A Novel Technique for Preparation of Recipient Site and Autologous Bone Grafting in Autotransplantation of Single-Rooted Teeth: A Report of Two Cases.

Low-speed drilling without irrigation has a long history of use in implant dentistry. It provides the advantage of avoiding the wash-out of proteins and biomolecules from the bone. In this case report, we describe the novel use of this drilling protocol in the preparation of bone alveolus during the procedure of tooth autotransplantation. Two cases with early tooth loss in the upper maxillary arch were treated by the autotransplantation of permanent teeth with immature root development and the use of plasma rich in growth factors. Autologous bone fragments (from drilling) were harvested and used for alveolar bone augmentation. The follow-up time was three and seven years since tooth autotransplantation. All the autotransplanted teeth achieved a closed apex with no signs of loss of vitality. Low-speed drilling without irrigation did not jeopardize the outcomes of tooth autotransplantation and warrants further investigation in the context of periodontal ligament healing.

Oral Lichen Planus Treated With Plasma Rich in Growth Factors.

The use of plasma rich in growth factors (PRGF) is a treatment for erosive oral lichen planus (OLP) resistant to steroid therapy. An anonymous database at a clinical center was reviewed to collect demographic data, lesion type, treatment protocol, number of infiltrations, pain score, and healing time of the lesions. Fifteen patients were included in this study. All patients were diagnosed with erosive OLP. The lesions in all patients were refractory to steroid therapy (topical and systemic). Results showed that the use of plasma rich in growth factors (PRGF) could be a promising alternative for the treatment of erosive OLP refractory to steroid therapy, though new prospective studies are needed to confirm these preliminary observations.

Implant-prosthetic treatment in patients with oral lichen planus: A systematic review.

AIMS: This review is aiming on identifying the ideal implant-prosthetic treatment design in patients with OLP. METHODS AND RESULTS: A systematic review was conducted using four electronic databases; Medline (PubMed), Cochrane library, DOAJ and SCOPUS, following the PRISMA statement recommendations to answer the PICO question: "which implant-prosthetic treatment design is most useful to ensure implant survival in OLP patients?". The study was pre-registered in PROSPERO (CRD 42020220102). Included articles quality was assessed using the "Newcastle-Ottawa scale" and the JBI critical appraisal tool for case series. No article was found specifically designed to analyze the prosthetic influence on implant survival in OLP patients. Despite, information about implant-prostheses in studies designed with other goals was compiled. Eight articles that involved 141 patients and 341 implants were finally selected. The weighted mean follow-up was 38 months and the weighted mean survival of the implants 98.9%. No statistical differences were observed between cemented or screw retained prostheses and the materials employed or the technology to manufacture the prostheses. CONCLUSION: The influence of prosthetic design on implant survival in OLP patients is still poorly understood, but important clinical recommendations can be drawn. The strength of evidence was grade 3b (CEBM) or low (GRADE).

Dental Implants Survival After Nasal Floor Elevation: A Systematic Review.

The aim of this work is to assess the clinical outcomes of implants placed after a nasal floor elevation procedure. A systematic review was conducted using 4 electronic databases: MEDLINE (PubMed), Cochrane Library, Directory of Open Access Journals, and Scopus, following the PRISMA (Preferred Reporting Items for Systematic Reviews) statement recommendations to answer the PICO (Population, Intervention, Comparison, Outcome) question: "In patients undergoing dental implant placement in the maxillary anterior region (P), Do implants placed after nasal floor elevation (I) have a different survival (O) from those implants placed without grafting procedures (C)? The study was pre-registered in PROSPERO (CRD42021229479). Included article quality was assessed using the "NIH quality assessment tool", "The Newcastle-Ottawa scale," and "JBI critical appraisal tools for case reports." Twelve articles were finally selected, including 151 patients and 460 implants. The weighted mean follow-up was 32.2 months, and the weighted survival rate after this period was 97.64% (range: 89.2%-100%). No statistical differences could be inferred between the treatments performed in 1- or 2-stage, following a lateral approach or a transcrestal approach or using different grafting materials. A great heterogeneity was found in study design and methodological aspects. For this reason, a quantitative analysis followed by meta-analysis was not possible. Within the limitations of this study, implants placed after a nasal floor elevation present a good survival and a low range of complications. In absence of randomized studies, the level of evidence was low, attending the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) system and based on the study quality level, the strength of evidence attending the SORT (Strength Of Recommendation Taxonomy) was B.

