In-house protocol for fully guided zygomatic implant surgery and prosthesis repositioning.

AIM: The present study aims to describe an in-house protocol for fully guided zygomatic implant surgery and prosthesis repositioning. MATERIALS AND METHODS: Four extramaxillary zygomatic dental implants (ZIs) were placed in one patient. The preoperative phase included digital planning, through which a surgical guide was designed and created. The analysis of the accuracy of guided surgery and the guided prosthesis repositioning was carried out by superimposing the digital planning with the final postsurgical implant positioning through CBCT. The radiologic evaluation included implant angular deviation, entrance and exit deviation, platform deviation, and apex apicocoronal and mesiodistal deviation. The prosthetic evaluation was performed in three directions: buccopalatal, apicocoronal, and mesiodistal. RESULTS: All the ZIs successfully osseointegrated after 3 months of healing, with no complications. The mean axial angular implant deviation was 0.52 ± 0.36 degrees, and the mean implant depth deviation was 0.47 ± 0.28 mm. The entrance and exit deviation of the implants was 0.74 ± 0.42 mm and 0.7 ± 0.43 mm, respectively. The virtual prosthesis was superimposed and compared with the standard tessellation language file of the provisional polymethyl methacrylate prosthesis at the level of the first molars and central incisors; the mean buccopalatal deviation was 0.6 ± 0.035 mm, the mean apicocoronal deviation was 0.65 ± 0.11 mm, and the mean mesiodistal deviation was 0.3 ± 0.07 mm. CONCLUSIONS: According to the results obtained in this first case of the present case series, careful and meticulous digital planning based on the correct prosthetic parameters can safely guide the performance of surgery.

UTILIZATION OF ARTIFICIAL INTELLIGENCE FOR PREDICTIVE MODELING IN DENTAL IMPLANTOLOGY.

Artificial intelligence (AI) is making waves in dentistry, with applications in predicting dental implant success. AI models analyze patient data (X-rays, medical history) to identify factors influencing implant viability. The aim is to identify existing research on the use of AI-based predictive models in dental implants. The following databases were searched: Web of Science, Scopus, Google Scholar, PubMed, and Cochrane Library, using the keywords "Artificial Intelligence," "Dentistry," "Implant," and "Success." The studies were reviewed qualitatively, as quantitative analysis was not feasible due to the lack of specific outcomes and the insufficient number of studies for comparison. Technology has presented dental implantology with many opportunities, and it is through artificial intelligence that it is advancing. AI is being applied to detect potential implant failure patients, prognosis osseointegration, improve implant design, and master planning and also for data analysis to predict early complications. Decision trees, random forests, Artificial Neural Networks (ANN), and Deep Learning (DL) improve diagnostics and treatment planning and introduce a powerful predictive model for a successful implant.

Importance of local and systemic factors in preventing implant displacement in the mandibular body: a scoping review of existing literature.

BACKGROUND: The aim of this research was to analyse the current literature on displaced dental implants in the mandibular body, including local and systemic variables related to their cause, and to identify the most frequent location. METHODS: The study conducted a search of three databases (Pubmed, Scopus, and Web of Science) using specific index terms such as 'dental implant', 'displacement', 'dislocation', 'displaced', and 'mandible'. The analysis focused on the direction of displacement and the characteristics of the bone tissue (bone quality, density, and quantity) in cases where dental implants were displaced. RESULTS: A total of 371 articles were obtained. Thirteen of these articles were selected and read in full. To define bone quality, the Lekholm and Zarb classification, modified by Rosas et al., was used. The type II-B bone, which is characterized by thick cortical bone surrounding cancellous bone with extremely wide medullary spaces, presented the largest number of complications. Twenty-two cases were found in which the displacement direction was horizontal. Of these, four were displaced vestibularly, fourteen lingually, and four remained in the center. Additionally, 24 cases presented vertical displacement, with 12 displaced towards the inferior border of the mandible, 9 towards the middle or adjacent to the inferior dental nerve canal, and 3 above the inferior dental nerve canal. CONCLUSION: The accidental displacement of implants within the mandibular body is associated with various risk factors, including the characteristics of the bony trabeculum and the size of the medullary spaces. It is reasonable to suggest that only an adequate pre-surgical diagnostic evaluation, with the help of high-resolution tomographic images that allow a previous evaluation of these structures, will help to have better control over the other factors, thus minimizing the risk of displacement.

