Primary stability and osseointegration comparing a novel tapered design tissue-level implant with a parallel design tissue-level implant. An experimental in vivo study.

OBJECTIVES: The aim of the present study was to compare a novel tapered, double-threaded self-tapping tissue-Level design implant (TLC) to a well-established parallel walled tissue-level (TL) implant in terms of primary and secondary stability over time. MATERIALS AND METHODS: Test TLC (n = 10/per timepoint) and control TL (n = 10/per timepoint) implants were placed in the mandible of minipigs and left for submerged healing for 3, 6, and 12 weeks. Maximum insertion torque and implant stability quotient (ISQ) were measured for each implant at placement. Osseointegration and cortical bone maintenance were histologically evaluated by measuring total bone-to-implant contact (BIC) and first bone-to-implant contact (fBIC). RESULTS: A significantly higher maximum insertion torque was measured for the test implant TLC compared to the control TL implant (57.83 ± 24.73 Ncm and 22.62 ± 23.16 Ncm, respectively; p < .001). The mean ISQ values were comparable between the two implant types (75.00 ± 6.70 for TL compared to 75.40 ± 3.20 for TLC, p = .988). BIC was comparable between both implant types at each of the evaluated time points. The fBIC was found to be significantly more coronal at 12 weeks for the TLC implant compared to the TL implant (0.31 ± 0.83 mm for TLC compared to -0.22 ± 0.85 for TL, p = .027). CONCLUSION: The novel tapered tissue level design implant showed improved primary stability and an overall improved crestal bone height maintenance compared to the parallel walled design at 12 weeks.

Group 1 ITI Consensus Report: The role of bone dimensions and soft tissue augmentation procedures on the stability of clinical, radiographic, and patient-reported outcomes of implant treatment.

OBJECTIVES: The aims of Working Group 1 were to address the role (i) of the buccolingual bone dimensions after implant placement in healed alveolar ridge sites on the occurrence of biologic and aesthetic complications, and (ii) of soft tissue augmentation (STA) on the stability of clinical, radiographic, and patient-related outcomes of implant treatments. MATERIALS AND METHODS: Two systematic reviews were prepared in advance of the Consensus Conference and were discussed among the participants of Group 1. Consensus statements, clinical recommendations, recommendations for future research, and reflections on patient perspectives were based on structured group discussions until consensus was reached among the entire group of experts. The statements were then presented and accepted following further discussion and modifications as required by the plenary. RESULTS: Dimensional changes of the alveolar ridge occurred after implant placement in healed sites, and a reduction in buccal bone wall thickness (BBW) of 0.3 to 1.8 mm was observed. In healed sites with a BBW of <1.5 mm after implant placement, increased vertical bone loss, and less favorable clinical and radiographic outcomes were demonstrated. Implants with buccal dehiscence defects undergoing simultaneous guided bone regeneration, showed less vertical bone loss, and more favorable clinical and radiographic outcomes, compared to non-augmented dehiscence defects during initial healing. At healthy single implant sites, probing depths, bleeding and plaque scores, and interproximal bone levels evaluated at 1 year, remained stable for up to 5 years, with or without STA. When single implant sites were augmented with connective tissue grafts, either for soft tissue phenotype modification or buccal soft tissue dehiscence, stable levels of the soft tissue margin, and stable or even increased soft tissue thickness and/or width of keratinized mucosa could be observed from 1 to 5 years. In contrast, non-augmented sites were more prone to show apical migration of the soft tissue margin in the long-term. Favorable aesthetic and patient-reported outcomes after STA were documented to be stable from 1 to 5 years. CONCLUSIONS: It is concluded that dimensional changes of the alveolar ridge occur after implant placement in healed sites and that sites with a thin BBW after implant placement are prone to exhibit less favorable clinical and radiographic outcomes. In addition, it is concluded that STA can provide stable clinical, radiographic, aesthetic, and patient-reported outcomes in the medium and long-term.

Patient-reported outcome measures focusing on the esthetics of implant-compared to tooth-supported single crowns-A systematic review and meta-analysis.

