Uso da terapia a laser de baixa potência como coadjuvante no levantamento de seios maxilares na implantodontia / Use of low-power laser therapy as an adjuvant in elevating maxillary sinuses in implantology

A busca por implantes dentários se tornou uma prática odontológica muito utilizada, no entanto, existem pacientes que não apresenta volume ósseo suficiente para receber o implante. A terapia a laser de baixa potência (LTBP) contém uma resposta relevante no desempenho dessas fases primárias da estabilidade da osseointegração. Dessa maneira, o estudo tem como objetivo analisar a eficiência e aplicação do LTBP em levantamento de seio maxilar dentro da implantodontia, ressaltando seus benefícios, limitações, importância e impacto para saúde bucal. Tratou-se de uma revisão narrativa de literatura, com seleção de artigos científicos encontrados nas bases de dados: PubMed, LILACS, BVS, SciELO e Google Acadêmico, sem período definido de publicação, com cruzamento dos Descritores em Ciências e Saúde (DeCS) e adotados os operadores booleanos "AND" e "OR". A quantidade ideal de altura óssea é importante para a reabilitação com implantes dentários e, em certos casos, o levantamento de seio maxilar se torna necessário expandir a altura de osso residual na maxila por meio da elevação da membrana de Schneider. Sendo assim, a literatura apresenta diversas formas para utilizar o LTBP na implantodontia, desde o início da limpeza na região que vai receber o implante até sua realização cirúrgica, a qual apresenta ótima melhoria na ação de osseointegração, amenizando desconfortos referentes ao pós-operatório e planejamento cirúrgico. Apesar de existir estudos controversos sobre a aplicação do LTBP no levantamento de seio maxilar para colocação de implantes, fica evidente que sua utilização obtém resultados efetivos no processo de cicatrização e reparação dos tecidos ósseos.

The search for dental implants has become a widely used dental practice; however, there are patients who do not have sufficient bone volume to receive the implant. Low-level laser therapy (LLLT) contains a relevant response in the performance of these primary phases of osseointegration stability. Thus, the study aims to analyze the efficiency and application of LLLT in maxillary sinus lifting within implantology, highlighting its benefits, limitations, importance, and impact on oral health. It was a narrative literature review, with the selection of scientific articles found in the databases: PubMed, LILACS, BVS, SciELO, and Google Scholar, without a defined publication period, with the crossing of the Health Sciences Descriptors (DeCS) and the adoption of the boolean operators "AND" and "OR." The ideal amount of bone height is important for rehabilitation with dental implants, and in certain cases, maxillary sinus lifting becomes necessary to expand the residual bone height in the maxilla through elevation of the Schneiderian membrane. Thus, the literature presents various ways to use LLLT in implantology, from the beginning of cleaning in the region that will receive the implant to its surgical implementation, which shows excellent improvement in osseointegration action, alleviating discomfort related to postoperative and surgical planning. Although there are controversial studies on the application of LLLT in maxillary sinus lifting for implant placement, it is evident that its use yields effective results in the healing and repair process of bone tissues.

Strontium-containing mineralized phospholipid coatings improve osseointegration in osteoporotic rats.

Surface treatments play an important role in enhancing the osseointegration of Titanium (Ti) and its alloys. This study introduces a method employing biomimetic hydroxyapatite (Hap) deposition guided by molecularly organized phospholipids, affixed to the metal implant surface. Using the Langmuir-Blodgett technique, phospholipids were deposited onto Ti-screws by using CaCl2 or CaCl2/SrCl2 aqueous solution in the subphase of a Langmuir trough in the target proportion (i.e. 10 and 90 mol% of Sr2+ in relation of Ca2+) followed by immersion in phosphate buffer and in supersaturated simulated body fluid. Coating composition and morphology were evaluated using infrared spectroscopy and scanning electron microscopy, respectively, while contact angle measurements assessed coating wettability and surface energy. Randomized screws were then implanted into the tibias of healthy and osteoporotic female rats (G1: Control-Machined, G2: Hap, G3: HapSr10, G4: HapSr90). Osseointegration, assessed 60 days post-implantation, included reverse torque, fluorochrome area, bone tissue-screw contact area, and linear extent of bone-screw contact. Results, grouped by surface treatment (Machined, Hap, HapSr10, HapSr90), revealed that the deposition of Hap, HapSr10, and HapSr90 resulted in thin and rough coatings composed of hydroxyapatite (Hap) on the screw surface with nanoscale pores. The coatings resulted in increased wettability and surface energy of Ti surfaces. The minerals are chemically similar to natural bone apatite as revealed by FTIR analysis. In vivo analyses indicated higher torque values for strontium-containing surfaces in the osteoporotic group (p = 0.02) and, in the control group superior torque for screw removal on the Hap surface (p = 0.023). Hydroxyapatite-treated surfaces enhance morphology, composition, and reactivity, promoting screw osseointegration in healthy and osteoporotic female rats. The incorporation of strontium into the mineral phase has been proposed to not only stimulate osteoblast activity but also reduce osteoclastic resorption, which may explain the improved outcomes observed here in experimental osteoporotic conditions.