Post sterilization of intraoral scan body and the effect it has on the axes and distances between three adjacent implants: in-vitro study.

BACKGROUND: The purpose of this pilot in-vitro study was to assess the effect of sterilization on the intra-implant axis, inter-implant axis, intra-implant distance and inter-implant distance of three implants in a straight line by using laboratory scanner (LBS) versus intra-oral scanner (IOS) with intra-oral scan bodies (ISB). METHODS: A printed 3D model with three internal hex analogs in the positions 15#,16#,17# was used. Zirkonzhan (ZZ) intra-oral scan body (ISB), two-piece titanium was used. The ZZ ISBs were scanned by 7 Series dental wings (LBS) and 30 times by Primescan (IOS) pre sterilization and 30 times post sterilization. For each scan (pre and post) stereolithography (STL) file was created and a comparison between all the scans pre sterilization and post sterilization were superimposed on the laboratory scan by using a 3D analyzing software. A Kolmogorov-Smirnov test performed followed by Wilcoxon Signed Ranks tests. (p < 0.05) Results: Post sterilization of the ZZ ISB, the mean errors were significantly increased for the inter-implant distances (p < 0.0005), intra-implant distances 1,2,3 (p < 0.0005), intra-implant axis 1,3 (p < 0.0005) and inter-implant axes 13,23 (p < 0.05). In contrast, the mean errors for intra-implant axis 2 (p < 0.0005) and inter-implant axis 12 (p < 0.0005) were significantly reduced. CONCLUSIONS: ZZ ISB showed changes in all four parameters after sterilization. The middle ISB had the largest changes in mean error regarding all four parameters. Sterilization process may affect the three-dimensional (3D) structure of the ZZ ISB after three cycles. There is a lack in the literature in this field and there is a need for further studies to explore the effect of sterilization (multiple cycles) on different ISBs and for creating an approved guidelines regarding the amount of sterilization for each ISB in the industry.

Cytotoxicity and antibacterial susceptibility assessment of a newly developed pectin-chitosan polyelectrolyte composite for dental implants.

Biopolymers such as chitosan and pectin are currently attracting significant attention because of their unique properties, which are valuable in the food industry and pharmaceutical applications. These properties include non-toxicity, compatibility with biological systems, natural decomposition ability, and structural adaptability. The objective of this study was to assess the performance of two different ratios of pectin-chitosan polyelectrolyte composite (PCPC) after applying them as a coating to commercially pure titanium (CpTi) substrates using electrospraying. The PCPC was studied in ratios of 1:2 and 1:3, while the control group consisted of CpTi substrates without any coating. The pull-off adhesion strength, cytotoxicity, and antibacterial susceptibility tests were utilized to evaluate the PCPC coatings. In order to determine whether the composite coating was the result of physical blending or chemical bonding, the topographic surface parameters were studied using Fourier transform infrared spectroscopy (FTIR) and atomic force microscopy (AFM). PCPC (1:3) had the highest average cell viability of 93.42, 89.88, and 86.85% after 24, 48, and 72 h, respectively, as determined by the cytotoxicity assay, when compared to the other groups. According to the Kirby-Bauer disk diffusion method for testing antibacterial susceptibility, PCPC (1:3) showed the highest average diameter of the zone of inhibition, measuring 14.88, 14.43, and 11.03 mm after 24, 48, and 72 h of incubation, respectively. This difference was highly significant compared to Group 3 at all three time periods. PCPC (1:3) exhibited a significantly higher mean pull-off adhesion strength (521.6 psi) compared to PCPC (1:2), which revealed 419.5 psi. PCPC (1:3) coated substrates exhibited better surface roughness parameters compared to other groups based on the findings of the AFM. The FTIR measurement indicated that both PCPC groups exhibited a purely physical blending in the composite coating. Based on the extent of these successful in vitro experiments, PCPC (1:3) demonstrates its potential as an effective coating layer. Therefore, the findings of this study pave the way for using newly developed PCPC after electrospraying coating on CpTi for dental implants.

Accuracy evaluation of a universal dental implant guide for simulating implantation in posterior area on dental molds.

