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

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

Complication, vertical bone gain, volumetric changes after vertical ridge augmentation using customized reinforced PTFE mesh or Ti-mesh. A non-inferiority randomized clinical trial.

OBJECTIVE: The aim of this non-inferiority randomized clinical trial was to compare the surgical and healing complications, vertical bone gain, and volumetric bone changes after vertical ridge augmentation using two different approaches: customized Ti-reinforced d-PTFE mesh versus customized CAD/CAM Ti-mesh. MATERIALS AND METHODS: Fifty patients with vertical bone defects were randomly treated with Ti-reinforced d-PTFE mesh (control group) or CAD/CAM Ti-mesh (test group) and a mix of autogenous bone and deproteinized bovine bone matrix. Surgical and healing complication rates (SCR-HCR), vertical bone gain (VBG), regenerated bone volume (RBV), and regeneration rates (RR and ERR) were recorded and analysed [significance level (α) of 0.05]. RESULTS: Of the 50 patients, 48 underwent bone augmentation surgery. SCR were 4% and 12% in PTFE and Ti-mesh, whereas HCR were 12.5% and 8.3%. VBG were 5.79 ± 1.71 mm (range: 3.2-8.8 mm) in the PTFE group and 5.18 ± 1.61 mm (range: 3.1-8.0 mm) in the Ti-mesh group (p = .233), whereas RBV were 1.46 ± 0.48 cc and 1.26 ± 0.55. RR was 99.5% and 87.0%, demonstrating a statistically significant difference (p = .013). Finally, the values related to pseudo-periosteum, bone density, and implant stability were similar in the two study groups. Osseointegration rates were 98.2% and 98.3%. CONCLUSIONS: This study confirmed the non-inferiority of customized CAD/CAM titanium meshes with respect to reinforced PTFE meshes in terms of surgical and healing complications. Although PTFE meshes showed higher vertical bone gain and regeneration rates than Ti-meshes, no significant differences were found.

A 3D micro-CT assessment of composition and structure of bone tissue after vertical and horizontal alveolar ridge augmentation using CAD/CAM-customized titanium mesh.

OBJECTIVES: To date, no studies have exploited micro-CT in humans to evaluate bone morphology and structure after bone augmentation with CAD/CAM-customized titanium mesh, in mandible and maxilla. The aim of this study was to assess the composition and microstructure of bone biopsy through micro-CT analysis. MATERIALS AND METHODS: Bone augmentation at both maxillary and mandible sites was performed on 30 patients randomly treated with customized mesh, either alone (M-) or covered with resorbable membrane (M+), in both cases filled 50:50 with autogenous bone and xenograft. After 6 months, biopsies were taken and micro-CT was performed on consecutive 1-mm-thick VOIs from coronal to apical side, measuring tissue volumes, trabecular thickness, spacing, and number. RESULTS: In both groups, irrespective of membrane use, bone tissue (M-: 29.76% vs. M+: 30.84%) and residual graft material (M-: 14.87% vs. M+: 13.11%) values were similar. Differences were site-related (maxillary vs. mandibular) with higher percentage of bone tissue and trabecular density of low-mineralized bone and overall bone in the mandible. CONCLUSIONS: The composition and structure of bone tissue, as assessed by micro-CT after alveolar ridge augmentation using CAD/CAM-customized titanium meshes, showed similar features regardless of whether a collagen membrane was applied.

Analysis of ultra-short implants with different angulations: a retrospective case-control study with 2 to 9 years of follow-up.