Oral Pemphigoid Recalcitrant Lesion Treated with PRGF Infiltration. Case Report.

Mucous membrane pemphigoid (MMP) is a heterogeneous group of chronic autoimmune subepithelial blistering diseases. Oral involvement is present in almost all patients, may represent the onset of the disease, and causes different degrees of pain, dysphagia, soreness, and bleeding. Treatment is based on systemic and/or oral corticoids, or other immunosuppressants. Occasionally, oral lesions can show a poor response to standard treatments. We present the case of a 61-year-old female patient with a painful extensive MMP oral ulcerative lesion recalcitrant to previous systemic azathioprine and local triamcinolone treatment, which was successfully treated in a novel way using PRGF infiltrations as adjuvant. After four weekly infiltrations, pain was reduced from 10 to 0 in a VAS and the lesion was completely healed. The patient continued with a low dose maintenance immunosuppressive treatment (prednisone 5 mg/day PO), and after 13 months of follow-up, there was no relapse of the lesion and no side effects. Although future research is necessary to confirm these observations, PRGF could be a useful adjuvant for the management of extensive mucous membrane pemphigoid oral lesions.

Histopathological features of oral lichen planus and its response to corticosteroid therapy: A retrospective study.

Oral lichen planus (OLP) exhibits variations in severity and response to corticosteroid therapy. This study aims to assess the histopathological features of OLP at the time of diagnosis and their relationship in response to corticosteroid therapy.In this retrospective study, OLP patients were selected if a histopathological report was available. Data were collected regarding patients' demographics and medical history. Clinical and histological data were also obtained. The outcomes were histopathological findings, clinical form of OLP, number of exacerbations per year, and the response to corticosteroid therapy.In this study, 100 OLP patients were enrolled. Basal layer hydropic degeneration and band-like subepithelial lymphocytes infiltrate were observed in all patients. Plasma cells, identified in 62% of OLP patients, were significantly associated with fewer disease exacerbations and better response to corticosteroid treatment.Identifying histopathological features that may affect the clinical course would be clinically helpful in tailoring patient management.

Frequency of Technical Complications in Fixed Implant Prosthesis: The Effect of Prosthesis Screw Emergence Correction by Computer-Aided Design/Computer-Aided Manufacturing.

Computer-aided design/computer-aided manufacturing (CAD-CAM) technology permits the angular correction of screw emergence into the prosthesis; however, there is lack of controlled clinical studies that assess the frequency of technical complications in angled screw channel restorations. This controlled clinical study was designed to assess technical incidences in angled screw channel restorations. Patients who underwent placement of implant prosthesis between November 2014 and December 2015 were screened. The patients were selected if they received a prosthesis with up to 30° correction of the prosthesis screw emergence and had at least 1 nonangulated prosthesis (screw retained). All prostheses were located completely/partially in the posterior region. The frequency of technical complications was the principal variable. A total of 52 patients with a mean age of 62 ± 10 years participated, with a total of 110 prostheses (55 in the test group and 55 in the control group). A total of 11 technical complications occurred (7 in the test group and 4 in the control group). These differences were not statistically significant. All prostheses in both groups survived the follow-up. The correction of the screw emergence into the prosthesis has not increased the risk of technical complications in CAD-CAM implant prostheses.

Biomolecules in the treatment of lichen planus refractory to corticosteroid therapy: Clinical and histopathological assessment.

BACKGROUND: Local deficit of several biomolecules have been described in oral lichen planus (OLP). Such a deficit impairs cellular functions and cell-matrix communication. PURPOSE: Assess the efficacy of the local application of autologous biomolecules in the treatment of erosive OLP. MATERIALS AND METHODS: In this study, the use of plasma rich in growth factors (PRGF) as a source of blood-derived and autologous growth factors and proteins were tested in erosive oral lichen planus refractory to corticosteroids. Histopathological features of the disease were also analysed at the time of diagnosis. Clinical data were the number of recurrences and achievement of pain reduction and complete healing of the lesions. A total of 10 patients with erosive OLP refractory to treatment by corticosteroids were included in the study. All patients were females with a mean age of 48±12years. RESULTS: A complete remission of the disease was achieved after one infiltration of PRGF in 8 patients. Only 2 patients required a total of 2 infiltrations to heal. Hydropic degeneration of the epithelium basal layer, band-like subepithelial lymphocytic infiltration and fibrin deposits in the epithelium were observed in all patients. Interestingly plasma cells were present in 2 patients. All patients presenting plasma cells healed after only one PRGF infiltration. However, 2 patients out of 6 (no plasma cells) required 2 infiltrations. CONCLUSIONS: The local administration of autologous local factors could overcome the deficit of biomolecular clues and thus improve cell functions and restore cell-matrix communication.