OBJECTIVES: To report a summary of published patient-reported esthetic outcome measures (PROMs) of implant-supported single crowns (SCs) compared with those of tooth-supported SCs. MATERIALS AND METHODS: Cochrane, Medline (PubMed), and EMBASE database search was performed by three reviewers on reports with patient-reported esthetic outcomes of tooth- and implant-supported SCs. Clinical studies with at least 12 months of mean follow-up period and a minimum of 10 patients, and English, French, or German reports were included. To compare the subgroups, for aggregate-level data, random-effects meta-regression was used. RESULTS: Two thousand fifteen titles were identified (initial search) and screened independently concluding 53 full-text articles to include in data extraction. Twenty-two studies with 29 study cohorts were included. Patients were satisfied with the esthetics of implant- and tooth- supported crowns Mean visual analogue scale (VAS) value from the PROMs data of 1270 implant-supported SCs evaluated by 1051 patients was 89.6% (80.0%-94.1%). The mean VAS value of patients (n = 201), who evaluated the esthetic outcome of 486 tooth-supported SCs was 94.4% (92.3%-96.0%). VAS scores of patients regarding their perception of esthetics did not show any difference among different crown materials or type of implant used. The patients' perception of esthetics focusing on SC had a tendency to be higher when the crowns were supported by teeth, however, no statistical difference was found when compared with implant-supported crowns (p = 0.067). CONCLUSIONS: Patient perception of esthetics in SCs was not affected by the type of support, crown material, implant, and presence of provisional crown for both implant- and tooth-supported SCs. CLINICAL SIGNIFICANCE: Despite that patient's expectations are increasing overall Patients are satisfied with with esthetic outcome of implant- and tooth-supported crowns.

Benchmark performance of anodized vs. sandblasted implant surfaces in an acute dehiscence type defect animal model.

OBJECTIVES: Crestal bone formation represents a crucial aspect of the esthetic and biological success of dental implants. This controlled preclinical study analyzed the effect of implant surface and implant geometry on de novo crestal bone formation and osseointegration. MATERIALS AND METHODS: Histological and histomorphometrical analysis was performed to compare three implant groups, that is, (1) a novel, commercially available, gradient anodized implant, (2) a custom-made geometric replica of implant "1," displaying a superhydrophilic micro-rough large-grit sandblasted and acid-etched surface, and (3) a commercially available implant, having the same surface as "2" but a different implant geometry. The study applied a standardized buccal acute-type dehiscence model in minipigs with observation periods of 2 and 8 weeks of healing. RESULTS: The amount of newly formed crestal bone (BATA) around control groups (2) and (3) was significantly increased when compared to the test group (1) at the 8 weeks of healing time point. Similar results were obtained for all parameters related to osseointegration and direct bone apposition, to the implant surface (dBIC, VBC, and fBIC), demonstrating superior osseointegration of the moderately rough, compared to the gradient anodized functionalization. After 2 weeks, the osseointegration (nBIC) was found to be influenced by implant geometry with group (3) outperforming groups (1) and (2) on this parameter. At 8 weeks, nBIC was significantly higher for groups (2) and (3) compared to (1). CONCLUSIONS: The extent (BATA) of de novo crestal bone formation in the acute-type dehiscence defects was primarily influenced by implant surface characteristics and their ability to promote osseointegration and direct bone apposition. Osseointegration (nBIC) of the apical part was found to be influenced by a combination of surface characteristics and implant geometry. For early healing, implant geometry may have a more pronounced effect on facilitating osseointegration, relative to the specific surface characteristics.

Innovation in the time of SARS-CoV-2: A collaborative journey between NHS clinicians, engineers, academics and industry.

During the pandemic healthcare faced great pressure on the availability of protective equipment. This paper describes the entire novel innovative process of design optimisation, production and deployment of face-visors to NHS frontline workers during SARS-CoV-2 pandemic. The described innovative journey spans collaboration between clinicians and academic colleagues for design to the implementation with industry partners of a face-visor for use in a healthcare setting. It identifies the enablers and barriers to development along with the strategies employed to produce a certified reusable, adjustable, high volume and locally produced face-visor. The article also explores aspects of value, scalability, spread and sustainability all of which are essential features of innovation.

The influence of mild versus severe hypodontia on facial soft tissues? A three-dimensional optical laser scanning-based cohort study.