OBJECTIVES: Does the angulation of ultrashort implants influence the stability of the peri-implant bone? The present study aimed to evaluate the effectiveness of non-axial ultrashort implants after 2 to 9 years of follow-up in resorbed alveolar ridges. MATERIALS AND METHODS: All partially edentulous patients with ultrashort implants (< 6 mm) used in the posterior region of an atrophic mandible or maxilla, to support partial dentures in conjunction with standard implants, were included in this study. Peri-implant bone loss, success and survival rates, crestal bone levels, crown-to-implant ratio and implant angulation were measured for each implant. Implants were divided into two groups: straight implants with angulation < 17° (control group) and tilted implants with angulation > 17° (test group). Statistical analysis was used to find any significant differences between the two study groups and to investigate significant linear correlations among all the variables (p = 0.05). RESULTS: A total of 42 ultrashort implants with a mean of 4 years of follow-up were included: 20 ultrashort axially loaded implants and 22 tilted implants. Mean crestal bone levels from baseline loading to maximum follow-up did not reveal statistical differences in regard to PBL; mean success and survival rates were 100% in all groups. CONCLUSIONS: PBL, success and survival rates of axial ultrashort implants and tilted ultrashort implants are comparable to those of conventional implants. CLINICAL RELEVANCE: This retrospective study revealed that ultrashort implants, even when placed with an angulation > 17°, can safely be used to support partial fixed prostheses. Further prospective clinical studies with larger samples and prospective design are needed to confirm these findings.

Vertical ridge augmentation (VRA) with Ti-reinforced d-PTFE membranes or Ti meshes and collagen membranes: 1-year results of a randomized clinical trial.

OBJECTIVES: The aim of this study was to evaluate hard and soft tissues around implants placed in posterior mandible 1 year after vertical ridge augmentation (VRA). MATERIALS AND METHODS: 40 patients with vertical defects were enrolled and treated according to the study protocol. Patients were randomly divided into two study groups: reinforced PTFE membranes (group A) and titanium meshes plus collagen membranes (group B). All patients received simultaneous implants which were evaluated after prosthetic restoration at baseline and after 1 year, using the following parameters: peri-implant bone levels (PBLs), interproximal bone peaks (IBPs), pocket probing depth (PPD), bleeding on probing (BoP), plaque index (mPI), gingival index (mGI), keratinized tissue thickness/width (tKT and wKT), and fornix depth (FD). Statistical analysis was performed to investigate any statistically significant differences and/or correlations (p = .05). RESULTS: 30 patients were completely followed up according to the study protocol. After 1 year, implants showed a change in PBL from 0.12 to 0.76 mm, with marginal bone loss of 0.67 and 0.61 mm for group A and group B, respectively, without significant differences (p > .9337). The estimated difference between treatments for the change from baseline in PBL was -0.05 (95% CI -0.27 to 0.16). Statistical analysis revealed strong correlations between PBL and IBP (p < .0001). However, no significant differences were observed for PPD, mPI, mGI, tKT, wKT, and FD (p > .05). CONCLUSION: The results indicate that GBR treatment with titanium meshes plus collagen membranes (Group B) compared to reinforced PTFE membranes does not appear to be inferior or superior in terms of PBL change. In both groups, hard and soft tissues were stable after 1 year of follow-up, with a peri-implant bone loss less than 1.0 mm in the first year (study registered at ClinicalTrials.gov NCT04332679).

Vertical and horizontal ridge augmentation using customized CAD/CAM titanium mesh with versus without resorbable membranes. A randomized clinical trial.

OBJECTIVES: The aim was to evaluate the role of resorbable membranes applied over customized titanium meshes related to soft tissue healing and bone regeneration after vertical/horizontal bone augmentation. MATERIALS AND METHODS: Thirty patients with partial edentulism of the maxilla/mandible, with vertical/horizontal reabsorption of the alveolar bone, and needing implant-supported restorations, were randomly divided into two groups: Group A was treated using only custom-made meshes (Mesh-) and Group B using custom-made meshes with cross-linked collagen membranes (Mesh+). Data collection included surgical/technical and healing complications, "pseudo-periosteum" thickness, bone density, planned bone volume (PBV), regenerated bone volume (RBV), regeneration rate (RR), vertical bone gain (VBG), and implant survival in regenerated areas. Statistical analysis was performed between the two study groups using a significance level of α = .05. RESULTS: Regarding the healing complications, the noninferiority analysis proved to be inconclusive, despite the better results of group Mesh+ (13%) compared to group Mesh- (33%): estimated value -1.13 CI-95% from -0.44 to 0.17. Superiority approach confirmed the absence of significant differences (p = .39). RBV was 803.27 mm3 and 843.13 mm3 , respectively, and higher RR was observed in group Mesh+ (82.3%) compared to Mesh- (74.3%), although this value did not reach a statistical significance (p = .44). All 30 patients completed the study, receiving 71 implants; 68 out of them were clinically stable and in function. CONCLUSION: The results showed that customized meshes alone do not appear to be inferior to customized meshes covered by cross-linked collagen membranes in terms of healing complication rates and regeneration rates, although superior results were observed in group Mesh+compared to group Mesh- for all variables.