OBJECTIVES: This study aims to compare the accuracy of self-developed universal implant guide (SDG), 3D printed digital guide (DG), and free hand (FH) simulated implantation in the posterior tooth area of dental models. METHODS: Ten junior dentists were selected to place three implants in the 35, 37, and 46 tooth sites of the mandibular models (35, 36, 37, and 46 missing teeth) by using SDG, DG, and FH, and the process was repeated again to take the average value. Cone beam computed tomography (CBCT) was used to evaluate the global coronal deviation, global apical deviation, depth deviation, and angular deviation between the actual position and preoperative planned position. RESULTS: The coronal deviation and apical deviation of the three implant sites in the SDG group were not significantly different from those in the two other groups (P>0.05). The depth deviation and angular deviation in the SDG group were smaller than those in the DG group (P<0.05) and FH group (P<0.05), respectively. All deviations at site 37 in the SDG group were not different from those at site 35 (P>0.05), while the depth and angular deviation at site 37 in the DG group were higher than those at site 35 (P<0.05). CONCLUSIONS: The precision of the self-developed universal dental implant guide can meet the requirements of clinical posterior implantation.

Experimental study on implant-abutment locking force and abutment subsidence in a pure Morse taper connection implant system.

OBJECTIVES: This test aimed to investigate the factors affecting the locking force between the implant and abutment and the amount of abutment subsidence in pure Morse taper connection implant systems. METHODS: With reference to the Bicon implant abutment connection design, different types of implant specimens and their corresponding types of abutments were fabricated. The implant-abutment locking taper was uniformly 1.5°. The locking depths were 1.0, 2.0, and 3.0 mm. The diameters of the locking column were 2.5, 3.0, and 3.5 mm. The thicknesses of the outer wall of the implant were 0.15 and 0.30 mm. The loading forces of the testing machine were 200, 300, and 400 N. At least 10 specimens of each group of implant-abutment were used. All specimens were loaded in the same manner using a universal testing machine (finger pressure + specified loading force, five times). The total height of the implant-abutment was measured before finger pressure, after finger pressure, and after the testing machine was loaded for five times to calculate the amount of sinking of the abutment. Finally, the implant and abutment were pulled apart using the universal testing machine, and the subluxation force was observed and recorded. RESULTS: The test loading force, locking depth, and locking post diameter had an effect on the implant-abutment locking force and abutment subsidence. The implant-abutment locking force increased with the increase in the test loading force, locking depth, and locking post diameter (R=0.963, 0.607, and 0.372, respectively), with the test loading force having the most significant effect. Abutment subsidence increased with the increase in test loading force (R=0.645) and decreased with the increase in locking depth and locking post diameter (R=-0.807 and -0.280, respectively), with locking depth having the most significant effect on abutment subsidence. No significant correlation was found between the thickness of the outer wall of the implant and the change in the magnitude of the implant-abutment locking force. However, an increase in the thickness of the outer wall of the implant decreased the amount of abutment subsidence, which was inversely correlated. CONCLUSIONS: The locking force of the implant-abutment can be increased by adjusting the design of the pure Morse taper connection implant⁃abutment connection, increasing the locking depth and locking post diameter, and increasing the amount and number of times the abutment is loaded during seating. Problems, such as loosening or detachment of the abutment, can be reduced. The recommended abutment to be loaded should be no less than five times during seating to prevent the abutment from sinking and causing changes in the occlusal relationship in the later stages. Preliminary occlusal adjustments should only be conducted in the early stages of the use of temporary restorations, and final restorations and occlusal adjustments are recommended to be performed after using the abutment for a period of time.

Effects of flapless and flapped implantations on soft tissue: a systematic review and Meta-analysis.