Combination of metal artifact reduction and sharpening filter application for horizontal root fracture diagnosis in teeth adjacent to a zirconia implant.

Purpose: This study examined the influence of metal artifact reduction (MAR), the application of sharpening filters, and their combination on the diagnosis of horizontal root fracture (HRF) in teeth adjacent to a zirconia implant on cone-beam computed tomography (CBCT) examinations. Materials and Methods: Nineteen single-rooted teeth (9 with HRF and 10 without) were individually positioned in the right central incisor socket of a dry human maxilla. A zirconia implant was placed adjacent to each tooth. Imaging was performed using an OP300 Maxio CBCT (Instrumentarium, Tuusula, Finland) unit with the following settings: a current of 8 mA, both MAR modes (enabled and disabled), a 5×5 cm field of view, a voxel size of 0.085 mm, and a peak kilovoltage of 90 kVp. Four oral and maxillofacial radiologists independently evaluated the CBCT scans under both MAR conditions and across 3 levels of sharpening filter application (none, Sharpen 1×, and Sharpen 2×). Diagnostic metrics were calculated and compared using 2-way analysis of variance (α=5%). The weighted kappa test was used to assess intra- and inter-examiner reliability in the diagnosis of HRF. Results: MAR tool activation, sharpening filter use, and their combination did not significantly impact the area under the receiver operating characteristic curve, sensitivity, or specificity of HRF diagnosis (P>0.05). Intra- and inter-examiner agreement ranged from fair to substantial. Conclusion: The diagnosis of HRF in a tooth adjacent to a zirconia implant is not affected by the activation of MAR, the application of a sharpening filter, or the combination of these tools.

Comparative clinical evaluation of the stability of implants using double acid etching treatment with and without the addition of fluoride solution: A randomized clinical trial.

Background: Osseointegration depends on primary stability, and further, implant surface modifications may improve secondary stability. This randomized clinical trial evaluates whether adding a fluoride solution enhances the implant stability. Materials and Methods: Stability of dental implants with two different types of surface treatments was compared utilizing resonance frequency analysis (RFA). Twelve patients were recruited: eight females and four males with an average age of 58.3 years and they received either double acid etched implants (control: Porus Implant, Sistema Conexão) and double acid etched implants containing fluoride on their surfaces (test: Porus Nano Implant, Sistema Conexão). Each patient received one implant from the test category and another implant from the control category, resulting in 24 implants in this study. RFA, utilizing Osstell was used to assess the implant stability, immediately after the placement of implant and 15, 30 and 45 days post-implant placement. Results: At the initial time, there was no difference between the test and control groups regarding the ISQ. However, after 15, 30, and 45 days, ISQ values for the test group were significantly higher than the control group. When using implants without fluoride addition, it was observed that after 15 days, the ISQ values were lower than those found at the initial time, but after 30 days, values matched the initial. Concerning the test group results, the ISQ values from T0 (immediately after implant placement) to T3 (45 days after implant placement) always increased from every period of evaluation. Conclusions: It was concluded that double acid etched implants with surfaces containing fluoride solution increases the implant stability quotient, compared to implants with fluoride-free double acid etched surfaces.

Modified Surgical Guide for Root Sectioning in the Socket Shield Technique-In Vitro Study.