Early marginal bone stability of dental implants placed in a transalveolarly augmented maxillary sinus: a controlled retrospective study of surface modification with calcium ions.

BACKGROUND: Recently, components of the extracellular cellular matrix have been assessed to enhance the biological response to dental implants. This study aims to assess the effect of surface modification with calcium ions on the early marginal bone loss of dental implants placed in a transalveolarly augmented maxillary sinus. METHODS: A retrospective study of transalveolar sinus floor augmentation was conducted in a single private dental clinic. The predictor variable was the surface of the dental implant. The primary outcome was the marginal bone loss. The secondary outcomes were the intraoperative complications and the dental implant failure. Descriptive analysis was performed for patients' demographic data and implant details. RESULTS: Fifty-one patients with a mean age of 58 ± 11 years had a mean follow-up time of 13 months. Thirty-four dental implants had a Ca2+-modified hydrophilic surface, and 31 had no Ca2 (control). The experimental group showed a statistically significant lower marginal bone loss (0.36 ± 0.42 vs 0.61 ± 0.39 mm). However, there were no statistically significant differences in the implant survival. No implant failed in the experimental group while two implants failed in the control group. CONCLUSIONS: The modification of an acid-etched surface with calcium ions seems to reduce the marginal bone remodeling around the dental implants, placed after transalveolar sinus floor elevation.

Prognosis of Dental Implants Immediately Placed in Sockets Affected by Peri-implantitis: A Retrospective Pilot Study.

The aim of this study was to describe a protocol and analyze the outcomes of immediate replacement of failed implants due to peri-implantitis. A total of 17 patients (mean age: 58 ± 10 years) had 22 failed implants that were immediately replaced. One implant failed 16 months after insertion, resulting in an implant survival rate of 94.7%. The mean follow-up time was 40 ± 16 months (range: 9-52 months) after insertion. Mesial and distal bone loss were 0.89 ± 0.62 mm and 0.97 ± 0.66 mm, respectively. Immediate implant replacement could be considered in the management of implant failure due to peri-implantitis.

Unusual Presentation of Castleman Disease in the Oral Cavity.

Castleman disease (CD) is a benign lymphoproliferative disease of unknown aetiology that rarely occurs in the head and neck region. Herein, the authors describe a patient of intraoral CD and its management. A 55-year-old female patient attended our clinic because of a 1-year history of a mass in the posterior hard palate region. Clinical and radiographic examination (cone-beam computed tomography scan), fine-needle aspiration, and incisional biopsy were performed. Both radiographic examination and fine-needle aspiration did not reveal relevant findings. The pathological analysis of the biopsy gave the diagnosis of hyaline vascular-type CD. The patient was treated by a complete surgical resection and 3 years after the treatment, the patient remained free of recurrence. Castleman disease in hard palate is quite different from other forms of cervical CD, mimicking other conditions like pleomorphic adenoma, lymphoma, and nodular necrotizing sialometaplasia. Careful clinical examination and histopathological analysis are essential for the diagnosis of rare and unusual pathological changes in the oral mucosa.

The use of topical corticosteroides in the treatment of oral lichen planus in Spain: A national survey

BACKGROUND: Explore the treatment of oral lichen planus with topical corticosteroids by the healthcare professionals in Spain. MATERIAL AND METHODS: A questionnaire targeted health professionals who treat OLP, in particular maxillofacial surgeons, dermatologist and dentist. The dissemination of the questionnaires was conducted through professional associations and dental and medical societies. The questionnaire was previously evaluated by means of a cognitive pre-test procedure to ensure that the questions were opportune and appropriate, understandable and acceptable among the professionals. RESULTS: Of the 890 questionnaires sent a total of 190 questionnaires were answered by 90 dentists, 60 dermatol gists and 40 by maxillofacial surgeons. The most frequent treatment was 0.1%triamcinolone acetonide in orobase 3 times a day. The effectiveness of the topical corticosteroid treatment was 6.68 (SD= 2.26) in a scale of 1 to 10. The 30% of the dentists and 10.49% of maxillofacial surgeons combined treatment with other drugs. The most frequent one (80%) was nystatin (100,000 IU per millimetre). Dermatologists did not use other treatments in co bination with corticosteroids CONCLUSIONS: There is a need for national guidelines in treatment for oral lichen planus (treatment criteria, drug, dose, treatment time and method of application of corticosteroid) that can be applied by all professionals who treat this disease

Long-Term Outcomes of Immediate Implant Placement Into Infected Sockets in Association With Immediate Loading: A Retrospective Cohort Study.

