Minimally invasive extractions with physics forceps - clinical evaluation and comparison.

INTRODUCTION: Tooth extraction is still one of the most common dental procedures, routinely performed for a variety of reasons. Tooth extraction forceps and elevators are well-known extraction instruments which have been the standard in tooth extraction procedures for well over a hundred years. Physics forceps are one possible alternative, aiming to perform less traumatic and more predictable extractions.

Influence of Kennedy class and number of implants on the accuracy of dynamic implant navigation: An in vitro study using an X-ray free evaluation methodology.

OBJECTIVES: The aim of this in vitro study was to evaluate the accuracy of fully guided dynamic implant navigation surgery in Kennedy I, II, and III class dental arch defects with two different implant designs, using an X-ray free evaluation method. METHODS: Polyurethane resin maxillary models simulated posterior edentulous defects. Four cone beam computed tomography (CBCT) scans and four intraoral (IOS) scans were obtained for each model and a digital wax-up with the correct implant positions was made. The accuracy of implant positions was evaluated using an IOS-based X-ray-free method (3Shape). Four deviation characteristics were evaluated: insertion point, depth deviation, horizontal and angle deviation. RESULTS: The insertion point deviation measures ranged from 0.19 mm to 1.71 mm. Depth (s) and (u) deviations ranged from -1.47 mm to 0.74 mm and from 0.02 mm to 1.47 mm, respectively. Horizontal deviation ranged from 0.09 mm to 1.37 mm. CONCLUSIONS: There is a tendency of a decreasing insertion point deviation for an increasing number and distribution area of the teeth (increasing Kennedy class number). Kennedy class II and distal implant position had the most influence for the higher deviations. CLINICAL SIGNIFICANCE: Dynamic implant guidance provides accurate spacing, angulation, depth and position of the implants. It is important to understand how the number of missing teeth and implant design could influence the accuracy of dynamic implant navigation. Thus, it is important to evaluate factors influencing the accuracy of dynamic systems by using a X-ray-free post-operative method and to overcome the limitations of providing multiple CBCT scans.

Clinical performance of full-arch implant-supported fixed restorations made of monolithic zirconia luted to a titanium bar: A retrospective study with a mean follow-up of 16 months.

OBJECTIVES: This retrospective case series aimed to evaluate the short-term clinical advantages and limitations of full-arch implant-supported restorations made of monolithic zirconia suprastructures passively luted to titanium bar infrastructures and to report the rate of complications within a minimum of 1-year follow-up. MATERIALS AND METHODS: This study included 31 patients (19 men and 12 women) requiring full-arch implant-supported prostheses in the upper or lower jaw. The patients were treated using an entirely digital approach from implant planning and guided implant placement to prosthetic construction planning, design, and fabrication. Full-arch implant-supported monolithic zirconia suprastructures luted to prism-shaped titanium bars were used in all the cases. All the restorations were evaluated for biological and technical complications during fixed control appointments. RESULTS: No implant failures or serviceable prosthetic complications were reported, and the prosthetic survival rate was 100%, with a follow-up duration ranging from 12 months to 20 months. In two cases, a fracture line was observed in the zirconia suprastructures, although it did not require any intervention. CONCLUSIONS: After a 16-month mean follow-up period, the monolithic zirconia implant-supported full-arch fixed dental prostheses demonstrated no biological or technical complications. Further clinical studies with long-term results are required to confirm these reported outcomes. CLINICAL SIGNIFICANCE: CAD-/CAM-milled monolithic zirconia structures passively luted to titanium bar infrastructures are a viable treatment option for full-arch restorations over implants, demonstrating 100% survival and success rates in the present study. The outcomes of this short-term retrospective study indicated high success in function, aesthetics, phonetics, and the ability to maintain flawless hygiene. However, the long-term results of restorations produced using the proposed technique should be considered before recommending this approach for routine clinical use.

The Effect of UV Treatment on Surface Contact Angle, Fibroblast Cytotoxicity, and Proliferation with Two Types of Zirconia-Based Ceramics.

UV photofunctionalization of Zirconia-based materials for abutment fabrication is a promising approach that might influence the formation of a sound peri-implant seal, thus promoting long-term soft and hard tissue implant integration. This study aimed to evaluate the effect of UV treatment of test specimens made by two different ZnO2-based ceramic materials on the hydrophilicity, cell cytotoxicity, and proliferation of human gingival fibroblasts (HGFs). Two Zirconia-based materials, high-translucent and ultra-translucent multi-layered Zirconia (Katana, Kuraray Noritake, Japan), were used to prepare a total of 40 specimens distributed in two equally sized groups based on the material (n = 20). The same surface finishing protocol was applied for all specimens, as suggested by the manufacturer. Half the specimens from each group were treated with UV-C light for 48 h. Water contact angle (WCA), fibroblast cytotoxicity, and proliferation were investigated. The WCA values for the high-translucent Zirconia ranged from 69.9° ± 6.4° to 73.7° ± 13.9° for the treated/non-treated specimens and from 79.5° ± 12.8° to 83.4° ± 11.4° for the ultra-translucent multi-layered Zirconia, respectively. However, the difference was insignificant (F(16) = 3.50, p = 0.292). No significant difference was observed for the fibroblast cytotoxicity test. The results for proliferation revealed a significant difference, which was material-dependent (F(8) = 9.58, p = 0.005). We found that UV surface photofunctionalization of ZrO2-based materials alters the human gingival fibroblast cell viability, which might produce favourable results for cell proliferation.

