The clinical efficacy of autogenous dentin blocks prepared chairside for alveolar ridge augmentation: A systematic review and meta-analysis.

OBJECTIVES: This systematic review aimed to evaluate the current evidence on the effectiveness of autogenous dentin block graft prepared chairside for alveolar ridge augmentation and compare its clinical outcomes to the main available grafting materials and techniques. MATERIALS AND METHODS: Three databases were screened, including prospective clinical studies, utilizing autogenous dentin blocks for ridge augmentation, with at least 3 months of postoperative follow-up. RESULTS: Eight articles were included, and four of them were meta-analyzed. Dentin blocks demonstrated similar vertical bone gain and significantly higher width gain, compared to bone blocks (WMD = 0.03, 95% CI -0.51 to 0.57, p = .92 and WMD = 1.34, 95% CI 0.57 to 2.12, p = .0007, respectively). Vertical and horizontal resorption were similar between the two groups (WMD = -0.36, 95% CI -0.91 to 0.18, p = .19, and WMD = -0.47, 95% CI -1.05 to 0.11, p = .11, respectively). Dentin blocks showed more incidences of postoperative complications, however, with no statistical significance (RR = 4.30, 95% CI 0.97 to 18.96, p = .054). The need for additional augmentation upon implant placement was also similar between both grafts (RR = 0.95, 95% CI 0.39 to 2.28, p = .90). Recorded incidences of graft exposure were low (2.27%), and no study stated surgical site infection. CONCLUSION: Within its limitations, this study indicates that the autogenous dentin blocks prepared chairside could be a possible alternative to the other established bone augmentation techniques for staged ridge augmentation. Nevertheless, future studies are needed to confirm its efficacy and implant success/survival in sites grafted with this material.

Effect of chemical and electrochemical decontamination protocols on single and multiple-used healing abutments: A comparative analysis of contact surface area, micro-gap, micro-leakage, and surface topography.

INTRODUCTION: Although the combined use of chemical and electrochemical decontamination protocols can completely remove contaminants from the surfaces of one-time used healing abutments (HAs), their effectiveness in multiple-used HAs remains unknown. We aimed to investigate the effect of reused HAs frequency on the implant-HA contact surface area, micro-gap, microleakage, and surface topography following chemical and combined chemical and electrochemical decontamination protocols. METHODS: Ninety bone level titanium implants were assembled with 90 bone level HAs, in which 80 contaminated HA samples were collected from human participants. The retrieved HAs were randomly divided into two groups according to the cleaning protocol: ultrasonication with 5.25% NaOCl solution for 15 min and steam autoclaving (group I); ultrasonication with 5.25% NaOCl solution for 15 min, followed by electrochemical cleaning and steam autoclaving (group II). The control group (group III) comprised 10 new unused HAs. The cleaning protocol was applied after each insertion as follows: (a) single-use and cleaning, (b) double-use and double cleaning cycles, (c) triple-use and triple cleaning cycles, and (d) more than triple-use and more than triple cleaning cycles. The contact surface area and micro-gap were assessed with micro-computed tomography scanning technique, microleakage test using 2% methylene blue staining, surface morphology with scanning electron microscopy, and surface elemental composition with energy-dispersive X-ray spectroscopy analysis. RESULTS: Group Id exhibited the smallest contact surface area. The values of the micro-gap volumes and microleakage were significantly different (p < 0.001) in the descending order of Id > Ic > Ib > IId > Ia, IIa, and III. Morphological evaluation of Groups IIa, IIb, and IIc revealed that residual biological debris was optimally removed without altering their surface properties. CONCLUSIONS: Chemical and electrochemical decontamination protocols are more effective than NaOCl cleaning methods, particularly for multiple consecutive uses with better decontamination levels, which decreases micro-gap volume and microleakage without surface alterations. Although the use of combined decontamination protocols for the contact surface area at the implant-HA interface showed comparable results with the control, change in the contact surface area was observed following the NaOCl cleaning methods. Therefore, titanium HA reuse can be considered in multiple times, if they are cleaned and sterilized using combined chemical and electrochemical decontamination protocols.

Dental implant healing abutment decontamination: A systematic review of in vitro studies.

PURPOSE: To investigate various cleaning protocols employed to enable the reuse of healing abutments in the past decade. MATERIALS AND METHODS: The review followed the guidelines set out in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, with guidance from the Cochrane Collaboration Handbook. Electronic searching and handsearching were performed using the National Library of Medicine (MEDLINE via PubMed) and the Cochrane Central Register of Controlled Trials from January 2010 to July 2022, respectively. Studies published in English were evaluated. Two independent examiners conducted the search and the review process. The risk of bias of the included studies was evaluated. RESULTS: In total, 178 articles were evaluated for review, but only 15 of them were selected for full-text reading. Regarding cleaning efficacy, chemical decontamination using sodium hypochlorite produced better results than laser and mechanical decontamination with airflow. Similar efficacy was found between chemical and electrochemical decontamination. Combined use of chemical and electrochemical decontamination protocols demonstrated the greatest efficacy. Chemical and electrochemical decontamination methods were found to achieve better outcomes in preserving the surface properties of decontaminated healing abutments than laser and mechanical methods. CONCLUSION: The present review found that combined decontamination protocols (chemical, electrochemical processing and autoclave treatment) are favourable for obtaining healing abutments with optimally cleaned surfaces. Moreover, healing abutments located in an area that is difficult to access can be cleaned without affecting the surface properties. This information could benefit researchers and clinicians when multiple-use healing abutments are considered.

