Explantación de implante mal posicionado en sector estético y regeneración posterior con injerto en bloque. Caso clínico / Explantation of a malpositioned implant in the aesthetic sector and regeneration with bone block grafting. Clinical case

La realización de una explantación en el sector estético produce un defecto óseo que en muchas ocasiones deja un área para la rehabilitación con implantes que debe ser regenerado a través de diferen tes procedimientos. El injerto en bloque puede ser una alternativa en los casos donde se precise regeneración ósea ver tical y horizontal de forma simultánea. En el presente caso clínico se muestra la explantación de un implante mal posicio nado en el sector estético, de imposible rehabilitación que debe ser retirado, regenerándose posteriormente el defecto para poder posicionar un nuevo implante, esta vez en una situación que permita una rehabilitación predecible y estéticamente satisfactoria (AU)

Performing an explantation in the aesthetic sector produces a defect that often leaves a bone loss that must be regenerated through different procedures. Bone block grafting can be an alternative in cases where simultaneous vertical and horizontal bone regeneration is required. In this clinical case we show the explantation of a poorly positioned implant in the aesthetic sector, impossible to rehabilitate, which must be explanted and the defect subsequently regenerated so that a new implant can be positioned, this time in a situation that allows us a predictable and aesthetically satisfactory rehabilitation (AU)

Comportamiento del injerto autólogo de diente en preservación alveolar: evaluación clínica, radiográfica e histomorfométrica de un caso clínico tras un año de seguimiento / Behavior of the autologous tooth graft in alveolar preservation: clinical, radiographic and histomorphometric evaluation of a clinical case after one year of follow-up

Introducción: tras las extracciones, se producen una serie de cambios dimensio nales en sentido horizontal y vertical de la cresta alveolar, los cuales pueden ser minimizados mediante algunas técnicas quirúrgicas, como la preservación alveo lar, que utiliza diferentes sustitutos óseos, entre los que se encuentra actualmente el injerto autólogo de diente. Caso clínico: se presenta el caso clínico de una mujer de 61 años, que acudió a consulta presentando dolor intenso en la zona del segundo premolar superior de recho (1.5). Se realizó la exodoncia del 1.5, usándose como diente donante para realizar una preservación del alveolo tras la extracción. Cuatro meses tras el proce dimiento, se colocó un implante y se tomó una biopsia para realizar un análisis histo morfométrico. Un año tras la carga del im plante se observaron buenos resultados clínicos y radiográficos. Discusión: el diente y el tejido óseo tie nen similitudes en su composición quími ca, tanto en sus componentes inorgáni cos y orgánicos como en la cantidad de agua. En cuanto al contenido orgánico destacan los factores de crecimiento, la proteína morfogenética ósea 2 (BMP-2) y el colágeno tipo 1, dotando al diente como biomaterial de la propiedad de os teoinducción. El empleo del diente como sustituto en preservación alveolar consi gue porcentajes altos de hueso neofor mado, variando entre 37,55% cuando se usa el diente completo, al 48,40% usando dentina desmineralizada. Además de los buenos resultados histomorfométricos, goza de una buena aceptación por parte de los pacientes, fundamentalmente en determinadas ra zas o culturas, y consigue una reducción de las dimensio nes óseas evaluadas mediante escáner de haz cónico. Sin embargo, requiere un tiempo de preparación, que aumenta si el diente tiene restauraciones o tratamientos de conduc tos asociados (AU)

Introduction: following tooth extraction, horizontal and vertical resorption of bone volume occurs, but they can be reduced by many surgical procedures, such as alveolar ridge preservation, which uses different bone substitutes, being one of them autogenous tooth-graft. Clinical case: a 61-year-old woman is presented, who came to private dental clinic presenting intense pain in the area of an upper bicuspid of the first quadrant (1.5). Exodontia of the 1.5 was performed, using it as a donor tooth to obtain the biomaterial to preserve its alveolus. After 4 months re-entry was performed and an implant was placed, harvesting a bone biopsy for histomorphometric analysis. One year post-loading, good clinical and radiographic results were shown. Discussion: human bone and tooth have similarities in their chemical composition, both in their inorganic and organic components and in the amount of water. The organic content, growth factors, bone morphogenetic protein 2 (BMP-2) and type 1 collagen stand out, give the tooth the property of osteoinduction. The use of the tooth as a substitute in alveolar preservation achieves high percentages of neoformed bone, varying between 37.55% when the whole tooth is used, to 48.40% using demineralized dentin. In addition, it is well accepted by patients, especially in certain races or cultures, and achieves a reduction in bone dimensions evaluated by cone beam computed tomography. However, it has a drawback, requiring a long preparation time, which increases if the tooth has associated restorations or root canals. Conclusions: Autologous tooth-graft has a high biocompatibility, a low rate of intraoperative complications and good patient acceptance. It requires 25 minutes for preparation, which increases if there are restorations, root canals and caries. The percentage of vital bone obtained in the present clinical case shows new bone formation of 20% 4 months after alveolar ridge preservation (AU)

Soft tissue dimensional change using customized titanium healing abutment in immediate implant placement in posterior teeth.