OBJECTIVES: This study aimed to systematically compare the effects of flapless and flapped implantations on the surrounding soft tissues of dental implants. METHODS: Nine databases were searched, including PubMed, Embase, Cochrane Library, Web of Science, Clinical Trials, OpenGrey, OpenDoar, Scopus, and Ovid, from January 1, 2013, to August 27, 2023. Randomized controlled trials comparing flapless implantation with flapped implantation for restoration of missing teeth were included. Meta-analysis was conducted on studies that met the inclusion criteria by using RevMan 5.3 and Stata 14.0. RESULTS: A total of 1 245 articles were retrieved, and 17 studies were ultimately included. The results of Meta-analysis showed that flapless implantation resulted in better healing of the soft tissues around the dental implants than flapped implantation. Moreover, flapless implantation showed superior changes in implant success rate [mean difference (MD)=1.06, 95% confidence interval (CI) (1.02, 1.10), P=0.004], the width of keratinized gingival changes [MD=0.10, 95%CI (0.00, 0.20), P=0.04], and probing depth [MD=-0.60, 95%CI (-0.67, -0.53), P<0.000 01], with statistically significant differences. The final combined results of modified plaque index [standardized mean difference (SMD)=-0.41, 95%CI (-0.81, 0.00), P=0.05] and modified sulcus bleeding index [SMD=-0.44, 95%CI (-0.78, -0.10), P=0.01] showed superiority over flapped implantation. The papillary presence index was higher in the flapless implantation group than in the flapped implantation group. No statistically significant differences were observed in plaque index and gingival indices changes between the two groups. CONCLUSIONS: Flapless implantation can achieve higher implant success rate, smaller changes in the width of keratinized gingival, and smaller probing depths than flapped implantation. It also has advantages in terms of modified plaque index, modified sulcus bleeding index, and papillary presence index.

Mechanical strength of stock and custom abutments as original and aftermarket components after thermomechanical aging.

OBJECTIVES: The study aimed to assess the impact on the mechanical strength and failure patterns of implant-abutment complexes of choosing different abutment types, designs and manufacturers, aiding in selecting the optimal restorative solution. Stock and custom abutments from original and aftermarket suppliers were subjected to thermomechanical aging. MATERIAL AND METHODS: Stock and custom abutments from the implant manufacturer (original) and a aftermarket supplier (nonoriginal) were connected to identical implants with internal connection. Custom abutments were designed in a typical molar and premolar design, manufactured using the workflow from the respective suppliers. A total of 90 implants (4 mm diameter, 3.4 mm platform, 13 mm length) equally divided across 6 groups (three designs, two manufacturers) underwent thermo-mechanical aging according to three different regimes, simulating five (n = 30) or 10 years (n = 30) of clinical function, or unaged control (n = 30). Subsequently, all samples were tested to failure. RESULTS: During aging, no failures occurred. The mean strength at failure was 1009N ± 171, showing significant differences between original and nonoriginal abutments overall (-230N ± 27.1, p < .001), and within each abutment type (p = .000), favoring original abutments. Aging did not significantly affect the failure load, while the type of abutment and manufacturer did, favoring original and custom-designed abutments. The most common failure was implant bending or deformation, significantly differing between original and nonoriginal abutments and screws. All failure tests resulted in clinically unsalvageable implants and abutments. CONCLUSIONS: Within the limitations of this study, original abutments exhibited a higher mechanical strength compared to the nonoriginal alternative, regardless of the amount of simulated clinical use. Similarly, custom abutments showed higher mechanical strength compared to stock abutments. However, mechanical strength in all abutments tested was higher than average chewing forces reported in literature, thus components tested in this study can be expected to perform equally well in clinical situations without excessive force.

Is routine antibiotic prophylaxis warranted in dental implant surgery to prevent early implant failure? - a systematic review.

BACKGROUND: The question of whether antibiotic prophylaxis should be administered routinely for dental implant surgery is unresolved. Despite the lack of conclusive supportive evidence, antibiotics are often administered to reduce the risk of infection, which could lead to early implant failure. Increasing antibiotic resistance is a major concern and it is therefore important to reduce the overall use of antibiotics, including in dentistry. The aim of the present systematic review and meta-analysis was to evaluate the efficacy of preoperative antibiotics in preventing early implant failure, in overall healthy patients undergoing dental implant surgery. METHODS: An electronic search was undertaken of PubMed (Medline), Web of Science and the Cochrane Library up to October 1st, 2023, to identify randomized clinical trials (RCTs). All RCTs comparing antibiotic prophylaxis with no antibiotics/placebo in overall healthy patients receiving dental implants were included. The primary outcome was patients with early implant failure. Risk of bias was assessed, data were extracted, a meta-analysis was done, and GRADE certainty-of-evidence ratings were determined. The risk ratio (RR), the risk difference (RD) and 95% confidence intervals (CI) were estimated. RESULTS: After removal of duplicates, 1086 abstracts were screened, and 17 articles were reviewed in full text. Seven RCTs with moderate or low risk of bias and with a total of 1859 patients and 3014 implants were included in the meta-analysis. With reference to early implant failure at patient level, the meta-analysis failed to disclose any statistically significant difference (RR: 0.66, 95% CI: 0.30-1.47) between antibiotic prophylaxis and a placebo. The risk difference was -0.007 (95% CI: -0.035-0.020) leading to a number needed to treat (NNT) of 143. CONCLUSION: Antibiotic prophylaxis for dental implant surgery does not seem to have any substantial effect on early implant failure ( ). The results do not support routine antibiotic prophylaxis for dental implant surgery.

