Clinical and Histological changes after ridge preservation with two xenografts: preliminary results from a multicentre randomized controlled clinical trial.

OBJECTIVES: To evaluate and compare clinical and histological changes after ridge preservation procedures with those of spontaneous healing. MATERIALS AND METHODS: Ninety patients were enrolled in the present randomized controlled clinical trial and underwent single-tooth extraction in the premolar/molar areas. Thirty sites were grafted with collagenated cortico-cancellous (coll), 30 sites with cortical (cort) porcine bone and 30 sites underwent natural healing. Primary (vertical and horizontal bone changes after 3 months) and secondary outcomes (histomorphometric after 3 months) were evaluated at implant placement. RESULTS: The vertical bone changes at the grafted sockets were significantly (p < 0.0001) lower (0.30 mm for cort group and 0.57 mm for coll group) when compared to non-grafted sockets (2.10 mm for nat group). Moreover, the width reduction of the coll (0.93 mm) and cort (1.33 mm) groups was significantly lower (p < 0.0001) than the non-grafted group (3.60 mm). The analysis of subgroups attested that when premolar and molar sites were compared, the buccal bone loss appeared to be dependent both on tooth position and grafting material employed. CONCLUSION: The ridge preservation procedures had significantly better outcomes when compared to natural healing. The biomaterials did not differ for maintenance of bone width; even though, the bone height seemed to be better preserved with the cortical porcine bone.

Volumetric analysis of remodelling pattern after ridge preservation comparing use of two types of xenografts. A multicentre randomized clinical trial.

OBJECTIVES: The aim of this randomized clinical trial was to analyse and compare the volumetric changes after ridge preservation procedures using two different biomaterials and to evaluate associations between outcome variables and pristine three-dimensional aspects of the ridges. MATERIALS AND METHODS: Twenty-eight patients subjected to single-tooth alveolar ridge preservation were enrolled in the present multicentre, single-blind, prospective and randomized clinical trial. Fourteen sites were randomly allocated to each experimental group. The experimental sites were grafted with pre-hydrated collagenated cortico-cancellous porcine bone (coll group) or with a cortical porcine bone (cort group) and a collagen membrane; a secondary soft tissue healing was obtained for all experimental sites. Plaster casts were scanned (preoperative, at 1 and 3 months postoperative). Analysis of volumes and areas was performed, and all measured variables were statistically compared. RESULTS: Intragroup analyses at 3 months revealed that when examining changes related to three-dimensional features of remodelling patterns (volume, surfaces, height and shape), the two biomaterials showed similar behaviours with a minor loss in volume and ridge surface. Intergroup analysis at 3-month survey revealed that volume resorption of the coll group (244 mm3 ) was significantly lower (P = 0.0140) than that of the cort group (349 mm3 ). The reduction for basal surface appeared significantly different between the two groups at 1-month survey only (P = 0.0137), while the final basal surface reduction was 4.9 and 12.2 mm2 for coll and cort group, respectively. The superior surface reduction was 40.8 mm2 for coll and 50.7 mm2 for cort group, with no significant difference between the two groups. CONCLUSION: At the 3rd month analysis, coll group showed a significantly lower reduction of ridge volume and a significantly smaller shrinkage of the basal area when compared to the cort group; moreover, the coll group experienced a smaller superior surface shrinkage when compared to the cort group, even though no significance was evaluated.

Clinical and Biological Validation of an Allogeneous Cancellous Bone Block for Alveolar Maxillary Ridge Reconstruction: A Case Series.

