3D extraoral morphometric changes after implant surgery: an exploratory pilot study using stereophotogrammetry.

OBJECTIVE: This pilot study aimed to evaluate, for the first time, the changes in facial tissues following the placement of a single dental implant. METHODS AND MATERIALS: Patients were scanned with a 3D facial scanner (3dMD) before implant surgery, immediately after surgery (T1), at 7 days post-operatively (T2), and at the impression stage (T3). Acquired images were processed using 3dMDVultus software program and volume differences and linear depth measurements were calculated to determine the morphometric changes over time. A total of 11 patients were included in the analyses. Descriptive statistics were employed to analyze the data. RESULTS: The volumetric changes and maximum depth differences indicated an initial increase, followed by a progressive decrease in tissue volume after implant placement in the area of the surgery. The volume change values ranged between 2.5 to 3.9 cc for T1, whereas for T2, the volume change decreased to a range of 0.8 to 1.8 cc. Maximum depth differences ranged between 2.06 to 2.80 mm in the soft tissues right after the implant surgery and reduced to around 2.01 mm to 0.55 mm in the impression stage. The amount of painkiller used was not related to the magnitude of linear depth measurements at any assessed time point. CONCLUSION: The results from this report documented that there is a longitudinal decrease in soft tissue volume and depth difference in extra-oral soft tissues in the region of implant placement after surgery to 6 weeks. The use of a facial scanner is a promising non-invasive method to monitor 3D morphometric changes after implant surgery.

Differences between first- and second-generation autologous platelet concentrates.

Autologous platelet concentrates (APCs) applied alone or combined with other biomaterials are popular bioactive factors employed in regenerative medicine. The main biological rationale of using such products is to concentrate blood-derived growth factors and cells into the wound microenvironment to enhance the body's natural healing capacity. First-generation APC is represented by platelet-rich plasma (PRP). While different protocols have been documented for PRP preparation, they overall consist of two cycles of centrifugation and have important limitations related to the use of an anticoagulant first and an activator afterward, which may interfere with the natural healing process and the release of bioactive molecules. The second generation of platelet concentrates is represented by leukocyte and platelet-rich fibrin (L-PRF). L-PRF protocols involve a single centrifugation cycle and do not require the use of anticoagulants and activators, which makes the preparation more straight forward, less expensive, and eliminates potential risks associated with the use of activators. However, since no anticoagulant is employed, blood undergoes rapid clotting within the blood collection tube; hence, a timely management of L-PRF is crucial. This review provides an overview on the most documented protocols for APC preparations and critically discusses the main differences between first- and second-generation APCs in terms of cell content, protein release, and the formation of a 3D fibrin network. It appears evident that the inconsistency in reporting protocol parameters by most studies has contributed to conflicting conclusions regarding the efficacy of different APC formulations and has significantly limited the ability to interpret the results of individual clinical studies. In the future, the use of a standardized classification system, together with a detailed reporting on APC protocol parameters is warranted to make study outcomes comparable. This will also allow to clarify important aspects on the mechanism of action of APCs (like the role of leukocytes and centrifugation parameters) and to optimize the use of APCs in regenerative medicine.

APCs in sinus floor augmentation.

After tooth loss in the posterior area of the maxilla, sinus floor elevation is often required to compensate the vertical bone loss due to sinus pneumatization. This narrative review reports on the potential benefits of autologous platelet concentrates (APCs) during this procedure. As for transcrestal approach, APCs have been used as "sole" substitute/graft. However, because of the low number of clinical trials available with PRGF, and even none for PRP, no definitive conclusions can be made regarding their efficacy. The number of studies on the use of L-PRF were outnumbered indicating good feasibility for vertical bone gain, with a high implant survival rate and a low degree of complications. PRP and PRGF have not been studied as a "single/sole" substitute for a one-stage lateral window approach, probably because of the weak physical characteristics of the membranes. L-PRF alone appears to be a predictable grafting material for lateral maxillary sinus grafting and a reduced RBH should not be considered as a risk factor. Compared to a "standard" bone substitute L-PRF shows slightly less vertical bone gain (consider enough membrane application and use of bony window as new sinus floor roof over the implant apices), enhanced early resorption (first 6 months after application), but a similar stable bone gain afterward. For a two-stage lateral window approach, APCs "alone" cannot be recommended, due to their weak withstand to the sinus pneumatization forces. APCs combined with bone substitutes seem to accelerate bone formation, without any additional benefits on the long-term new bone gain. The use of L-PRF membranes for the treatment of perforations appears to be an effective treatment option, but further clinical studies are needed to confirm this. Even though the abovementioned statements are based on large numbers of studies, additional RCTs comparing APCs with different types of grafting procedures for sinus elevation are needed.