Efficacy of combined chemical and electrochemical decontamination treatments on contaminated healing abutments and their effect on surface topography: An in vitro study.

OBJECTIVE: To evaluate the efficacy of four decontamination protocols on contaminated healing abutments (HAs) and their effects on surface topography. METHODS: Eighty contaminated single-use HA samples collected from human participants were stained with phloxine B and examined microscopically. The retrieved HAs were randomly divided into four test groups: (1) Autoclaving only (AU), (2) 5.25% sodium hypochlorite (NaOCl) + AU, (3) Electrochemical treatment (EC) + AU, (4) NaOCl + EC + AU, and positive control (contaminated without any treatment). Four new unused HAs served as negative controls (NC). The surface features were analyzed using stereo microscopy (SM), scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (EDS), and optical profilometry. RESULTS: The lowest decontamination efficacy was observed for the AU group. The NaOCl + AU and EC + AU groups effectively removed residual contamination, whereas EC + AU showed better decontamination results than NaOCl + AU. SM, SEM, and EDS analyses revealed the best decontamination efficacy in the combined NaOCl + EC + AU group compared to the other groups. Surface roughness (Sa), developed surface area ratio (Sdr), and texture-aspect ratio (Str) in AU, NaOCl + AU, EC + AU, and NaOCl + EC + AU groups were not statistically significant compared to the NC group. CONCLUSIONS: The combination of NaOCl with subsequent EC can remove soft and hard deposits from the surface of HAs compared to NaOCl alone and EC alone, without altering the surface topography of HAs.

Investigation of different electrochemical cleaning methods on contaminated healing abutments in vitro: an approach for metal surface decontamination.

BACKGROUND: To evaluate the effects of electrolysis on cleaning the contaminated healing abutment surface and to detect the optimal condition for cleaning the contaminated healing abutment. METHODS: Ninety healing abutments removed from patients were placed in 1% sodium dodecyl sulfate solution and randomly divided for electrolysis with 7.5% sodium bicarbonate in the following three different apparatuses (N = 30): two stainless steel electrodes (group I), a copper electrode and a carbon electrode (group II), and two carbon electrodes (group III). The samples were placed on cathode or anode with different electric current (0.5, 1, and 1.5 A) under constant 10 V for 5 min. Electrolyte pH before and after electrolysis were measured. Then, the samples were stained with phloxine B and photographed. The proportion of stained areas was calculated. The surface was examined with a scanning electron microscope (SEM) and energy-dispersive X-ray spectroscopy (EDS). RESULTS: Electrolyte pH decreased after electrolysis at 1 A and 1.5 A in group I and II. Applying cathode at 1 A in group III, the amount of residual contamination was the lowest in all the conditions examined in the present study. SEM images revealed that applying cathode at 1.5 A in group I induced a rough surface from the smooth surface before the treatment. EDS analysis confirmed that the surfaces treated on cathode at 1 A in group III revealed no signs of organic contamination. CONCLUSION: Electrolysis of using carbon as electrodes, placing the contaminated healing abutments on cathode, and applying the electric current of 1 A at constant 10 V in 7.5% sodium bicarbonate could completely remove organic contaminants from the surfaces. This optimized electrochemical cleaning method seems to be well worth investigation for the clinical management of peri-implant infections.

Evaluation of residual contamination on healing abutments after cleaning with a protein-denaturing agent and detergent.

OBJECTIVE: This study evaluated the cleaning potential of a protein-denaturing agent with or without anionic detergent by monitoring the residual contamination on healing abutments used for dental implant treatment. METHOD AND MATERIALS: Forty contaminated healing abutments removed from patients were randomized and immediately treated with differing cleaning methods; either Method A (presoaking in 1% sodium dodecyl sulfate followed by ultrasonication with 4 mol/L guanidine hydrochloride), or Method B (soaking in distilled water followed by ultrasonication with 4 mol/L guanidine hydrochloride) was used. Samples were stained with phloxine B and photographed using a light microscope. The proportion of stained and contaminated areas on each healing abutment was then calculated using Image J. The surface was examined with a scanning electron microscope and energy-dispersive x-ray spectroscopy. RESULTS: The percentages of contaminated surfaces of the screwdriver engagement region, upper body, and lower body for methods A and B were 50% and 38%, 10% and 80%, and 38% and 18%, respectively. There was a statistically significant difference (engagement region [P < .001], upper body [P = .043], and lower body [P = .017]; Mann-Whitney) regarding the residually stained areas between the two cleaning methods. No surface alterations were seen by scanning electron microscopy. Energy-dispersive x-ray spectroscopy confirmed that the cleaned surfaces of the healing abutments revealed no signs of organic contamination. CONCLUSION: Although the combination of a strong denaturing agent and detergent effectively cleaned contaminated healing abutments, perfect cleaning was not always possible, indicating that the reuse of healing abutments in different patients is not recommended.