This exploratory case series clinically and histologically investigated the performance of allogeneic cancellous freeze-dried bone allograft (FDBA) bone blocks (Maxgraft®) for the lateral augmentation of local alveolar defects in the posterior maxilla as part of two-staged implant therapy. Five patients receiving eight implants 5 months after block augmentation with a follow-up period of up to 3 years were documented and analyzed. Horizontal alveolar dimensions before and 5 months after block augmentation were quantified using CBCT. Radiographic marginal bone level changes were quantified at implant placement, loading, and 1 year post-placement. Graft integration and resorption were histologically qualitatively evaluated from core biopsies retrieved at implant placement. Block augmentations resulted in a pronounced horizontal median bone gain of 7.0 (5.5 to 7.8) mm. Marginal implant bone levels in block-augmented bone remained constant over the 1 year follow-up period. Block grafts appeared histologically well integrated. Histologic analysis also revealed signs of progressive resorption and new bone formation at the lateral aspects of the grafts. The results of this case series support using Maxgraft® cancellous FDBA blocks as suitable materials for the lateral augmentation of local alveolar defects.

Heat Generation During Initial Osteotomy for Implant Site Preparation: An In Vitro Measurement Study.

Introduction: Controlling temperature generation during implant site preparation is important to prevent implant early failure. Aim: The present in vitro study aimed at measuring temperature variation generated during the initial osteotomy using both rotatory and piezo-surgical inserts. Methods: Nine groups were defined according to drill and insert type, cooling volume (mL/min) and cooling temperature. A total of 315 implant site preparations were performed in an artificial bone sample and the temperature was measured using an infrared camera. Drills' wear was assessed using scanning electron microscopy at baseline and after 10 and 35 utilizations. Results: Piezo-surgical insert groups determined a temperature increase that was significantly higher than the one generated by rotatory drills groups (p < 0.001). When considering rotatory drills groups a temperature ≥ 40 °C was never recorded. Conclusion: Lower saline temperature implied a significant temperature decrease (p < 0.001), while the increase in cooling volume did not imply a temperature decrease. The scanning electron microscopy analysis of the drills demonstrated that little drill wear occurred up to 35 utilization times.

Immediate placement of bone level Sraumann implants: a case series.

Endosseous dental implants have revolutionized the methods clinicians use to treat edentulous and partially edentulous patients. Traditional implant protocol specifies a healing period of several months after tooth extraction, as well as an unloaded healing period prior to restoration. Over the last decade, numerous studies have documented successful immediate placement of endosseous dental implants in fresh extraction sites and have found positive results with early functional loading. The purpose of this article is to present a clinical treatment protocol for the immediate placement and early loading of dental implants and to report the clinical and radiographic outcomes of the SLActive surface Straumann Bone Level implant placed in either maxillary or mandibular fresh extraction sockets.

The influence of the mixing technique on the content of voids in two polyether impression materials.

One of the most critical problems related to hand mixing of an elastomeric impression material is air entrapment during spatulation. This leads the formation of both surface and subsurface bubbles which in turn may result in inaccurate dental impressions and/or jeopardize their physical properties. In the present study the influence of the mixing technique has been determined by evaluating the surface area and the number of voids in two polyether materials (Permadyne and Impregum, Espe, Seefeld, Germany). The techniques tested were the stropping technique as hand-mixing and the Pentamix device (Espe) as mechanical mixing. Eighty special trays (10 mm x20 mm x43mm) featuring 10 transverse slots were fabricated and divided into four groups of twenty units. Groups 1 and 2 received the hand-mixed materials Permadyne high viscosity and Impregum F, respectively. Groups 3 and 4 (Pentamix group) received the mechanically mixed materials Permadyne Penta H and Impregum Penta, respectively. After polymerization, 10 slices of material were obtained for each tray by sectioning through the tray slots with a surgical blade. The slices were glued on a card and black and white photographs were taken. Subsequently, the negative films were placed on a viewing box and digitized with a video camera. A special software program allowed to identify and calculate the total surface area and the number of voids. Significant differences between the "stropping" groups (groups 1 and 2) and "Pentamix" groups (groups 3 and 4) were found. The mechanical mixing (Pentamix) generated the smallest number and total surface area of voids, while no significant differences were detected between Permadyne Penta H and Impregum Penta. Clearly, mechanical mixing represents a marked improvement over the traditional hand-mixing methods.