Correlation Between Implant Stability Quotient and Percussion Sound Frequency.

OBJECTIVES: To determine the correlation between the primary implant stability quotient and the implant percussion sound frequency. MATERIALS AND METHODS: A total of 14 pigs' ribs were scanned using a dental cone beam computed tomography (CBCT) scanner to classify the bone specimens into three distinct bone density Hounsfield units (HU) value categories: D1 bone: >1250 HU; D2: 850-1250 HU; D3: <850 HU. Then, 96 implants were inserted: 32 implants in D1 bone, 32 implants in D2 bone, and 32 implants in D3 bone. The primary implant stability quotient (ISQ) was analyzed, and percussion sound was recorded using a wireless microphone connected and analyzed with frequency analysis software. RESULTS: Statistically significant positive correlations were found between the primary ISQ and the bone density HU value (r = 0.719; p < 0.001), and statistically significant positive correlations between the primary ISQ and the percussion sound frequency (r = 0.606; p < 0.001). Furthermore, significant differences in primary ISQ values and percussion sound frequency were found between D1 and D2 bone, as well as between D1 and D3 bone. However, no significant differences were found in primary ISQ values and percussion sound frequency between D2 and D3 bone. CONCLUSION: The primary ISQ value and the percussion sound frequency are positively correlated.

Xenogeneic Collagen Matrix Versus Free Gingival Graft for Augmenting Peri-Implant Keratinized Mucosa Around Dental Implants: A Systematic Review and Meta-Analysis.

OBJECTIVES: There is a growing evidence to suggest augmenting peri-implant keratinized mucosa in the presence of ≤ 2 mm of keratinized mucosa. However, the most appropriate surgical technique and augmentation materials have yet to be defined. The aim of this systematic review and meta-analyses was to evaluate the clinical and patient-reported outcomes of augmenting keratinized mucosa around implants using free gingival graft (FGG) versus xenogeneic collagen matrix (XCM) before commencing prosthetic implant treatment. MATERIAL AND METHODS: Electronic databases were searched to identify observational studies comparing implant sites augmented with FGG to those augmented with XCM. The risk of bias was assessed using the Cochrane Collaboration's Risk of Bias tool. RESULTS: Six studies with 174 participants were included in the present review. Of these, 87 participants had FGG, whereas the remaining participants had XCM. At 6 months, sites augmented with FGG were associated with less changes in the gained width of peri-implant keratinized mucosa compared to those augmented with XCM (mean difference 1.06; 95% confidence interval -0.01 to 2.13; p = 0.05). The difference, however, was marginally significant. The difference between the two groups in changes in thickness of peri-implant keratinized mucosa at 6 months was statistically significantly in favor of FGG. On the other hand, XCM had significantly shorter surgical time, lower postoperative pain score, and higher color match compared to FGG. CONCLUSIONS: Within the limitation of this review, the augmentation of keratinized mucosa using FGG before the placement of the final prosthesis may have short-term positive effects on soft tissue thickness. XCM might be considered in aesthetically demanding implant sites and where patient comfort or shorter surgical time is a priority. The evidence support, however, is of low to moderate certainty; therefore, further studies are needed to support the findings of the present review.

The Addition of Hydroxyapatite Nanoparticles on Implant Surfaces Modified by Zirconia Blasting and Acid Etching to Enhance Peri-Implant Bone Healing.