Autologous Platelet Concentrates (APCs) for Hard Tissue Regeneration in Oral Implantology, Sinus Floor Elevation, Peri-Implantitis, Socket Preservation, and Medication-Related Osteonecrosis of the Jaw (MRONJ): A Literature Review.

Over recent years, the usage of autologous platelet concentrates (APCs) has risen in hard tissue regeneration and oral implantology. The purpose of the present review is to offer an overview of the use of three APC techniques in dentistry: platelet-rich plasma (PRP), platelet-rich fibrin (PRF), and concentrated growth factor (CGF). A narrative summary of articles published between January 2011 and April 2022 is provided. The PubMed, Cochrane Library, Scopus, and Embase databases were used to conduct the search. The following keywords were used in the preliminary: "VEGF", "TGF-b1", "PRP", "PRF", "CGF", AND "sinus augmentation" OR "implants" OR "peri-implantitis" OR "socket preservation" OR "MRONJ". A total of 82 articles was finally included. The review then takes into account the application of the three techniques in different areas of treatment-including oral implantology, sinus floor elevation, peri-implantitis, socket preservation, and medication-related osteonecrosis of the jaw (MRONJ)-as well as their advantages and disadvantages.

Immunological Response to Nonresorbable Barrier Membranes Used for Guided Bone Regeneration and Formation of Pseudo Periosteum: a Narrative Review.

Here we review the knowledge on the local biological immunological response (formation of "pseudo periosteum" of the host) to two types of nonresorbable membranes used in the horizontal and vertical alveolar ridge augmentation: the titanium-reinforced polytetrafluoroethylene membrane and the titanium mesh membrane. A literature search was conducted including available in vitro, in vivo, and clinical studies on cellular and molecular immunological response to these two types of nonresorbable membranes, in particular the formation of "pseudo periosteum".

Correlation between Primary, Secondary Stability, Bone Density, Percentage of Vital Bone Formation and Implant Size.

BACKGROUND: This study aims to evaluate whether there is a correlation between implant stability, bone density, vital bone formation and implant diameter and length. METHODS: Ninety patients were enrolled in this study. They underwent a socket preservation procedure with allograft or PRF and after 4 months, a total of 90 implants were placed. CBCT scans were assigned prior to implant placement in order to assess the bone density. During the surgical re-entry, a bone biopsy was harvested with a trephine drill. Immediately after implant insertion, the primary stability was measured. The secondary stability was measured 4 months after implant placement. RESULTS: Primary stability showed a significant positive linear correlation with bone density (r = 0.471, p < 0.001) as well as with percentage of new bone formation (r = 0.567, p < 0.001). An average significant association of secondary stability with bone density (rs = 0.498, p < 0.001) and percentage of newly formed bone (r = 0.477, p < 0.001) was revealed. The mean values of primary stability in all three implant sizes, regarding the diameter of the implants, were similar (narrow 67.75; standard 66.78; wide 71.21) with no significant difference (p = 0.262). The same tendency was observed for secondary stability (narrow 73.83; standard 75.25; wide 74.93), with no significant difference (p = 0.277). CONCLUSIONS: The study revealed a high correlation between primary and secondary implant stability, and bone density, as well as with the percentage of vital bone formation. Implant length and diameter revealed no linear correlation with the implant stability.

Comparison Study of the Histomorphometric Results after Socket Preservation with PRF and Allograft Used for Socket Preservation-Randomized Controlled Trials.

The aim of the present clinical study was to assess and compare the histomorphometric results and efficacy of freeze-dried bone allograft (FDBA) in combination with platelet-rich fibrin (PRF), and PRF as a sole grafting material for socket preservation. Ninety patients in need of tooth extraction and implant restoration were included in this study. The participants were randomly divided into three groups based on post-extraction clinical protocol: socket preservation procedure with allograft in combination with a PRF membrane (PRFm), PRF as a sole grafting material, and a control group. A total of 90 implants were placed four months post-extraction. During the surgical re-entry a bone biopsy was harvested with a trephine drill. Histological samples were prepared and analyzed for percentage vital bone and connective tissue. One-way ANOVA with Bonferroni post-hoc analysis were used to assess the results. Both test groups revealed a significantly higher percentage of vital bone formation compared to the control group. No statistically significant differences regarding vital bone formation and connective tissue quantity between the tested groups were observed (FDBA + PRFm: 3.29 ± 13.03%; and PRF: 60.79 ± 9.72%). From a clinical and histological point of view, both materials in the test groups are suitable for the filling of post-extraction sockets without bone defects. Both of the tested groups revealed a significantly higher percentage of vital bone formation compared to the control group.

