Clinical outcomes and significance of postoperative ultrasound biomicroscopy in patients with Boston type 1 keratoprosthesis

ABSTRACT Purpose: To determine the clinical outcomes in patients after type 1 Boston keratoprosthesis surgery and the significance of ultrasound biomicroscopy imaging for postoperative follow-up. Methods: This retrospective analysis included 20 eyes of 19 patients who underwent corneal transplantation with type 1 Boston keratoprosthesis between April 2014 and December 2021. Data on patient demographics, preoperative diagnosis, visual acuity, and postoperative clinical findings were analyzed. Results: Type 1 Boston keratoprosthesis implantation resulted in intermediate- and long-term positive outcomes. However, blindness and other serious complications such as glaucoma, retroprosthetic membrane formation, endophthalmitis, or retinal detachment also occurred. The use of ultrasound biomicroscopy imaging allowed for better evaluation of the back of the titanium plate, anterior segment structures, and the relationship of the prosthesis with surrounding tissues, which provided valuable postoperative information. Conclusion: Regular lifetime monitoring and treatment are necessary in patients who undergo Boston type 1 keratoprosthesis implantation for high-risk corneal transplantation. ultrasound biomicroscopy imaging can be a valuable imaging technique for the evaluation of patients with Boston type 1 keratoprosthesis, providing important information on anterior segment anatomy and potential complications. Further studies and consensus on postoperative follow-up protocols are required to optimize the management of patients with Boston type 1 keratoprosthesis.

[Role of cranioplasty in the management of decompressive craniectomies: Study of the Adolphe de Rothschild Foundation Hospital cohort over 7 years]. / Place de la cranioplastie dans la prise en charge des crâniectomies décompressives : étude de la cohorte de l'Hôpital Fondation Adolphe de Rothschild sur 7 ans.

OBJECTIVES: The objective of our study is to take stock of the cranioplasty implants used within our establishment. MATERIALS AND METHOD: We analyzed the patients files who underwent craniectomy followed by cranioplasty between 2017 and 2023, with at least 1 year of follow-up after cranioplasty (n=75). The data were extracted from the computerized patient file (DxCare®, Dédalus) and the pharmaceutical management tool for drugs and sterile medical devices (Pharma®, Computer Engineering). The sex ratio, indication for craniectomy, operating time, time between craniectomy and cranioplasty, complications and aesthetic result were statistically analyzed. RESULTS: The main indications are stroke (n=59; 78.5%) and aneurysms (n=7; 9.5%). Among the 75 patients, 52 benefited from the placement of a custom implant (PolyEtherEtherCetone/PEEK or Hydroxyapatite) and 23 from cementoplasty. The operating time was significantly shorter (P<0.05) for custom cranioplasty (1.93±0.61h vs. 1.62±0.53). Only 4 patients (5.3%) were not satisfied with the aesthetic result following the placement of a custom implant. A greater risk of infection was found in the context of cementoplasty (43% for cementoplasties vs. 25% for the custom implant, so χ2 (P=0.1095), this difference not being statistically significant. CONCLUSION: This collaborative work between the pharmacy and the adult neurosurgery department served to establish an initial register for monitoring patients who have undergone cranioplasty for whom the ideal implant remains to be determined.

Alternating magnetic fields (AMF) and linezolid reduce Staphylococcus aureus biofilm in a large animal implant model.

OBJECTIVES: We aimed to evaluate the effectiveness of alternating magnetic fields (AMF) combined with antibiotics in reducing Staphylococcus aureus biofilm on metal implants in a large animal model, compared to antibiotics alone. METHODS: Metal plates were inoculated with a clinical MRSA strain and then implanted into thirty-three ewes divided into three groups: positive control, linezolid only, and a combination of linezolid and AMF. Animals had either titanium or cobalt-chrome plates and were sacrificed at 5 or 21 days post-implantation. Blood and tissue samples were collected at various time points post-AMF treatment. RESULTS: In vivo efficacy studies demonstrated significant biofilm reduction on titanium and cobalt-chrome implants with AMF-linezolid combination treatment compared to controls. Significant bacterial reductions were also observed in surrounding tissues and bones. Cytokine analysis showed improved inflammatory responses with combination therapy, and histopathology confirmed reduced inflammation, necrosis, and bacterial presence, especially at 5 days post-implantation. CONCLUSIONS: This study demonstrates that combining AMF with antibiotics significantly reduces biofilm-associated infections on metal implants in a large animal model. Numerical simulations confirmed targeted heating, and in vivo results showed substantial bacterial load reduction and reduced inflammatory response. These findings support the potential of AMF as a non-invasive treatment for prosthetic joint infections.

