Masticatory Function in Stage IV Periodontitis Patients Treated with Fixed Prosthetic Rehabilitations: A Case Series.

The present study assessed the impact of a fixed prosthetic rehabilitation on masticatory function in patients diagnosed with stage IV periodontitis. Eligible participants were adults in need of complex rehabilitation due to masticatory dysfunction. Masticatory function was evaluated using the two-colored chewing gum mixing ability test (VOH) at the diagnostic phase (T0), 1 week after delivery of the prosthetic prototype (T1), and 1 week after delivery of the final prosthetic solution (T2). Ten subjects were treated with a fixed prosthesis following periodontal and implant surgery using an individualized, fully digital workflow. Full-mouth plaque and bleeding scores, pocket depth, and clinical attachment level improved significantly. VOH was 0.472 ± 0.168 at T0, 0.358 ± 0.166 at T1, and 0.250 ± 0.123 at T2. A significant improvement in VOH was observed from T0 to T1 (difference: -0.114; 95% CI: -0.199 to -0.029; P = .014) and from T1 to T2 (difference: -0.108; 95% CI: -0.200 to -0.015; P = .027). From T0 to T2, VOH increased by 44.3%. Self-perceived assessment of masticatory function also improved from T0 to T2 (P = .002). The fixed prosthetic rehabilitation in patients with stage IV periodontitis allowed for a significant improvement in objective and subjective measurements of masticatory function.

Reliability assessment of the 2018 classification case definitions of peri-implant health, peri-implant mucositis, and peri-implantitis.

BACKGROUND: The purpose of this study was to evaluate the reliability and accuracy in the assignment of the case definitions of peri-implant health and diseases according to the 2018 Classification of Periodontal and Peri-implant Diseases and Conditions. METHODS: Ten undergraduate students, 10 general dentists, and 10 experts in implant dentistry participated in this study. All examiners were provided with clinical and radiographic documentation of 25 dental implants. Eleven out the 25 cases were also accompanied by baseline readings. Examiners were asked to define all cases using the 2018 classification case definitions. Reliability among examiners was evaluated using the Fleiss kappa statistic. Accuracy was estimated using percentage of complete agreement and quadratic weighted kappa for pairwise comparisons between each rater and a gold standard diagnosis. RESULTS: The Fleiss kappa was 0.50 (95% CI: 0.48 to 0.51) and the mean quadratic weighted kappa value was 0.544. Complete agreement with the gold standard diagnosis was achieved in 59.8% of the cases. Expertise in implantology affected accuracy positively (p < 0.001) while the absence of baseline readings affected it negatively (p < 0.001). CONCLUSION: Both reliability and accuracy in assigning case definitions to dental implants according to the 2018 classification were mostly moderate. Some difficulties arose in the presence of specific challenging scenarios.

Surgical guides for dental implants: Measurement of the accuracy using a freeware metrology software program.

PURPOSE: Manufacturing-related inaccuracies of surgical guides for static computer-aided implant surgery may contribute to the overall potential error in the obtained implant position. Measuring such inaccuracies before surgery may provide quality control assessment and improve the safety and outcomes of guided implant surgery. This technical report demonstrates a workflow to measure the accuracy of a surgical guide (at the intaglio surface and sleeve housing) using a freeware metrology software program. METHODS: The scan of a milled surgical guide was aligned to and compared with its reference computer-aided design model using a freeware metrology software program (GOM Inspect suite; GOM GmbH). The trueness of the internal surface of the surgical guide was measured as an indicator of adaptation to the supporting tissues. Additionally, some features were constructed to extract the plane at the sleeve entrance and sleeve axis and to set a local coordinate system on them. Linear and angular deviations between the planned and obtained sleeve axes were measured using this system. Such measurements, together with additional known data (sleeve offset and the planned implant length), allowed the estimation of linear errors in implant position at both the implant platform and apex by applying common geometric formulas, based on the assumption that all other sources of error in implant position could be effectively controlled during the surgical procedure. CONCLUSIONS: The proposed digital technique is a cost-effective approach for quality control of the inaccuracies of a surgical guide and predicts the related potential error in implant position.

Clinical decision-making and management of stage IV periodontitis: A survey.