This study investigated the impact of adding hydroxyapatite nanoparticles to implant surfaces treated with zirconia blasting and acid etching (ZiHa), focusing on structural changes and bone healing parameters in low-density bone sites. The topographical characterization of titanium discs with a ZiHa surface and a commercially modified zirconia-blasted and acid-etched surface (Zi) was performed using scanning electron microscopy, profilometry, and surface-free energy. For the in vivo assessment, 22 female rats were ovariectomized and kept for 90 days, after which one implant from each group was randomly placed in each tibial metaphysis of the animals. Histological and immunohistochemical analyses were performed at 14 and 28 days postoperatively (decalcified lab processing), reverse torque testing was performed at 28 days, and histometry from calcified lab processing was performed at 60 days The group ZiHa promoted changes in surface morphology, forming evenly distributed pores. For bone healing, ZiHa showed a greater reverse torque, newly formed bone area, and bone/implant contact values compared to group Zi (p < 0.05; t-test). Qualitative histological and immunohistochemical analyses showed higher features of bone maturation for ZiHa on days 14 and 28. This preclinical study demonstrated that adding hydroxyapatite to zirconia-blasted and acid-etched surfaces enhanced peri-implant bone healing in ovariectomized rats. These findings support the potential for improving osseointegration of dental implants, especially in patients with compromised bone metabolism.

Influence of the Surface Topography of Titanium Dental Implants on the Behavior of Human Amniotic Stem Cells.

The dental implant surface plays a crucial role in osseointegration. The topography and physicochemical properties will affect the cellular functions. In this research, four distinct titanium surfaces have been studied: machined acting (MACH), acid etched (AE), grit blasting (GBLAST), and a combination of grit blasting and subsequent acid etching (GBLAST + AE). Human amniotic mesenchymal (hAMSCs) and epithelial stem cells (hAECs) isolated from the amniotic membrane have attractive stem-cell properties. They were cultured on titanium surfaces to analyze their impact on biological behavior. The surface roughness, microhardness, wettability, and surface energy were analyzed using interferometric microscopy, Vickers indentation, and drop-sessile techniques. The GBLAST and GBLAST + AE surfaces showed higher roughness, reduced hydrophilicity, and lower surface energy with significant differences. Increased microhardness values for GBLAST and GBLAST + AE implants were attributed to surface compression. Cell viability was higher for hAMSCs, particularly on GBLAST and GBLAST + AE surfaces. Alkaline phosphatase activity enhanced in hAMSCs cultured on GBLAST and GBLAST + AE surfaces, while hAECs showed no mineralization signals. Osteogenic gene expression was upregulated in hAMSCs on GBLAST surfaces. Moreover, α2 and ß1 integrin expression enhanced in hAMSCs, suggesting a surface-integrin interaction. Consequently, hAMSCs would tend toward osteoblastic differentiation on grit-blasted surfaces conducive to osseointegration, a phenomenon not observed in hAECs.

[Effects of cortical bone thickness and jaw bone density on pain during implant surgery].

PURPOSE: To investigate the effects of different cortical bone thickness and jaw bone density at implant sites on intraoperative pain during implant surgery. METHODS: One hundred and eighty-seven patients(263 implant sites) who underwent implant placement surgery at the Fourth Affiliated Hospital of Nanchang University from August 2021 to August 2022 were selected to investigate the effects of different cortical bone thickness and jaw bone density HU values at implant sites on the anesthetic effect under local infiltration anesthesia with epinephrine in articaine. SPSS 26.0 software package was used for data analysis. RESULTS: The mean cortical bone thickness at the painful sites[(3.90±1.36) mm] was significantly greater than that at the non-painful sites [(2.24±0.66) mm], and the difference was statistically significant(P＜0.05). The differences in cortical bone thickness in the mandibular anterior, premolar, and molar regions were statistically significant in the comparison of pain and non-pain sites. The mean HU value of bone density was (764.46±239.75) for the painful sites and (612.23±235.31) for the non-painful sites, with significant difference(P＜0.05). The difference was not significant(P＞0.05) when comparing the HU values of painful sites with non-painful sites in the mandibular anterior teeth and anterior molar region, while the difference was significant(P＜0.05) when comparing the HU values of painful sites with non-painful sites in the mandibular molar region. CONCLUSIONS: Sites with large cortical bone thickness have a greater effect on blocking infiltrative anesthetic penetration and are more prone to intraoperative pain during implantation. In the mandibular anterior and premolar regions, the HU value of the implant sites had less effect on infiltrative anesthetic penetration, and the effect was greater in the mandibular molar region, and the implant sites with high HU values in the mandibular molar region were more likely to have intraoperative pain. When the cortical bone thickness in the planned implant site is greater than 3.9 mm and the mean bone density in the mandibular molar region is greater than 665 HU. If there is sufficient safe distance for hole operation, it is recommended to apply mandibular nerve block anesthesia combined with articaine infiltration anesthesia to avoid intraoperative pain and bad surgical experience for the patients.

