Implant Dentistry

Objectives: The primary aim of the present article was to review the effect and the clinical significance of abutment dis- and reconnection on the peri-implant marginal bone levels. Materials and methods: English articles published from 2009 to April 2019 were identified on the MEDLINE, Cochrane Library, and PubMed databases, according to the PRISMA guidelines. Comparative in vivo studies on humans were included. Results: A total of 4 studies with different levels of bias were included in this review. A significant heterogeneity of the reported data was observed, which limited the comparison of the findings. The only parameter that was homogenous throughout all 4 studies was the marginal bone level measurement. Conclusion: Within the limitations of the present review, it can be suggested that minimizing the number of abutment dis- and reconnections would be beneficial to ensure minimal disruption to the peri-implant tissue and marginal bone level. However, the clinical significance of the marginal bone level changes is still inconclusive.

Purpose: The primary aim of this randomized, controlled, blinded, clinical trial was to compare a mix of particulate allograft and harvested autogenous particles (Autogenous) to an osteoinductive demineralized bone matrix (DBM) allograft on clinical and histologic outcomes for horizontal ridge augmentation procedure. Materials and Methods: Fourteen patients with a horizontal ridge defect with at least 1 adjacent tooth were entered into this study. The test group of 7 subjects received corticocancellous particulate allograft (Mineross) mixed with autogenous bone chips (70:30) harvested using a bone scraper (SafeScraper TWIST). Seven subjects in the control group received DBM (Optecure-CCC). Both groups had a corticocancellous particulate allograft overlay and an acellular dermis membrane (ADMG) (AlloDerm GBR) to cover the grafts. Results: For the Autogenous group, there was a gain of 3.5 ± 1.4 mm while the DBM group gained 3.8 ± 1.6 mm (P < 0.05). Vertical change was minimal for both groups (P > 0.05). The Autogenous group had a mean of 35% vital bone while the DBM had 39% (P > 0.05). Conclusions: Both treatments provided similar gain of ridge width and minimal loss of ridge height. The autogenous bone chips did not provide any additional benefit when compared with allograft alone that had lot verified osteoinductive activity.

Background: During implantation planning, dentists should be able to make an informed decision regarding whether to use an implant template to assist the surgery. Purpose: The aim of this meta-analysis was to assess the results of implantation with or without an implant template based on the accuracy, survival rate, and other considerations. Materials and Methods: In January 2018, a systematic review was undertaken for randomized controlled trials and retrospective and prospective cohort studies with relevance to implant accuracy and the survival rate between the implant template and free-hand method. The odds ratios (ORs) of the survival rate and the mean difference of accuracy deviation from the selected papers were estimated by meta-analysis. Results: Of the 362 screened articles, 6 studies were included in the meta-analysis. Comparison of the survival rate of implant surgery with or without an implant template revealed no significant result (OR = 1.71, 95% confidence interval [CI] 0.65–4.51). Significant differences in accuracy were observed in angular (mean difference = −5.45 degrees, 95% CI −0.66 to −4.24 degrees) and apical deviation (mean difference = −0.83 mm, 95% CI −1.12 to −0.54). Conclusions: With the technology of computer-aided surgical template, implant placement can be more accurate than free-hand operation. No significant difference is observed in the survival rate between template and free-hand.

Purpose: To compare the clinical and patient-reported outcomes of ≤6-mm implants with those of ≥10-mm implants placed after both lateral and transcrestal sinus floor elevation. Materials and Methods: Using PubMed (MEDLINE), EMBASE, and Cochrane, a literature search for randomized controlled trials was performed. All the outcome variables were evaluated through a quantitative meta-analysis, and the influence of other clinical covariates were determined with a metaregression. For the survival outcomes, trial sequential analysis (TSA) was performed to adjust results for type I and II errors and to analyze the power of the available evidence. Results: After full-text reading, 12 studies were included in the analyses. No statistically significant difference was found after 3 years between the 2 study groups (P = 0.36). Short implants displayed fewer biological complications (P = 0.05), less marginal bone loss (MBL) from implant placement (P < 0.01), and reduced surgical time and treatment cost. However, long implants showed a statistically significant smaller number of prosthetic complications (P = 0.03). TSA confirmed the results of the meta-analysis, revealing that additional studies are needed due to low statistical power of the available evidence. Conclusion: The placement of short implants is a predictable option in treating patients with maxillary atrophy up to a 3-year follow-up. Studies with a longer observational period are needed to study the long-term performance of these implants.