OBJECTIVE: To investigate the clinical management of stage IV periodontitis patients among clinicians within the Italian Society of Periodontology and Implantology. METHODS: A cross-sectional study was designed on a web-based anonymous survey. Comparison between ordinary members (OMs) versus active and certified members (ACMs) and comparison between members with at least 10 years of experience in periodontology (Ov10) and members with less than 10 years of experience in periodontology (Un10) were performed. RESULTS: A total of 324 out of 1362 members (response rate of 24%) responded to the questionnaire. ACMs and Ov10 more often reported their teams hold adequate skills to manage cases. Step I and II periodontal therapy took more time in the ACMs and Ov10 groups. ACMs used different strategies to perform step I-II therapy, and antibiotics were used less frequently than OMs. Unresponsive sites were treated more often with surgery by ACMs compared to OMs. ACMs adopted different treatment sequences compared to OMs. Ov10 group used more often CBCT, lateral cephalogram, and wax-up while Un10 group tend to avoid orthodontic therapy. CONCLUSIONS: More experienced members spent more time in step I and II of periodontal therapy, used more diagnostic tools, and performed more often surgery and orthodontics in the treatment of stage IV periodontitis patients.

The Multilayer GBR Technique: An Alternative Approach for One-Stage Transmucosal Implant Placement in the Presence of Horizontal Defects. A Case Series.

This study presents a one-stage technique for horizontal guided bone regeneration and transmucosal implant placement in the presence of hard and soft tissue defects. The proposed technique uses autologous bone particles, deproteinized bovine bone matrix, collagen membranes, and concentrated growth factor membranes to create a multilayer barrier and enhance tissue regeneration. Four patients were treated with a total of seven implants. Digital analyses of intraoral scan data taken at baseline and at 6 months postsurgery showed a mean increase in tissue volume of 157.4 mm3. The patient satisfaction was high, and no complications were observed.

Lateral Sinus Floor Elevation in the Severely Atrophied Maxilla: Concentrated Growth Factors Versus Bone Substitutes. A Controlled Clinical Trial.

The present study clinically and radiographically compares the outcome of implants inserted in maxillary sinuses augmented with concentrated growth factors (CGFs) or demineralized bovine bone matrix (DBBM) in a one-stage lateral approach. In 20 patients with a residual bone height of 1 to 4 mm, lateral sinus floor elevation was performed, using CGFs or DBBM as the sole grafting material, with simultaneous implant placement. Outcome variables were implant and prosthesis failures, complications, subjective satisfaction, and radiographic changes in marginal bone level (MBL) 12 months after surgery. The patients were consecutively recruited: 10 to the CGF group and 10 to the DBBM group. No implant failed in either group at 12 months postsurgery, and there were no complications. There was no statistically significant difference in MBL change between the CGF and DBBM groups (difference of -0.3 mm, favoring the CGF group; 95% confidence interval [CI]: -0.8 to 0.2; P = .18). There was no statistically significant difference in satisfaction (difference of 0.2, favoring the CGF group; 95% CI: -0.2 to 0.6; P = .29). Within the limitations of the present study, the lateral sinus floor elevation performed with the use of CGFs as the sole grafting material showed implant survival rates and marginal bone level changes comparable to DBBM grafting.

Use of autogenous bone versus deproteinised bovine bone matrix in one-stage lateral sinus floor elevation in severely atrophied maxillae: A 7-year randomised controlled trial.

PURPOSE: To compare 100% deproteinised bovine bone matrix grafts (DBBM, test group) and 100% autogenous bone grafts (AB, control group) for lateral maxillary sinus floor elevation in a blinded, parallel-group, randomised clinical trial. MATERIALS AND METHODS: Patients with 1 to 3 mm of residual bone height were randomised for sinus floor elevation with DBBM or AB grafts and simultaneous implant placement. The outcome variables were implant failure, complications, subjective satisfaction and radiographic peri-implant bone level 7 years after loading. RESULTS: A total of 20 patients (27 implants) were randomised to the test group and 20 (32 implants) to the control group. Ten patients from the test group and seven from the control group dropped out. Two implant failures occurred in the test group, whereas none were observed in the control group (P = 0.178). One complication occurred in the test group and two were recorded in the control group (P = 1.000). The radiographic peri-implant crestal bone level was 2.5 ± 1.3 mm in the test group and 0.9 ± 0.9 mm in the control group. The difference was 1.6 mm, favouring the control group (95% confidence interval 0.7-2.6; P = 0.002). The difference in vertical bone height was -0.4 mm, favouring the control group (95% confidence interval -1.9-1.1; P = 0.590). The difference in satisfaction measured using a visual analogue scale 7 years after loading was 0.0 mm (95% confidence interval -1.0-0.0; P = 0.639). CONCLUSIONS: Differences between treatments were found for crestal bone level, favouring the control group. No differences were observed for the other variables evaluated.