Tailoring zirconia surface topography via femtosecond laser-induced nanoscale features: effects on osteoblast cells and antibacterial properties.

The performance and long-term durability of dental implants hinge on the quality of bone integration and their resistance to bacteria. This research aims to introduce a surface modification strategy for zirconia implants utilizing femtosecond laser ablation techniques, exploring their impact on osteoblast cell behavior and bacterial performance, as well as the integral factors influencing the soft tissue quality surrounding dental implants. Ultrafast lasers were employed to craft nanoscale groove geometries on zirconia surfaces, with thorough analyses conducted using x-ray diffraction, scanning electron microscopy, atomic force microscopy, and water contact angle measurements. The study evaluated the response of human fetal osteoblastic cell lines to textured zirconia ceramics by assessing alkaline phosphatase activity, collagen I, and interleukin 1ßsecretion over a 7 day period. Additionally, the antibacterial behavior of the textured surfaces was investigated usingFusobacterium nucleatum, a common culprit in infections associated with dental implants. Ciprofloxacin (CIP), a widely used antibacterial antibiotic, was loaded onto zirconia ceramic surfaces. The results of this study unveiled a substantial reduction in bacterial adhesion on textured zirconia surfaces. The fine biocompatibility of these surfaces was confirmed through the MTT assay and observations of cell morphology. Moreover, the human fetal osteoblastic cell line exhibited extensive spreading and secreted elevated levels of collagen I and interleukin 1ßin the modified samples. Drug release evaluations demonstrated sustained CIP release through a diffusion mechanism, showcasing excellent antibacterial activity against pathogenic bacteria, includingStreptococcus mutans, Pseudomonas aeruginosa, andEscherichia coli.

Production and characterization of the lipopeptide with anti-adhesion for oral biofilm on the surface of titanium for dental implants.

Titanium implants are subject to bacterial adhesion and peri-implantitis induction, and biosurfactants bring a new alternative to the fight against infections. This work aimed to produce and characterize the biosurfactant from Bacillus subtilis ATCC 19,659, its anti-adhesion and antimicrobial activity, and cell viability. Anti-adhesion studies were carried out against Streptococcus sanguinis, Staphylococcus aureus, Fusobacterium nucleatum, Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, and Proteus mirabilis as the minimum inhibitory concentration and the minimum bactericidal concentration. Cell viability was measured against osteoblast and fibroblast cells. The biosurfactant was classified as lipopeptide, with critical micelle concentration at 40 µg mL- 1, and made the titanium surface less hydrophobic. The anti-adhesion effect was observed for Staphylococcus aureus and Streptococcus sanguinis with 54% growth inhibition and presented a minimum inhibitory concentration of 15.7 µg mL- 1 for Streptococcus sanguinis and Aggregatibacter actinomycetemcomitans. The lipopeptide had no cytotoxic effect and demonstrated high potential application against bacterial biofilms.

Nano-Based Approaches in Surface Modifications of Dental Implants: A Literature Review.