BACKGROUND: The morphologic and dimensional alveolar bone is significant for resorption in the first 3 months after tooth removal because they restrict treatment outcomes with respect to function and esthetic. Following teeth extraction, the width and height of the alveolar ridge contour are reduced in both the horizontal and vertical dimensions. Following implant placement, the gingival morphology should be changed minimally compared to pre-extraction. Surrounding natural-like tissue is also an ultimate goal of the dental implant treatment, which is correlated with the cervical third contour on the anatomical tooth, for comfortable cleansing, food impaction avoidance, and esthetics. PURPOSE: To evaluate the peri-implant soft tissue changes after immediate implant placement (IIP) with the use of a customized titanium healing abutment in the posterior teeth. METHOD: Digital impressions using the intraoral scanner (MEDIT i500) were taken from 30 patients. Customized titanium healing abutments were designed and milled before extraction. Flapless extractions were done using surgical guides, 32 immediate implants placement were done in posterior areas, and healing abutments were placed. Soft tissues were scanned during pre-operation, and post-surgery during the 1st, 3rd, and 6th months. A 3D analysis program (Final Surface) evaluated the gingival margin distance, height, contour width, and volume in each period. SPSS was used to analyze the data with a p-value = 0.05. The between-time interval comparisons were done and the analysis was done using a Multivariate test. RESULTS: Customized titanium healing abutments used in immediate implantation maintained optimal peri-implant mucosa. In intermittent periods, there was no significant reduction in all aspects of the margin distances and heights. During the entire period, the margin height reduction on the buccal, lingual, mesial, and distal was 0.63 mm, 0.93 mm, 0.08 mm, and 0.24 mm, respectively, and contour width reduction on the buccal, lingual, and buccolingual was 0.59 mm, 0.43 mm, and 1.03 mm, respectively. There was a significant reduction in the total buccolingual contour width in the 1st month and total volume in the 3rd to 6th months. CONCLUSIONS: Immediate implant placement with customized titanium healing abutment can achieve the optimal peri-implant mucosa and this protocol is an alternative for soft tissue management.

Implantes cortos y extracortos e inserción. Estudio retrospectivo con un seguimiento de 1 a 7 años / Short and extra-short implants in the maxilla and mandible with low insertion torque. Retrospective study with a follow-up of 1 to 7 years

Introducción: La realización de implantes cortos y extracortos en situaciones de extrema reabsorción maxilar y mandibular supone que la colocación del implante se realiza en condiciones de escaso volumen óseo residual y, por lo tanto. puedeser posible que el torque de inserción que se logre sea menor que en otras situaciones. En el presente artículo se investiga la posible relación que puede tener este bajo torque de inserción con la supervivencia del implante y la pérdida ósea crestal. Material y método: Fueron revisadas historias clínicas de forma retrospectivade los implantes insertados en el segundo semestre del año 2015 y primer trimestre del año 2021, para identificar implantes cortos y extracortos con torque de inserción < 20 N/cm. El implante fue la unidadde análisis para la estadística descriptiva en cuanto a la localización, dimensiones del implante, y mediciones radiográficas. El paciente fue la unidad de medida para el análisis de la edad, sexo y la historia médica. Las variables cualitativas se describieron mediante un análisis de frecuencias y las cuantitativas mediante media ydesviación estándar. La supervivencia de los implantes se calculó mediante el método de Kaplan-Meier.Resultados: Fueron reclutados 36 pacientes en los que se insertaron 40 implantes que cumplieron los criterios de inclusión marcados para el estudio. El torque de inserción de los implantes reclutados varió entre 5 y 15 Ncm, siendo 5 Ncm en el 37,5% de los casos, 10 Ncm en el 30% de los casos y 15 Ncm en el 32,5 % restante...(AU)

Introduction: The use of short, extrashort implants in situations of extrememaxillary and mandibular resorptionmeans that the implant is placed inconditions of low residual bone volumeand therefore it is possible that theinsertion torque achieved may be lowerthan in other situations. This article investigates the possible relationship thatthis low insertion torque may have with implant survival and crestal bone loss. Methods: Medical records of implants inserted in the second half of 2015 and first quarter of 2021 were retrospectively reviewed to identify short, extra-short implants with insertion torque < 20 N/cm.The implant was the unit of analysis for descriptive statistics in terms of location, implant dimensions, and radiographic measurements. The patient was the unit of measurement for the analysis ofage, sex and medical history. Qualitative variables were described by frequency analysis and quantitative variables by mean and standard deviation. Implant survival was calculated using the Kaplan Meier method. Results: Thirty-six patients were recruited and 40 implants were inserted that met the inclusion criteria for the study. The insertion torque of the recruited implants...(AU)