The influence of implant position and of prosthetic characteristics on the occurrence of peri-implantitis: a retrospective study on periapical radiographs.

OBJECTIVE: The present retrospective study aimed to investigate the influence of malposition on the occurrence of peri-implantitis. MATERIALS AND METHODS: The study included clinical records of systemically healthy patients with single and partial implant-supported rehabilitations and at least 1-year post-loading follow-up. The parameters collected included implant-related factors, patient-related factors, site-related factors, and prosthesis-related factors. The radiographic measurements were taken by using a dedicated software and the diagnosis of peri-implantitis was made based on all the available clinical and radiographic data. Descriptive statistics were provided for all variables. Following an exploratory approach, an implant-level analysis of factors influencing the occurrence of peri-implantitis was done through a multilevel multivariate logistic regression (mixed). RESULTS: A total of 180 implants belonging to 90 subjects were randomly selected. Malposition showed no statistically significant association with the occurrence of peri-implantitis. According to the multi-level analysis, the parameters that were significantly associated with peri-implantitis included presence / history of periodontitis (OR = 5.945, 95% CI: 1.093 - 32.334, P = 0.039) and presence of an emergence profile angle ≥ 45° (OR = 9.094, 95% CI: 2.017 - 40.995, P = 0.005). CONCLUSIONS: Implant malposition, as defined following Buser's criteria (2004), did not influence the occurrence of peri-implantitis in the selected cohort. Conversely, history of periodontitis and presence of a prosthetic emergence profile with an angle ≥ 45° were correlated to an increased risk of peri-implantitis.

Efficacy of biomaterials for lateral bone augmentation performed with guided bone regeneration. A network meta-analysis.

Bone regeneration is often required concomitant with implant placement to treat a bone fenestration, a dehiscence, and for contouring. This systematic review assessed the impact of different biomaterials employed for guided bone regeneration (GBR) simultaneous to implant placement on the stability of radiographic peri-implant bone levels at ≥12 months of follow-up (focused question 1), as well as on bone defect dimension (width/height) changes at re-assessment after ≥4 months (focused question 2). Only randomized controlled trials (RCTs) and controlled clinical trials (CCTs) that compared different biomaterials for GBR were considered. A Bayesian network meta-analysis (NMA) was performed using a random-effects model. A ranking probability between treatments was obtained, as well as an estimation of the surface under the cumulative ranking value (SUCRA). Overall, whenever the biological principle of GBR was followed, regeneration occurred in a predictable way, irrespective of the type of biomaterial used. A lower efficacy of GBR treatments was suggested for initially large defects, despite the trend did not reach statistical significance. Regardless of the biomaterial employed, a certain resorption of the augmented bone was observed overtime. While GBR was shown to be a safe and predictable treatment, several complications (including exposure, infection, and soft tissue dehiscence) were reported, which tend to be higher when using cross-linked collagen membranes.

Survival and success of zirconia compared with titanium implants: a systematic review and meta-analysis.