OBJECTIVE: This in vitro study aimed to evaluate the effectiveness of a printed surgical guide for root sectioning in the socket-shield technique. MATERIALS AND METHODS: A typodont model of the maxilla with augmented filler was used for the upper right central incisor, and CBCT images were obtained. Two types of vertical root sectioning guides were tested: one with a buccal sleeve (Group A, n = 10) and another with a buccal orientation slit (Group B, n = 10). Control group (n = 10) performed freehand cuts on printed models. After crown cutting with diamond burs, root sectioning was conducted using an ultrasonic tip with the guides. Mean and standard deviation were calculated for the remaining root length, width, and volume. Data were analyzed using the Kruskal-Wallis test and Dunn's post hoc test. RESULTS: Statistical analysis showed significant differences in root width between the control group (2.0 mm) and both Groups A (2.655 mm; p < 0.0001) and B (2.460 mm; p < 0.0001). Group B (5.585 mm) also showed a significant difference in root remnant compared with the control (13.880 mm; p < 0.0043). Groups A and B did not differ significantly from each other. CONCLUSIONS: The socket shield technique is safe and effective, this study aimed to add improvements through the introduction of surgical guides, facilitating the root section, which is the critical phase so that the parameters that are requisite for success are achieved in terms of width, length, and volume of the root remnant. Both guided techniques effectively facilitated root sectioning, maintaining satisfactory root thickness and length. CLINICAL SIGNIFICANCE: Sectioning the root is challenging for the correct angulation to remove the palatal portion in the socket shield technique. Therefore, modifying this technique with the use of the presented guides, it is possible to prevent damage to the soft tissues and to plan the surgery with the help of cone beam computed tomography (CBCT) scans to remove the root apex and maintain the root remnant with a thickness greater than 1.5 mm, making the socket-shield technique more predictable.

Chitosan coatings on titanium-based implants - From development to characterization and behavior: A systematic review.

Chitosan is a promising natural polymer for coatings, it combines intrinsic antibacterial and pro-osteoblastic properties, but the literature still has a gap from the development to behavior of these coatings, so this systematic review aimed to answer, "What is the relationship between the physical and chemical properties of polymeric chitosan coatings on titanium implants on antibacterial activity and osteoblast viability?". PRISMA guidelines was followed, the search was applied into 4 databases and grey literature, without the restriction of time and language. The selection process occurred in 2 blinded steps by the authors. The criteria of eligibility were in vitro studies that evaluated the physical, chemical, microbiological, and biological properties of chitosan coatings on titanium surfaces. The risk of bias was analyzed by the specific tool. Of 734 potential articles 10 were included; all had low risk of bias. The coating was assessed according to the technique of fabrication, FT-IR, thickness, adhesion, roughness, wettability, antibacterial activity, and osteoblast viability. The analyzed coatings showed efficacy on antibacterial activity and cytocompatibility dependent on the class of material incorporated. Thus, this review motivates the development of time-dependent studies to optimize manufacturing and allow for an increase in patents and availability on the market.

Analysis of osseointegration of implants with macrogeometries with healing chambers: a randomized clinical trial.

BACKGROUND: To verify the influence of macrogeometry with healing chambers on the osseointegration of dental implants by analyzing implant stability quotient (ISQ) and evaluate the correlation between insertion torque and ISQ insertion with different macrogeometries. METHODS: In total, 26 implants were installed in the posterior mandible of eight patients with sufficient bone height for the installation of implants measuring 3.5 mm in diameter and 9.0 mm in length. The implants were categorized according to two types of macrogeometry: a test group (GT) with 13 conical implants with healing chambers and a control group (GC) with 13 conical implants with conventional threads. To insert the implants, a bone drilling protocol was used up to a diameter of 3 mm with the last helical bur. The insertion torque of the implants was evaluated, followed by the measurement of ISQ at 0 (T-0), 7 (T-7), 14 (T-14), 21 (T-21), 28 (T-28), and 42 (T-42) days. RESULTS: The mean insertion torque was 43 Ncm in both groups, without a significant difference. Moreover, no significant difference in the ISQ values was found between the groups at different time points (p > 0.05), except at T-7 (GT = 69.87±1.89 and GC = 66.48±4.49; p = 0.01). Although there was no significant difference, ISQ median values were higher in the GT group than GC group at 28 days (GT = 67.98 and GC = 63.46; p = 0.05) and 42 days (GT = 66.12 and GC = 60.33; p = 0.09). No correlation was found between the insertion torque and ISQ insertion (p > 0.05). CONCLUSION: Furthermore, implants with a 3.5 mm diameter macrogeometry, with or without healing chambers, inserted with a drilling protocol up to 3 mm in diameter of the last helical bur, led to a similar secondary stability, with no difference in ISQ values. Although, implants with healing chamber demonstrates ascending values in the graph of ISQ, having a trend of faster osseointegration than implants without healing chambers. Both macrogeometries provide a similar primary stability to implants. TRIAL REGISTRATION: This study was registered retrospectively in ReBec (brazilian registry of clinical trials) under the number RBR-96n5×69, on the date of 19/06/2023.