The Wafer Technique: Histomorphometric Results.

This study presents the histomorphometric results of the Wafer Technique, which is based on guided bone regeneration and onlay grafts for 3D bone augmentation. This two-stage technique utilizes autogenous cortical bone plates and collagen membranes, forming a barrier containing a mixture of deproteinized bovine bone matrix, autologous blood, and bone grafted from intraoral sites. Twelve patients were treated. At 6 months postsurgery, histologic analysis of the regenerated areas revealed the presence of compact newly formed bone with no sign of inflammation. The percentages of new bone and native bone (mineralized tissue) were 16.4% (95% CI: 9.5% to 23.2%) and 42.6% (95% CI: 28.2% to 57.0%), respectively. Twenty-five implants were placed. The procedure has been proven to be safe and reliable, and only one transient complication was observed.

The fence technique: Autogenous bone graft versus 50% deproteinized bovine bone matrix / 50% autogenous bone graft-A clinical double-blind randomized controlled trial.

OBJECTIVES: The aim of this short-term double-blind, parallel, randomized clinical trial was to compare bone augmentation grafting with 100% autogenous bone (AB) or 50% deproteinized bovine bone matrix (DBBM)/ 50% autogenous bone (BOAB) using a guided bone regeneration procedure, the fence technique, in a two-stage implant placement. MATERIAL AND METHODS: Partially edentulous patients with extensive three-dimensional osseous defects were included in this study. The main outcome measure was the differences in bone volume from pre-surgery (T1) to 6 months post-surgery (T2). Bone height, chair-time, pain, functional limitation, and complications were also assessed. RESULTS: Fifteen patients were allocated to the AB group and 15 patients to the BOAB group. The difference in bone volume from T1 to T2 was 648 mm3 for the AB group and 869mm3 for the BOAB group (difference between groups 221 mm3 , 95% CI from -363 to 804, p = .442). The surgery pain VAS was 1.6 for the AB group and 2.3 for the BOAB group (difference between groups 0.8, 95% CI from 0.0 to 1.5, p = .045 favoring the AB group). The height difference in bone from T1 to T2 was 2.2 mm for the AB group and 3.7 mm for the BOAB group (difference between groups 1.5mm, 95% CI from 0.1 to 2.9, p = .038 favoring the BOAB group). For complications, chair-time, post-surgery pain, and functional limitation, there were no differences between AB and BOAB. CONCLUSIONS: No significant differences, except for surgery pain VAS and difference in bone height, were observed in this trial comparing grafting with AB or BOAB.

Short-term comparison of two non-surgical treatment modalities of peri-implantitis: Clinical and microbiological outcomes in a two-factorial randomized controlled trial.

AIM: To compare the efficacy of two different therapies (amino acid glycine abrasive powder and a desiccant material) and their combination in the non-surgical treatment of peri-implantitis. MATERIALS AND METHODS: This was an examiner-blind randomized clinical trial, with 2-factorial design with a follow-up of 6 months. The combination of the two factors resulted in four interventions: (a) non-surgical debridement alone (C); (b) non-surgical debridement and a desiccant material (H); (c) non-surgical debridement and glycine powder (G); and (d) non-surgical debridement, desiccant material and glycine powder (HG). RESULTS: Sixty-four patients with peri-implantitis were randomized, 16 for each intervention. After six months, two implants failed in the G intervention. Mean pocket depth reduction was higher in patients treated with the desiccant material (estimated difference: 0.5 mm; 95% CI from 0.1 to 0.9 mm, p = .0229) while there was no difference in the patients treated with glycine powder (estimated difference: 0.1 mm; 95% CI from -0.3 to 0.5 mm, p = .7333). VAS for pain during intervention and VAS for pain after one week were higher for patients treated with glycine powder (p = .0056 and p = .0339, respectively). The success criteria and other variables did not reveal differences between interventions. CONCLUSIONS: In this 6-month follow-up study, pocket reduction was more pronounced in patients using the desiccant material. Pain was higher in patients using glycine. All the interventions resulted in low success rate.