OBJECTIVE: This systematic review assessed the available evidence on the survival and success rate of zirconia and titanium implants. As secondary outcomes, aesthetic, radiographic and clinical parameters, as well as biological and mechanical complications, were considered. MATERIALS AND METHODS: A systematic search was performed up to March 2022 to identify CCTs/RCTs comparing zirconia and titanium implants with a minimum of 12 months of follow-up. Meta-analysis was performed when ≥ 2 articles with similar characteristics were retrieved. RESULTS: Four published articles with two RCTs (2 different patient populations) with 100 zirconia and 99 titanium implants that were followed up over 12-80 months were selected out of the 6040 articles. A non-statistically significant difference between zirconia and titanium implant survival at 12 months was suggested (P = 0.0938). The success rates were 57.5-93.3% and 57.1-100% for zirconia and titanium implants, respectively. The pink aesthetic score (PES) was higher for zirconia (10.33 ± 2.06 to 11.38 ± 0.92) compared to titanium implants (8.14 ± 3.58 to 11.56 ± 1.0). CONCLUSION: Based on the 2 RCTs retrieved in the literature, similar survival rates were reported for zirconia and titanium implants in the short term (12 months of follow-up). Future RCTs are warranted to evaluate the long-term outcomes of zirconia implants. CLINICAL RELEVANCE: Zirconia implants may be the procedure of choice, particularly in the aesthetic zone, since they show a similar survival and success rate as titanium implants on a short-term follow-up. TRIAL REGISTRATION: Systematic review registration number-CRD42021288704 (PROSPERO).

Bone regeneration in implant dentistry: Which are the factors affecting the clinical outcome?

The key factors that are needed for bone regeneration to take place include cells (osteoprogenitor and immune-inflammatory cells), a scaffold (blood clot) that facilitates the deposition of the bone matrix, signaling molecules, blood supply, and mechanical stability. However, even when these principles are met, the overall amount of regenerated bone, its stability over time and the incidence of complications may significantly vary. This manuscript provides a critical review on the main local and systemic factors that may have an impact on bone regeneration, trying to focus, whenever possible, on bone regeneration simultaneous to implant placement to treat bone dehiscence/fenestration defects or for bone contouring. In the future, it is likely that bone tissue engineering will change our approach to bone regeneration in implant dentistry by replacing the current biomaterials with osteoinductive scaffolds combined with cells and mechanical/soluble factors and by employing immunomodulatory materials that can both modulate the immune response and control other bone regeneration processes such as osteogenesis, osteoclastogenesis, or inflammation. However, there are currently important knowledge gaps on the biology of osseous formation and on the factors that can influence it that require further investigation. It is recommended that future studies should combine traditional clinical and radiographic assessments with non-invasive imaging and with patient-reported outcome measures. We also envisage that the integration of multi-omics approaches will help uncover the mechanisms responsible for the variability in regenerative outcomes observed in clinical practice.

Laser treatments as an adjunct to non-surgical periodontal therapy in subjects with periodontitis and type 2 diabetes mellitus: a systematic review and meta-analysis.

OBJECTIVES: Periodontal disease and diabetes have an extensively investigated bidirectional correlation. Non-surgical periodontal treatment (NSPT) was proven to contribute to glycemic control. Moreover, it may benefit from the association of adjunctive therapies. The aim of the present systematic review is to assess the clinical efficacy of NSPT in association with laser (LT) or photodynamic therapy (PDT) in controlled or uncontrolled diabetic patients, and to grade the level of evidence. MATERIALS AND METHODS: Randomized controlled clinical trials with at least 3-month follow-up were searched in MEDLINE via OVID, EMBASE, and Cochrane Central, screened for inclusion, and grouped based on the performed treatments, follow-up time, type of diabetes, and level of glycemic control. RESULTS: Eleven RCTs with 504 total subjects were included. The adjunct of PDT showed a statistically significant 6-month difference in PD changes (with low certainty of evidence), but not in CAL changes, while a significant difference in 3-month PD and CAL changes was found with the adjunct of LT (low certainty of evidence). Patients treated with PDT registered a higher decrease in HbA1c levels at 3 months, but no significant difference was noted at 6 months; LT also led to better HbA1c changes at 3 months with a moderate certainty of evidence. CONCLUSION: Despite the promising short-term HbA1c decrease, the results should be interpreted with caution due to the small effect sizes and the statistical heterogeneity, and further evidence from well-designed RCTs is needed to support the routine use of PDT or LT in adjunct to NSPT.

The efficacy of bone reconstructive therapies in the management of peri-implantitis. A systematic review and meta-analysis.

