Patient-reported outcome measures of leucocyte- and platelet-rich fibrin (L-PRF) or hemostatic agent application at palatal donor sites after free gingival graft harvesting: a randomized controlled clinical trial.

OBJECTIVE: The aim of this study was to evaluate the patient's morbidity and postsurgical complications after treatment of palatal donor sites after free gingival graft harvesting using leucocyte- and platelet-rich fibrin (L-PRF) membranes or a hemostatic agent with oxidized and regenerated cellulose. METHOD AND MATERIALS: Forty-two palatal donor sites after free gingival graft harvesting in 42 patients were randomly assigned to experimental (L-PRF membrane) or control procedure (hemostatic agent). The primary outcome was postoperative pain related to the wound located at the palatal area, and the secondary outcomes were postoperative discomfort, inability to chew, postoperative stress, surgical chair time, thickness of the palatal fibromucosa, and thickness of the free gingival graft. The patient-reported outcome measures were recorded after 1 week. RESULTS: After 1 week, a statistically significant difference was found between groups in terms of postoperative stress (P = .008). No statistically significant differences in terms of postoperative pain (P = .326), patient discomfort (P = .509), inability to chew (P = .936), or surgical chair time (P = .932) were recorded between the test and the control group. No statistically significant differences were recorded in terms of thickness of the palatal fibromucosa (P = .647) and thickness of the free gingival graft (P = .756) between groups. Postsurgical wound healing complications (ie, necrosis or infections) were not observed in both groups. CONCLUSION: Within their limitations, the present outcomes indicated that the application of L-PRF membrane at palatal donor sites after FGG harvesting did not produce significant advantages for the patients.

Role of New Hydrophilic Surfaces on Early Success Rate and Implant Stability: 1-Year Post-loading Results of a Multicenter, Split-Mouth, Randomized Controlled Trial.

OBJECTIVE: To compare early implant failure and implant stability of one-stage Hiossen ET III implants with its new hydrophilic (NH) surface, compared with Hiossen ET III implants with the sandblasted and acid-etched (SA) surface at 1-year follow-up. MATERIALS AND METHODS: This study was designed as a split-mouth, multicenter randomized controlled trial aimed to compare SA surface implants (SA group) and NH surface, (NH group). Outcomes were implant and prosthetic survival rates, complications, the insertion torque at implant placement, and implant stability quotient (ISQ) values. RESULTS: Twenty-nine patients (mean age 59.9 ± 11.3 years) were treated and followed up to 1 year after loading. No patient dropped out. Fifty-eight implants (29 SA group and 29 NH group) were placed. No implants or prostheses failed and no complications were experienced during follow-up. The mean insertion torque was 40.5 ± 3.23 (38.17-41.83) Ncm in the SA group and 40.48 ± 3.49 (38.02-41.98) Ncm in the NH group (p = 0.981). There was a statistically significant difference at the second week (T2) with higher values in the NH group (p = 0.041). Similar results were found in the maxilla (p = 0.045), but not in the mandible (p = 0.362). A positive correlation was found between initial insertion torque and ISQ with higher value in the NH group (0.73 vs. 0.66). CONCLUSIONS: NH implants are a viable alternative to SA surface, as they seem to avoid the ISQ drop during the bone remodeling phase.

Patient-centered rehabilitation of single, partial, and complete edentulism with cemented- or screw-retained fixed dental prosthesis: The First Osstem Advanced Dental Implant Research and Education Center Consensus Conference 2017.

The aim of this consensus conference was to provide clinical guidelines, based on the available evidence and on the author's daily practice and experience, for general dentistry and dental practitioners to allow them to delivery long-term successful restorations. Three groups of expert clinicians and dental technicians were invited to evaluate all of the scientific literature from 1967 up to March 2017 to identify relevant studies on assigned topics and to prepare in advance narrative/systematic review, written according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, to fulfill the consensus statement criteria. The three topics assigned to the three groups were abutment/framework materials and customization (metal vs. metal-free restorations), abutment/framework protocols and designs, and abutment/framework retentions (cemented- vs. screw-retained implant-supported prostheses). All the expert clinicians presented their results, and the lectures were followed by discussions. No significant differences in clinical parameters (marginal bone loss, bleeding on probing, and pocket probing depth) between screw- or cemented-retained were found for single and multiple implant-supported restorations. There is moderate evidence that nonoriginal abutments provide worse mechanical behavior than originals and high evidence that different implant neck designs do not offer any clinical or radiographic advantage. All the participants agreed that it is desirable to connect and remove abutments as few times as possible. There is medium evidence that an adequate platform switching tends to enhance tissue volume and stability in the medium- and long-term follow-up. No statistically significant differences exist between metal and zirconia as a framework material. The authors discussed and all agreed that retrievability and patient's expectation (function and esthetics) should guide the choice of the most adequate technique, component, and material.