Patient-reported outcomes and complication rates after lateral maxillary sinus floor elevation: a prospective study.

OBJECTIVES: Oral surgery morbidity is highly variable based on patients' characteristics and kind of surgical intervention. However, poor data are available in the literature regarding patient outcomes after oral surgery. The aim of this retrospective study was to evaluate patient-reported outcome and complication rates after maxillary sinus floor elevation. MATERIALS AND METHODS: Data from the records of patients undergoing maxillary sinus elevation have been collected from a private dental office. Patient-reported outcome has been assessed using a 100-mm visual analog scale to evaluate the post-operative pain (VASpain) experienced in the first week following surgery and visual rating scales to evaluate discomfort level (VRSdiscomfort: 0 to 4) and willingness to repeat the same surgical procedure (VRSwillingness: 0 to 3). Analgesics intake, swelling onset and duration, and ecchymosis have been also recorded. RESULTS: VASpain showed moderate values in the first 2 days (< 50) post-surgery, with a tendency to progressively decrease over the next 2 days. Average assumption of painkillers was 3.93 ± 3.03. Discomfort level (VRSdiscomfort) after surgery was low (median: 1; IR: 1-0), while willingness to undergo the same surgical procedure was very high (77.63% of patients). Swelling and ecchymosis were experienced by 97.36% and 51.32% of patients, respectively, with a mean duration of 4.09 ± 1.43 and 2.21 ± 2.31 days, respectively. Membrane perforation occurred in 4 cases. Other post-operative complications were not observed. CONCLUSIONS: Maxillary sinus grafting is a safe procedure, with a low complication rate and moderate morbidity that is well tolerated by patients. Particular attention is needed in case selection, surgical planning and operator expertise. CLINICAL RELEVANCE: The analysis of patient-reported outcomes can be of great help in surgical planning and in providing correct and adequate treatment.

Influence of crown-implant ratio on implant success rate of ultra-short dental implants: results of a 8- to 10-year retrospective study.

OBJECTIVES: The use of short implants has been suggested in recent years as an option for facilitating prosthetic restoration in resorbed jawbones. The aim of the present study was to determine how implant success rate is affected in the long term when ultra-short implants are rehabilitated with fixed restorations, resulting in a crown to implant (C/I) ratio of more than 3:1. MATERIALS AND METHODS: The study was conducted as an analysis on all patients operated from December 2005 to November 2007 with ultra-short dental implants. All implants were sintered porous-surfaced (SPS) with a length of 5 mm and a diameter of 5 mm (5 × 5 mm) and were restored with a single crown or a fixed dental prosthesis (FDP). Data collected included implant positioning site, crestal bone levels (CBL), and clinical and anatomical C/I ratios, and pre-established success criteria were used to evaluate the success rate of the implants. Statistical analysis was used to determine any significant differences or correlations (p = 0.05). RESULTS: Forty-one patients completed the follow-up and were eligible for this retrospective study on a total of 50 ultra-short SPS implants. The mean follow-up was 9.5 years (range 8.3 to 10.2 years). Three of the 50 implants failed because they were lost due to peri-implantitis, while all the other 47 met the pre-established success criteria giving an overall implant success rate of 94%. During the follow-up period, the mean peri-implant bone loss (PBL) was 0.41 + 0.36 mm. CONCLUSIONS: This study shows that ultra-short SPS implants can prove a reliable solution for prosthetic restoration in patients with severe alveolar bone atrophy. In selected patients with a sufficient bone width, ultra-short implants with a resulting C/I ratio of more than 3:1 presented no contraindications. CLINICAL RELEVANCE: In selected cases, ultra-short implants may represent an alternative to bone augmentation procedures and a long-term predictable solution.