Fracture rate and risk factors associated with the fracture of narrow diameter implants: A long-term retrospective analysis.

OBJECTIVES: The objective of this long-term retrospective study was to evaluate the fracture rate and the risk factors associated with the fracture of 3.3 mm narrow diameter implants (NDIs). MATERIALS AND METHODS: A total of 524 records of patients rehabilitated with 3.3 mm NDIs between 1997 and 2015 were assessed. Data on patients, implants, and prostheses were collected, and descriptive analysis of the variables was performed. NDIs were separated into 2 groups: "fractured" and "non-fractured", and a multilevel logistic regression model was applied to identify the risk factors associated with NDI fracture. RESULTS: Eighty-four patients were removed from the analysis for interrupting follow-up or presenting failures other than fractures. Of the 440 patients included (64.66 ± 13.4 years), 272 were females (61.8%), and 168 males (38.2%), and mean follow-up time was 129 ± 47.1 months. Of the 1428 NDIs, 15 (1.05%) in 9 patients (2.04%) fractured during the studied period. Ten fractures (66.66%) happened in 6 patients (66.66%) showing signs of parafunction. NDI with modified sandblasted, large grit, acid-etched surface was the only implant variable to show a protective statistical significance (p = .0439). CONCLUSIONS: NDI fracture was a rare event in the studied sample. NDIs manufactured with modified sandblasted, large grit, acid-etched surface may provide extra protection against NDI fracture. Patient-specific factors and implant characteristics should be carefully considered to limit the risk of fracture of 3.3 mm NDIs.

Importance of local and systemic factors in preventing implant displacement in the mandibular body: a scoping review of existing literature.

BACKGROUND: The aim of this research was to analyse the current literature on displaced dental implants in the mandibular body, including local and systemic variables related to their cause, and to identify the most frequent location. METHODS: The study conducted a search of three databases (Pubmed, Scopus, and Web of Science) using specific index terms such as 'dental implant', 'displacement', 'dislocation', 'displaced', and 'mandible'. The analysis focused on the direction of displacement and the characteristics of the bone tissue (bone quality, density, and quantity) in cases where dental implants were displaced. RESULTS: A total of 371 articles were obtained. Thirteen of these articles were selected and read in full. To define bone quality, the Lekholm and Zarb classification, modified by Rosas et al., was used. The type II-B bone, which is characterized by thick cortical bone surrounding cancellous bone with extremely wide medullary spaces, presented the largest number of complications. Twenty-two cases were found in which the displacement direction was horizontal. Of these, four were displaced vestibularly, fourteen lingually, and four remained in the center. Additionally, 24 cases presented vertical displacement, with 12 displaced towards the inferior border of the mandible, 9 towards the middle or adjacent to the inferior dental nerve canal, and 3 above the inferior dental nerve canal. CONCLUSION: The accidental displacement of implants within the mandibular body is associated with various risk factors, including the characteristics of the bony trabeculum and the size of the medullary spaces. It is reasonable to suggest that only an adequate pre-surgical diagnostic evaluation, with the help of high-resolution tomographic images that allow a previous evaluation of these structures, will help to have better control over the other factors, thus minimizing the risk of displacement.

Bone Regeneration in the Anterior Maxilla With Titanium Mesh and Advanced-Platelet-Rich Fibrin: A Case Report With 2-Year Follow-up.

