Histological and histomorphometric analysis of bone tissue using customized titanium meshes with or without resorbable membranes: A randomized clinical trial.

OBJECTIVES: To date, no clinical studies have investigated the effect of using resorbable collagen membrane in conjunction with customized titanium mesh to promote bone formation in guided bone regeneration. Therefore, a non-inferiority analysis (one-sided 95% CI approach) was designed to compare the augmented bone gained using meshes with and without collagen membranes, through histological and histomorphometric investigations. MATERIALS AND METHODS: Thirty patients undergoing bone augmentation procedures at both maxillary and mandible sites were randomly treated with customized titanium meshes alone (M-, n = 15) or covered with resorbable membrane (M+, n = 15), in both cases filled with autogenous bone and xenograft. After 6 months of healing, bone tissue biopsies were taken from the augmented region. The bone tissue (B.Ar), grafting material (G.Ar), and non-mineralized tissue (NMT.Ar) areas were quantified through histomorphometric analysis, as were the osteoid area (O.Ar) and its width. RESULTS: Collagen membrane did not appear to significantly influence the investigated parameters: B.Ar, G.Ar, NMT.Ar, and O.Ar were similar between Group M- (34.3%, 11.5%, 54.1%, 1.95 µm2 , respectively) and Group M+ (35.3%, 14.6%, 50.2%, and 1.75 µm2 , respectively). Considering the overall population, significantly higher rates of newly formed bone were obtained in mandibular sites, while non-mineralized and dense connective tissue rates were higher in the maxilla (p < .05). CONCLUSIONS: The application of collagen membrane over titanium mesh did not lead to significant results. Bone formation appeared significantly different in the maxilla compared with the mandible. Additional studies are required to further investigate the issues observed.

Detection and sensing of oral xenobiotics in edentulous patients rehabilitated with titanium dental implants: Insights from a scoping review.

STATEMENT OF PROBLEM: Titanium has been considered the standard element in implant manufacturing. Recent studies have evaluated the role of titanium as a biological modulator of oral health. However, evidence regarding the association between the release of metal particles and peri-implantitis is lacking. PURPOSE: The purpose of this scoping review was to evaluate the literature regarding the release of metal particles in peri-implant tissues correlated with the methods of detection and the local and systemic implications. MATERIAL AND METHODS: The study was performed in adherence with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines and was registered with the National Institute for Health Research PROSPERO (Submission No. 275576; ID: CRD42021275576). A systematic search was conducted in the Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE via PubMed, Scopus, and Web of Science bibliographic databases, complemented by a manual evaluation. Only in vivo human studies written in the English language and published between January 2000 and June 2022 were included. RESULTS: In total, 10 studies were included according to eligibility criteria. Different tissues and analytic techniques were reported: the characterization technique most used was inductively coupled plasma mass spectrometry. All 10 studies analyzed the release of metal particles in patients with dental implants, continuously detecting titanium. None of the studies reported a significant association between metal particles and biological effects. CONCLUSIONS: Titanium is still considered the material of choice in implant dentistry, despite the detection of metal particles in peri-implant tissues. Further studies are necessary to evaluate the association between analytes and local health or inflammatory status.

Effectiveness of Bichat's Buccal Fat Pad (BFP) Technique for Vertical Ridge Augmentation in the Maxilla.

This study evaluated the efficacy of buccal fat pad (BFP) as a natural barrier to cover nonresorbable devices for vertical ridge augmentation (VRA). Twelve consecutive patients with 14 vertical bone defects in need of bone augmentation for implantprosthetic rehabilitation were treated according to the described protocol. VRA was performed by means of customized titanium meshes, titanium-reinforced d-PTFE membranes, or resorbable membranes and titanium plates. After buccal flap release, the BFP was identified and isolated, then mesially and coronally advanced to cover the whole augmented area. BFP was used as a pedicle flap in 11 cases and as a free graft in 3 cases. The mean BFP surface area was 13.5 ± 5.5 cm2. Healing was uneventful in all 14 augmented sites. No patients reported healing complications or facial volumetric changes. The mean vertical bone gain (VBG) was 4.2 ± 1.8 mm. In this limited number of cases, using the BFP as a natural barrier has proven to be efficient in bone augmentation, as it improved the healing process while reducing the risk of complications. Int J Periodontics Restorative Dent 2023;43:e99-e109. doi: 10.11607/prd.5473.

Vertical ridge augmentation with Ti-reinforced dense polytetrafluoroethylene (d-PTFE) membranes or Ti-meshes and collagen membranes: 3-year results of a randomized clinical trial.