Analysis of osseointegration of implants with macrogeometries with healing chambers: a randomized clinical trial.

BACKGROUND: To verify the influence of macrogeometry with healing chambers on the osseointegration of dental implants by analyzing implant stability quotient (ISQ) and evaluate the correlation between insertion torque and ISQ insertion with different macrogeometries. METHODS: In total, 26 implants were installed in the posterior mandible of eight patients with sufficient bone height for the installation of implants measuring 3.5 mm in diameter and 9.0 mm in length. The implants were categorized according to two types of macrogeometry: a test group (GT) with 13 conical implants with healing chambers and a control group (GC) with 13 conical implants with conventional threads. To insert the implants, a bone drilling protocol was used up to a diameter of 3 mm with the last helical bur. The insertion torque of the implants was evaluated, followed by the measurement of ISQ at 0 (T-0), 7 (T-7), 14 (T-14), 21 (T-21), 28 (T-28), and 42 (T-42) days. RESULTS: The mean insertion torque was 43 Ncm in both groups, without a significant difference. Moreover, no significant difference in the ISQ values was found between the groups at different time points (p > 0.05), except at T-7 (GT = 69.87±1.89 and GC = 66.48±4.49; p = 0.01). Although there was no significant difference, ISQ median values were higher in the GT group than GC group at 28 days (GT = 67.98 and GC = 63.46; p = 0.05) and 42 days (GT = 66.12 and GC = 60.33; p = 0.09). No correlation was found between the insertion torque and ISQ insertion (p > 0.05). CONCLUSION: Furthermore, implants with a 3.5 mm diameter macrogeometry, with or without healing chambers, inserted with a drilling protocol up to 3 mm in diameter of the last helical bur, led to a similar secondary stability, with no difference in ISQ values. Although, implants with healing chamber demonstrates ascending values in the graph of ISQ, having a trend of faster osseointegration than implants without healing chambers. Both macrogeometries provide a similar primary stability to implants. TRIAL REGISTRATION: This study was registered retrospectively in ReBec (brazilian registry of clinical trials) under the number RBR-96n5×69, on the date of 19/06/2023.

Effectiveness of dexamethasone implants in treating diabetic macular edema with hard exudates: a clinical observation.

OBJECTIVE: This study seeks to explain the relationship between systemic conditions and hard exudate formations in diabetic macular edema patients. Besides, the study aimed to quantitatively examine changes in the area, location, and impact on visual function of hard exudates following intravitreal dexamethasone implant injections. METHODS: A retrospective analysis was conducted, including 40 patients (40 eyes) diagnosed with non-proliferative diabetic retinopathy and concurrent macular edema between January 1, 2022, and January 1, 2024. Preoperative evaluations included glycated hemoglobin, lipid profile, and renal function examinations. Based on the location of HE, patients were divided into two groups: Group A, with HE in 1 mm of the central fovea, and Group B, with HE outside 1 mm of the central fovea. Selected eyes were subject to pre- and postoperative examinations, including best-corrected visual acuity (BCVA), intraocular pressure, slit-lamp biomicroscopy, scanning laser ophthalmoscopy (SLO), optical coherence tomography, and multifocal electroretinography. Following screening and examination, patients received an immediate intravitreal injection of the DEX implant, with an injection administered at the four-month mark. Hard exudate (HE) areas were measured utilizing SLO fundus imaging. RESULTS: Total cholesterol, low-density lipoprotein, and triglyceride levels were found to be positively correlated with the presence of HE. Following surgical intervention, all patients demonstrated an improvement in BCVA. The mean BCVA increased from a preoperative measurement of 0.79 ± 0.04 to 0.39 ± 0.02 at the 6 month follow-up, indicating a statistically significant difference (p < 0.001). The baseline HE area for the entire patient cohort was 2.28 ± 0.22. One month post-operation, the HE area exhibited a slight increase to 2.27 ± 0.22. However, by the 6 month follow-up, the HE area had significantly decreased to 0.8 ± 0.87, representing a 35.09% reduction from the baseline measurement (p < 0.001). It is worth noting that Patient P1 did not exhibit a statistically significant difference between preoperative and six-month postoperative HE area (p = 0.032). Preoperative BCVA measurements for Group A and Group B were 0.81 ± 0.03 and 0.77 ± 0.03, respectively, with no statistically significant intergroup difference (p = 0.333). The baseline HE area for Group A was 2.61 ± 0.16, which decreased to 0.38 ± 0.20 at the six-month follow-up, representing a 14.60% reduction from the baseline total area. For Group B, the baseline HE area was measured at 1.95 ± 0.09, then decreasing to 1.21 ± 0.13 at the six-month follow-up, indicating a 62.05% reduction from the baseline total area. A statistically significant difference in the postoperative 6 month HE area was observed between Group A and Group B (p < 0.001). In Group A, the reduction in HE area (initial HE area-final HE area) was positively correlated with the improvement in P1 (initial P1-final P1) (r = 0.610, p = 0.004). In Group B, a similar positive correlation was found (initial HE area-final HE area with initial P1-final P1) (r = 0.488, p = 0.029). In Group B, the reduction in HE area (initial HE area-final HE area) correlated positively with the improvement in BCVA (initial BCVA-final BCVA) (r = 0.615, p = 0.004). Additionally, in Group B, the reduction in HE area (initial HE area-final HE area) was positively correlated with the improvement in CMT (initial CMT-final CMT) (r = -0.725, p< 0.001). Aggravated cataracts were observed in thirteen eyes during a follow-up examination 6 months later. CONCLUSION: HE formation is associated with lipid levels. Dexamethasone implants demonstrate effectiveness in reducing HE areas in the short term, reducing macular edema, improving retinal structure, and enhancing visual function. The incidence of postoperative complications such as cataracts and glaucoma remains low.