OBJECTIVE: To determine whether there are differences in the facial soft tissue morphology between participants with mild (up to two) or severe (six or more) hypodontia. DESIGN AND SETTING: A prospective hospital-based cohort study. PARTICIPANTS AND METHODS: Ninety-two participants, aged 11-16 years, with confirmed hypodontia were recruited. Participants were sub-grouped based on the severity (mild, two or less and severe, six or more) and distribution of the missing teeth and age. They underwent a three-dimensional (3D) optical surface scan of the facial soft tissues. Facial surface scans were compared quantitatively, applying landmark measurements and surface-based analysis. RESULTS: In total, 92 participants, with an equal distribution between the mild (n=46) and severe (n=46) categories, were recruited. Patients with severe hypodontia displayed a reduced alar base, lower facial height, nasolabial angle (P = 0.02) and transgonial width (P < 0.001) compared to those with milder hypodontia. Furthermore, significant differences were observed between mild-male and severe-female groups regarding alar base, lower anterior face height and transgonial width and between mild-male and mild-female groups regarding nasolabial angle and transgonial width. CONCLUSION: Significant reductions were seen in the 3D soft tissue morphology of participants with severe hypodontia, in terms of the nasolabial angle, lower facial height, alar base and transgonial widths, emphasising the importance of using facial scanning as a relatively simple non-invasive method of assessment.

Randomized clinical trial comparing PEG-based synthetic to porcine-derived collagen membrane in the preservation of alveolar bone following tooth extraction in anterior maxilla.

OBJECTIVES: The objective of this randomized controlled trial was to compare alveolar ridge preservation using a bone substitute material and covered with a synthetic or porcine collagen membrane. MATERIALS AND METHODS: Thirty-two sockets in the aesthetic maxillary region of 30 patients were randomized into two groups. Randomization was stratified according to bone wall defect. Flapless technique was used, and sockets were grafted with bi-phasic calcium phosphate particulate bone substitute and covered by synthetic polyethylene glycol (PEG; test group) or porcine-derived collagen membrane (CM; control group). No primary closure was attempted. A cone beam computed tomography (CBCT) scan was performed immediately after the surgical procedure and repeated 22 weeks later. OnDemand3D was used to superimpose scan images and assess changes. The mean vertical and horizontal percentage bone loss were calculated and implants placed after 6 months with or without additional augmentation. RESULTS: There were no baseline differences between groups or dropouts. The mean percentage loss at the labial plate and at the coronal part of the sockets was statistically significantly lower in the test group compared with controls (-2.86% [SD = 13.48] versus 7.42% [SD = 11.95]; 13.45% [SD = 11.97] versus 28.59% [SD = 16.97]). Implants were placed after 6 months, and there was no difference in need for further augmentation between PEG (n = 5) or CM (n = 4). CONCLUSION: Sites treated with PEG membrane showed less percentage loss in horizontal and vertical measurements in this trial.

Prosthetic Rehabilitation of a Patient Diagnosed With Sarcoidosis Using Dental Implants: A Clinical Case Report.

No previously published studies have reported on the placement and restoration of dental implants in a patient diagnosed with sarcoidosis. Patients with sarcoidosis may develop periodontitis as a manifestation of systemic disease and are therefore at increased risk of tooth loss. These patients are likely to want fixed dental prostheses, which may need to be supported by dental implants. The case presented is that of a 31-year-old female patient presenting with a missing maxillary central incisor and a sarcoidal process affecting the anterior maxilla, which had severely compromised the periodontium of the adjacent lateral incisor. The patient was successfully rehabilitated with an implant-retained prosthesis following a staged horizontal and vertical bone augmentation procedure. At the 4-year review, the implant restoration performed well with stable peri-implant bone levels. We conclude that dental implant rehabilitation in patients with sarcoidosis may be a predictable treatment option, depending on disease stability and concurrent systemic therapy, but these patients will require additional maintenance because of the possibility of an increased risk of peri-implantitis. The effects of sarcoidosis and its management on the success of dental implants are discussed to aid treatment planning for such patients.

Group 3 ITI Consensus Report: Patient-reported outcome measures associated with implant dentistry.