The novel role of HtrA1 in gingivitis, chronic and aggressive periodontitis.

Proteolytic tissue degradation is a typical phenomenon in inflammatory periodontal diseases. HtrA1 (High temperature requirement A 1) has a serine protease activity and is able to degrade fibronectin whose fragments induce the expression and secretion of several matrix metalloproteinases (MMPs). The aim of this study was to investigate for the first time if HtrA1 has a role in gingivitis and in generalized forms of chronic and aggressive periodontitis. Expression of HtrA1 was investigated in 16 clinically healthy gingiva, 16 gingivitis, 14 generalized chronic periodontitis and 10 generalized aggressive periodontitis by immunohistochemistry and real-time PCR. Statistical comparisons were performed by the Kruskall-Wallis test. Significantly higher levels of HtrA1 mRNA and protein expression were observed in pathological respect to healthy tissues. In particular, we detected an increase of plasma cell HtrA1 immunostaining from gingivitis to chronic and aggressive periodontitis, with the higher intensity in aggressive disease. In addition, we observed the presence of HtrA1 in normal and pathological epithelium, with an increased expression, particularly in its superficial layer, associated with increasingly severe forms of periodontal disease. We can affirm that HtrA1 expression in plasma cells could be correlated with the destruction of pathological periodontal tissue, probably due to its ability to trigger the overproduction of MMPs and to increase the inflammatory mediators TNF-α and IL-1ß by inhibition of TGF-ß. Moreover, epithelial HtrA1 immunostaining suggests a participation of the molecule in the host inflammatory immune responses necessary for the control of periodontal infection.

Rational basis for the use of a new clinical procedure in immediately loaded implant rehabilitations: a case report.

This report presents a new clinical protocol that facilitates the diagnostic, surgical, and prosthetic phases of immediately loaded implant rehabilitations. The proposed technique aims to simplify recording of the centric relation, which is usually done immediately after surgery, during the surgical impression phase. This shortens operative time while meeting requirements for an accurate impression and is thus simple and cost effective. The case report of a maxillary full-arch immediately loaded implant rehabilitation in a 45-year-old patient illustrates the clinical steps in the proposed procedure and confirms its repeatability.

Cementable implant crowns composed of cast superstructure frameworks luted to electroformed primary copings: an in vitro retention study.

OBJECTIVE: The aim of this in vitro study was to investigate, on ITI solid abutments, the retention values of single crowns fabricated using an alternative prosthetic solution: secondary cast superstructure luted to an electroformed primary coping. MATERIALS AND METHODS: Fifty standard 4.1 mm ITI implants and 5.5 mm high ITI machined abutments were assembled and mounted in acrylic resin. Implant/abutment assemblies were randomly divided into two groups. In the test group, primary galvanic caps were directly fabricated on implant abutments (A.G.C. Micro machine), and a secondary cast noble alloy superstructure was luted on each primary galvanic cap with a resin cement (Nimetic Cem). In the control group, prefabricated burn-out caps were used for casting the metal frameworks. Test and control crowns were cemented using a resin cement (Panavia 21). After storage at 37 degrees for 24 h, the specimens were subjected to a pull-out test using an Instron universal testing machine. The load required to dislodge each sample and the respective mode of failure were recorded. Means and standard deviations of loads at failure were analyzed using ANOVA. Statistical significance was set at P< or =0.05. RESULTS: The retention values (+/-SD) of loads at failure were 67.26 (+/-16.61) for the test group and 44.03 (+/-9.45) for the control group. In the test group no separation occurred between the electroformed (galvanic) primary cap and the secondary superstructure. CONCLUSIONS: The results showed that this prosthetic solution is superior on retentive performance than the conventional cast framework. An added clinical advantage of this novel method is its potential to provide a totally passive fit. Further in vitro and in vivo studies involving multiple-unit restorations are needed in order to more generally validate this prosthetic concept.