Guided bone regeneration involving the use of titanium mesh and platelet-rich fibrin could be a feasible approach in cases of severely atrophic ridges. The purpose of this case report was to present an esthetic and functional rehabilitation in the anterior maxilla with the installation of dental implants in conjunction with guided bone regeneration using titanium mesh and advanced platelet-rich fibrin (A-PRF). A 60-year-old patient presented bone atrophy and partial edentulism in the anterior maxilla. After clinical and cone beam computed tomography assessment, guided bone regeneration was planned using a titanium mesh and A-PRF with xenograft bone. After 8 months of healing, the dental implants were placed with the aid of a surgical guide to obtain accurate 3-dimensional positioning. Prosthetic rehabilitation was carried out with individualized crowns. After 2 years of follow-up, radiographic analysis demonstrated a good quality and density of the bone tissue adjacent to the dental implants. No radiolucent areas were observed, and there were no clinical signs of failure. In cases of severe atrophy, using a titanium mesh and A-PRF proved to be a feasible alternative for bone reconstruction prior to dental implant placement. This approach can aid dental professionals in achieving an ideal implant positioning for rehabilitation with individualized crowns.

Ten-year follow-up after peri-implantitis treatment using resective surgery: A case report.

BACKGROUND: Peri-implantitis poses significant challenges in clinical practice, necessitating effective therapeutic strategies. This case report presents a comprehensive treatment approach for managing peri-implantitis, focusing on resective surgery, including implantoplasty and long-term maintenance. METHODS: We describe the case of a 50-year-old female patient with peri-implantitis affecting a maxillary full-arch implant-supported rehabilitation. The treatment strategy involved resective surgery with implantoplasty, a new maxillary overdenture, and a regular maintenance care schedule of three to four visits per year. Clinical and radiographic assessments were performed over a 10-year follow-up period. RESULTS: Post-treatment, all maxillary implants demonstrated no probing depths exceeding 4 mm, absence of bleeding on probing or suppuration, minimal plaque accumulation, and no further bone loss. Resective surgery with implantoplasty seems to have effectively provided submucosal decontamination and created a supra-mucosal implant surface conducive to oral hygiene. Despite regular maintenance, some mandibular implants exhibited bone loss during the follow-up period and were managed using the same approach as for the maxillary implants. CONCLUSIONS: The comprehensive treatment approach yielded favorable long-term clinical and radiographic outcomes, underscoring the effectiveness of the combined strategies in managing peri-implantitis. Nevertheless, the potential for recurrence or the development of peri-implantitis in new implants, even after a decade of successful treatment and strict maintenance, highlights the importance of ongoing, diligent care and regular evaluations to promptly diagnose and address these issues. KEY POINTS: Why is this case new information? The long-term effectiveness of peri-implantitis treatments, particularly involving implantoplasty, remains under-documented. This case provides insights from a 10-year follow-up on the efficacy of a comprehensive approach for managing peri-implantitis. Furthermore, these findings illustrate the potential for new peri-implantitis to develop, regardless of sustained peri-implant health and rigorous maintenance. This finding highlights the critical role of continuous monitoring for the early diagnosis and treatment of new implants exhibiting peri-implantitis. What are the keys to the successful management of this case? The success of this case hinged on a comprehensive treatment approach that combines surgical intervention associated with implantoplasty to remove implant threads, thereby creating smoother surfaces, less retentive for plaque accumulation. A critical aspect of this approach was also the redesign of prosthetic components to improve hygiene accessibility, continuous monitoring, and consistent maintenance care. What are the primary limitations to success in this case? The primary challenge in achieving success in this case was the prevention of new implants with peri-implantitis, despite the patient's consistent adherence to the maintenance program. Moreover, a critical evaluation of implant characteristics, particularly their susceptibility to mechanical failures, is paramount when performing implantoplasty. Furthermore, aligning patient expectations with the realistic esthetic and functional outcomes of the treatment is often challenging. PLAIN LANGUAGE SUMMARY: Peri-implantitis, an inflammatory disease affecting dental implants, is quite challenging to treat. This case report describes how a 50-year-old woman with this condition was successfully treated and maintained over 10 years. The approach included a surgical method called resective surgery, which involved reshaping the bone defect (osteoplasty) and smoothing the implant surface (implantoplasty). Additionally, she was fitted with a new upper denture and had regular follow-up visits three to four times a year. After ten years, her upper implants were stable with no signs of infection or further bone loss, and they were easy to keep clean. Some of her lower implants did experience inflammation with progressive bone loss during this time, but they were managed using the same surgical procedure as for her upper implants. This 10-year case report highlights positive and stable clinical results after resective surgery for treating peri-implantitis and the importance of an interdisciplinary approach and regular check-ups for maintenance, early diagnosis, and management of peri-implantitis over the long term.