AIM: To evaluate the efficacy of bone reconstructive procedures for the reduction of probing pocket depth (PPD), bleeding on probing (BOP), and suppuration in peri-implantitis-related bone defects at ≥12-month follow-up. MATERIALS AND METHODS: Three databases were searched for randomized controlled trials (RCTs) and controlled clinical trials (CCTs) that compared bone reconstructive therapies to access flap surgery (AFS) (Focused Question-FQ 1), and RCTs, CCTs, and prospective case series that assessed the efficacy of reconstructive therapies (FQ 2). Meta-analysis was performed for FQ1 when more than three studies were identified, while for FQ2 a network was drawn based on RCTs with common treatment arms. RESULTS: Seven RCTs were identified for FQ1 while five RCTs and six prospective case series for FQ2. There was no significant difference in PPD change between AFS and reconstructive surgery (-0.387; p = .325) at 12 months. Furthermore, no clear differences in terms of PPD and BOP changes resulted from the different reconstructive therapies included in the network. Only a small percentage of treated cases with any modality achieved peri-implantitis resolution, as defined by different composite outcomes. CONCLUSIONS: Reconstructive surgery does not offer significant improvements in peri-implant clinical parameters as compared to AFS at 12 months. It was not possible to establish a hierarchy of efficacy among the different biomaterials employed for reconstructive surgery.

Clinical efficacy of hand and power-driven instruments for subgingival instrumentation during periodontal surgical therapy: a systematic review.

OBJECTIVE: This systematic review aims to assess the available literature on the clinical efficacy of hand versus power-driven instruments for subgingival instrumentation during surgical periodontal therapy (ST). MATERIALS AND METHODS: A search of the literature was carried out on MEDLINE via Ovid, Embase, Web of Science, the Cochrane Database, LILACS, and Scopus. RCTs comparing the use of powered instruments (test) to hand scalers (control) for subgingival instrumentation in terms of changes in probing pocket depth (PPD) after surgical periodontal treatment were included and screened in duplicate. Descriptive synthesis of the data and risk of bias assessment were undertaken. RESULTS: Four RCTs met the inclusion criteria and were included in this systematic review. ST in all studies was performed by means of open flap debridement. Gracey curettes were the most commonly used hand instruments, while sonic and ultrasonic devices were used in the test group. Sites with initial PPD ≥ 6 mm had pocket reduction ranging from 2.93 to 4.89 mm in the control group and from 2.77 to 3.86 mm in the test group. All studies found no significant difference between the different types of instruments/devices in terms of PPD reduction. CONCLUSIONS: Despite the limited number of studies, both manual and power-driven instruments appear to be effective in reducing PPD after surgical treatment of periodontitis. CLINICAL RELEVANCE: Based on the findings of this systematic review, the clinician may make a decision whether to use manual or powered instruments during ST on a case-by-case basis and considering other factors, such as the risk of creating high concentrations of aerosols.

Testosterone Enanthate: An In Vitro Study of the Effects Triggered in MG-63 Cells.

The aim of this study was to investigate the effects of the androgenic hormone testosterone enanthate (TE) on human MG-63 cells. MG-63 were cultured for 24 h in the presence of TE at increasing concentrations to assess its lethal dose. Therefore, the suitable concentration for a prolonged use of TE in vitro was assessed by viability assay over 9 days. Finally, MG-63 were exposed to TE for 14 days and assayed for differentiation by qPCR and Alizarin Red S staining. TE in the amount of 100 µM resulted as the maximum dose tolerated by MG-63 cells after 24 h. However, a prolonged exposure in culture TE in the amount of 100 µM showed a cytostatic effect on cell proliferation. On the contrary, TE 10 µM was tolerated by the cells and did not boost cell proliferation, but did enhance new bone formation, as revealed by COL1A1, ALPL, BGLAP, and IBSP gene expression after 3, 7, and 14 days, and calcium deposition by Alizarin Red S staining after 14 days. Based on the current study, 10 µM is the critical dose of TE that should be used in vitro to support bone differentiation of MG-63 cells.

The efficacy of adjunctive periodontal therapies during supportive periodontal care in patients with residual pockets. A systematic review and meta-analysis.