BACKGROUND: The present study aimed to evaluate hard and soft tissue parameters around implants placed in augmented posterior mandible, comparing Ti-reinforced d-PTFE membranes with Ti-meshes covered with collagen membranes, after 3 years of follow-up. MATERIALS AND METHODS: Forty eligible patients were randomly assigned to group A (Ti-reinforced d-PTFE membrane) or group B (mesh covered with collagen membrane) for vertical ridge augmentation (VRA) and simultaneous implants. Implants were evaluated using specific peri-implant parameters for bone and soft tissues: probing pocket depth (PPD), modified plaque index (mPI), bleeding on probing (BoP), modified gingival index (mGI), thickness of keratinized tissue (tKT), width of keratinized tissue (wKT), fornix depth (FD), peri-implant bone level (PBL), interproximal bone peaks (IBP), marginal bone loss (MBL), interproximal bone loss (IBL). RESULTS: A total of 28 patients with 79 implants were evaluated after 3 years of follow-up. The mean value of MBL was 0.70 mm (group A = 0.73 mm; group B = 0.71 mm), while mean IBL was 0.54 mm (group A = 0.64 mm; group B = 0.40 mm). The treatment with meshes resulted not inferior to PTFE and their clinical results appeared similar. A strong correlation between PBL and IBP was confirmed. Both study groups showed an increase of tKT and wKT values. CONCLUSION: In the posterior mandible, VRA using both techniques provides stable PBLs up to 3 years. A correct soft tissue management and a strict professional oral hygiene protocol play a crucial role on peri-implant health over time.

Autogenous Chin Block Grafts for Implant-Supported Rehabilitation: A 20-Year Follow-Up Case Series.

The aim of the present study was to analyze the survival and success rates of dental implants placed in atrophic alveolar ridges reconstructed with mandibular symphysis autogenous onlay bone grafts, with a 20-year follow-up. A sample of five patients referred to the authors' department between 2000 and 2001 seeking for an implant-supported fixed rehabilitation. Patients were treated by means of autogenous bone blocks grafted from the mandibular symphysis and covered with bone substitutes (DBB) and a resorbable membrane. Then delayed implants were placed and finally prosthetic restoration was performed. In total, 10 implants placed in 5 patients were evaluated with a follow-up of 20 years. Both implant survival and success rate were 100%. The mean marginal bone loss was 0.32  [[EQUATION]]  0.39 mm (range 0-1.3 mm). Considering the conditions of peri-implant hard and soft tissues, the diagnosis of peri-implant health was made for all the implants included. According to this study, implants placed in alveolar ridges augmented by means of autogenous chin bone grafts showed long-term survival and high success rates. A correct management of peri-implant soft tissues and an accurate prosthetic rehabilitation are also fundamental to obtain the durable success of the treatment.

Effectiveness Of Bichat's Buccal Fat Pad (BFP) Technique For Vertical Ridge Augmentation In The Maxilla.

The aim of this study was to evaluate the efficacy of buccal fat pads (BFP) as a natural barrier to cover nonresorbable devices for vertical ridge augmentation (VRA). A total of 12 consecutive patients with 14 vertical bone defects in need of bone augmentation for implant-prosthetic rehabilitation were treated according to the described protocol. VRA was performed by means of (1) customized titanium meshes, (2) titanium-reinforced PTFE membranes, or (3) resorbable membranes plus titanium plates. After buccal flap release, the BFP was identified, isolated, then mesially and coronally advanced to cover the whole augmented area. BFP was used as a pedicle flap in 11 cases and as free graft in 3 cases. The mean surface of the BFP obtained was 13.5 ± 5.5 cm2. In all 14 augmented sites, uneventful healing was assessed. No patients reported healing complications or facial volumetric changes. The mean VBG was 4.2 ± 1.8 mm. In this limited number of cases, the technique using the BFP as a natural barrier has proven to be efficient in bone augmentation, as it has shown to improve the healing process while reducing the risk of complications.

A novel technique for digitalisation and customisation of reinforced polytetrafluoroethylene meshes: Preliminary results of a clinical trial.

PURPOSE: To evaluate the clinical, radiographic and patient-related outcomes of a novel technique for digitalisation and customisation of reinforced polytetrafluoroethylene meshes in vertical ridge augmentation surgery. MATERIALS AND METHODS: A total of 10 patients (five men and five women, mean age 54 years) with vertical defects were included in the study. Prior to surgery, digital planning of bone augmentation, manufacturing of 3D printed models and replicas of the meshes and modelling of a customised reinforced polytetrafluoroethylene mesh were carried out. All patients were treated using a 50:50 mixture of xenogeneic and autogenous bone, customised reinforced polytetrafluoroethylene mesh and collagen membrane. After 6 to 9 months, computer-guided surgery was planned, the reinforced polytetrafluoroethylene mesh was removed and implants were placed in augmented sites using a fully guided surgical template. Patient-related outcomes, intraoperative timing, surgical and healing complications, vertical bone gain, bone density, pseudoperiosteum type and number and stability of implants were recorded. RESULTS: All 10 patients were treated without surgical complications. Healing was largely uneventful, with the exception of one case of abscess formation without mesh exposure (exposure rate 0%). The mean duration of digital planning was 17.0 minutes, reinforced polytetrafluoroethylene mesh customisation took 9.0 minutes, and the total intraoperative time was 91.3 minutes. The mean planned bone volume was 1.52 cc, vertical bone defect depth was 6.0 ± 1.7 mm and vertical bone gain was 5.5 ± 1.9 mm; most sites showed medium bone density and a Type 1 pseudoperiosteum. All patient-related outcomes were favourable. CONCLUSIONS: The preliminary results of this pilot study demonstrated the feasibility and reliability of a fully digital workflow for the customisation of reinforced polytetrafluoroethylene mesh in vertical ridge augmentation.