[Graftless maxillary sinus lift with simultaneous implant placement: a case report]. / Levantamiento del seno maxilar sin injerto óseo e implante simultáneo: un reporte de caso.

A maxillary sinus lift was performed without bone grafting in a 23-year-old female patient who required the placement of a dental implant in the edentulous area of tooth 16. The clinical and tomographic evaluation made it possible to plan and perform the maxillary sinus lift using the transcrestal approach and without the need for bone grafting. The residual ridge of 6mm allowed the placement of a simultaneous dental implant. After 6 months of tomographic follow-up, before prosthetic loading, a vertical bone height of 8.83 mm was achieved, resulting in a vertical bone gain of 2.83 mm. Additionally, an adequate integration of the dental implant was observed without postoperative complications. Transcrestal sinus lift without the use of bone graft is shown to be a viable, safe and effective technique for the simultaneous placement of dental implants in patients with bone atrophy in the maxillary area. This technique offers advantages such as reduced surgical time, less morbidity, lower cost and a faster healing process compared to conventional methods.

Smart Delivery of Biomolecules Interfering with Peri-Implant Repair in Osteoporotic Rats.

Bisphosphonates are widely used for the treatment of postmenopausal osteoporosis; however, they cause several long-term side effects, necessitating the investigation of local ways to improve osseointegration in compromised bone tissue. The purpose of this study was to evaluate peri-implant bone repair using implants functionalized with zoledronic acid alone (OVX ZOL group, n = 11), zoledronic acid + teriparatide (OVX ZOL + TERI group, n = 11), and zoledronic acid + ruterpy (OVX ZOL + TERPY group, n = 11) compared to the control group (OVX CONV, n = 11). Analyses included computer-assisted microtomography, qualitative histologic analysis, and real-time PCR analysis. Histologically, all functionalized surfaces improved peri-implant repair, with the OVX ZOL + TERI group standing out. Similar results were found in computerized microtomography analysis. In real-time PCR analysis, however, the OVX ZOL and OVX ZOL + TERPY groups showed better results for bone formation, with the OVX ZOL + TERPY group standing out, while there were no statistical differences between the OVX CONV and OVX ZOL + TERI groups for the genes studied at 28 postoperative days. Nevertheless, all functionalized groups showed a reduced rate of bone resorption. In short, all surface functionalization groups outperformed the control group, with overall better results for the OVX ZOL + TERI group.

Impact of the spatial orientation of the patient's head, metal artifact reduction, and tube current on cone-beam computed tomography artifact expression adjacent to a dental implant: A laboratory study using a simulated surgical guide.

Purpose: The aim of this study was to evaluate image artifacts in the vicinity of dental implants in cone-beam computed tomography (CBCT) scans obtained with different spatial orientations, tube current levels, and metal artifact reduction algorithm (MAR) conditions. Materials and Methods: One dental implant and 2 tubes filled with a radiopaque solution were placed in the posterior region of a mandible using a surgical guide to ensure parallel alignment. CBCT scans were acquired with the mandible in 2 spatial orientations in relation to the X-ray projection plane (standard and modified) at 3 tube current levels: 5, 8, and 11 mA. CBCT scans were repeated without the implant and were reconstructed with and without MAR. The mean voxel and noise values of each tube were obtained and compared using multi-way analysis of variance and the Tukey test (α=0.05). Results: Mean voxel values were significantly higher and noise values were significantly lower in the modified orientation than in the standard orientation (P<0.05). MAR activation and tube current levels did not show significant differences in most cases of the modified spatial orientation and in the absence of the dental implant (P>0.05). Conclusion: Modifying the spatial orientation of the head increased brightness and reduced spatial orientation noise in adjacent regions of a dental implant, with no influence from the tube current level and MAR.

Influence of the Surface Topography of Titanium Dental Implants on the Behavior of Human Amniotic Stem Cells.