Rehabilitation of fully or partially edentulous patients with dental implants represents one of the most frequently used surgical procedures. The work of Branemark, who observed that a piece of titanium embedded in rabbit bone became firmly attached and difficult to remove, introduced the concept of osseointegration and revolutionized modern dentistry. Since then, an ever-growing need for improved implant materials towards enhanced material-tissue integration has emerged. There is a strong belief that nanoscale materials will produce a superior generation of implants with high efficiency, low cost, and high volume. The aim of this review is to explore the contribution of nanomaterials in implantology. A variety of nanomaterials have been proposed as potential candidates for implant surface customization. They can have inherent antibacterial properties, provide enhanced conditions for osseointegration, or act as reservoirs for biomolecules and drugs. Titania nanotubes alone or in combination with biological agents or drugs are used for enhanced tissue integration in dental implants. Regarding immunomodulation and in order to avoid implant rejection, titania nanotubes, graphene, and biopolymers have successfully been utilized, sometimes loaded with anti-inflammatory agents and extracellular vesicles. Peri-implantitis prevention can be achieved through the inherent antibacterial properties of metal nanoparticles and chitosan or hybrid coatings bearing antibiotic substances. For improved corrosion resistance various materials have been explored. However, even though these modifications have shown promising results, future research is necessary to assess their clinical behavior in humans and proceed to widespread commercialization.

Is immediate dental implant in fibula free flap beneficial for implant survival and osteoradionecrosis in jaw reconstruction?

OBJECTIVES: This study aimed to compare the risk of osteoradionecrosis and implant survival in oral cancer patients undergoing immediate dental implants during jaw reconstruction, termed "Jaw in a Day" (JIAD), with those receiving no implants or delayed implants (non-JIAD). PATIENTS & METHODS: Clinicopathologic data were collected from prospectively enrolled JIAD patients (n = 10, 29 implants) and retrospectively from non-JIAD patients (n = 117, 86 implants). Survival analyses were performed to assess implant survival and osteoradionecrosis-free survival. RESULTS: Osteoradionecrosis occurred in 0 % of JIAD cases compared to 19.3 % in non-JIAD cases without implants and 71.4 % in non-JIAD cases with delayed implants (p = 0.008). Osteoradionecrosis-free survival was significantly better in the JIAD group than the non-JIAD group (p = 0.0059). Implants in the JIAD group all survived regardless of radiation therapy (29/29, 100 %) and 95.1 % (58/61) of implants survived in delayed implants in non-irradiated fibula without radiotherapy. Meanwhile, only 11 of 25 implants placed in irradiated fibula flaps survived, even when the implants were placed after a median time interval of 624 days after radiotherapy, and none of them were earlier than 360 days. The survival analysis revealed a significant difference (p < 0.0001). CONCLUSION: JIAD appears to offer superior outcomes in terms of implant survival and osteoradionecrosis prevention compared to delayed implant placement. Placing implants in irradiated fibula, even after years, significantly poses high risk of implant failure and osteoradionecrosis. JIAD represents a promising approach for optimal rehabilitation, particularly in oral cancer patients requiring postoperative radiotherapy. Proper positioning and orientation of implants and flaps are crucial for implant survival.

Antimicrobial Potential of Strontium-Functionalized Titanium Against Bacteria Associated With Peri-Implantitis.

OBJECTIVES: To explore the antimicrobial potential of strontium (Sr)-functionalized wafers against multiple bacteria associated with per-implant infections, in both mono- and multispecies biofilms. MATERIALS AND METHODS: The bactericidal and bacteriostatic effect of silicon wafers functionalized with a strontium titanium oxygen coating (Sr-Ti-O) or covered only with Ti (controls) against several bacteria, either grown as a mono-species or multispecies biofilms, was assessed using a bacterial viability assay and a plate counting method. Mono-species biofilms were assessed after 2 and 24 h, while the antimicrobial effect on multispecies biofilms was assessed at Days 1, 3, and 6. The impact of Sr functionalization on the total percentage of Porphyromonas gingivalis in the multispecies biofilm, using qPCR, and gingipain activity was also assessed. RESULTS: Sr-functionalized wafers, compared to controls, were associated with statistically significant less viable cells in both mono- and multispecies tests. The number of colony forming units (CFUs) within the biofilm was significantly less in Sr-functionalized wafers, compared to control wafers, for Staphylococcus aureus at all time points of evaluation and for Escherichia coli at Day 1. Gingipain activity was less in Sr-functionalized wafers, compared to control wafers, and the qPCR showed that P. gingivalis remained below detection levels at Sr-functionalized wafers, while it consisted of 15% of the total biofilm on control wafers at Day 6. CONCLUSION: Sr functionalization displayed promising antimicrobial potential, possessing bactericidal and bacteriostatic ability against bacteria associated with peri-implantitis grown either as mono-species or mixed in a multispecies consortium with several common oral microorganisms.