The "CROMa" Project: A Care Pathway for Clinical Management of Patients with Bisphosphonate Exposure.

Aim. To describe 7 years of activity of "CROMa" (Coordination of Research on Osteonecrosis of the Jaws) project of "Sapienza" University of Rome. Materials and Methods. A preventive and therapeutic care pathway was created for patients with bisphosphonates (BPs) exposure. Demographic, social, behavioural, pharmacological, and clinical variables were registered in a dedicated database. Results. In the project, 502 patients, 403 females and 99 males, were observed. Bone pathologies were 79% osteometabolic diseases (OMD) and 21% metastatic cancer (CA). Females were 90% in OMD group and 41% in CA. BP administration was 54% oral, 31% IV, and 11% IM; 89% of BPs were amino-BP and 11% non-amino-BP. Consistently with bone pathology (OMD/CA), alendronate appears to be prevalent for OMD (40% relative), while zoledronate was indicated in 92% of CA patients. Out of 502 cases collected, 28 BRONJ were detected: 17 of them were related to IV BP treatment. Preventive oral assessment was required for 50% of CA patients and by 4% of OMD patients. Conclusions. The proposed care pathway protocols for BP exposed patients appeared to be useful to meet treatment and preventive needs, in both oncological and osteometabolic diseases patients. Patients' and physicians' prevention awareness can be the starting point of a multilevel prevention system.

Surgical treatment options for grafting areas of gingival recession association with cervical lesions: a review.

STATEMENT OF THE PROBLEM: Gingival recession (GR) is a highly prevalent dental problem that may be associated with dentin hypersensitivity and aesthetic complaint. Furthermore, GR is often complicated by dental cervical wear of substance, such as erosion, abrasion, or abfraction lesions, as well as initial or more extensive carious involvement of the cervical area, which worsen the symptoms and make the treatment of this periodontal condition more challenging. THE PURPOSE OF THE STUDY: To provide an overview of surgical treatment options presented in the literature for sites affected by GR with carious cervical lesions (CCLs) or non-carious cervical lesions (NCCLs). METHODS: The Medline database was searched for items dealing with GR and its treatment options, especially on GR associated with CCLs or NCCLs. RESULTS: Several periodontal surgical techniques have shown good potential for treating GR over the years. Specifically, considering GR associated with CCL or NCCL, an assessment of both hard (dental) and soft (gingival) tissue characteristics of the involved site is recommended in selecting the surgical procedure. CONCLUSIONS: For GR associated with CCL or NCCL, hard and soft tissue characteristics of the involved site have to be carefully evaluated in order to choose the most appropriate surgical procedure. CLINICAL SIGNIFICANCE: A structured decision-making process, considering both hard and soft tissue characteristics of the involved site, is recommended in choosing the most appropriate surgical procedures to treat GR associated with CCL or NCCL defects. The restitutio ad integrum of the dento-periodontal unit is an essential condition to restore the tooth to its original function and esthetics.

Peri-implant marginal bone level: a systematic review and meta-analysis of studies comparing platform switching versus conventionally restored implants.

AIM: To systematically review the literature to compare implant survival (IS) and marginal bone loss (MBL) around platform-switched (PS) versus conventionally restored platform-matching dental implants. MATERIAL AND METHODS: Randomized, controlled human clinical trials (RCTs) comparing IS and MBL in PS and conventionally restored implants, with 12 months of follow-up and at least 10 implants were identified through electronic and manual search. Review and meta-analysis were performed according to PRISMA statement. Risk ratio (RR) for implant failure and mean difference (MD) for MBL, with 95% confidence interval (CI) were calculated. Sources of heterogeneity among studies were also investigated by subgroup analyses. RESULTS: Ten RCTs involving 435 subjects and 993 implants contributed to this review. The cumulative estimated implant success rate revealed no statistically significant difference between the two groups. At a patient level, a smaller amount of MBL [MD -0.55 mm, 95%CI (-0.86; -0.24), p = 0.0006] was noted around PS implants. Subgroup analyses performed at implant level suggested less MBL when platform switching showed a larger mismatching. CONCLUSION: PS technique appeared to be useful in limiting bone resorption. Nevertheless, these data should be interpreted cautiously as significant heterogeneity and possible publication bias were noted. Further research is needed to identify the factors most associated with successful outcomes.