The dental implant surface plays a crucial role in osseointegration. The topography and physicochemical properties will affect the cellular functions. In this research, four distinct titanium surfaces have been studied: machined acting (MACH), acid etched (AE), grit blasting (GBLAST), and a combination of grit blasting and subsequent acid etching (GBLAST + AE). Human amniotic mesenchymal (hAMSCs) and epithelial stem cells (hAECs) isolated from the amniotic membrane have attractive stem-cell properties. They were cultured on titanium surfaces to analyze their impact on biological behavior. The surface roughness, microhardness, wettability, and surface energy were analyzed using interferometric microscopy, Vickers indentation, and drop-sessile techniques. The GBLAST and GBLAST + AE surfaces showed higher roughness, reduced hydrophilicity, and lower surface energy with significant differences. Increased microhardness values for GBLAST and GBLAST + AE implants were attributed to surface compression. Cell viability was higher for hAMSCs, particularly on GBLAST and GBLAST + AE surfaces. Alkaline phosphatase activity enhanced in hAMSCs cultured on GBLAST and GBLAST + AE surfaces, while hAECs showed no mineralization signals. Osteogenic gene expression was upregulated in hAMSCs on GBLAST surfaces. Moreover, α2 and ß1 integrin expression enhanced in hAMSCs, suggesting a surface-integrin interaction. Consequently, hAMSCs would tend toward osteoblastic differentiation on grit-blasted surfaces conducive to osseointegration, a phenomenon not observed in hAECs.

The innovative double or triple dental abutment-implant: Case study with a 3-to-12-year follow-up.

BACKGROUND: The aim of this case study is to present the rationality and scientific evidence of a new design for a double (DA) and triple (TA) dental abutment-implant with their specific new concept of biodynamic optimized peri-implant tissue (BOPiT). METHODS: The innovative design of these abutments with a paraboloid geometry was based on BOPiT, simultaneously involving the principles of mechanobiology, biotensegrity, and mechanotransduction. Thus, 37 consecutive individuals/43 cases rehabilitated with single dental implant using the innovative DA (n = 28) and TA (n = 15) on 43 implants were included in this case study. The DA and TA support 2 or 3 dental crowns on a single implant, respectively. Clinic and radiographic examinations were presented at T1 (loading after 4 months) and T2 [final examination with an average follow-up time of 7.2 years (>3 to 12 years)]. RESULTS: At T2, mean scores for plaque index, peri-implant bleeding on probing, and peri-implant probing depth were low, depicting healthy peri-implant conditions. All radiographic images showed insignificant annual marginal bone loss (0.022 ± 0.05 mm) when compared to T1, reflecting great bone stability. CONCLUSION: DA and TA, based on the BOPiT concept, represent an advantageous, simple and non-invasive mechanism for the longevity and healthy regulation of the peri-implant tissues.

Titanium: A systematic review of the relationship between crystallographic profile and cell adhesion.

Dental implant surface properties such as roughness, wettability, and porosity ensure cell interaction and tissue integration. The clinical performance of dental implants depends on the crystallographic texture and protein and cell bonds to the substrates, where grain size, orientation, and inclination are parameters responsible for favoring osteoblast adhesion and limiting bacterial adhesion. The lack of consensus on the best crystallographic plan for cell adhesion prompted this systematic review, which aims to answer the following question: "What is the influence of the crystallographic plane on titanium surfaces on cell adhesion?" by evaluating the literature on the crystallographic characteristics of titanium and how these dictate topographical parameters and influence the cell adhesion of devices made from this material. It followed the Preferred Reporting Standards for Systematic Reviews and Meta-Analyses (PRISMA 2020) registered with the Open Science Framework (OSF) (osf.io/xq6kv). The search strategy was based on the PICOS method. It chose in vitro articles that analyzed crystallographic structure correlated with cell adhesion and investigated the microstructure and its effects on cell culture, different crystal orientation distributions, and the influence of crystallinity. The search strategies were applied to the different electronic databases: PubMed, Scopus, Science Direct, Embase, and Google Scholar, and the articles found were attached to the Rayyan digital platform and assessed blindly. The Joanna Bringgs Institute (JBI) tool assessed the risk of bias. A total of 248 articles were found. After removing duplicates, 192 were analyzed by title and abstract. Of these, 18 were selected for detailed reading in their entirety, 9 of which met the eligibility criteria. The included studies presented a low risk of bias. The role of the crystallographic orientation of the exposed faces in a multicrystalline material is little discussed in the scientific literature and its impact is recognized as dictating the topographical characteristics of the material that facilitate cell adhesion.