OBJECTIVES: The aim of Working Group 3 was to focus on three topics that were assessed using patient-reported outcome measures (PROMs). These topics included the following: (a) the aesthetics of tooth and implant-supported fixed dental prostheses focusing on partially edentulous patients, (b) a comparison of fixed and removable implant-retained prostheses for edentulous populations, and (c) immediate versus early/conventional loading of immediately placed implants in partially edentate patients. PROMs include ratings of satisfaction and oral health-related quality of life (QHRQoL), as well as other indicators, that is, pain, general health-related quality of life (e.g., SF-36). MATERIALS AND METHODS: The Consensus Conference Group 3 participants discussed the findings of the three systematic review manuscripts. Following comprehensive discussions, participants developed consensus statements and recommendations that were then discussed in larger plenary sessions. Following this, any necessary modifications were made and approved. RESULTS: Patients were very satisfied with the aesthetics of implant-supported fixed dental prostheses and the surrounding mucosa. Implant neck design, restorative material, or use of a provisional restoration did not influence patients' ratings. Edentulous patients highly rate both removable and fixed implant-supported prostheses. However, they rate their ability to maintain their oral hygiene significantly higher with the removable prosthesis. Both immediate provisionalization and conventional loading receive positive patient-reported outcomes. CONCLUSIONS: Patient-reported outcome measures should be gathered in every clinical study in which the outcomes of oral rehabilitation with dental implants are investigated. PROMs, such as patients' satisfaction and QHRQoL, should supplement other clinical parameters in our clinical definition of success.

Vital Bone Formation After Grafting of Autogenous Bone and Biphasic Calcium Phosphate Bioceramic in Extraction Sockets of Rats: Histological, Histometric, and Immunohistochemical Evaluation.

PURPOSE: The study aimed to investigate through histology, histometry, and immunohistochemistry the vital bone formation after grafting of biphasic calcium phosphate bioceramic (BC) in combination with calvarial autogenous bone into the dental sockets of rats. MATERIALS AND METHODS: Forty-five male rats were submitted to upper right incisor extraction and divided according to the grafted material in: control, bioceramic (BC), and bioceramic + autogenous bone (BC + AB). The animals were killed 7, 21, and 42 days after surgery for histological, histometric, and immunohistochemistry analysis. RESULTS: Histomorphometric results demonstrated, for BC + AB group, formation of trabecular bone between the particles of BCs and autogenous bone, connecting them, as well as higher percentage of vital bone in comparison with BC. Immunohistochemical reactions showed intense labeling for Runx2-positive cells in the group BC + AB. CONCLUSIONS: Autogenous bone was able to stimulate bone turnover enabling a larger amount of vital bone synthesis and can be recommended as a viable grafting material in combination with synthetic biphasic BC.

Implant Treatment in Patients with Sjogren's Syndrome: A Review of the Literature and Two Clinical Case Reports.

Implant rehabilitation in patients with Sjogren's Syndrome is reported to offer an improvementin the quality of life, but the scientific evidence on implant survival in patients with Sjogren's Syndrome is scarce. The paper presents a review of the literature on the performance of dental implants in patients with Sjogren's Syndrome and two case reports of patients with Sjogren's Syndrome treated successfully with dental implants. Two female patients suffering from Sjogren's Syndrome were rehabilitated with implant-supported prostheses. After eighteen months and two years respectively, the patients were satisfied with function and aesthetics; restorations were comfortable, stable radiographic bone levels were noted and xerostomia was not reported to affect the function anymore.

Spontaneous Alveolar Bone Growth in Ankylosed, Infraoccluded Teeth in Adolescents after Elective Decoronation--A Clinical Case Series.

This article considers a possible solution to prevent or manage spontaneous alveolar bone growth in ankylosed, infraoccluded teeth in adolescents after elective decoronation, allowing replacement resorption to take place, preserving the surrounding alveolar bone and enabling vertical bone development coronal to the decoronated segment. CPD/Clinical Relevance: To illustrate the advantages of decoronation allowing subsequent replacement of infraoccluded ankylosed teeth with implant-retained restorations and minimal aesthetic compromise.

Rehabilitation of an Edentulous Maxilla in a Patient with Isolated Cleft Palate.

This article aims to discuss the use of short dental implants in cleft patients, the construction of an implant-retained obturator and the use of a Createch milled titanium bar with three Locator overdenture attachments incorporated within the bar. CPD/Clinical Relevance: Implant-retained obturators offer a possible solution for treating patients with isolated cleft palate who are struggling with dentures due to the unfavourable soft and hard tissue profile. This paper demonstrates how to manage such patients and shows all the clinical and laboratory stages involved.