Horizontal and vertical ridge augmentation in localized alveolar deficient sites: a retrospective case series.

PURPOSE: This study reviews the clinical outcomes of ridge augmentations performed via horizontal- or vertical-guided bone regeneration (h-GBR, v-GBR) or edentulous ridge expansion. MATERIALS AND METHODS: The degree of defect correction, the marginal bone level, and the horizontal stability of the augmented bone (five patients) were examined with a new proposed rigid resin survey template. RESULTS: Thirty ridge defects ranging from 1 to 8 mm were corrected, and 56 implants were positioned. The percentages of alveolar defect correction were 91.85% ± 22.30%, 97.13% ± 4.48%, and 90.42% ± 11.93% for h-GBR, edentulous ridge expansion, and v-GBR, respectively; a limited amount of marginal bone level was reported for all three groups, while a large amount of horizontal bone resorption was detected. CONCLUSIONS: All surgical techniques considered in this study are predictable procedures, and the proposed survey template measurement system showed to be a reliable method of evaluating horizontal bone stability of the augmented ridges.

Usefulness of the aesthetic result as a success criterion for implant therapy: a review.

PURPOSE: The purpose of this study was to review the reported evaluation criteria of the aesthetic result in oral implant rehabilitation. MATERIALS AND METHODS: A literature search of MEDLINE, the Cochrane Collaboration, and EMBASE was performed to retrieve studies published between January 1990 and December 2008 using the following key words: "dental implants,""clinical trial," and "aesthetic index" (and their synonyms). A manual search of the literature published in the same period was also carried out using the following publications: Clinical Oral Implant Research, The International Journal of Oral and Maxillofacial Implants, and The International Journal of Periodontics and Restorative Dentistry. The inclusion criteria of the published studies were the following: human clinical trial, oral implant rehabilitation, at least 10 implants, at least 6 months of follow-up from insertion of the prosthesis, and evaluation of the aesthetic result by means of an index. RESULTS: The literature search revealed 650 relevant bibliographic references, of which 89 were selected for further analysis. A final total of 29 articles fulfilled the inclusion criteria; these included 10 retrospective case series, 11 prospective case series, 1 retrospective controlled clinical trial, 1 prospective controlled clinical trial, and 6 randomized controlled clinical trials. In general, evaluations of aesthetic results appear only in the more recent studies and refer mostly to implant rehabilitation in the maxillary anterior zone; the index used, in most cases, was the Papilla Index of Jemt. CONCLUSIONS: Although there appears to be a growing interest in aesthetics in dental implantology, there are as yet no universally accepted evaluation criteria of the aesthetic result. Therefore, further research is necessary to establish a common, complete, and reproducible index for the evaluation of aesthetic outcome that can add in the success criteria for implant therapy in the maxillary and mandibular anterior areas.

Human maxillary sinuses augmented with mineralized, solvent-dehydrated bone allograft: a longitudinal case series.

BACKGROUND: This prospective case series aimed to assess the clinical stability of maxillary sinus floors regenerated with mineralized, solvent-dehydrated bone allograft (MSDBA) and restored with dental implants after at least 5 years of function. MATERIALS AND METHODS: Eleven sinuses in 7 patients (4 bilateral) were augmented with 50% cortical and 50% cancellous MSDBA (Puros, Zimmer Dental Italy srl, Vittorio Veneto, Treviso, Italy). After a mean healing period of 8.1 months, a total of 11 bone specimens (1 per sinus graft) were retrieved and 25 implants were placed. Bone samples were analyzed using histology, histomorphometry, and immunohistochemistry. Standardized periapical radiographs were taken at prosthetic loading (baseline) and annually. RESULTS: There were no complications or failures. Histologically, almost all residual MSDBA particles were surrounded by bone. Histomorphometry characterized the tissue as 39% ± 1.6% newly formed bone, 34% ± 1.6% marrow spaces, and 31% ± 1.4% residual material reflective of high cortical content of the composite graft. Immunohistochemistry indicated that osteoblasts expressed OB-cadherin at high levels. After a mean follow-up of 5.1 years, implants and regenerated bone appeared clinically stable. Radiographically, implants appeared to be surrounded by dense bone and ridges did not lose clinically measurable volume. CONCLUSIONS: Composite MSDBA allografts formed good quality maxillary sinus bone without complications after 8.1 months of mean healing time, and demonstrated clinical and radiographic stability after a mean follow-up time of 5.14 years.