BACKGROUND: There is a paucity of studies examining long-term outcomes of immediate loading of dental implants immediately placed into infected sites. This study aims to evaluate long-term outcomes of immediate loading of postextraction implants placed in infected sites. METHODS: Patients were selected if they had postextraction implants in the anterior maxilla that were inserted in the period from December 2006 to June 2015 and immediately loaded. Information collected about patients included: 1) demographic data; 2) implant details; 3) soft tissue stability; and 4) prosthodontics data. Marginal bone loss (BL) and implant and prosthesis survival rates were calculated. RESULTS: Thirty patients (mean age: 56 years) had 43 implants immediately inserted into infected sites and immediately loaded. Implants were inserted at torque ≥35 Ncm. Mean follow-up time was 6 years (range: 1 to 8 years), and 65% of implants had a follow-up time >5 years. No implant failure occurred, and implant success rate was 93%. Proximal BL was 1.42 mm (range: 0.21 to 5.61 mm). Three prosthetic complications (all fracture of veneer material) occurred. CONCLUSIONS: Immediate loading of implants inserted into fresh and infected extraction sockets is not a risk factor for implant survival. However, stability of peri-implant soft and hard tissues indicates the need to take measures that minimize loss.

Nontraumatic Implant Explantation: A Biomechanical and Biological Analysis in Sheep Tibia.

Preclinical research in a sheep tibia model has been conducted to evaluate the underlying mechanisms of the nontraumatic implant explantation of failed implants, which allow placing a new one in the bone bed. Twelve dental implants were placed in sheep diaphysis tibia and once osseointegrated they were explanted using a nontraumatic implant explantation approach. Implant osseointegration and explantation were monitored by means of frequency resonance, removal torque, and angle of rotation measurement. The host bone bed and the explanted implant surface were analyzed by conventional microscopy and scanning electron microscope. Results show that osseointegration was broken with an angular displacement of less than 20°. In this situation the implant returns to implant stability quotient values in the same range of their primary stability. Moreover, the explantation technique causes minimal damage to the surrounding bone structure and cellularity. This nontraumatic approach allows the straightforward replacement of failed implants and emerges as a promising strategy to resolve clinically challenging situations.

Rehabilitation of Atrophied Low-Density Posterior Maxilla by Implant-Supported Prosthesis.

The rehabilitation of edentulous posterior maxilla is a challenging task that could be complicated by the availability of low-density and reduced height of alveolar bone. Patients were enrolled in this study upon the presence of type IV bone and residual bone height <5 mm in posterior maxilla. Novel procedure for transalveolar sinus floor elevation was described to insert 10 short implants in 4 patients. Neither implant failure nor prosthetic failure was observed during a follow-up of 44 ± 3 months. Mesial bone loss of 0.5 ± 0.6 mm and a distal bone loss 1.3 ± 0.9 mm were measured after 35 ± 4 months of loading.

Pyogenic granuloma in relation to dental implants: Clinical and histopathological findings.

BACKGROUND: The occurrence of pyogenic granuloma in association to dental implants is rare and only five cases have been reported in the literature. MATERIAL AND METHODS: Patients charts were analyzed to select patients who had been diagnosed for pyogenic granuloma and its association with dental implants had been evaluated. The clinical status of the dental implants and the prosthesis had also been assessed. RESULTS: Clinical and histopathological diagnosis of pyogenic granuloma had been reached for soft mass growth in association with dental implants in 10 patients. Histological analysis of all samples was performed to obtain a firm diagnosis of finding against pyogenic granuloma lesions. Accumulation of dental plaque due to poor oral hygiene and improper design of the prosthesis had been related to the occurrence of pyogenic granuoloma. This lesion showed no predilection to specific surface type and had no significant association with marginal bone loss. CONCLUSIONS: Pyogenic granuloma should be included in the differential diagnosis of soft mass growth around dental implants. KEY WORDS: Reactive lesion, soft mass, pyogenic granuloma, dental implant, titanium.

Effects of calcium ions on titanium surfaces for bone regeneration.