An Alternative Design to Overcome the Problem of Unfavorable Implant Angulations for a Screw-Retained, Implant-Supported Fixed Prosthesis: Two Clinical Reports.

Two clinical reports present an alternative design to address the problem of unfavorable implant angulations if a screw-retained prosthesis is desired. The restorations were designed as screw-retained prostheses, except in the area with the unfavorable implant screw emergence. The frameworks in these areas were customized to receive individual cement-retained crowns. This design offers retrievability and helps to minimize complications associated with excess cement without compromising the functional or esthetic outcome.

The role of dental implants in the management of dento-alveolar trauma. Part 2.

Patients who suffer dento-alveolar trauma present a unique challenge for the dentist. There are numerous options to consider when attempting to restore the dentition. This article reviews the role of dental implants and how thorough planning and execution of such treatment could result in an optimal outcome. Clinical Relevance: Knowledge of the role of dental implants and factors imperative for a successful treatment outcome will assist the clinician in achieving optimal restorative results.

Relationship between labial bone dimensions, labio-palatal implant position and esthetic outcomes of single tooth implants.

PURPOSE: To investigate the association between the oro-facial implant position distance (ID) and facial bone crest thickness (FBCT) in single-tooth implant crowns (STIC) placed in the esthetic zone, and predict presence of facial bone above the implant shoulder and its impact on Pink and White Esthetic Score (PES and WES) and patient related outcome measurements (PROMS). MATERIAL AND METHODS: In this cross-sectional study, all patients treated with STIC in esthetic zone between 2006 and 2013, with at least 12 months post-loading were invited to enroll. CBCTs were used to assess ID and FBCT. Esthetic outcomes included the PES and WES. PROMS measures included participants' satisfaction questionnaire with 13 formulated questions for this study. Descriptive statistics and ROC analysis were used. The association between ID, FBCT, esthetic outcomes and PROMS were calculated. RESULTS: Data was available for 60 implants. Mean ID was 2.02mm (SD=0.77). Mean FBCT at implant shoulder was 0.99mm (SD=0.98). FBCT was significantly associated with higher PES scores (P=0.040), but not with WES scores (P=0.149). FBCT was significantly associated with ID (P=0.009) and implants positioned ≥ 1.6mm palatal in relation to the adjacent teeth were likely to have higher FBCT. CONCLUSIONS: FBCT influences PES and is more predictable if implants are positioned ≥ 1.6mm palatal in relation to the adjacent teeth. Int J Prosthodont 2023. Doi: 10.11607/ijp.8052.

Relationship Between Facial Bone Dimensions, Orofacial Implant Position, and Esthetic Outcomes of Single-Tooth Implants.

PURPOSE: To investigate the association between the orofacial implant position distance (ID) and facial bone crest thickness (FBCT) in single-tooth implant crowns (STICs) placed in the esthetic zone and to predict the presence of facial bone above the implant shoulder, as well as its impact on Pink and White Esthetic Scores (PES and WES) and patient-related outcome measures (PROMs). MATERIALS AND METHODS: In this cross-sectional study, all patients treated with STICs in the esthetic zone between 2006 and 2013 with at least 12 months postloading were invited to enroll. CBCTs were used to assess ID and FBCT. Esthetic outcomes included the PES and WES. PROMs included a participant satisfaction questionnaire with 13 questions formulated for this study. Descriptive statistics and receiver operating characteristic curve analysis were used. The associations between ID, FBCT, esthetic outcomes, and PROMs were calculated. RESULTS: Data were available for 60 implants. Mean ID was 2.02 mm (SD = 0.77). Mean FBCT at the implant shoulder was 0.99 mm (SD = 0.98). FBCT was significantly associated with higher PES scores (P = .040), but not with WES scores (P = 0.149). FBCT was significantly associated with ID (P = .009), and implants positioned ≥ 1.6 mm palatal in relation to the adjacent teeth were likely to have higher FBCT. CONCLUSIONS: FBCT influences PES and is more predictable if implants are positioned ≥ 1.6 mm palatal in relation to the adjacent teeth.

Passive Fit Analysis of Laser-Sintered, Three-Unit Implant Prostheses: An In Vitro Study.