Impact of graphene incorporation in dental implants-A scoping review.

There are numerous variables governing the formation of new bone around a dental implant. Of those variables, the implant surface is an important factor influencing the quality of osseointergration. Numerous techniques and materials have been used to alter the surface of an implant to enhance osseointergration and improve the survival and success rate. One such modification is utilizing graphene to modify the surface of an implant. This paper summarizes data collected form articles published in online databases in the past 10 years about the various means of modifying the implant surfaces and provides an in-depth review of the impact of graphene incorporation in dental implants. The document comprised of different sections and emphasized on the use of graphene as an implant surface coating material. The role of graphene on flexural strength, hardness and corrosion resistance have been discussed under mechanical properties whereas the potential of this combination on the osteogenesis, osseointergration and soft tissue seal is covered under biological properties. Lastly, how this combination acts as a drug delivery carrier and renders antimicrobial property has been addressed under pharmacological properties. This review has highlighted the various applications of graphene in the field of implant dentistry. It has outlined the various implant surface modifying methods and thrown light on the various affect this combination has on the mechanical, biological and pharmacological properties. Considering the various research done on the material, it can be concluded that graphene does have a bright future in implant dentistry and continued research in this area will provide fruitful benefits.

Longevity and risk factors of CAD-CAM manufactured implant-supported all-ceramic crowns - A prospective, multi-center, practice-based cohort study.

OBJECTIVES: The aim of this prospective, multi-center, practice-based cohort study was to analyze factors associated with the success of implant supported all-ceramic single-unit crowns, made by computer-aided-design/computer-aided-manufacturing (CAD-CAM). METHODS: All-ceramic crowns placed in a private practice-based research network (Ceramic Success Analysis, AG Keramik) were analyzed. Data from 567patients with CAD-CAM implant supported all-ceramic crowns placed between 2008-2023 by 54dentists were evaluated. Firstly, all crowns with at least one follow-up control were included (n = 907). Secondly, all crowns being followed up for ≥ 5years and all failures were included (n = 151). At the latest follow-up visit, crowns were considered as successful (not failed) if they were still in function without the need for additional therapy. Multi-level Cox proportional hazards models were used to evaluate the association between a range of predictors and time of success. RESULTS: Within a mean follow-up period (SD) of 2.5 (2)years (first scenario) and 6.2 (1.2)years (second scenario) [maximum:12years], 27crowns failed (annual failure rate [AFR]:0.74 %). The main failure types were decementation, (n = 11), fracture of the ceramic (n = 4) or Ti-Base (n = 4). In 5-year-scenario, crowns fabricated in the laboratory had 26times lower failure rate than those fabricated chairside (95 %CI:0.0-0.7;p = 0.038). Furthermore, the use of a silane (HR:0.051;95 %CI:0.0-0.5;p = 0.014) and etching of the ceramic (HR:0.053;95 %CI:0.0-0.8;p = 0.035) resulted in a significantly higher risk for failure than their non-use. SIGNIFICANCE: For CAD-CAM manufactured implant supported all-ceramic crowns, high success rates were found in up to 12-year evaluation. Furthermore, after 5years, no patient-or implant-level factors, but operative-level factor (i.e.fabrication method, use of silane/etching) were significantly associated with failure. The study was registered in the German Clinical Trials Register (DRKS-ID: DRKS00020271).