Reconstrucción maxilar con un implante subperióstico en un caso de atrofia severa. De la planificación a la rehabilitación siguiendo un protocolo totalmente digital. A propósito o clínico y revisión bibliográfica / Maxillary reconstruction with a subperiosteal implant in a case of severe atrophy. From planning to rehabilitation following a fully digital protocol. A clinical case report and literature review

Introducción: Los implantes subperiósticos personalizados de titanio, diseñadosa partir de un software de planificación yfabricación, constituyen una alternativaen la rehabilitación de atrofias severasen los maxilares, evitando cirugías de reconstrucción óseas y el de partes blandasmás complejas y disminuyendo los tiempos de cicatrización. El objetivo de este trabajo es presentar la rehabilitación enun caso clínico con una atrofia severa enmaxilar superior, utilizando una estructuracon implantes subperiósticos, medianteun protocolo digital.Descripción del caso: Se diseñó unaestructura subperióstica de titanio sinterizada con seis conexiones transepitelialesque fueron rehabilitadas con una prótesisfija inmediata implantosoportada fabricada en PMMA. Dos meses después, serealizó una estructura sinterizada en cromo-cobalto con bases mecanizadas recubierta con dientes de resina acrílica comorestauración final. En el seguimiento a unaño, el caso permanece estable.Conclusiones: Hoy en día, la rehabilitación con implantes subperiósticos constituye una herramienta alternativa en casosde cirugías complejas con grandes atrofias con la posibilidad, además, de realizar una carga inmediata. (AU)

Introduction: Customized subperiosteal titanium implants, designed from planning and fabrication software, constitute analternative in the rehabilitation of severe maxillary atrophy, avoiding more complex bone and soft reconstruction surgeries and reducing healing times. The aim of this article is to present the rehabilitation in a clinical case with severe atrophy in the upper jaw, using a structure with subperiosteal implants, by means of a digital protocol.Clinical Case: A subperiosteal sintered titanium structure was fabricated with six transepithelial connections that were rehabilitated with an immediate implant-supported fixed prosthesis made of PMMA. Two months later, a sintered Chromium-Cobalt framework with machined bases covered with acrylic resin teeth was fabricated as the final restoration. At one year follow-up, the case remains stable. Conclusions: Nowadays, rehabilitatin with subperiosteal implants is an alternative tool in cases of complex surgeries with large atrophies with the possibility of immediate loading. (AU)

Outcome measures and methods of assessment of soft tissue augmentation interventions in the context of dental implant therapy: A systematic review of clinical studies published in the last 10 years.

AIM: To identify and report outcome measures and methods of assessment on soft tissue augmentation interventions in the context of dental implant therapy reported in clinical studies published in the last 10 years. MATERIALS AND METHODS: The protocol of this Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) 2020-compliant systematic review was registered in PROSPERO (CRD42021252214). A literature search was conducted to identify articles that met the pre-established eligibility criteria. Data of interest, with an emphasis on outcome measures, were extracted. For each outcome, specific methods and timing of assessment were described in detail. Following a critical qualitative analysis of the data, outcome measures were categorized. Primary outcomes were identified, and the frequency of reporting in the selected articles was calculated. Additionally, risk-of-bias assessments were performed for individual articles and primary outcomes. RESULTS: Ninety-two articles, of which 39 reported randomized controlled trials (RCTs), 20 non-RCTs, and 33 case series studies, were selected. Outcome measures were categorized into either investigator-evaluated outcome measures (i.e., clinical, digital imaging, aesthetic, histological, biomarker, and safety) or patient-reported outcome measures (PROMs). Clinical outcomes were the most frequently reported type of outcome. Considering all categories, the most frequently reported primary outcomes were facial mucosa thickness assessed with clinical methods (22.83%), facial keratinized mucosa width assessed with clinical methods (19.57%), facial mucosal margin position/recession assessed with clinical methods (18.48%), facial mucosa thickness assessed with digital imaging methods (11.96%), facial soft tissue volume assessed with digital imaging methods (9.78%), and supracrestal tissue height assessed with clinical methods (9.78%). No distinguishable patterns of association between specific types or quality (level of bias) of clinical studies and the choice of primary outcomes were observed. CONCLUSIONS: Clinical research on peri-implant soft tissue augmentation has progressively increased in the last 10 years. Although clinical outcome measures were the most frequently reported outcomes in the selected literature, trends in the field are indicative of a shift from traditional clinical assessment methods to the use of digital technologies. PROMs were generally under-reported but should be considered an integral methodological component in future clinical studies.