PURPOSE: To assess if the implant-retained prostheses produced with laser-sintering technique present an accuracy and passive fit comparable to their milled counterpart. MATERIALS AND METHODS: Two regular neck Straumann analogs were placed in a block of PMMA 15 mm apart and parallel to each other. The PMMA block was then scanned and two groups of cobalt-chromium, screw-retained, three-unit implant prostheses were fabricated using milling (control) and laser-sintering (test) techniques. The prostheses were then screwed on the PMMA block and the vertical marginal gap between the prostheses and the analogs at the implant-abutment junction was measured twice, (1) when only one screw was tightened, and (2) when both screws were fully tightened. The average of each marginal gap measurement was compared to assess the difference in term of passive fit between the laser-sintered and the milled prostheses. RESULTS: The mean marginal gap of the milled and the laser-sintered groups were 23.18 µm (SD = 6.2) and 23.71 µm (SD = 19.5) respectively. CONCLUSIONS: Laser-sintered prostheses presented a marginal fit comparable to their milled counterpart and represent a clinically valid alternative to their milled counterpart. Int J Prosthodont 2023;36:e53-e60.

Comparative barrier membrane degradation over time: Pericardium versus dermal membranes.

OBJECTIVE: The effectiveness of GBR procedures for the reconstruction of periodontal defects has been well documented. The objective of this investigation was to evaluate the degradation kinetics and biocompatibility of two resorbable collagen membranes in conjunction with a bovine xenograft material. MATERIALS AND METHODS: Lower premolars and first molars were extracted from 18 male Yucatan minipigs. After 4 months of healing, standardized semi-saddle defects were created (12 mm × 8 mm × 8 mm [l˙̇ × W˙ × d]), with 10 mm between adjacent defects. The defects were filled with a bovine xenograft and covered with a either the bilayer collagen membrane (control) or the porcine pericardium-derived collagen membrane (test). Histological analysis was performed after 4, 8, and 12 weeks of healing and the amount of residual membrane evaluated. Non-inferiority was calculated using the Brunner-Langer mixed regression model. RESULTS: Histological analysis indicated the presence of residual membrane in both groups at all time points, with significant degradation noted in both groups at 12 weeks compared to 4 weeks (p = .017). No significant difference in ranked residual membrane scores between the control and test membranes was detected at any time point. CONCLUSIONS: The pericardium-derived membrane was shown to be statistically non-inferior to the control membrane with respect to resorption kinetics and barrier function when utilized for guided bone regeneration in semi-saddle defects in minipigs. Further evaluation is necessary in the clinical setting.

Fallow time determination in dentistry using aerosol measurement in mechanically and non-mechanically ventilated environments.

Aim To calculate fallow time (FT) required following dental aerosol generating procedures (AGPs) in both a dental hospital (mechanically ventilated) and primary care (non-mechanically ventilated). Secondary outcomes were to identify spread and persistence of aerosol in open clinics compared to closed surgeries (mechanically ventilated environment), and identify if extraoral scavenging (EOS) reduces FT and production of aerosol.Methods In vitro simulation of fast handpiece cavity preparations using a manikin was conducted in a mechanically and non-mechanically ventilated environment using Optical Particle Sizer and NanoScan at baseline, during the procedure and fallow period.Results AGPs carried out in the non-mechanically, non-ventilated environment failed to achieve baseline particle levels after one hour. In contrast, when windows were opened after AGPs, there was an immediate reduction in all particle sizes. In mechanically ventilated environments, the baseline levels of particles were very low and particle count returned to baseline within ten minutes following the AGP. There was no detectable difference between particles in mechanically ventilated open bays and closed surgeries. The effect of the EOS on reducing the particle count was greater in the non-mechanically ventilated environment; additionally, it also reduced the spikes in particle counts in mechanically ventilated environments.Conclusion High-efficiency particulate, air-filtered mechanical ventilation, along with mitigation (high-volume suction), resulted in reduction of fallow time (ten minutes). Non-ventilated rooms failed to reach baseline level even after one hour of fallow time. There was no difference in particle counts in open bays or closed surgeries in mechanically ventilated settings with an extraoral suction device reducing particulate spikes. This study confirms that AGPs are not recommended in dental surgeries where no ventilation is possible.