Long-Term Survival of Implants Placed in Earlier Failed Implant Sites.

Dental implant therapy is generally successful. However, when such therapy fails, considerations for implant replacement must be carefully considered. The survivability of implants placed into previously implanted sites must be considered. Appraisal of early implant loss versus late implant loss is important in presurgical planning for implant replacement. This review highlights the factors that can impact the success of implant reimplantation.

Advanced porous hip implants: A comprehensive review.

The field of orthopaedic implants has experienced significant advancements in recent years, transforming the approach to orthopaedic treatments. Amongst these advancements, porous structures have emerged as a promising solution to address the limitations of traditional solid implants. This comprehensive review paper offers a thorough overview of the importance of advanced porous hip implants, focusing on three key areas bone morphology and biomechanical parameters, complications associated with solid implants, and the benefits of porous structures and porous implants. Understanding the intricate interplay between bone morphology and biomechanical parameters is crucial when designing orthopaedic implants. Mimicking the native bone structure ensures optimal osseointegration, load distribution, and long-term success. Porous implants closely resemble natural bone structures, facilitating improved integration and biomechanical compatibility. Complications with solid implants are a significant concern in orthopaedic procedures. Stress shielding, cortical hypertrophy, and micromotion can lead to implant failure or revision surgeries. By contrast, porous structures promise to mitigate these issues by promoting bone ingrowth, reducing stress concentrations, and providing stability at the bone-implant interface. The benefits of porous structures and porous implants go beyond addressing solid implant complications. These structures enhance bone in-growth potential, strengthening integration and long-term stability. The interconnected porosity promotes nutrient diffusion and new blood vessel formation, supporting healing and minimizing infection risk. Furthermore, porous implants exhibit improved mechanical properties, such as lower elastic modulus and higher energy absorption, that better match those of bone. This feature helps alleviate stress shielding and enhances the overall performance and longevity of the implant. In conclusion, advanced porous implants have tremendous potential in orthopaedics. By closely mimicking native bone structure and reducing complications associated with solid implants, they can revolutionize orthopaedic treatments. Further research and development are warranted to fully exploit the potential of these innovative solutions and improve patient outcomes.

Comparative Evaluation of Tear Strength and Tensile Strength of Different Types of Gingival Mask Materials: An In Vitro Study.

INTRODUCTION: The implant-supported prosthetic treatment strategy is commonly chosen in modern dentistry to address tooth loss caused by a variety of conditions or dental defects. To achieve healthy and natural-looking results in implant dentistry, it is essential to replicate the peri-implant soft tissue. The gingival tissue that surrounds implants is quite accurately replicated by gingival masks. They facilitate more accurate prosthesis restoration design, enhance periodontal health, and promote oral cleanliness. Furthermore, gingival masks allow for the accurate observation of superstructure seating on implant analogs, which is essential for creating superstructures that fit perfectly. AIM AND OBJECTIVE:  To evaluate the change in tear strength and tensile strength of three different gingival mask materials (esthetic mask auto mix, Gi-Mask and Gingifast Rigid) available in the market at various time intervals. MATERIALS AND METHODS: Total of 540 specimens were fabricated with 180 samples of each group. Changes in tensile strength and tear strength of three different gingival mask materials (esthetic mask auto mix, Gi-Mask and Gingifast Rigid) at intervals of one day, three days, and seven days were measured by a universal testing machine. Statistical analysis was done using one-way ANOVA and Tukey Post Hoc test. We also performed correlation and regression analyses on tear and tensile strength. RESULTS: The null hypothesis, which is supported by these data, claims that there is no discernible variation in the tear strength and tensile strength of three distinct materials across various time intervals. Thus, the null hypothesis was rejected, and it was concluded that there was a significant change in the tear strength and tensile strength of these gingival mask materials at different time intervals. Esthetic mask auto mix has a high tear strength compared to Gi-Mask and gingifast rigid. Gi-Mask has the least tear strength among all three. Tensile strength decreases as time increases, but the Esthetic mask auto mix has high strength compared to Gi-Mask and gingifast rigid. CONCLUSION: Selecting the right material for gingival masks is essential, taking into account the clinical scenario and the articulation time. Time influences gingival mask materials' tear strength and tensile strength, which impacts their performance and durability. Esthetic mask auto mix has a high tear and tensile strength compared to Gi-Mask and gingifast rigid.