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Purpose: The aim of this study was to compare the results of indirect sinus augmentation with and without the addition of a biomaterial. Materials and Methods: Thirty patients aged 40 to 60 years participated in this randomized controlled clinical trial. After closed sinus lift operation, patients were randomly and equally divided into blood clot control and acemannan14 sponge graft groups. Simultaneous implant placement was then performed. Cone beam computed tomography was performed immediately and at 3 and 6 months postoperation. Bone formation was evaluated by the radiographic endo-sinus bone gain percentage around the implant. Results: Compared with the control group, the acemannan-treated group had a significantly greater radiographic endo-sinus bone gain percentage of approximately 2.4- and 2-fold at 3 and 6 months postsurgery, respectively (P < 0.05). Conclusion: The addition of a biomaterial (Acemannan) with indirect sinus augmentation and simultaneous implant placement significantly enhances bone formation at 3 and 6 months postsurgery.

Purpose: Short implants are a minimally invasive alternative in the management of alveolar bone atrophy. This study aimed to assess the influence of the surgical approach (1-stage vs 2-stage) on the 15-year survival and marginal bone loss of short implants in a fixed complete denture. Materials and Methods: A retrospective clinical study was conducted in a single private dental clinic that included short implants placed between January 2001 and December 2002. Results: Forty-one short implants supported 18 screw-retained complete dentures. The mean follow-up time was 15 ± 3 years. The surgical approach (1-stage vs 2-stage) did not significantly affect implant survival and marginal bone loss. The implant survival rate was 90.2%. Conclusions: Short dental implants could be predictably indicated to support fixed complete dentures. The implants could be placed through a 1- or 2-stage surgery.

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Objectives: To compare the histomorphometric outcomes of biopsies collected from the antrostomy and from the alveolar crest of the maxillary sinus after a sinus-lift procedure. Material and Methods: In 12 volunteers, sinus floor elevation was performed using collagenated corticocancellous porcine bone. Nine months after the surgery, 2 biopsies, 1 from the alveolar crest and 1 from the antrostomy, were collected for histological analysis. Results: Biopsies from 11 patients were available for histological analyses (n = 11). At the alveolar crest sites, the percentage of mineralized bone was 40.1 ± 14.1%, of bone marrow was 40.1 ± 18.0%, and of the xenograft was 14.7 ± 15.2%. Small amounts of soft tissue were found. At the antrostomy sites, the percentages of mineralized bone, bone marrow, and xenograft were 26.0 ± 10.8%, 23.4 ± 17.0%, and 28.2 ± 15.7%, respectively. Soft tissue was represented by 19.7 ± 19.4%. Conclusion: Higher amounts of mineralized bone and bone marrow were found in the alveolar crest compared with the antrostomy.

Purpose: The aim of the study was an evaluation of risk factors for an innovative bone regeneration technique using a customized titanium mesh that was tested in a clinical setting. Materials and Methods: This retrospective study included 65 patients with 70 grafting procedures of osseous defects of the jaws with a customized titanium mesh together with Advanced- and Injectable-Platelet-Rich Fibrin (A- and I-PRF), resorbable membranes, and bone grafting materials. Exposures of the meshes and grafting outcome were analyzed according to a novel classification as (a) punctual and (b) tooth width or complete exposure of the mesh (c). No exposure was stated as (d). Results: In 37% of cases, exposures of the meshes occurred that were significantly associated with loss of grafted material (P < 0.001). Tobacco abuse (P = 0.032) and grafting procedures together with simultaneous sinus floor elevation techniques (P = 0.001) were found to be risk factors for success of the grafted material. Implant placement was not possible in 2 cases only. Conclusion: The results of this study verified the treatment of large defects with a customized titanium mesh as a useful protocol with a predictable outcome, even in cases of dehiscences.