Implantes de 4, 5 y 5, 5 mm longitud insertados de forma directa en elevación crestal con hueso autólogo unido al endoret-prgf en alturas óseas residuales de 2-3 mm: estudio retrospectivo / 4.5 and 5.5 mm implants directly inserted in crestal elevation with autologous bone added to endoret-prgf in 2-3 mm residual bone heights: retrospective study

Introducción. El abordaje del maxilar atrófico en altura es un reto para el odontólogo, presentándose cada vez más habitualmente nuevas técnicas que nos permiten la colocación de implantes con menor invasividad para el paciente. La incorporación del abordaje transcrestal y la disminución de la longitud de los implantes han sido clave para llegar al tratamiento de más pacientes con un menor número de intervenciones quirúrgicas. En el presente estudio se muestran una serie de casos con extrema atrofia ósea en altura rehabilitados mediante elevación transcrestal e implantes de 4,5 y 5,5 mm de longitud. Material y método. Se ha realizado un estudio retrospectivo en pacientes en los que se insertaran implantes extracortos (4,5 y 5,5 mm longitud) de forma directa Mediante elevación transcrestal con alturas de cresta residual entre 2 y 3 mm. El implante fue la unidad de análisis para la estadística descriptiva en cuanto a la localización, dimensiones del implante, y mediciones radiográficas. El paciente fue la unidad de medida para el análisis de la edad, sexo y la historia médica. La variable principal fue la ganancia en altura sobre el ápice del implante tras 6 meses de la cirugía y un año después de la carga comparándose las dos mediciones y como variables secundarias se registraron las complicaciones biológicas y el fracaso del implante.Resultados. Fueron reclutados diez pacientes que cumplieron los criterios de inclusión, en los que fueron insertados 20 implantes. La altura media del volumen óseo residual fue de 3,1 mm (+/- 0,3 mm con un rango de 3-4 mm). En todos los casos se realizó una elevación de seno transcrestal, con hueso autólogo particulado obtenido del fresado de la zona de generación del neoalveolo para la inserción del implante, siendo la media de elevación sobre el ápice del implante en milímetros de 2,8 mm (+/- 0,99 rango 1,9 -5 mm). En el Cone-beam de control al año de carga de los implantes estudiados, e mantiene la ganancia ósea lograda (AU)

Introduction. The approach to the atrophic maxilla in height is a challenge for the dentist, and new techniques that allow us to place implants with less invasiveness for the patient are becoming more and more common. The incorporation of the transcrestal approach and the reduction in implant length have been key to treating more patients with a smaller number of surgical interventions. In this study we present a series of cases with extreme bone atrophy in height rehabilitated using transcrestal elevation and 4.5 and 5.5 mm long implants.Methods. A retrospective study was carried out in patients in whom extra-short implants (4.5 and 5.5 mm in length) were inserted directly by transcrestal elevation with residual ridge heights between 2 and 3 mm. The implant was the unit of analysis for descriptive statistics in terms of location, implant dimensions, and radiographic measurements. The patient was the unit of measurement for the analysis of age, sex and medical history. The primary variable was the gain in height above the implant apex 6 months after surgery and one year after loading, comparing the two measurements. Biological complications and implant failure were recorded as secondary variables. Results. Ten patients who met the inclusion criteria were recruited and 20 implants were inserted. The mean residual bone volume height was 3.1 mm (+/- 0.3 mm with a range of 3-4 mm). In all cases a transcrestal sinus lift was performed, with autologous particulate bone obtained from the drilling of the neoalveolus generation zone for implant insertion, the mean of this elevation above the implant apex in millimetres being 2.8 mm (+/- 0.99 range 1.9 -5 mm). In the control TC at one year of loading of the implants studied, the bone gain achieved was maintained (AU)

The impact of cone beam computer tomography field of view on the precision of digital intra-oral scan registration for static computer-assisted implant surgery: A CBCT analysis.

OBJECTIVES: Registration of intra-oral surface scans to cone beam computer tomography (CBCT) is critical in the digital workflow for static computer-aided implant surgery (sCAIS). This study aimed to assess the impact of CBCT field of view (FoV) on the precision of digital intra-oral scan registration. MATERIALS AND METHODS: Cone beam computer tomography data and intra-oral scans from 20 patients were included. Small FoV CBCT's were created by digitally segmenting a large FoV into three sextants. Virtual implant planning was performed. Digital intra-oral scans were repeatedly registered onto their corresponding large and small FoV CBCT datasets. The distances and angulations between the matching implant positions of each repeated registration were used to determine the precision of the registration process. Wilcoxon Signed Rank Paired Tests were used to compare the differences between large FoV and small FoV. The threshold for statistical significance was set at p = .05. RESULTS: Differences in 3D implant position based on the registration precision between small FoV and large FoV present at both the implant entry point (0.37 ± 0.25 mm vs 0.35 ± 0.23 mm, p = .482) and implant tip (0.49 ± 0.34 mm vs 0.37 ± 0.24 mm, p < .001). Differences in overall angular precision were observed between small FOV and large FoV (1.43 ± 1.36° vs 0.51 ± 0.38°, p < .001). CONCLUSION: CBCT with a small FoV is accompanied by greater precision errors in intra-oral scan registration. However, when sufficient well-distributed teeth are visible in small FoV CBCT, the precision of digital intra-oral scan registration appears to be within clinically acceptable limits for sCAIS.