Immediate, early, and late implant placement in first-molar sites: a retrospective case series.

PURPOSE: To review the clinical outcomes of immediate, early, and conventional single-tooth implant placement in mandibular or maxillary first molar sites. MATERIALS AND METHODS: The charts of patients treated consecutively for first molar replacement according to unconventional (immediate = group 1, early = group 2) or conventional (late = group 3) surgical protocols were examined. All available clinical parameters were reviewed to calculate implant survival and success rates according to well-established criteria. Periapical radiographs obtained upon delivery of the definitive crown (T2) and 1 year later (T3) were digitized and assessed to evaluate marginal bone loss (MBL). Clinical photographs were evaluated to determine soft tissue health. RESULTS: Forty-seven patients were treated with a total of 53 immediate, early, or late single implants. The last follow-up examination was at 38.84 ± 16.14 months (mean ± SD) for group 1, 32.91 ± 18.49 months for group 2, and 42.66 ± 12.41 months for group 3. The implant survival rate was 100% for all groups. The success rates were 91.7% for early implants, 95.0% for immediate postextraction implants, and 100% for implants placed in healed sites. MBL and soft tissue parameters did not differ significantly among the three groups at definitive restoration delivery or 1 year later; a thin gingival biotype, irrespective of treatment timing, was the only covariate that was able to slightly affect the outcome variables. CONCLUSIONS: Short-term implant survival and success rates, as well as MBL values for immediate, early, and conventional implants, appear similar for maxillary and mandibular first molar sites. Early placement should be considered as a suitable alternative to immediate placement when unfavorable conditions at the time of extraction could affect the clinical outcome of immediate placement.

Immediate positioning of a definitive abutment versus repeated abutment replacements in post-extractive implants: 3-year follow-up of a randomised multicentre clinical trial.

PURPOSE: The aim of this randomised clinical trial was to evaluate the influence of restoration on marginal bone loss (MBL) using immediately definitive abutments (one abutment­one time concept) versus provisional abutments later replaced by definitive abutments. MATERIALS AND METHODS: In three private clinics, 32 patients with 32 hopeless maxillary premolars were selected for post-extractive implant-supported immediate restoration and randomised to provisional abutment (PA) and definitive abutment (DA) groups, 16 sites in each group. After tooth extraction, 7 patients had to be excluded for buccal wall fracture at tooth extraction or lack of sufficient primary implant stability (< 35 Ncm). The remaining 25 patients (10 PA, 15 DA) received a post-extractive wide-diameter implant. Immediately after insertion, the PA group were immediately restored using a platform-switched provisional titanium abutment. In the DA group, definitive platform-switched titanium abutments were tightened. In both groups, provisional crowns were adapted, avoiding occlusal contacts. All implants were definitively restored after 3 months. In the PA group, a traditional impression technique with coping transfer was adopted, dis/reconnecting abutments several times; in the DA group, metal prefabricated copings were used and final restorations were seated, avoiding abutment disconnection. Digital standardised periapical radiographs using a customised film holder were recorded at baseline (T0 = implant insertion), final restoration (T1 = 3 months later), and at 18-month (T2) and 3-year (T3) follow-ups. The MBL was evaluated with a computerised measuring technique and digital subtraction radiography (DSR) software was used to evaluate radiographic density. RESULTS: At the 3-year follow-up a success rate of 100% in both groups was reported. In the PA group, peri-implant bone resorption was 0.36 mm at T1, 0.43 mm at T2, and 0.55 mm at T3. In the DA group, peri-implant bone resorption was 0.35 mm at T1, 0.33 mm at T2, and 0.34 mm at T3. Statistically significant lower bone losses were found at T2 (0.1 mm) and T3 (0.2 mm) for the DA group. At T3, significantly higher DSR values around implant necks were recorded in the DA group (72 ± 5.0) when compared with the PA group (52 ± 9.5). CONCLUSIONS: The current trial suggests that the 'one abutment­one time' concept might be a possible additional strategy in post-extraction immediately restored platform-switched single implants to further minimise peri-implant crestal bone resorption, although a 0.2 mm difference may not have any clinical effect. Additional clinical trials with larger groups of patients should be performed to better investigate this hypothesis.