In vitro and in vivo evaluation of in situ forming polyester implants for the extended release of carvedilol.

Polyester based in situ forming implants (ISFIs) are injectable long-acting drug delivery systems that offer a wide range of unique advantages. As a result of these advantages, two relatively high molecular weight, ester terminated grades of poly (D,L-lactide-co-glycolide) (PLGA) and poly(D,L-lactide) (PLA) were evaluated for their ability (i) to form ISFIs loaded with carvedilol, and (ii) to control its release both in vitro and in vivo. At a polymeric concentration of 40% w/w, implant solutions were syringeable, injectable, and able to encapsulate carvedilol to a high degree (encapsulated drug% > 97%). When visualized using scanning electron microscopy (SEM), implants were found to have a dense thin surface atop porous sublayers. As for their in vitro evaluation, PLGA and PLA implants were able to maintain drug release over the course of 49 and 84 days, respectively. On the other hand, in vivo drug release from both implants was almost identical and lasted for only 42 days. This may be due to the overriding effect of the similar host environment at the injection site that diminished the effect of polymeric physiochemistry on phase inversion and drug release. Lastly, while the polymer-free drug/NMP solution completely released its drug content within the initial half hour in vitro, the formulation extended drug release in vivo. This could be due to a yet to be investigated interaction between carvedilol and NMP under in vivo conditions. These results cement the significance of formulating carvedilol loaded ISFIs for the management of chronic conditions.

Trans-crestal dental implants in the rehabilitation of a severely atrophic maxilla: A retrospective case series.

PURPOSE: To evaluate the mid-term clinical and radiographic results of immediate fixed full-arch prosthesis supported by two anterior axial and two posterior trans-crestally placed tilted implants in patients with severely atrophic posterior maxilla. MATERIALS AND METHODS: Patients with posterior maxillary ridge less than 4 mm high and 3 mm wide were rehabilitated with an immediate fixed provisional prosthesis supported by two anterior axially placed and two trans-crestal posterior tilted implants within 3 h after implant surgery. The final prosthesis, consisting of a CAD-CAM titanium framework and composite teeth was delivered 6 months later. Patients were scheduled for follow-up visits every 6 months to assess clinical and radiological parameters. Patients' satisfaction was assessed by a questionnaire up to 5 years. RESULTS: From April 2008 to May 2017, 56 implants (28 axial and 28 tilted) were inserted in 14 subjects (eight female and six male). The average bone loss for the anterior axial implants was 0.99 ± 0.19 mm at 1 year (n = 28 implants), 1.37 ± 0.31 mm at 5 years (n = 28), and 2.05 ± 0.32 mm at 10 years (n = 14). Only for three implants in two subjects the marginal bone loss was higher than 2 mm after 60 months. No implant was lost, and no prosthetic failure occurred after a mean follow-up of 125 months (range 79-186 months), leading to 100% implant and prosthesis survival rates. The upper 95% confidence limit of the failure rate was 23% and 6% at patient and implant level, respectively. High level of satisfaction was reported at 5-year follow-up. CONCLUSION: Wider sample sizes will be required to determine whether the presented technique is a reliable treatment option for the immediate rehabilitation of the atrophic maxilla.

Finite element analysis of non-ultraviolet and ultraviolet-irradiated titanium implants.