Elevación de seno conBetafosfato Tricálcico yposterior colocación deimplantes. A propósito deun caso / Sinus lift with tricalcium beta-phosphate and subsequent implant placement. Case report

La extracción o pérdida dental supone la remodelación del alveolo y una pérdida progresiva del hueso alveolar residual. Esta disminución en altura, debido a la presencia delseno maxilar en el sector posterosuperior, puede comprometer la disponibilidad ósea adecuada para la colocación de implantes. Como solución a esto, surge la técnica de elevación de seno. En esta técnica, se emplean diversos materiales de injerto, entre los que se encuentran el betafosfatotricálcico (b-TCP). Este material presenta propiedades osteoconductivas y osteoinductivas. Además, se reabsorbe más fácil que otros sustitutos óseos y es fácilmente reemplazado por nuevo hueso. Se ha comparado su comportamiento clínico con otros materiales de injerto, sin encontrar diferencias significativas. Además, a 10 años, los implantes colocados en elevaciones de seno realizadas con b-TCP han mostrado altas tasas de supervivencia. Caso clínico. Se presenta el caso clínico de una paciente, mujer de 52 años de edad, sin antecedentes médicos de interés. Acude a consulta por dolor en el 26. Tras la exploración diagnóstica radiológica e intrabucal se aconsejó a la paciente la extracción del 26. Ocho meses después, y realizando un estudio con CBCT se informó a la paciente sobre la posibilidad de rehabilitación con implantes, previa cirugía de elevación sinusal. Se realizó la elevación sinusal con b-TCP como material de injerto. Pasados tres meses, se procedió a la colocación de tres implantes, adquiriendo estos una buena estabilidad primaria Discusión y conclusiones. Se utilizan diversos materiales de injerto en la técnica de elevación sinusal, injertos de hueso autólogo, xenoinjertos e injerto aloplásticos. Se ha comparado el comportamiento clínico del b-TCP con otros materiales de injerto sin mostrar diferencias significativas. Por otro lado, se ha estudiado un periodo de espera menor a 6 (AU)

Tooth extraction or loss involves alveolar remodelling and progressive loss of residual alveolar bone. This reduction in height, due to the presence of the maxillary sinus in the posterosuperior sector, can compromise adequate bone availability for implant placement. The sinus lift technique has emerged as a solution to this problem. In this technique, various grafting materials are used, including beta-phosphatidic acid (b-TCP). This material has osteoconductive and osteoinductive properties. In addition, it is more easily resorbed than other bone substitutes and is easily replaced by new bone. Its clinical behaviour has been compared with other graft materials, without finding significant differences. In addition, at 10 years, implants placed in sinus lifts performed with b-TCP have shown high survival rates. Clinical case: The clinical case of a 52-year-old female patient with no medical history of interest is presented. She went for consultation due to pain in tooth 26. Following the radiological and intraoral diagnostic examination, the patient was advised to have tooth 26 extracted. Eight months later, and after a CBCT study, the patient was informed about the possibility of rehabilitation with implants, following sinus lift surgery. The sinus lift was performed with b-TCP as graft material. After three months, three implants were placed, acquiring a good primary stability. Discussion and conclusions: different graft materials are used in the sinus lift technique, autologous bone grafts, xenografts and alloplastic grafts. The clinical performance of b-TCP has been compared with no significant differences found. Furthermore, a waiting period of less than 6 months has been studied for the placement of implants. These implants showed high primary stability and survival rates of 99-100%. Therefore, b-TCP is a safe material for sinus lifts and allows the placement of implants in a healing time of less than 6 months (AU)

Elevación de seno maxilar sin injerto y colocación simultánea de implante dental / Graftless maxillary sinus lift with simultaneous dental implant placement