The chemistry and topography of implant surfaces are of paramount importance for the successful tissue integration of load-bearing dental and orthopedic implants. Here we evaluate in vitro and in vivo titanium implant surfaces modified with calcium ions (Ca(2+) surfaces). Calcium ions produce a durable chemical and nano-topographical modification of the titanium oxide interface. Time of flight secondary ion mass spectrometry examination of the outermost surface composition, shows that calcium ions in Ca(2+) surfaces effectively prevent adventitious hydrocarbon passivation of the oxide layer. In aqueous solutions Ca(2+) surfaces release within the first minute, 2/3 of the total measured Ca(2+), the rest is released over the following 85 days. Additionally, Ca(2+) surfaces significantly increase human fetal osteoblasts-like cell adhesion, proliferation and differentiation, as measured by the autocrine synthesis of osteopontin. Relevant for clinical application, after 12 weeks of healing in sheep tibia, microcomputer tomography and histomorphometric analysis show that Ca(2+) surfaces develop significantly more bone contacts and higher bone density in the 1mm region around the implant. Consequently, titanium implants modified with calcium ions represent a valuable tool to improve endosseous integration in the clinical practice.

Retrospective study of short and extra-short implants placed in posterior regions: influence of crown-to-implant ratio on marginal bone loss.

AIM: The aim of this study is to evaluate the influence of crown-to-implant (CI) ratio as well as other surgical, prosthetic and biomechanical variables on marginal bone loss (MBL) and on the survival rates of implant-supported prostheses in short implants (≤8.5 mm in length) placed in posterior areas of maxilla and mandible. MATERIAL & METHODS: This was a retrospective study based on clinical charts and follow-up recordings from a single private practice over a period of 10 years. Patients rehabilitated in the posterior region of the jaws by means of prostheses supported by implants of ≤8.5 mm length were included. Patients-related, surgery-related. and implant-related variables, as well as other prosthetic and biomechanical variables. were registered. The data were split into two groups according to the value of CI ratio (CI < 2 and CI ≥ 2). MBL was measured from radiographs using an image analysis software. Implant and prosthesis survival rates were recorded. RESULTS: One hundred twenty-eight short implants placed in 63 patients were evaluated. The mean follow-up period was 21.88 months (standard deviation (SD): 22.9, range 7-113 months). Eighty-six implants (67.2%) had a CI ratio of <2, whereas it was ≥2 in 42 implants (32.8%). The mean value of CI ratio was 1.82 (SD: 0.42; range 1.04-3.31). The average MBL after 1 year of follow-up was 0.35 (SD: 0.50), and it was 0.45 (SD: 0.46) mm for subsequent evaluations. Survival rates of implants and prosthesis were 100%. The presence of a cantilever had a negative influence on the first year MBL (p < .05). CONCLUSIONS: The CI ratio had not a significant influence on MBL in Biotechnology Institute (BTI; Vitoria, Spain) short implants humidified with PRGF-Endoret and placed in posterior areas. The only variable that showed a significant negative influence on first year postloading MBL was the use of cantilever for rehabilitations.

Efficacy of biologically guided implant site preparation to obtain adequate primary implant stability.

The primary stability of dental implants is essentially influenced by the quality and quantity of hosting bone. To study the effects of adaptation of the drilling protocol to the biological quality of bone estimated by bone density and cortical/cancellous bone ratio, 8.5mm-short implants were placed in different bone types by adapting the drilling protocol to result in a socket under-preparation by 0.2, 0.4, 0.7, 1 and 1.2mm in bone types I, II, III, IV and V, respectively. The effect of the drilling protocol was studied on implant insertion torque and osseointegration. Additionally, we analyzed the relationship of demographic data and social habits to bone type and insertion torque. Then the correlation between insertion torque and bone quality was tested. One hundred ninety two patients (mean age: 62 ± 11 years) participated with 295 implants. The most common bone type at implant site was type III (47.1%) followed by type II (28.1%). Data analysis indicated that gender, age, and social habits had neither correlation with bone type nor with insertion torque. The insertion torque was 59.29 ± 7.27 Ncm for bone type I, 56.51 ± 1.62 Ncm for bone type II, 46.40 ± 1.60 Ncm for bone type III, 34.84 ± 2.38 Ncm for bone type IV and 5 Ncm for bone type V. Statistically significant correlation was found between bone type and insertion torque. The followed drilling protocol adapts socket under-preparation to the needs of establishing a sufficient primary stability for implant osseointegration.