic evaluation of the maxillary sinus prior to dental implant therapy: A comparison between two-dimensional and three-dimensional radiographic imaging.

PURPOSE: This study was performed to evaluate the diagnostic efficacy of panoramic radiography and cone-beam computed tomography (CBCT) in detecting sinus pathology. MATERIALS AND METHODS: This study was based on a retrospective evaluation of patients who had undergone both a panoramic radiograph and a CBCT exam. A total of 100 maxillary sinuses were evaluated. Four examiners with various levels of expertise evaluated the images using a five-point scoring system. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic efficacy of the two modalities. The image analysis was repeated twice, with at least two weeks between the evaluation sessions. Interobserver reliability was assessed using Cronbach's alpha, and intraobserver reliability was assessed using Cohen's kappa. RESULTS: Maxillary sinus pathology was detected in 72% of the patients. High interobserver and intraobserver reliability were observed for both imaging modalities and among the four examiners. Statistical analyses using ROC curves demonstrated that the CBCT images had a larger area under the curve (0.940) than the panoramic radiographs (0.579). CONCLUSION: Three-dimensional evaluation of the sinus with CBCT was significantly more reliable in detecting pathology than panoramic imaging.

Artifacts in Cone Beam Computed Tomography Image Volumes: An Illustrative Depiction.

INTRODUCTION: The evolution of cone beam computed tomography (CBCT) has brought about a paradigm shift in radiographic evaluation of the maxillofacial skeleton. Because of its low cost, high resolution, and relatively low-radiation dose, CBCT is fast becoming the 3-D imaging modality of choice in dentistry. The ubiquitous availability of this new imaging modality poses unique challenges in understanding this technology and recognizing the associated artifacts that present themselves in the acquired image volumes. There are several artifacts that are inherent to CBCT scans by virtue of the physics behind their acquisition and image reconstruction algorithms. BACKGROUND: An image artifact may be defined as a visualized structure in the reconstructed data that was not originally present in the object or the imaged area of interest. It can be explained as any distortion or error in the image that is unrelated to the subject being studied. Artifacts are induced by discrepancies between the physical conditions of the measuring setup, which is usually the CBCT scanner's technical composition and position of the object under investigation. OBJECTIVE: The objective of this study is to present an illustrative depiction of the most commonly encountered CBCT artifacts with an explanation of how each artifact is caused and how it presents itself in CBCT image volumes. CONCLUSION: Because these artifacts cause significant image degradation and often misrepresent the region of interest, they should be recognized, understood, and taught along with normal CBCT anatomy to facilitate accurate evaluation of the image volumes and prevent inaccurate diagnoses.

Single versus double flap approach in periodontal regenerative treatment.

AIM: to compare the outcomes of a regenerative strategy based on recombinant human platelet-derived growth factor-BB (rhPDGF-BB, 0.3 mg/ml) and ß-tricalcium phosphate (ß-TCP) in the treatment of intraosseous defects accessed with the Single Flap Approach (SFA) versus Double Flap Approach based on papilla preservation techniques (DFA). MATERIALS AND METHODS: Fifteen and 13 defects, randomly assigned to SFA or DFA, respectively, were grafted with rhPDGF-BB + ß-TCP. Probing parameters were assessed before and 6 months after surgery. Pain (VAS(pain)) was self-reported using a visual analogue scale. RESULTS: Twelve SFA sites and DFA 6 sites showed complete flap closure at 2 weeks post-surgery. No significant differences in 6-month changes in probing parameters and radiographic defect fill were found between groups. Significantly lower VAS(pain) was observed in SFA group compared to DFA group at day +1, +2 and +6. A significantly greater number of analgesics were consumed in the DFA group compared to the SFA group at day +1. CONCLUSIONS: When combined with rhPDGF-BB and ß-TCP, the SFA may result in similar clinical outcomes, better quality of early wound healing, and lower pain and consumption of analgesics during the first postoperative days compared to the DFA.

Change in the Gingival Margin Profile After the Single Flap Approach in Periodontal Intraosseous Defects.