Immediate versus early non-occlusal loading of dental implants placed flapless in partially edentulous patients: A 10-year randomized clinical trial.

AIM: To compare immediate versus early non-occlusal loading of dental implants placed flapless in a 10-year, parallel group, randomized clinical trial. MATERIALS AND METHODS: Patients were randomized to receive implants for fixed partial dentures. The immediate group was represented by immediate non-occlusal implant loading, whereas the early group was represented by early non-occlusal implant loading. The outcome variables were implant failure, complications, subjective satisfaction and radiographic bone level at implant sites 10 years after loading. RESULTS: Sixty patients were randomized: 30 to the immediately loaded group and 30 to the early loaded group. Three patients dropped out in the immediate group, and three patients dropped out in the early group. One implant failure occurred in the early group (p = 1.0). Three complications occurred in the immediate group and four in the early group (RR = 0.75, 95% CI 0.19 to 3.04, p = 1.0). The difference in bone level was 0.1 mm (95% CI -0.2 to 0.5, p = .3752) favouring the early group. Difference in subjective functional satisfaction was 0.2 (95% CI -0.2 to 0.7; p = .3271). Difference in subjective aesthetic satisfaction was 0.0 (95% CI -0.4 to 0.4; p = .9656). CONCLUSION: At 10-year follow-up, no differences between implants loaded immediately and early were detected in this randomized clinical trial.

The Fence Technique: 100% Autogenous Bone Graft vs 50% Deproteinized Bovine Bone Matrix and 50% Autogenous Bone Graft. A Histologic Randomized Controlled Trial.

The aim of this histologic, single-blind, parallel, randomized clinical trial was to compare vertical bone augmentation grafting with 100% autogenous bone (group AB) vs 50% deproteinized bovine bone matrix (DBBM)/50% autogenous bone (group BOAB) using the Fence Technique in a two-stage implant placement. A biopsy was performed in the regenerated area at implant insertion 6 months after the augmentation surgery. The results reflect a sample size of four patients treated per group. At implant placement, 6 months after grafting, no significant differences were evident in the histomorphometric comparisons, even if the percentage of residual graft was obviously greater in the BOAB group (P = .0314).

Comparing membranes and bone substitutes in a one-stage procedure for horizontal bone augmentation. Three-year post-loading results of a double-blind randomised controlled trial.

PURPOSE: The objective of this 3-year post-loading parallel randomised controlled trial is to compare two bone substitutes and resorbable membranes in a one-stage procedure for horizontal bone augmentation: anorganic bovine bone and porcine collagen membranes (BB group) versus synthetic resorbable bone graft substitute made of pure ß-tricalcium phosphate and porcine pericardium collagen membranes (CJ group). MATERIALS AND METHODS: Patients in need of implant treatment having at least one site with horizontal osseous defect at a private clinic in Rimini, Italy, were included in this study. Patients were randomised to receive either BB or CJ in a one-stage procedure for horizontal bone augmentation in a submerged approach. Randomisation was computer-generated with allocation concealment by opaque sequentially numbered sealed envelopes. Patients and the outcome assessor were blinded to group assignment. The abutment connection was made after 6 months of healing. The application of the provisional prosthesis was performed after abutment connection and a definitive metal-ceramic prosthesis was placed 6 months post-loading. The patients were followed-up to 3 years post-loading. Primary outcome measures were: implant failure, complications and peri-implant margin bone level changes. Secondary outcome measures were: visual analogue scale (VAS) for functional and aesthetic satisfaction and pink aesthetic score (PES). RESULTS: Twenty-five patients with 32 implants were randomly allocated to the BB group and 25 patients with 29 implants to the CJ group. All 50 randomised patients received the treatment as allocated and there were 7 drop-outs in the BB group and 11 drop-outs in the CJ group up to 3 years' post-loading. There were no implant failures. There were six complications in five patients of the BB group and three complications in three patients of the CJ group (relative risk: 1.32, 95% CI from 0.37 to 4.64, P = 1.0000). Radiographic bone loss was 1.61 mm for the BB group and 1.02 mm for the CJ group (difference 0.54 mm, 95% CI from -0.53 to 1.60, P = 0.3100). The functional VAS was 9.0 for the BB group and 9.6 for the CJ group (difference 0.6, 95% CI from -0.4 to 1.5, P = 0.2393). The aesthetic VAS was 9.4 for the BB group and 9.6 for the CJ group (difference 0.2, 95% CI from -0.5 to 0.8, P = 0.6141). PES was 8.7 for the BB group and 8.5 for the CJ group (difference -0.1, 95% CI from -2.9 to 2.7, P = 0.9360). CONCLUSIONS: No significant differences were observed in this randomised controlled trial comparing anorganic bovine bone with porcine collagen membranes versus synthetic resorbable bone made of pure ß-tricalcium phosphate with pericardium collagen membranes for horizontal augmentation.