Clinical and volumetric outcomes after vertical ridge augmentation using computer-aided-design/computer-aided manufacturing (CAD/CAM) customized titanium meshes: a pilot study.

BACKGROUND: One of the most recent innovations in bone augmentation surgery is represented by computer-aided-design/computer-aided-manufacturing (CAD/CAM) customized titanium meshes, which can be used to restore vertical bone defects before implant-prosthetic rehabilitations. The aim of this study was to evaluate the effectiveness/reliability of this technique in a consecutive series of cases. METHODS: Ten patients in need of bone augmentation before implant therapy were treated using CAD/CAM customized titanium meshes. A digital workflow was adopted to design virtual meshes on 3D bone models. Then, Direct Metal Laser Sintering (DMLS) technology was used to produce the titanium meshes, and vertical ridge augmentation was performed according to an established surgical protocol. Surgical complications, healing complications, vertical bone gain (VBG), planned bone volume (PBV), lacking bone volume (LBV), regenerated bone volume (RBV), average regeneration rate (RR) and implant success rate were evaluated. RESULTS: All augmented sites were successfully restored with definitive implant-supported fixed partial dentures. Measurements showed an average VBG of 4.5 ± 1.8 mm at surgical re-entry. Surgical and healing complications occurred in 30% and 10% of cases, respectively. Mean values of PBV, LBV, and RBV were 984, 92, and 892 mm3, respectively. The average RR achieved was 89%. All 26 implants were successfully in function after 1 year of follow-up. CONCLUSIONS: The results of this study suggest that the bone augmentation by means of DMLS custom-made titanium meshes can be considered a reliable and effective technique in restoring vertical bone defects.

Solid index impression protocol: a hybrid workflow for high accuracy and passive fit of full-arch implant-supported restorations.

AIM: The purpose of this article is to present the preliminary clinical results obtained with a novel hybrid digital-analog technique, the solid index impression protocol (SIIP), which uses a solid index to capture accurate impressions of multiple implants for the fabrication of implant-supported fixed full arches (FFAs). MATERIALS AND METHODS: This pilot study was based on five patients, each treated with a FFA supported by four implants. Three months after implant placement, impressions were taken for all patients with an intraoral scanner (IOS) (direct digital impression) and with the SIIP, using a custom tray consisting of four hollow cylinders connected with a bar. This index was linked to the implant transfers and transferred to the laboratory, and the definitive FFAs were fabricated based on it. The outcomes of the study were the passive fit of implant superstructures and the accuracy of the models generated by the SIIP, inspected using a coordinate measuring machine (CMM) and reverse engineering software, and compared with the accuracy of direct digital impressions. RESULTS: Excellent clinical precision and passive fit were obtained in all five implant-supported FFAs fabricated with the SIIP. One year after delivery, all FFAs were functional without any complication. Differences in accuracy were found between the SIIP and direct intraoral scanning. CONCLUSIONS: The SIIP seems to represent a viable option for capturing accurate impressions for the fabrication of clinically precise implant-supported FFAs with a hybrid digital-analog workflow. Further studies are needed to confirm these results.

In Vitro Effect of Bromelain on the Regenerative Properties of Mesenchymal Stem Cells.