Association between Bone Density Values, Primary Stability and Histomorphometric Analysis of Dental Implant Osteotomy Sites on the Upper Jaw.

INTRODUCTION: Sufficient bone volume, as well as the bone quality characteristics are necessary prerequisites to ensure optimal mechanical stability of the implants and subsequent osseointegration. AIM: The aim of the present study was to assess the correlation between bone density values obtained by cone-beam computed tomography (CBCT), the primary stability of dental implants and the histomorphometric analysis of bone quality. MATERIALS AND METHODS: Following tooth extraction, socket preservation with frieze-dried bone allograft or protein-rich fibrin (PRF) was performed on 30 patients with 30 maxillary teeth in the region from second premolar to second premolar. Four months after the procedure, CBCT was used to assess the bone density (Hounsfield units) in the area of extraction. Thirty bone samples were harvested from implant sites using a trephine drill. They were analyzed with Image J software. Immediately after placing the implant, the implant stability quotient was measured using the Osstell Idx device. RESULTS: The results revealed significant correlations between bone density and primary stability along the vestibulo-oral (r=0.392, p=0.032) and mesiodistal axes (r=0.407, p=0.026). Bone density also correlated strongly with the percentage of newly formed bone (r=0.776, p<0.001). CONCLUSION: Bone quality, in terms of bone density measured in CBCT and new bone formation are correlated to the primary stability of the dental implants and vice versa.

Comparative Study between a Novel In Vivo Method and CBCT for Assessment of Ridge Alterations after Socket Preservation-Pilot Study.

The aim of this study was to compare two different methods for evaluation of alveolar bone resorption after the socket preservation procedure. In the current study, 9 patients with a total of nine teeth indicated for extraction were included. Patients received alveolar ridge preservation with allograft (BoneAlbumin™, OrthoSera Dental, Gyor, Hungary) or Platelet-Rich fibrin (PRF). CBCT (Planmeca ProMax 3D, Helsinki, Finland), was taken at 1 week and 4 months after the socket preservation procedure. A 3D scan, obtained with Trios (3Shape, Copenhagen, Denmark) of the alveolar bone of the surgical site and the adjacent teeth at the place of extraction was performed during the surgical procedure, immediately after the graft placement in the alveolar socket, and after 4 months. Virtual study models were generated using the three-dimensional file processing software "Meshlab" (ISTI-CNR Rome Italy). The changes of alveolar height and width were measured and analyzed. Results were taken from both methods. Radiographic examination revealed that the average value of horizontal resorption is 0.6⁻2.4 mm, and vertical resorption is 0.46⁻2.8 mm. On virtual models, the average value for horizontal resorption is 1.92⁻3.64 mm, the vertical resorption value is 0.95⁻2.10 mm. The Trios intraoral scan can provide non-invasive and more accurate quantitative insights into the dimensional changes in the alveolar ridge after the bone remodeling process. More research is needed for verification of these results.

Application of Platelet-Rich Fibrin and Injectable Platelet-Rich Fibrin in Combination of Bone Substitute Material for Alveolar Ridge Augmentation - a Case Report.

BACKGROUND: Different barrier membranes and augmentation techniques are used in oral surgery to recover lost bone structures with varied success. Recently, a combination between bone graft materials and Platelet-Rich-Fibrin (PRF) is implemented in the periodontology and implantology. AIM: The aim of this case report was to assess the possibility for augmentation of the alveolar ridge in the frontal region of the upper jaw, utilizing a combination of bone graft material, injectable platelet-rich-fibrin (i-PRF) and advanced platelet-rich fibrin (A-PRF). MATERIALS AND METHODS: An 18 year-old male with expulsion of tooth 11 and partial fracture of the alveolar ridge was treated with augmentation of the alveolar ridge using bone graft material, injectable platelet-rich-fibrin(i-PRF) and advanced platelet-rich-fibrin (A-PRF). Clinical results were reviewed 4 months after the augmentation and a dental implant was placed. RESULTS: The postoperative period was uneventful. The control CBCT scan showed good organization of new bone allowing placement of a dental implant. CONCLUSION: The successful clinical and radiographic results of the case suggest that using A-PRF and i-PRF can be beneficial for bone augmentation of the alveolar ridge before implant placement.