Introducción: La elevación de seno maxilar con implante dental simultáneo, sin el uso de substitutos óseos, ha retomado la teoría del potencial de neoformación ósea, que el coágulo de sangre alojado bajo la membrana de Schneider por sí solo presenta. Excluyendo así la necesidad de materiales exógenos. Objetivo: Exponer la efectividad de la elevación de seno maxilar con implante dental simultáneo, sin el uso de injerto, mediante la evaluación de la cantidad de ganancia ósea vertical. Presentación de casos: Caso 1: Paciente de 62 años, género femenino, que fue sometida a una elevación de seno maxilar sin injerto e implante dental simultáneo, con técnica de ventana lateral debido a altura ósea reducida de 5,24 mm. Luego del período de seguimiento tomográfico de 12 meses, después de la carga protésica, se logró una altura ósea vertical de 10,2 mm, lo que dio como resultado una ganancia ósea vertical de 4,96 mm. Caso 2: Paciente de 48 años, género femenino, que fue sometida a una elevación de seno maxilar sin injerto e implante dental simultáneo, con técnica transalveolar, mediante el uso de piezoeléctrico debido a una altura ósea reducida de 8,33 mm. Luego del período de seguimiento radiográfico de 4 meses, antes de la carga protésica, se logró una altura ósea vertical de 11,55 mm, lo que dio como resultado una ganancia ósea vertical de 3,19 mm. Conclusiones: Con base en estos 2 informes de casos, la elevación de seno maxilar e implante dental simultáneo sin injerto se asocian con la reducción de la morbilidad quirúrgica, menor probabilidad de procesos infecciosos y menor costo de la cirugía. Por lo tanto, puede considerarse una alternativa quirúrgica para la colocación de implantes en el maxilar posterior superior debido a deficiencias óseas verticales, independientemente de la técnica (lateral o transalveolar(AU)

Introduction: Maxillary sinus lift with simultaneous dental implantation without using bone substitutes, reapproaches the theory about the bone neoformation potential of the blood clot housed under the Schneider membrane, all by itself, thus excluding the need to use exogenous materials. Objective: Discuss the effectiveness of graftless maxillary sinus lift with simultaneous dental implant placement through an evaluation of the amount of vertical bone gain. Case presentation: Case 1: Female 62-year-old patient undergoing graftless maxillary sinus lift with simultaneous dental implantation by lateral window technique due to a reduced bone height of 5.24 mm. After a 12-month tomographic follow-up period subsequent to prosthetic loading, a 10.2 mm vertical bone height was achieved, resulting in 4.96 mm vertical bone gain. Case 2: Female 48-year-old patient undergoing graftless maxillary sinus lift with simultaneous dental implantation by transalveolar technique using a piezoelectric generator due to a reduced bone height of 8.33 mm. After a 4-month radiographic follow-up period, before prosthetic loading, an 11.55 mm vertical bone height was achieved, resulting in 3.19 mm vertical bone gain. Conclusions: According to these two case reports, graftless maxillary sinus lifting with simultaneous dental implantation is associated to reduced surgical morbidity, a lesser probability of infectious processes and lower surgical costs. It may therefore be considered to be a surgical alternative for implant placement in the posterior maxilla due to vertical bone deficiencies, regardless of the technique used (lateral or transalveolar(AU)

Resolución de un caso con implicación estética en el sector antero-superior. A propósito de un caso / Resolution of a case with aesthetic involvement in the upper anterior sector. Clinical case

En la clínica dental nos encontramos retos cada vez más complejos a la hora de rehabilitar con implantes dentales nuestros casos clínicos. Los que afectan el sector anterior presentan una mayor exigencia estética y por ello son considerados de más difícil resolución. Además, cuando se implican diferentes disciplinas de la odontología para lograr el éxito del tratamiento se precisa de una visión global y el trabajo en equipo de varios profesionales, como el caso que mostramos en el presente artículo (AU)

On-Bone Fixation of Free Gingival Graft Induces an Osteoinductive Effect in Human Alveolar Bone.

We examined alveolar bone samples in the area of on-bone fixation of a free gingival graft performed during surgery in patients aged 37-55 years with a diagnosis of secondary partial adentia of the upper and lower jaws. Six months after fixation of the graft in the alveolar bone, foci of neoosteogenesis were found in the contact zone. They were characterized by the appearance of appositional lines, cords of basophilic osteoblasts, and growing osteons. An immunohistochemical study revealed an increase in the number of CD44+, CD29+, and osteocalcin+ cells in the layer of the outer circumferential lamellae, primary osteons, and the lining of the Haversian canals. TGF-ß1+ cells were located in the intertrabecular reticular tissue and wall of microvessels. The results indicate activation of mesenchymal stem cells in the area of localization of the graft and differentiating osteoblasts. The observed osteoinductive effect of free gingival graft is associated with its participation in reorganization in MSC and induction of morphogenetic molecules.

Classical Dichotomy of Macrophages and Alternative Activation Models Proposed with Technological Progress.

Macrophages are important immune cells that participate in the regulation of inflammation in implant dentistry, and their activation/polarization state is considered to be the basis for their functions. The classic dichotomy activation model is commonly accepted, however, due to the discovery of macrophage heterogeneity and more functional and iconic exploration at different technologies; some studies have discovered the shortcomings of the dichotomy model and have put forward the concept of alternative activation models through the application of advanced technologies such as cytometry by time-of-flight (CyTOF), single-cell RNA-seq (scRNA-seq), and hyperspectral image (HSI). These alternative models have great potential to help macrophages divide phenotypes and functional genes.