AIM: The purpose of this study is to calculate von Mises stresses, von Mises strains, deformation, principal stresses and principal elastic strains of non-UV and UV-irradiated hybrid SLA (sandblasted, large-grit, acid-etched)-coated titanium implants. MATERIALS AND METHODS: A cross-sectional analytical study was conducted at the Institute of Dentistry, CMH Lahore Medical College. Cone beam computed tomography (CBCT) data of One Hundred and Thirty Eight Dio Hybrid sandblasted and acid-etched implants of identical dimensions (10 mm in length and 4.5 mm in diameter) were allocated in the three groups. Control group A samples were not given UV irradiation, while groups B and C were given UVA (382 nm, 25 mWcm-2) and UVC (260 nm, 15 mWcm-2) irradiation, respectively. The CBCT data were analyzed using FEA (ANSYS software). CBCT images were taken before functional loading (8th week) and after functional loading (26th week). A 3-way ANOVA test was employed to see the difference between the three groups. Tukey test was utilized for multiple comparisons. p ≤ 0.05 was considered significant. RESULTS: The control group exhibited the highest average values for maximum von Mises stress, von Mises strain, deformation, principal stress, and principal elastic strain in both the maxilla and mandible compared to the UV-irradiated groups. Additionally, these measures consistently displayed higher averages in the maxilla across all groups compared to the mandible. Particularly, the UVC-irradiated group demonstrated the lowest von Mises stresses around the implants compared to the UVA group. CONCLUSION: Insignificant differences were observed between UVA- and UVC-irradiated implants in terms of principal stress, deformation, von Mises strain, and principal elastic strain. The only notable distinction was in von Mises stress, where the UVC-irradiated group exhibited lower von Mises stress around SLA-coated titanium implants.

Ten-Year Follow-Up of Oral Implants in Bone With Limited Bucco-Oral Dimensions: A Prospective Case Series.

BACKGROUND: It has been suggested that 1-2 mm of bone width at the buccal and lingual aspect is required for a successful long-term implant outcome. Low levels of evidence support this minimum threshold of bone width. This prospective study aimed at evaluating the outcome of implants placed in alveolar ridges with limited bucco-oral dimensions. MATERIALS AND METHODS: One-hundred implants (dia. 3.5 mm) were placed in 28 patients with narrow alveolar ridge dimensions (<4.5 mm width) without augmentation procedures and conventionally loaded. Intra-oral radiographs were taken at implant placement and abutment connection and at 1, 2, 3, 5 and 10 years of follow-up. At the 10-year follow-up (21 patients; 75 implants), full-mouth periodontal charting was performed, and the peri-implant keratinized tissue width and attachment type were recorded. Two calibrated periodontists analysed the peri-implant bone changes. RESULTS: After 10 years, all implants showed successful osseointegration and a cumulative survival rate of 100%. The implants were placed 0.85 mm ± 0.89 mm subcrestally. After 10 years, the marginal bone was located 1.59 ± 2.11 mm apical to the implant shoulder. Throughout this period of follow-up, the mean annual marginal bone loss was 0.094 mm. Furthermore, 84% of implants in 72% of patients presented with bleeding on probing. CONCLUSION: After 10 years of functional loading, implants placed in alveolar ridges with limited bucco-oral dimensions (≤4.5 mm) exhibited only minimum marginal bone loss.

Microbiome of diseased and healthy implants-a comprehensive microbial data analysis.

Objective: The purpose of this systematic bioinformatics analysis was to describe the compositions and differences in submucosal microbial profiles of peri-implants' diseases and healthy implant. Material and methods: PubMed, Embase, ETH Z, Scopus, CNKI, and Wanfang databases were searched to screen relevant literature on the analysis of peri-implant microflora based on the sequencing analysis technique of 16S ribosomal RNA (16S rRNA) gene. High-throughput sequencing of the 16S rRNA gene of microorganisms from healthy implants, peri-implant mucositis, and peri-implantitis was downloaded from the screened articles. EasyAmplicon and Usearch global algorithm were used to match the reads from each dataset to a full length of 16S rRNA or ITS gene sequence. The microorganisms based on the Human Oral Microbiome Database (HOMD) were re-classified, and the microbial diversity, flora composition, and differential species of the samples were re-analyzed, including taxonomic classification and alpha and beta diversity calculations. The co-occurrence network was also re-analyzed. Results: A total of seven articles with 240 implants were included. Among them, 51 were healthy implants (HI), 43 were in the peri-implant mucositis (PM) group, and 146 were in the peri-implantitis (PI) group. A total of 26,483 OTUs were obtained, and 877 microorganisms were annotated. The alpha diversity including Chao1 (healthy implants, 121.04 ± 92.76; peri-implant mucositis, 128.21 ± 66.77; peri-implantitis, 131.15 ± 84.69) and Shannon (healthy implants, 3.25 ± 0.65; peri-implant mucositis, 3.73 ± 0.61; peri-implantitis, 3.53 ± 0.67) of the samples from the three groups showed a significant difference. The beta diversity of the three samples was statistically different among groups. The genera of Treponema and Fretibacterium were significantly more abundant in the PI group than in the other two groups, and the genus of Streptococcus was more abundant in the HI group. The relative abundance of Porphyromonas in the peri-implantitis group was 6.1%. The results of the co-occurrence network showed differences in the network topology among the three groups of samples. The most connected three genera in the healthy implants were Halomonas, Fusobacterium, and Fretibacterium. The most connected three genera in peri-implant mucositis were Alistipes, Clostridia UCG-014, and Candidatus Saccharimonas. The most connected three genera in the peri-implantitis group were Lachnoanaerobaculum, Fusobacterium, and Atopobium. The betweenness of Porphvromonas gingivalis (red complex) in the PI group (7,900) was higher than in the HI group (23). Conclusions: The community compositions of peri-implant submucosal microorganisms were significantly different in healthy implants, peri-implant mucositis, and peri-implantitis. The submucosal microbial communities in peri-implantitis were characterized by high species richness and diversity compared with the healthy implants; the relative abundance of red complex, some members of the yellow complex, and some novel periodontal pathogens was higher in the peri-implantitis and peri-implant mucositis groups than in the healthy implant group. The core flora of the co-occurrence network of healthy implants, peri-implant mucositis, and peri-implantitis varied considerably. The peri-implantitis site presented a relative disequilibrium microbial community, and Porphyromonas may play an important role in the co-occurrence network.