While it is well-established that patients that develop signs of relapsing periodontitis in supportive periodontal care (SPC) will need to repeat subgingival instrumentation of the residual pockets, less certainty is available in terms of which protocol should be followed and whether the use of adjunctive therapies or physical agents might provide additional benefits to repeated instrumentation alone. The aim of this systematic review was therefore to assess whether repeating subgingival instrumentation in combination with adjunctive therapies (other than antimicrobials) might provide a significant benefit in terms of pocket closure, probing pocket depth (PPD) reduction or clinical attachment level (CAL) gain in patients during SPC with residual/relapsing pockets. Four databases were searched to identify randomized controlled trials (RCTs) and controlled clinical trials (CCTs) with a minimum follow-up of 3 months that investigated the use of adjunctive therapies (other than antimicrobials) in case of residual/relapsing pockets in patients in SPC since at least 3 months. Data extraction and risk of bias assessment were performed in the studies meeting the inclusion criteria and meta-analysis was performed when ≥3 studies assessing the same adjunctive therapy were identified. 12 studies (2 CCTs and 10 RCTs) were included for qualitative analysis. Meta-analysis was performed only for 3 studies on the adjunctive use of photodynamic therapy (PDT) and it indicated a nonsignificant benefit compared to the placebo in terms of PPD reduction and CAL gain at 3 months (weighted mean difference 0.07 and -0.03, respectively) and at 6 months of follow-up (weighted mean difference -0.09 and -0.18, respectively). While antiseptics did not provide significant benefits, one study on probiotics and one on the use of vitamin D and calcium supplementation showed significant improvements in periodontal parameters. There is currently insufficient/poor evidence to determine the efficacy of adjunctive strategies (other than antimicrobials) to improve the outcomes of SPC in case of residual/relapsing pockets.

A long-lasting guided bone regeneration membrane from sequentially functionalised photoactive atelocollagen.

The fast degradation of collagen-based membranes in the biological environment remains a critical challenge, resulting in underperforming Guided Bone Regeneration (GBR) therapy leading to compromised clinical results. Photoactive atelocollagen (AC) systems functionalised with ethylenically unsaturated monomers, such as 4-vinylbenzyl chloride (4VBC), have been shown to generate mechanically competent materials for wound healing, inflammation control and drug delivery, whereby control of the molecular architecture of the AC network is key. Building on this platform, the sequential functionalisation with 4VBC and methacrylic anhydride (MA) was hypothesised to generate UV-cured AC hydrogels with reduced swelling ratio, increased proteolytic stability and barrier functionality for GBR therapy. The sequentially functionalised atelocollagen precursor (SAP) was characterised via TNBS and ninhydrin colourimetric assays, circular dichroism and UV-curing rheometry, which confirmed nearly complete consumption of collagen's primary amino groups, preserved triple helices and fast (< 180 s) gelation kinetics, respectively. Hydrogel's swelling ratio and compression modulus were adjusted depending on the aqueous environment used for UV-curing, whilst the sequential functionalisation of AC successfully generated hydrogels with superior proteolytic stability in vitro compared to both 4VBC-functionalised control and the commercial dental membrane Bio-Gide®. These in vitro results were confirmed in vivo via both subcutaneous implantation and a proof-of-concept study in a GBR calvarial model, indicating integrity of the hydrogel and barrier defect, as well as tissue formation following 1-month implantation in rats. STATEMENT OF SIGNIFICANCE: Collagen-based membranes remain a key component in Guided Bone Regeneration (GBR) therapy, but their properties, e.g. proteolytic stability and soft tissue barrier functionality, are still far from optimal. This is largely attributed to the complex molecular configuration of collagen, which makes chemical accessibility and structure-function relations challenging. Here, we fabricated a UV-cured hydrogel network of atelocollagen, whereby triple helices were sequentially functionalised with two distinct ethylenically unsaturated monomers. The effects of the sequential functionalisation and UV-curing on the macroscopic properties, degradation behaviour and GBR capability were investigated in vitro and in vivo. The results highlight the key role of the sequential functionalisation and provide important insights for the design of future, longer-lasting resorbable membranes for GBR therapy.

Efficacy of tooth-supported compared to implant-supported full-arch removable prostheses in patients with terminal dentition. A systematic review.