Primary stability and PES/WES evaluation for immediate implants in the aesthetic zone: a pilot clinical double-blind randomized study.

The use of immediate implants in the aesthetic area is a technique widely used in modern implantology. The characteristics of the patient, the implant, and the surgical procedure used may influence the final results. The aim was to assess whether the implant design affects primary (P.S.) and secondary stability (S.S.), bone level (B.L.), and PES/WES evaluation. Twenty implants with two different designs (n = 10) were immediately placed and randomly located in the upper anterior maxilla with no grafting material. Implant-Stability-Quotient (ISQ), B.L., and Pink-Esthetic-Score/White-Esthetic-Score (PES/WES) were evaluated. Shapiro-Wilk normality test was performed to determine the sample normality, as the data did not follow a normal distribution, the Wilcoxon-Mann-Whitney test was applied (p < 0.05). ISQ was determined at placement (PS): control 59.1 (C.I.54.8-63.3); experimental 62.2(C.I.60.1-64.2) and three months after placement (SS): control 62.2.1 (C.I.53.3-71.0); experimental 67.2(C.I.65.8-68.5). The BL was measured at three months after placement: control 0.38 mm (C.I.- 0.06 to + 0.83); experimental 0.76 mm (C.I.0.33-1.19) and at 12 months post-loading: control 0.07 mm (C.I.- 0.50-0.65); experimental 0.90 mm (C.I.0.38-1.42). PES/WES values were evaluated for the control group: 15 (C.I.12.68-17.32), and for the experimental group 15.20 (C.I.11.99-18.41). No significant differences were shown between both implant designs. A good grade of osseointegration and primary/secondary stability was achieved, as well as proper maintenance of crestal bone and adequate PES/WES scores. The criteria for selection for the ideal patient for immediate implant placement is essential.ClinicalTrials Protocol ID: NCT04343833.

A new inertial navigation system for guiding implant placement. An in-vitro proof-of-concept study.

The aim of this study was to assess the potential use of a new advanced inertial navigation system for guiding dental implant placement and to compare this approach with standard stereolithographic template guiding. A movement processing unit with a 9-axis absolute orientation sensor was adapted to a surgical handpiece and wired to a computer navigation interface. Sixty implants were placed by 10 operators in 20 jaw models. The 30 implants of the test group were placed in 10 models guided by the new inertial navigation prototype. The 30 implants of the control group were placed in another 10 models using a CAD-CAM template. Both groups were subdivided into experienced and non-experienced operators. Pre- and postoperative computer tomography images were obtained and matched to compare the planned and final implant positions. Four deviation parameters (global, angular, depth, and lateral deviation) were defined and calculated. The primary outcome was the angular deviation between the standard stereolithographic approach and the new inertial navigation system. Results showed no significant differences between both groups, suggesting that surgical navigation based on inertial measurement units (IMUs) could potentially be useful for guiding dental implant placement. However, more studies are still needed to translate this new approach into clinical practice.

Whole-Process Digitalization-Assisted Immediate Implant Placement and Immediate Restoration in the Aesthetic Zone: A Prospective Study.

BACKGROUND This study explored the clinical effects of whole-process digitalization (WD)-assisted immediate implant placement (IIP) and immediate restoration (IR) in the aesthetic zone and clarified the clinical procedures. MATERIAL AND METHODS Patients who received maxillary aesthetic region IIP and IR treatment were randomly distributed into WD-assisted and conventional groups. Postoperative assessment included implant accuracy, marginal bone loss, aesthetic evaluation, and patient satisfaction evaluation. The aesthetic evaluation included visual analog score (VAS), pink aesthetic score (PES), and white aesthetic score (WES). Numerical data, measurement data, and grade data were analyzed by χ² test, t test, and Mann-Whitney U test. RESULTS The WD-assisted group exhibited decreased implant accuracy, including coronal deviation, apical deviation, angular deviation, and depth deviation, compared with the conventional group (P<0.05). The marginal bone loss in both the mesiodistal direction and the buccolingual direction were significantly lower in the WD-assisted group than in the conventional group (P<0.05). The VAS, PES, and WES were all significantly higher in the WD-assisted group than in the conventional group at 3, 6, and 12 months after surgery (P<0.05). Patients in the WD-assisted group also reported a higher satisfaction level than those in the conventional group (P<0.05). CONCLUSIONS WD-assisted IIP and IR treatment in the aesthetic zone increased implant accuracy, decreased marginal bone loss, improved aesthetic effect, and increased patient satisfaction compared with conventional treatment. Therefore, WD-assisted IIP and IR treatment constitutes a promising approach in clinical oral implantology.

Influence of different incision designs on bone increment of guided bone regeneration (Bio-Gide collagen membrane +Bio-OSS bone powder) during the same period of maxillary anterior tooth implantation.