BACKGROUND: Bromelain belongs to a group of protein-digesting enzymes obtained commercially from the fruit or stem of pineapple. Several studies demonstrated that bromelain exhibits various fibrinolytic, anti-edematous, antithrombotic, and anti-inflammatory activities supporting its application for many therapeutic benefits. The aim of this study was to analyze the effects of bromelain on the pro-wound healing activities and the regenerative properties of mesenchymal stem cells. METHODS: Mesenchymal stem cells were treated in vitro with bromelain alone or combined with dexamethasone sodium phosphate. Real-time polymerase chain reaction was performed to profile the expression of extracellular matrix components and remodeling enzymes, and cytokines. RESULTS: The combination of bromelain and dexamethasone sodium phosphate induced a great activation of mesenchymal stem cells with an increase in hyaluronan and collagen production and anti-inflammatory cytokines release. CONCLUSION: Based on the results of this in vitro study, the combined use of bromelain and dexamethasone sodium phosphate stimulated the pro-wound healing activities and the regenerative properties of mesenchymal stem cells better than bromelain and dexamethasone alone.

Statements and Recommendations for Guided Bone Regeneration: Consensus Report of the Guided Bone Regeneration Symposium Held in Bologna, October 15 to 16, 2016.

INTRODUCTION: In the past 10 years, long-term studies have demonstrated that guided bone regeneration (GBR) is a successful and reliable technique for vertical and horizontal ridge augmentation, but strict and rigorous protocols must be adopted. MATERIAL AND METHODS: Because no reports have yet been published with statements and clinical recommendations for GBR, a closed meeting of all authors was organized to discuss this matter during a GBR symposium held in Bologna (Italy) in October 2016. The authors focused on the findings of systematic and narrative reviews, prepared before the meeting, covering aspects of the clinical management of GBR techniques. Successively, a discussion based on the scientific evidence and on the experts' opinions led to the formulation of statements, clinical recommendations, and implications for future research. RESULTS: To avoid complications and to optimize outcomes, the following factors should be considered by clinicians: patient selection; analysis of defect type; blood supply; antibiotic treatment; flap passivation; delayed implant placement; combination of autogenous bone and xenograft or allograft; rigorous fixation of membranes; removal after 6 to 9 months; analysis of complications; soft-tissue management; and high care in scarred sites and in esthetic areas. CONCLUSIONS: The present consensus report reviewed the scientific evidence and provided specific guidelines and recommendations for clinical practice and the different approaches to GBR techniques to ensure surgical success and predictable outcomes.

Evaluation of Crestal Bone Loss Around Straight and Tilted Implants in Patients Rehabilitated by Immediate-Loaded Full-Arch All-on-4 or All-on-6: A Prospective Study.

The aim of this prospective study was to compare implant success rate and crestal bone loss around tilted and straight implants supporting immediate-loading full-arch rehabilitations. Twenty consecutive patients with edentulous jaws treated between June 2013 and July 2015 who satisfied all inclusion and exclusion criteria were included in the study. All patients were rehabilitated through a full-arch restoration supported by 4 or 6 immediately loaded implants. Clinical and radiographic examinations were scheduled every 12 months to evaluate implant success rates and crestal bone levels. Significant differences in crestal bone levels and success rates between straight and tilted implants were investigated by means of independent statistical analysis; differences were regarded as significant if P < .05. Seventy straight and 50 tilted implants were placed to rehabilitate 14 mandibles and 12 maxillae in 20 patients. After a follow-up of 12 to 36 months, survival rate was 97.1% for straight implants and 96.0% for tilted implants; while success rates were 94.3% and 94.0%, respectively. Success and survival rates were not significantly different (P > .05). Change in crestal bone level was 0.5 ± 0.4 mm for straight implants and 0.6 ± 0.4 mm for tilted implants (P > .05). Straight and tilted implants seemed to have similar behavior after immediate loading rehabilitations. After functional loading, straight and tilted implants did not differ significantly in clinical outcome.

Relationship Between Crestal Bone Levels and Crown-to-Implant Ratio of Ultra-Short Implants With a Microrough Surface: A Prospective Study With 48 Months of Follow-Up.