AIMS: To compare tooth- (TSRP) and implant-supported (ISRP) removable prostheses in terms of abutment and prosthesis survival (PICO 1) and estimated cumulative survival of teeth/implants and prostheses (PICO 2) at ≥12-month post-prosthesis delivery in patients with stage IV periodontitis. MATERIALS AND METHODS: Five databases were searched to identify RCTs, CCTs, single arms, prospective cohort studies, case series and retrospective studies. Duplicate screening was performed, and ranges for abutment and prosthesis survival were calculated. RESULTS: Twenty-six studies were included in the qualitative assessment. Only one study with critical risk of bias comparing the two treatment modalities reported similar survival rates at 2 years. Overall, prospective studies on ISRPs indicated an implant survival rate ranging from 96.4% to 100% and a prosthesis survival rate of 100% with a follow-up from 12 to 54 months. Prospective studies on TSRPs indicated a tooth survival ranging from 85.71% to 100% at 1- to 10-years follow-up. CONCLUSIONS: The available evidence is of poor quality, and it does not allow to make robust conclusions on the efficacy of these rehabilitations in stage IV periodontitis patients. Particularly for TSRPs, careful patient selection is crucial and a certain number of biological and prosthetic complications should be expected.

Systematic review and meta-analysis on the adjunctive use of host immune modulators in non-surgical periodontal treatment in healthy and systemically compromised patients.

Considering the central role of inflammation in the pathogenesis of periodontitis, the combination of NSPT with different agents that can modulate the host immune-inflammatory response has been proposed to enhance the outcomes of NSPT. The aim of this paper is to systematically review the literature on the efficacy of systemic host modulators (HMs) as adjuncts to non-surgical periodontal therapy (NSPT) in improving pocket depth (PD) reduction and clinical attachment level (CAL) gain in healthy and systemically compromised patients. RCTs with ≥ 3 months follow-up were independently searched by two reviewers. Meta-analysis was performed when ≥ 3 studies on the same HM were identified. The quality of the evidence was rated according to the GRADE approach to rate the certainty of evidence. 38 articles were included in the qualitative assessment and 27 of them were included in the meta-analysis. There is low/very low evidence that the adjunctive use of sub-antimicrobial dose of doxycicline, melatonin and the combination of omega-3 and low dose aspirin (in type 2 diabetic patients) to NSPT would improve PD and/or CAL. Conflicting evidence is available on the efficacy of probiotics. Future studies controlling for confounding factors, using composite outcomes to define the endpoint of therapy and considering not only the patient- but also as the site-specific effect of systemic HMs are warranted. The dosage, posology and long-term effect of HMs still need to be clarified, also in association to the presence of systemic conditions potentially affecting the response to HMs administration.

Medium- and Long-Term Survival Rates of Implant-Supported Single and Partial Restorations at a Maximum Follow-up of 12 Years: A Retrospective Study.

PURPOSE: To present medium- and long-term biologic outcomes of implant-supported single-tooth restorations and fixed partial dentures and to analyze their correlations with prosthesis and patient characteristics. MATERIALS AND METHODS: The records of patients treated with implant-supported fixed restorations between 2004 and 2019 reporting the presence or absence of peri-implantitis and/or implant failure were analyzed. The cumulative survival rate (%) over time was calculated, as well as the cumulative prevalence of units free of peri-implantitis. RESULTS: A total of 344 implants in 112 patients were included, with a mean follow-up period of 5.3 ± 4.0 years after loading. The cumulative survival rates for implants supporting single crowns and fixed partial dentures were 98.11% and 100% after 5 years, respectively, and 97.43% and 98.96% after 10 years, with an overall survival rate of 91.69% after 12 years. At the patient level, the implant survival rates were 95.42%, 92.73%, and 85.31% at 5, 10, and 12 years, respectively. The cumulative rate of implants free from peri-implantitis was 87.46% at the implant level and 72.39% at the patient level. Implant and prosthesis characteristics did not affect the long-term occurrence of implant failure or peri-implantitis. The development of peri-implantitis was statistically correlated with patient smoking habits, but not with history of periodontitis or with diabetes mellitus. CONCLUSION: Implants supporting single crowns and fixed partial dentures showed relatively high medium- and long-term survival rates that were not influenced by the implant or prosthesis characteristics, including the retention method. As for patient characteristics, only smoking was correlated with the occurrence of peri-implantitis.