Exploring the influence of different incision designs on bone increment of guided bone regeneration [Bio-Gide collagen membrane +Bio-OSS bone powder (carbonate apatite crystal extracted from bovine bones), Bio-OSS bone meal was placed on the surface of the bone defect and then covered with a Bio-Gide membrane to close the wound] during the same period of maxillary anterior tooth implantation. The 99 patients from the stomatology department were divided into 3 groups: small incision (N = 30, group A), wide incision (N = 39, group B), internal gingival sulcus incision (N = 30, group C). At the different time (immediately after surgery, 6 months, 12 months and 24 months), the width and height of labial bone at different implant margin (2 mm, 4 mm, 6 mm) has no significant difference in comparison of any two of the three groups (p > 0.05). The score of esthetic feeling in group A was significant higher than group C (P < 0.05). The PPD, the incidence of SH, BOP in group A were all significant higher than group B (P < 0.05). The PISm, PISd, PPD, the incidence of SH and BOP in group A were all significant higher than group C (P < 0.05). The PISm, PISd, PPD, the incidence of SH and BOP in group B were all significant higher than group C (P < 0.05). The three groups has no significant different on the influence bone increment. The soft tissue condition around the implant after surgery was better in internal gingival crevicular incision than others two incisions, large-scale incision better than small incisions.

Sequential drug delivery of vancomycin and rhBMP-2 via pore-closed PLGA microparticles embedded photo-crosslinked chitosan hydrogel for enhanced osteointegration.

As generally accepted, inhibiting the bacterial invasion at initial stage and promoting the behavior of related osteogenesis cells afterwards is crucial to achieve favorable osteointegration after dental implantation. In this study, a novel combined structured hydrogel composed of chitosan and pore-closed poly(lactic-co-glycolic acid) microparticles was prepared and characterized. In vitro and in-vivo studies have identified that this biocompatible material can rapidly release vancomycin at initial 2 days and then sustainedly release recombinant human bone morphogenetic protein-2 for about 12 days, thus respectively accomplish antibacterial and osteogenesis functions. This sequential drug release system can be used as a promising coating material to improve the surface conditions of dental implant to enhance the osteointegration after surgery.

Which experimental models and explorations to use in regenerative endodontics? A comprehensive review on standard practices.

Since the discovery of dental pulp stem cells, a lot of teams have expressed an interest in dental pulp regeneration. Many approaches, experimental models and biological explorations have been developed, each including the use of stem cells and scaffolds with the final goal being clinical application in humans. In this review, the authors' objective was to compare the experimental models and strategies used for the development of biomaterials for tissue engineering of dental pulp with stem cells. Electronic queries were conducted on PubMed using the following terms: pulp regeneration, scaffold, stem cells, tissue engineering and biomaterial. The extracted data included the following information: the strategy envisaged, the type of stem cells, the experimental models, the exploration or analysis methods, the cytotoxicity or viability or proliferation cellular tests, the tests of scaffold antibacterial properties and take into account the vascularization of the regenerated dental pulp. From the 71 selected articles, 59% focused on the "cell-transplantation" strategy, 82% used in vitro experimentation, 58% in vivo animal models and only one described an in vivo in situ human clinical study. 87% used dental pulp stem cells. A majority of the studies reported histology (75%) and immunohistochemistry explorations (66%). 73% mentioned the use of cytotoxicity, proliferation or viability tests. 48% took vascularization into account but only 6% studied the antibacterial properties of the scaffolds. This article gives an overview of the methods used to regenerate dental pulp from stem cells and should help researchers create the best development strategies for research in this field.

Integración de tres especialidades estomatológicas en el tratamiento protésico / Integration of three stomatological specialties in the prosthetic treatment

Los implantes dentales son una opción de restauración estética, funcional y armónica, cuya tasa de éxito es superior a 95 %. Se presenta el caso clínico de una paciente de 24 años de edad, atendida en la consulta de Ortodoncia de la Clínica Estomatológica Provincial Docente Mártires del Moncada de Santiago de Cuba, quien fue remitida desde el Servicio de Prótesis Estomatológica, con el fin de lograr el espacio adecuado para colocarle un implante, pues desde los 12 años de edad aproximadamente había perdido un diente a causa de caries. La restauración protésica mediante el implante dental proporcionó un excelente resultado.

Dental implants are an option of cosmetic, functional and harmonic repairs whose rate of success is higher than 95 %. The case report of a 24 years patient is presented. She was assisted in the Orthodontics Service of Mártires del Moncada Teaching Provincial Stomatological Clinic in Santiago de Cuba and was referred from the Stomatological Prosthesis Service, with the purpose of achieving the appropriate space to place an implant, because she had lost a tooth due to dental decay since she was approximately 12 years. The prosthetic repair by means of dental implant provided an excellent result.