Implant prosthetic rehabilitation in partially edentulous patients with bone atrophy. An umbrella review based on systematic reviews of randomised controlled trials.

PURPOSE: To summarise systematic reviews that assess the effects of different interventions for implant prosthetic rehabilitation in partially edentulous patients with the presence of bone atrophy. MATERIALS AND METHODS: Only systematic reviews of randomised controlled trials (RCTs) dealing with partially edentulous adult patients presenting bone defects were included. Treatments of interest were bone augmentation procedures, use of short, tilted or zygomatic implants, sinus lift and transposition of the inferior alveolar nerve. Outcome variables considered were: prosthetic and implant failure, complications, radiological and clinical peri-implant bone level variation, aesthetic and functional satisfaction, and vestibular peri-implant soft tissue recession. A search of systematic reviews of RCTs selected from MEDLINE, the Cochrane Database of Systematic Review, and the Prospero register published in the past 5 years (May 2012 - May 2017) was performed. Systematic reviews were also manually searched. Independent data extraction by two authors using predefined data fields, including ROBIS risk of bias, was executed. RESULTS: A total of 12 systematic reviews of RCTs were identified for inclusion in the overview. Eight reviews were considered at low risk of bias. Short implants (≤ 8 mm) were associated with a notable decrease in complications compared to long implants with bone augmentation procedures. Many trials compared different sinus lift procedures and different bone augmentation techniques. None of these indicated that one procedure could reduce prosthetic or implant failures when compared to the other. The use of a membrane can contribute to the regeneration of the hard tissue in horizontal augmentation. Different membranes or bone substitutes did not give substantially different results. No data are available regarding comparisons involving zygomatic implants or tilted implants or transposition of the alveolar nerve. CONCLUSIONS: Overall, the evidence is not sufficiently robust to determine the best treatment for implant prosthetic rehabilitation in partially edentulous patients presenting bone atrophy. In terms of vertical defects, if the short implants can be used they should be used because the number of complications are reduced compared to longer implants with sinus lift or bone augmentation. Nevertheless, caution should be exercised because long-term follow-up studies were not available. No conclusions can be drawn regarding the comparison between different vertical bone augmentation techniques in atrophic posterior mandible because quantitative meta-analyses were not performed. With regards to horizontal defects, the use of a membrane appears to increase the regeneration of the hard tissue but no differences were detected in prosthesis or implant failures or in complications.

Short, parallel-walled, conical-connection implants for a broad range of indications in the maxilla and mandible: Retrospective multicenter study with up to 33 months of follow-up.

OBJECTIVE: To evaluate the survival and complication rate of 7-mm short, parallel-walled, conical-connection implants in daily practice. METHOD AND MATERIALS: This multicenter retrospective study included 219 consecutive patients who received 323 implants. Indication was limited vertical bone height preventing placement of implants longer than 7 mm. Placement and loading protocols were determined on a case-by-case basis and included placement in fresh extraction sockets and healed sites, and loading was either immediate, early, or delayed. Patients were followed for up to 33 months. Outcome measures were implant survival rate and any biologic or technical complications. RESULTS: In total, eight implants in seven patients failed, accounting for the survival rate of 97.3% at implant level and 96.4% at patient level. The mean time to failure was 7.5 months and 10.2 months at the implant and patient level, respectively. The majority of patients (67.1%) received one implant and the placement was predominantly in healed sites (82.7%). Immediate loading was done for 21.4% of implants placed in the extraction site and for 21.3% of implants placed in healed sites. In most of the cases (71.8%) implants were placed in the premolar or molar position in the mandible. No complications were reported. CONCLUSION: These results suggest that in cases of limited vertical bone height, the short, parallel-walled, conical-connection implant can successfully support different prosthesis types in a wide variety of indications and loading protocols.