A Prospective Multicenter Study on Radiographic Crestal Bone Changes Around Dental Implants Placed at Crestal or Subcrestal Level: One-Year Findings.

PURPOSE: To compare the peri-implant radiographic crestal bone changes around implants placed at the subcrestal or crestal level. MATERIALS AND METHODS: Systemically healthy patients with at least two missing teeth requiring implant-supported fixed prosthetic restorations were enrolled in the study. Implants were randomly placed either 1 mm subcrestally or at the bone crest level. Radiographic examination was performed using the long-cone parallel technique and customized film holders. Digital periapical radiographs were obtained at the time of implant placement (T0), at the time of prosthesis delivery (T1), and 12 months (T2) after prosthetic loading. Marginal bone levels were measured at the mesial and distal aspects of each implant with digital image software. RESULTS: A total of 54 implants were present for the radiographic analysis at the 12-month follow-up. No implant showed mechanical or biologic complications throughout the follow-up period. The implant survival percentage was 100%. After 1 year, the mean bone loss was 0.711 ± 0.721 mm in the subcrestal group and 0.224 ± 0.418 mm in the crestal group. Furthermore, only the subcrestal group showed statistically significant radiographic bone resorption at the end of the follow-up. CONCLUSION: Within the limitations of this study, implants placed at the crestal level showed greater peri-implant bone stability during the 1-year follow-up. Studies with larger samples and longer follow-up are needed to confirm the results of this investigation.

Maxillary Sinus Membrane Elevation Using a Special Drilling System and Hydraulic Pressure: A 2-Year Prospective Cohort Study.

The purpose of this study was to evaluate clinical and radiologic outcomes using a newly developed device for maxillary sinus membrane elevation. Patients with a residual bone height of at least 3 mm were enrolled. Crestal sinus lift elevation and sinus graft were performed using the crestal approach sinus (CAS) kit. Graft was avoided if the residual bone crest was ≤ 2 mm less than the length of the planned implant. Outcome measures were implant and prosthesis failure, any biologic or technical complications, and marginal bone loss (MBL). A total of 35 consecutive patients underwent 49 crestal elevations of the sinus membrane. All the implants were followed for at least 2 years after placement (mean follow-up 37.3 months; range 24 to 54 months). No implants or prostheses failed during follow-up, and no membrane tears or other intraoperative or postoperative adverse events were observed. At the 2-year follow-up, mean MBL was 0.33 ± 0.24 mm (95% confidence interval: 0.08 to 0.30 mm). A total of 32 implants were placed after filling the sinus with anorganic bovine bone, while 17 implants were placed without grafting the sinus. Post-hoc analysis was performed using the sinus grafting remodeling index (SGRI) to evaluate radiographically the tissue remodeling patterns. The SGRI was statistically significantly higher when the sinus was grafted (P = .000). The CAS kit may provide a new option for minimally invasive crestal sinus surgery. Long-term randomized controlled trials with larger sample size are needed to confirm these preliminary results.

Molar replacement with 7 mm-wide diameter implants: to place the implant immediately or to wait 4 months after socket preservation? 1 year after loading results from a randomised controlled trial.