The aim of this cohort study was to investigate the relationship between crestal bone levels and crown-to-implant ratio of ultra-short implants, after functional loading. Sixty patients with single or partial edentulism and alveolar bone atrophy were enrolled and treated between December 2009 and January 2016. Without using bone-grafting procedures, patients were rehabilitated with ultra-short implants characterized by a microrough surface and a 6-mm length. Clinical and anatomical crown-to-implant (C/I) ratios and crestal bone levels (CBL) were measured after a follow-up period ranging from 12 to 72 months; all peri-implant and prosthetic parameters were recorded. The data collected were statistically analyzed ( P = .05). A total of 47 patients with 66 ultra-short implants were completely followed up according to described protocol. The mean follow-up was 48.5 ± 19.1 months. The mean anatomical C/I ratio was 2.2, while the mean clinical C/I ratio was 2.6 ± 0.6 at baseline and 2.8 ± 0.6 at the last follow-up appointment. Mean CBL as calculated at the baseline was 0.7 ± 0.5 mm, while at the last appointment it measured 1.0 ± 0.5 mm. The overall implant-based success rate was 96.9%, and the mean peri-implant bone loss (PBL) was 0.3 ± 0.3 mm. No statistically significant relationship was found between anatomical or clinical C/I ratio and PBL. Ultra-short implants appear to offer a predictable solution for implant-prosthetic rehabilitation in patients with edentulism and bone atrophy. A high percentage of implants were successful, with minimal crestal bone loss. The high C/I ratio did not appear to influence either peri-implant bone loss or prosthetic complication rates.

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.

Effect of Oral Administration of Bromelain on Postoperative Discomfort After Third Molar Surgery.

INTRODUCTION: The purpose of this prospective randomized controlled clinical trial was to evaluate the effect of oral administration of bromelain on discomfort after mandibular third molar surgery. MATERIALS AND METHODS: Eighty-four consecutive patients requiring surgical removal of a single mandibular impacted third molar under local anesthesia were randomly assigned to receiving no drug (control group, Group A), postoperative 40 mg bromelain every 6 hours for 6 days (Group B), preoperative 4 mg dexamethasone sodium phosphate as a submucosal injection (Group C), and preoperative 4 mg dexamethasone sodium phosphate as a submucosal injection plus postoperative 40 mg bromelain every 6 hours for 6 days (Group D). Standardized surgical and analgesic protocols were adopted. Maximum interincisal distance and facial contours were measured at baseline and on postoperative days 2 and 7. Pain was measured objectively by counting the number of analgesic tablets required. Patient perception of the severity of symptoms was assessed with a follow-up questionnaire (PoSSe scale). RESULTS: On postoperative day 2, there was a statistically significant reduction in facial edema in both Groups C and D compared with the control group, but no statistically significant differences were observed between Group B and the control group. At evaluation on postoperative day 7, Group D showed a statistically significant reduction in postoperative swelling compared with the control group. The combined use of bromelain and dexamethasone (Group D) induced a statistically significant reduction in the total number of analgesic tablets taken after surgery compared with the control group. The treatment groups had a limited, nonsignificant effect on trismus when compared with the control group. CONCLUSIONS: Bromelain used singly showed moderate anti-inflammatory efficacy, reducing postoperative swelling, albeit not to any significant extent compared with no drug administration. The combined use of bromelain and dexamethasone sodium phosphate yielded the best results in terms of control of postoperative discomfort.

Minimally Invasive Approach Based on Pterygoid and Short Implants for Rehabilitation of an Extremely Atrophic Maxilla: Case Report.

INTRODUCTION: Extremely atrophic maxillae can be considered the most important indication for three-dimensional maxillary reconstruction. Different bone-augmentation techniques have been suggested to accomplish this. This article illustrates a minimally invasive approach to rehabilitation of the extremely atrophic maxilla. MATERIAL AND METHODS: A 63-year-old male patient was referred for restoration of his totally edentulous maxilla with a fixed full-arch implant-prosthetic rehabilitation. Four short implants in the premaxillary region and 2 longer implants in the pterygomaxillary regions were inserted with piezoelectric implant site preparation. DISCUSSION: At the 1-year follow-up appointment, no clinical or radiographic changes in the soft-tissue contours or crestal bone levels were observed. CONCLUSION: This surgical approach, based on the combination of short implants in the premaxillary regions and pterygoid implants in the pterygomaxillary regions, represents a way to shorten treatment timing, minimize the risk of surgical complications, and reduce patient discomfort and costs.