Deciphering the Mutilation: Skillful Orthodontic Treatment Using Temporary Anchorage Devices and Asymmetric Extractions for a Patient With a Knife-Edge Ridge.

One of the biggest challenges in orthodontic management of adult patients is the presence of mutilated dentition, which is characterized by severe tooth loss and subsequent tipping of adjacent teeth or extruding of antagonists, worsening the malocclusion. As they offer a solid anchor for intricate tooth movement, temporary anchorage devices (TADs) have proven invaluable to orthodontic treatment. In this case study, we highlight the importance of TADs in getting the best possible treatment outcomes while describing the effective management of a patient with mutilated dentition. TADs made it possible to control tooth movement precisely, restoring esthetics and functional occlusion. This case report emphasizes the value of TADs in contemporary orthodontic practice and shows their potential for correcting mutilated dentition.

Bone augmentation using titanium mesh: A systematic review and meta-analysis.

PURPOSE: To review and compare the available literature on bone regeneration using titanium mesh and map the current evidence on bone gain outcomes and complications while comparing this scaffold with collagen membranes. MATERIALS AND METHODS: A comprehensive electronic and manual search was performed to identify randomised and non-randomised prospective controlled clinical trials that involved the use of titanium mesh in at least one arm, with outcomes including complications and vertical and/or horizontal bone gain. The focused questions were defined as follows: What are the outcomes of using titanium mesh in ridge augmentation compared to other types of barrier membrane, and what is the complication rate (membrane exposure and infection) when titanium mesh is used in these procedures? RESULTS: A total of 22 articles were included in the qualitative analysis. Overall, the studies that measured bone gain resulted in 3.36 mm vertical (196 subjects; 95% confidence interval 2.44 to 4.64 mm, range 1.4 to 5.7 mm) and 3.26 mm horizontal augmentation (81 subjects; 95% confidence interval 2.93 to 3.63 mm, range 2.6 to 3.7 mm), with variability among studies. The most commonly noted complication was mesh exposure, regardless of the type of mesh used, and the second most common was graft failure. The overall pooled complications rate reported in clinical trials was 10.8%. The meta-analysis comparing titanium mesh and collagen membranes, controlling for the type of bone regeneration (staged or simultaneous with implant placement), failed to show a significant difference in horizontal bone gain between the two techniques. CONCLUSIONS: Within the limitations of the present study and acknowledging the heterogeneity among the articles included, titanium mesh can serve as a feasible protective scaffold for bone regeneration with a relatively acceptable complication rate and in defects requiring around 4 mm 3D reconstruction. Data on patient-reported outcomes were scarce. CONFLICT-OF-INTEREST STATEMENT: None of the authors have any financial interests, either directly or indirectly, in the products or information mentioned in the present article.

A randomised controlled trial comparing the effectiveness of guided bone regeneration with polytetrafluoroethylene titanium-reinforced membranes, CAD/CAM semi-occlusive titanium meshes and CAD/CAM occlusive titanium foils in partially atrophic arches.