Ceramic vs composite veneering of full arch implant-supported zirconium frameworks: assessing patient preference and satisfaction. A crossover double-blind randomised controlled trial.

PURPOSE: The objectives of this two-period, crossover, mono-centred, double-blind, randomised controlled trial (RCT) were to compare two different materials used for full arch implant-supported prosthetic restorations with regard to patient preference and impact on a patient's quality of life. MATERIALS AND METHODS: Edentulous patients requesting one full arch restoration in the mandible or maxilla supported by dental implants were included in this study. Patients were randomised to receive either a full arch zirconia framework hand-veneered with ceramic, or a full arch zirconia framework hand-veneered with composite material. After 1 month, the first randomised restoration was substituted by the other, which was left in function for a further observation period of 1 month. Outcome measures were: patient preference and satisfaction (OHIP-21), complications, visual analogue scales for chewing comfort, aesthetic acceptance, phonetic comfort, full mouth plaque score (FMPS). RESULTS: Twenty-four patients were randomised to the treatments in the two periods. There was one dropout. At the end of the study, 16 patients (70%) preferred to wear ceramic prosthesis and 7 patients (30%) preferred to wear composite prosthesis (ceramic preference: 70%; 95%CI from 47 to 87%; P = 0.0605). Difference in OHIP-21 reduction between the two treatments was not significant (difference 0.5, 95%CI from -2.8 to 3.8, P = 0.7788). There was one minor complication during the ceramic period in one patient and one minor complication during the composite period in another patient (odds ratio 1.00, 95%CI from 0.06 to 15.99, P = 1.0). The difference in FMPS between treatments was not significant (0.5, 95%CI from -1.3 to 2.2, P = 0.5731). Difference in VAS between the two treatments was not significant for general satisfaction (P = 0.2067), chewing comfort (P = 0.8345) and phonetics (P = 0.9167). Difference in VAS between the two treatments was significant for aesthetic acceptance favouring the ceramic prosthesis (difference 0.9, 95%CI from 0.006 to 1.8, P = 0.0486). CONCLUSIONS: No difference between the two treatments was detected for preference, changes of OHIP-21, complications, reduction of FMPS, VAS changes regarding patient satisfaction, chewing and phonetics. Nevertheless, a slight difference was detected in the VAS regarding aesthetic acceptance favouring the ceramic material. FUNDING: The study was supported by Nobel Biocare (grant 2012-1077). Thanks to this contribution, the patients who consented to participate in this RCT were not charged for the material provided by Nobel Biocare. In addition, the patients benefited from a further back-up prosthesis that was provided to them completely free of charge.

A Novel Approach to Bone Reconstruction: The Wafer Technique.

This study presents a novel technique based on guided bone regeneration and onlay grafts for three-dimensional bone augmentation. This two-stage technique uses an autogenous cortical bone plate and collagen membranes to form a barrier containing a mixture of deproteinized bovine bone matrix, autologous blood, and bone grafted from intraoral sites. Five patients were treated. At 6 months postsurgery, a mean increase in bone volume of 1,062 mm³ was shown. Mean maximum linear augmentation was 3.65 mm. Histologic analysis of the regenerated areas revealed the presence of compact newly formed bone with no sign of inflammation. A total of 13 implants were placed. The patients were satisfied, and complications were not observed.

Peri-implant bleeding on probing: a cross-sectional multilevel analysis of associated factors.

OBJECTIVES: The objective was to evaluate the association between peri-implant bleeding on probing (BoP) and probing depth. Other factors regarding patients, implants, and sites were taken into consideration. MATERIAL AND METHODS: Consecutive adult patients with ≥1 dental implant were eligible. Two calibrated operators examined the patients. BoP was the outcome variable. The effects of patient, implant and site factors on BoP were assessed using a 3-level logistic model. RESULTS: Fifty-two patients for a total of 92 implants and 552 sites were included in the analysis. The BoP was observed in 217 sites (39%). The odds ratio increased by 1.81 (95% CI from 1.47 to 2.23; P < 0.0001) for each 1 mm increment in probing pocket depth. A significant higher risk was observed also for interproximal vs. approximal surfaces (OR = 1.55; 95% CI from 1.02 to 2.36; P = 0.0402). CONCLUSIONS: Peri-implant bleeding was associated with site-specific factors.