Objective: To evaluate the long-term incidence of complications in abutment teeth and dental implants in periodontally treated and maintained patients, refusing bone grafting surgical therapies, rehabilitated with full-arch telescopic-retained retrievable prostheses (TRPs) and full-arch fixed prosthesis (FPs), both supported by teeth-implants combination. Materials and Methods: After active periodontal therapy, 18 patients were rehabilitated with full-arch TRPs, whereas 17 patients were rehabilitated with full-arch FPs. Patients were annually evaluated for technical and/or biological failures/complications. Results: During the 15-year observation period, 6 of 164 (3.6%) implants failed and 19 of 233 teeth were extracted (9.2%) in the TRPs group, whereas 6 of 152 (3.9%) implants failed and 23 of 221 (10.4%) abutment teeth were extracted in the FPs group. Differences in implant failures and abutment teeth loss between the 2 groups were not statistically significant. In both the groups, Cox regressions identified significant difference (P < 0.05) for mean initial bone loss, aggressive periodontitis, and smoking, as factors contributing to tooth loss and implant failures in general. Conclusion: In periodontally treated patients, refusing bone grafting surgical therapies, rehabilitated with full-arch TRPs and full-arch fixed prostheses, both supported by teeth-implants connection, high survival rates can be expected if regular supportive periodontal therapy had been performed.

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Objective: The aim of this clinical study was to analyze the accuracy of computer-guided implant surgery. Materials and Methods: Assisted by computed tomography (CT)-based planning software and navigational templates, 16 patients successfully received 26 dental implants. Each implant parameter (a–d) was calculated based on superimposed preoperative and postoperative cone beam CT scans: (a) deviation at entry point; (b) deviation at apex; (c) angular deviation; and (d) depth deviation. Results: Mean central deviation at implant entry point and apex was 0.91 mm (standard error [SE] = 0.11 mm; 95% confidence interval [CI]: 0.69–1.13) and 1.22 mm (SE = 0.11 mm; 95% CI: 0.99–1.45), respectively. Mean angulation deviation was 4.11 degrees (SE = 0.52 degrees; 95% CI: 3.04–5.17) and the average depth deviation was 0.65 mm (SE = 0.11 mm; 95% CI: 0.42–0.87). For the total number of implants placed, the maximum error was 2.34 mm at entry point, 2.71 mm at apex, 9.44 degrees in angular deviation, and 2.00 mm in depth deviation. Conclusion: Great accuracy was reached even in advanced cases with prior bone augmentation and complex traumas. This leads to the conclusion that particularly in advanced cases, computer-guided implantation can be beneficial.

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Purpose: The aim of this study is to investigate the biological activity and antibacterial property of cerium oxide–incorporated calcium silicate coatings (CeO2-CS) in dental implants. Materials and Methods: In this study, MC3T3-E1 cells cultured on the plastic, Ti-6Al-4V, and the cerium oxide–incorporated calcium silicate coatings (CeO2-CS) coating served as the blank, control, and CeO2-CS groups, respectively. A cell counting kit-8 (CCK-8) and flow cytometry were used to evaluate the biocompatibility. The osteoblastic differentiation of the MC3T3-E1 cells was also analyzed by quantitative real-time polymerase chain reaction analysis. The CCK-8 and counts of colony-forming units (CFUs) were used to detect the antibacterial activity of the coating on Enterococcus faecalis. The study showed that the cerium oxide–incorporated calcium silicate coating (CeO2-CS) has better biocompatibility. Meanwhile, the ALP, OCN, and BSP mRNA expression levels in the CeO2-CS group were significantly upregulated (P < 0.05). The number of viable bacteria and the CFU results were significantly reduced in the CeO2-CS group (P < 0.05). Conclusion: The cerium oxide–incorporated calcium silicate coatings (CeO2-CS) may promote the osteoblastic differentiation of osteoblasts. Meanwhile, the cerium oxide–incorporated calcium silicate coating (CeO2-CS) showed strong antimicrobial activity on E. faecalis, with good biocompatibility.

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