PURPOSE: To compare the clinical effectiveness of three different devices used in guided bone regeneration procedures for partially atrophic arches. MATERIALS AND METHODS: A randomised controlled trial with three parallel arms was conducted. The study evaluated titanium-reinforced polytetrafluoroethylene membrane (PTFE group), semi-occlusive CAD/CAM titanium mesh (mesh group) and occlusive CAD/CAM titanium foil (foil group) in terms of surgical outcomes and complications as well as surgical times and surgeon satisfaction in 27 guided bone regeneration procedures, presenting results from 1 year post-implant placement. RESULTS: Complications occurred in seven patients. No significant difference was found between the groups in terms of the occurrence of complications (P = 0.51), device exposure (P = 0.12) and implant failure (P = 0.650). Surgeon satisfaction varied significantly, with the PTFE group differing from the mesh (P = 0.003) and foil groups (P 0.001), but not between meshes and foils (P = 0.172). Surgical times also differed significantly, with longer times for PTFE membranes compared to meshes (P 0.001) and foils (P = 0.006), but with no difference between meshes and foils (P = 0.308). The mean reconstructed bone volume was 1269.55 ± 561.08 mm3, with no significant difference observed between the three groups (P = 0.815). There was also no significant difference for mean maximum height (6.72 mm, P = 0.867) and width (7.69 mm, P = 0.998). The mean marginal bone loss at 1 year after implant placement was 0.59 ± 0.27 mm. CONCLUSIONS: Although this study provides valuable insights into the potential benefits of using different types of CAD/CAM devices, further research with larger sample sizes and longer follow-up periods is warranted to validate these findings. CONFLICT-OF-INTEREST STATEMENT: The authors declare there are no conflicts of interest relating to this study.

Impact of proton pump inhibitors on periodontal health - A systematic review.

Introduction: In recent times, proton pump inhibitors (PPI) are frequently prescribed to manage acid reflux and to aid in completion of course of medication, which cause gastric irritation. Although this practice may minimize compliance to drug therapies and probably prevent development of drug resistance, the adverse effects of chronic PPI use have to be assessed. Inadvertent chronic use of PPIs has been found to inhibit normal gastrointestinal microbiome and even bone metabolism. The current study aimed to review available evidence based literature to understand the beneficial effects of PPIs weighed against their adversities with respect to periodontal and peri-implant health. Materials and Methods: The search strategy was followed according to the PRISMA guidelines for systematic reviews. Proton pump inhibitors, periodontal disease, dental implant (DI) and bone osseointegration were used as key MESH terms to search and select the required articles for review. While primary inclusion criteria were original researches, published in English, between 2014 to till-date, case reports, reviews and editorial communications were excluded. Results: The overall search strategy resulted in 445 articles. Applying the inclusion and exclusion criteria 37 articles were selected. Scrutinizing the abstracts for relevance, 17 publications were finally selected for review. This included three in vivo animal studies evaluating DI osseointegration and 14 retrospective clinical studies (nine in patients with dental implants, four in patients with periodontitis and one evaluating bone quality using panoramic radiographs). Conclusion: Findings from this systematic review revealed a plausible relationship between chronic PPI use and poor peri-implant bone health leading to early DI failure, and mandibular osteoporotic changes. On the contrary, use of PPI among patients with periodontitis, resulted in an improvement in periodontal health and reduction in periodontal disease severity.

Aesthetic problems related to dental implants in the aesthetic zone: A systematic review.

Background: Patient satisfaction is a crucial indicator of a successful dental implant treatment. Attainment of an aesthetically acceptable final result is central to this success. Hence, the primary objective of this systematic review was to identify aesthetic concerns linked to dental implants within the aesthetic zone. Methods: An electronic search was conducted on different databases such as PubMed, Medline, and Google Scholar using the key terms "tooth implant," "anterior implant," "dental implantation in the aesthetic zone," and "aesthetic area implant. Following the elimination of duplicate articles and adherence to the inclusion criteria, 14 articles (five randomized clinical trials, four prospective clinical trials, four case series, and one pilot study) published between 2007 and 2020 were deemed suitable for this review. Results: The selected studies highlighted several aesthetic issues, such as recession, marginal bone loss, gingival loss, and pink aesthetic scores related to dental implants placed in the aesthetic zone. Conclusion: Addressing these challenges necessitates meticulous treatment planning, effective soft tissue management, regular follow-ups, patient education, expectation management, and collaborative efforts among specialists. A limitation of this systematic review is that it focused solely on studies conducted within a relatively short timeframe (2007-2020). However, it is essential to recognize that significant changes occurred in the treatment procedures and materials within the field during this period. These changes have resulted in notable variances in the treatment protocols utilized across studies, potentially affecting the generalizability of the findings.