Bone augmentation at implant dehiscences and fenestrations. A systematic review of randomised controlled trials.

PURPOSE: To evaluate the efficacy of the bone augmentation procedure at dehiscence or fenestration defects in one-stage implant insertion and to evaluate which is the most effective procedure. MATERIALS AND METHODS: A systematic review of articles selected from MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL) and Google Scholar was performed. Additional studies handsearched and found in printed versions of the principal dental implant journals were included. Only randomised controlled trials (RCTs) were included. Outcome variables considered were implant failure, complications, aesthetic and functional satisfaction, complete fill of the defect, clinical and radiological bone level variation, and vestibular peri-implant recession. Independent data extraction by two authors using predefined data fields, including study quality indicators, was completed. All pooled analyses were based on random effects models. RESULTS: A total of 65 full-text articles were examined in detail. Forty-six of the 65 articles did not meet the inclusion criteria. Nineteen articles involving 15 trials were identified for inclusion in the review. Only one study was considered to be at a low risk of bias. The included studies involved 396 patients and 535 implants. Comparing the test group using membranes with the control without membranes, a statistically significant difference was obtained for vertical variation of the peri-implant defect; the difference was 1.64 mm (three RCTs, 95% CI from 0.47 to 2.80 mm; P = 0.006, I2 = 0%) favouring the use of a membrane. Non-resorbable polytetrafluoroethylene (ePTFE) membranes obtained a complete clinical fill of defects more frequently than resorbable polylactide/polyglycolide (PLGA) membranes. The odds ratio was 0.15 (two RCTs, 95% CI from 0.04 to 0.64 mm; P = 0.01, I2 = 0%), favouring the use of ePTFE membranes. No differences were observed comparing nonresorbable ePTFE membranes and resorbable collagen membranes. The comparison between crosslinked membranes and collagen native membranes yielded a very high heterogeneity for vertical variation of the peri-implant defect (two RCTs, I2 = 91%, P = 0.001). Dehiscence complications were more frequent using cross-linked membranes but the odds ratio was not significant (three RCTs, odds ratio 0.44, 95% CI from 0.18 to 1.10; P = 0.08, I2 = 4%). CONCLUSIONS: Overall, the evidence is not sufficiently robust to determine if any treatment is needed and which is the best treatment for dehiscence or fenestration defects at one-stage implant placement. Only 15 trials were included and the majority are of limited sample size, have short follow-ups as well as having a high risk of bias. The use of a membrane can contribute to the regeneration of the hard tissue in horizontal one-stage augmentation. The complete fill of the defect was obtained more frequently when a non-resorbable ePTFE membrane was used compared to a resorbable PLGA membrane. No differences were observed comparing non-resorbable ePTFE membranes and resorbable collagen membranes. No substantial differences were obtained using different non-resorbable membranes and grafts, and the results were positive for the variables examined. A high result of heterogeneity was observed in studies dealing with cross-linked membranes.

A minimally invasive technique for lateral maxillary sinus floor elevation: a Bayesian network study.

OBJECTIVES: To describe a minimally invasive technique for lateral maxillary sinus elevation and to identify the relationship between the involved factors. MATERIALS AND METHODS: This is a retrospective study on patients treated with an original minimally invasive technique for lateral maxillary sinus elevation in a private dental clinic from 2008 to 2013. Failures, complications, and radiographic measurements were registered 9 months after surgery at the provisional prosthesis delivery. The relationship between demographic and clinical factors was investigated using Bayesian network analyses. RESULTS: One hundred and twenty-four patients (147 maxillary sinuses) were treated, and 242 implants were placed. Seven patients dropped out. A total of two implants in two patients failed. Perforation of the sinus membrane occurred in seven patients (6%). Five different complications in five patients were observed. Mean peri-implant marginal bone level 9 months after surgery was 1.10 ± 0.74 mm. Mean vertical bone gain was 7.44 ± 1.95 mm. Perforation was more frequently observed in patients that did not undergo the sedation procedure. Complications (excluding perforation and including implant failure) were more frequent in cases where only bone substitutes were used. CONCLUSIONS: This technique can be considered noninvasive, with a low early failure and early complication rate.