The effect of a behavioural management tool in adults with mild to moderate periodontitis. A single-blind, randomized controlled trial.

OBJECTIVE: To compare a behavioural management program (test) to a standard communication approach (control) to reduce plaque, improve clinical outcomes and patient's compliance with oral self-care. BACKGROUND: Since psychological factors affect oral health-related behaviours, approaches directed at changing behaviours and improving compliance might improve the effect of oral health education. MATERIALS AND METHODS: This was a randomized, single-blind, parallel-design trial involving 71 patients with mild to moderate periodontitis. During a run-in period, all participants began using a power toothbrush. Two sessions of non-surgical periodontal therapy were performed post-baseline, along with one of the two oral healthcare communication approaches. Plaque and bleeding scores, probing pocket depth (PPD) and clinical attachment level (CAL) were recorded at the screening visit, baseline visit and at 8 and 14 weeks post-baseline. Patients were asked to fill in oral self-care diaries. Experience questionnaires were administered to both clinicians and patients to assess subjective experience of the clinician-patient interactions during the visits. RESULTS: In both groups, a significant reduction in plaque and bleeding scores was observed from baseline to 8 weeks after baseline, which then remained stable at week 14, but no differences between the groups were noted. An improvement in CAL and PPD was recorded at week 8 post-baseline in the test compared to the control group. No inter-group differences in the clinician's and subject's experience questionnaires were observed. CONCLUSION: Both approaches significantly promoted periodontal health. However, changing lifestyle requires repeated communication/engagement over time and a behavioural management program based upon two visits did not provide additional benefit compared to a standard approach.

The effect of a 2-mm inter-implant distance on esthetic outcomes in immediately non-occlusally loaded platform shifted implants in healed ridges: 12-month results of a randomized clinical trial.

BACKGROUND: Three millimeter is considered as the minimum distance to obtain soft and bone tissue stability in case of adjacent implants. The possibility to preserve peri-implant bone level using a platform switching connection has questioned this concept. PURPOSE: The study evaluates soft tissue maintenance and marginal bone stability around implants, placed at 2 or 3 mm of distance. MATERIALS AND METHODS: Thirty patients received two immediately loaded implants either at 2-mm (test) or at 3-mm (control) of distance in the premolar area. Soft tissue esthetics (papilla height and fill, keratinized tissue, recession) and radiographic peri-implant bone level changes were measured at 3, 6, and 12 months. RESULTS: No significant differences between the two groups were detected neither for all soft tissue esthetic outcomes nor for bone level modifications up to 12 months. CONCLUSION: The results suggested that up to 12 months post-loading, both 2- and 3-mm inter-distance platform-switched implants in healed site, supported adequate esthetic outcomes and peri-implant bone stability.

Proteomic and Transcriptomic Approaches for Studying Bone Regeneration in Health and Systemically Compromised Conditions.

Bone regeneration is a complex biological process, where the molecular mechanisms are only partially understood. In an ageing population, where the prevalence of chronic diseases with an impact on bone metabolism is increasing, it becomes crucial to identify new strategies that would improve regenerative outcomes also in medically compromised patients. In this context, omics are demonstrating a great potential, as they offer new insights on the molecular mechanisms regulating physiologic/pathologic bone healing and, at the same time, allow the identification of new diagnostic and therapeutic targets. This review provides an overview on the current evidence on the use of transcriptomic and proteomic approaches in bone regeneration research, particularly in relation to type 1 diabetes and osteoporosis, and discusses future scenarios and potential benefits and limitations on the integration of multi-omics. It is suggested that future research will leverage the synergy of omics with statistical modeling and bioinformatics to prompt the understanding of the biology underpinning bone formation in health and medically compromised conditions. With an eye toward personalized medicine, new strategies combining the mining of large datasets and bioinformatic data with a detailed characterization of relevant phenotypes will need to be pursued to further the understanding of disease mechanisms.