BACKGROUND: The aim of the present study is to evaluate the association of patient-related and site-specific factors, as well as the adopted treatment modality, with the change in buccal (bREC) and interdental (iREC) gingival recession observed at 6 months after treatment of periodontal intraosseous defects with the single flap approach (SFA). METHODS: Sixty-six patients contributing 74 intraosseous defects accessed with a buccal SFA and treated with different modalities were selected retrospectively. A two-level (patient and site) model was constructed, with the 6-month changes in bREC and iREC as the dependent variables. RESULTS: (1) Significant 6-month increases in bREC (-0.6 ± 0.7 mm) and iREC (-0.9 ± 1.1 mm) were observed. (2) bREC change was significantly predicted by presurgery interproximal probing depth (PD) and depth of osseous dehiscence at the buccal aspect. (3) iREC change was significantly predicted by presurgery interproximal PD and the treatment modality, with defects treated with SFA in combination with a graft material and a bioactive agent being less prone to iREC increase compared to defects treated with SFA alone. CONCLUSIONS: After buccal SFA, greater post-surgery increase in bREC must be expected for deep intraosseous defects associated with a buccal dehiscence. The combination of a graft material and a bioactive agent in adjunct to the SFA may limit the postoperative increase in iREC.

Randomized controlled multicentre study comparing short dental implants (6 mm) versus longer dental implants (11-15 mm) in combination with sinus floor elevation procedures. Part 1: demographics and patient-reported outcomes at 1 year of loading.

AIM: To test whether or not the use of short dental implants (6 mm) results in an implant survival rate similar to long implants (11-15 mm) in combination with sinus grafting. METHODS: This multicentre study enrolled 101 patients with a posterior maxillary bone height of 5-7 mm. Patients randomly received short implants (6 mm) (group short) or long implants (11-15 mm) with sinus grafting (group graft). Six months later, implants were loaded with single crowns and patients re-examined at 1 year of loading. Outcomes included treatment time, price calculations, safety, patient-reported outcome measures (OHIP-49 = Oral Health Impact Profile) and implant survival. Statistical analysis was performed using a non-parametric approach. RESULTS: In 101 patients, 137 implants were placed. Mean surgical time was 52.6 min. (group short) and 74.6 min. (group graft). Mean costs amounted to 941EUR (group short) and 1946EUR (group graft). Mean severity scores between suture removal and baseline revealed a statistically significant decrease for most OHIP dimensions in group graft only. At 1 year, 97 patients with 132 implants were re-examined. The implant survival rate was 100%. CONCLUSIONS: Both treatment modalities can be considered suitable for implant therapy in the atrophied posterior maxilla. Short implants may be more favourable regarding short-term patient morbidity, treatment time and price.

Immediate Placement and Restoration of an Implant in an Infected Socket in the Esthetic Zone.

INTRODUCTION: Despite recent reports on immediate implant placement in infected sockets, it remains unclear whether positive functional and esthetic results are repeatable in treating teeth with periapical infections. This case report describes important diagnostic factors and decision-making steps in the treatment planning of a fractured tooth with a periapical lesion in the anterior maxilla. CASE PRESENTATION: A healthy, non-smoking 36-year-old male patient presented with the chief complaint of trauma to the right maxillary central incisor. Radiographs displayed horizontal root fracture and a periapical lesion. Treatment comprised extraction of the fractured tooth with minimal trauma, followed by immediate implant placement and provisionalization. Clinical and radiographic analyses at 12 months after surgery showed maintenance of soft- and hard-tissue configuration and symmetry with the contralateral tooth. CONCLUSIONS: A multidisciplinary approach and careful case selection are of utmost importance for the successful treatment of challenging implant therapy. This case report shows esthetic and functional results 1 year after the immediate placement and functional loading of an implant in an infected socket in the esthetic zone.

Corticotomy-assisted molar protraction with the aid of temporary anchorage device.

This case report describes the interdisciplinary management of a 58-year-old woman who was missing lower first molars and supraerupted maxillary first molars. The treatment plan included intrusion of the upper first molars and corticotomy-assisted mandibular second molar protraction with the aid of temporary anchorage devices. Miniscrews were effective in intrusion of the maxillary first molars and protraction of the lower second molars. Although good functional outcome was achieved in 41 months, the corticotomy-assisted procedure did not significantly reduce the treatment time.