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.

Peri-implant conditions around sintered porous-surfaced (SPS) implants. A 36-month prospective cohort study.

OBJECTIVES: The specific aim of this study was to assess sintered porous-surfaced (SPS) implant system from a biological point of view, through a prospective study of the health status and the evolution of the peri-implant tissues over time and analysis of the changes observed in the various peri-implant parameters. MATERIAL AND METHODS: Hundred and fifty-one patients were treated consecutively from 2005 to 2007 using 280 SPS implants, which were restored with a single crown or a partial fixed denture. To accurately monitor the health and biological evolution of peri-implant soft and hard tissues, a number of clinical parameters were adopted, such as the modified Plaque Index (mPI), the modified sulcus Bleeding Index (mBI), Peri-implant Probing Depth (PPD), and Crestal Bone Level (CBL). Clinical and radiographic examinations were scheduled over a 36-month follow-up of functional loading according to a well-established protocol generally applied to determine implant success rates and Peri-implant Bone Loss (PBL). Statistical analysis was used to determine any significant differences or correlations (P = 0.05). RESULTS: A total of 259 SPS implants in 136 patients were followed up for 36 months. According to Buser's success criteria, the overall implant-based success rate was 98.1% and the mean PBL was 0.48 ± 0.29 mm. MBI and mPI mean values showed statistically significant differences between baseline and follow-up analyses (P < 0.001). No statistically significant differences in mean PPD values were found between baseline and control analyses (P = 0.060). CONCLUSION: This prospective cohort study revealed that the biological behavior of SPS implant system was characterized by high tissue stability during the observation period, both as regards soft and hard tissues. In particular, the crestal bone remodeling pattern was very similar to that reported in other studies, confirming that the bone loss around SPS implants, at least at 36 months, seems to be predictable.

Influence of crown-implant ratio on implant success rates and crestal bone levels: a 36-month follow-up prospective study.

OBJECTIVES: The aim of this prospective study was to determine how the crown-implant ratio (C/I ratio) influences crestal bone loss and implant success rates after a 3-year follow-up, using implants with a sintered porous surface (SPS). MATERIALS AND METHODS: On the basis of preestablished inclusion and exclusion criteria, 151 of a cohort of 160 patients with single or partial edentulism were selected as eligible for the study. The 151 patients were treated consecutively from 2005 to 2007 using 280 SPS implants, which were restored with a single crown or a partial fixed denture. The data collection included both clinical and anatomical C/I ratios; other implant prosthetic factors were also recorded. Implants were divided into three groups according to the C/I ratio. Clinical and radiographic examinations were scheduled over a 36-month follow-up of functional loading according to a well-established protocol generally applied to determine implant success rates and crestal bone levels. Statistical analysis was used to determine any significant differences or correlations (P = 0.05). RESULTS: A total of 259 SPS implants in 136 patients were followed up for 36 months. According to the success criteria, the overall implant-based success rate was 98.1%, and the mean peri-implant bone loss (PBL) was 0.48 ± 0.29 mm. Statistical analysis revealed significant correlation between implant success rate and C/I ratio (P < 0.05) and between PBL and C/I ratio (P < 0.05). The critical threshold value of the anatomical and clinical C/I ratio for avoiding excessive bone loss or implant failure was 3.10 and 3.40. CONCLUSION: This prospective cohort study revealed that SPS implants offer a predictable solution for implant prosthetic rehabilitation in patients with edentulism characterized by different alveolar bone atrophy. From the biomechanical point of view, the C/I ratio would appear to be the main parameter capable of influencing implant success and crestal bone loss. Consequently, it is important not to exceed the threshold values in order to avoid excessive stress at the bone-implant interface capable of resulting in excessive crestal bone loss or implant failure.