PURPOSE: To test the hypothesis that there is no difference in clinical, radiographic and aesthetic outcomes positioning single post-extractive 7 mm-diameter implants or waiting 4 months after molar extraction and socket preservation procedure. MATERIAL AND METHODS: Patients requiring one implant-supported single restoration to replace a failing tooth in the molar region of both maxilla and mandible were selected. Patients were randomised according to a parallel group design into two arms: implant installation in fresh extraction sockets grafted with cortico-cancellous heterologous bone and porcine derma (group A) or delayed implant installation 4 months after tooth extraction and socket preservation using the same materials (group B). Implants were submerged for 4 months. The primary outcome measures were the success rates of the implants and prostheses and the occurrence of any surgical and prosthetic complications during the entire follow-up. Secondary outcome measures were: peri-implant marginal bone level (MBL) changes, resonance frequency analysis (ISQ) and pink esthetic score (PES) values at implant placement (baseline) up to 1 year after loading. RESULTS: Twelve patients were randomised to group A and 12 to group B. No patient dropped out within 1 year after loading. No implant and prosthesis failed and no complications occurred during the entire follow-up. One year after loading, statistically significant higher mean MBL loss was experienced in group A (0.63 mm ±â€…0.31 mm) compared to group B (0.23 mm ±â€…0.06 mm); difference 0.41 mm (95% CI 0.17-0.53; P = 0.001). Six months after implant placement, mean ISQ value was 78.8 ±â€…2.8 for group A and 79.9 ±â€…3.6 for group B, showing no statistically significant difference between groups (difference 1.1; 95% CI: 0.04 to 2.96; P = 0.422). One year after loading, mean PES was 10.6 ±â€…1.8 [range: 8 to13] in group A and 12.2 ±â€…1.2 [range: 11 to 14] in group B. The difference was statistically significant (1.6 ±â€…2.7; 95% CI -0.55-2.55; P = 0.019) with better results for group B. CONCLUSIONS: Within the limitations of this study, both procedures achieved successful results over the 1-year follow-up period, but waiting 4 months after tooth extraction and socket preservation procedure was associated with less marginal bone loss and a better aesthetic outcome. Conflict-of-interest statement: Dr Marco Tallarico is Research Project Manager of Osstem AIC Italy. However no company supported this study and all authors declare no conflicts of interest.

Outcome of dental implants in partially edentulous patients with and without a history of periodontitis: a 5-year interim analysis of a cohort study.

PURPOSE: To evaluate the outcome of dental implants placed in partially edentulous patients with a history of severe periodontitis (SP), moderate periodontitis (MP) and no periodontitis (NP). MATERIALS AND METHODS: Sixty-two partially edentulous patients were consecutively enrolled in this study. Patients were divided into three groups according to their initial periodontal conditions, assessed with a modified Periodontal Screening and Recording (PSR) index: 26 patients were in the SP group, 7 in the MP group, and 29 in the NP group. Patients requiring periodontal treatment were treated prior to implantation. Various dental implants and procedures were used. In the SP group 129 implants were placed, 26 were placed in the MP group, and 72 in the NP group. Outcome measures were prosthetic success, implant survival, prevalence of peri-implantitis and mean peri-implant bone level changes on periapical radiographs. RESULTS: Six patients dropped out, two from each group, at 5 years. Two implants and their prosthesis failed with peri-implantitis in one patient and two implants were successfully treated for periimplantitis in another patient in the SP group. After 5 years, patients affected by SP and MP lost on average twice the amount of peri-implant bone compared with healthy patients (2.6 mm versus 1.2 mm). This difference was highly statistically significant. CONCLUSIONS: Patients with a history of SP and MP lose more peri-implant bone than periodontally healthy patients and might be at higher risk for peri-implantitis and implant failures.

Immediate loading of dental implants placed in severely resorbed edentulous mandibles reconstructed with autogenous calvarial grafts.

OBJECTIVE: The aim of this prospective study was to present the clinical outcome of immediately loaded dental implants placed in edentulous, severely atrophied mandibles, after reconstruction with autogenous multilayered calvarial grafts. MATERIALS AND METHODS: Six patients, two males and four females, aged 40-67 years (mean: 56 years) presenting with severely atrophied edentulous mandibles (Cawood and Howell class VI), were reconstructed with multilayered calvarial bone grafts placed in the intraforaminal area of the mandible. Five to 8 months afterwards, 23 dental implants were placed in the reconstructed areas (three to four implants per patient) and immediately loaded with implant-supported overdentures. Patients were followed with clinical and radiographic controls annually. RESULTS: Recovery after the reconstruction was uneventful in all patients. All 23 implants were osseointegrated 1-3 years after the start of immediate loading. The survival and success rates of implants were 100% and 95.7%, respectively. CONCLUSION: Results from this study showed that immediate loading of dental implants placed in severely atrophied edentulous mandibles reconstructed with calvarial bone grafts is a predictable procedure, which permits a successful dental rehabilitation with a shortening of treatment times.