Digital Implant-Supported Restoration Planning Placed in Autologous Graft Using Titanium Implants Produced by Additive Manufacturing.

This clinical report presents a technique to reconstruct extensively resected mandibles using a combination of autologous bone grafts and additive manufacturing techniques. Mandibular defects, often arising from trauma, tumors, or congenital anomalies, can severely impact both function and aesthetics. Conventional reconstruction methods have their limitations, often resulting in suboptimal outcomes. In these reports, we detail clinical cases where patients with different mandibular defects underwent reconstructive surgery. In each instance, autologous grafts were harvested to ensure the restoration of native bone tissue, while advanced virtual planning techniques were employed for precise graft design and dental implant placement. The patients experienced substantial improvements in masticatory function, speech, and facial aesthetics. Utilizing autologous grafts minimized the risk of rejection and complications associated with foreign materials. The integration of virtual planning precision allowed customized solutions, reducing surgical duration and optimizing implant positioning. These 2 cases underscores the potential of combining autologous grafts with virtual planning precision and dental implants produced by additive manufacturing for mandible reconstruction.

Microbial Leakage through Three Different Implant-Abutment Interfaces on Morse Taper Implants In Vitro.

The objective of this study was to evaluate microbial leakage by means of genome counts, through the implant-abutment interface in dental implants with different Morse taper abutments. Fifty-six samples were prepared and divided in four groups: CMC TB (14 Cylindrical Implants-14 TiBase Abutments), CMX TB (14 Conical Implants-14 TiBase Abutments), CMX PU (14 Conical Implants-14 Universal Abutment) and CMX U (14 Tapered Implants-14 UCLA Abutments). Assemblies had their interface submerged in saliva as the contaminant. Samples were subjected either to thermomechanical cycling (2 × 106 mechanical cycles with frequency of 5 Hz and load of 120 N simultaneously with thermal cycles of 5-55 °C) or thermal cycling (5-55 °C). After cycling, the contents from the inner parts of assemblies were collected and analyzed using the Checkerboard DNA-DNA hybridization technique. Significant differences in the total genome counts were found after both thermomechanical or thermal cycling: CMX U > CMX PU > CMX TB > CMC TB. There were also significant differences in individual bacterial counts in each of the groups (p < 0.05). Irrespective of mechanical cycling, the type of abutment seems to influence not only the total microbial leakage through the interface, but also seems to significantly reflect differences considering individual target species.

Early Peri-Implant Bone Healing on Laser-Modified Surfaces with and without Hydroxyapatite Coating: An In Vivo Study.

(1) Objective: The aim of this study was to assess the biological behavior of bone tissue on a machined surface (MS) and modifications made by a laser beam (LS) and by a laser beam incorporated with hydroxyapatite (HA) using a biomimetic method without thermic treatment (LHS). (2) Methods: Scanning electron microscopy coupled with energy-dispersive X-ray spectrometry (SEM/EDX) was performed before and after installation in the rabbit tibiae. A total of 20 Albinus rabbits randomly received 30 implants of 3.75 × 10 mm in the right and left tibias, with two implants on each surface in each tibia. In the animals belonging to the 4-week euthanasia period group, intramuscular application of the fluorochromes calcein and alizarin was performed. In implants placed mesially in the tibiofemoral joint, biomechanical analysis was performed by means of a removal torque (N/cm). The tibias with the implants located distally to the joint were submitted for analysis by confocal laser microscopy (mineral apposition rate) and for histometric analysis by bone contact implant (%BIC) and newly formed bone area (%NBA). (3) Results: The SEM showed differences between the surfaces. The biomechanical analysis revealed significant differences in removal torque values between the MSs and LHSs over a 2-week period. Over a 4-week period, both the LSs and LHSs demonstrated removal torque values statistically higher than the MSs. BIC of the LHS implants were statistically superior to MS at the 2-week period and LHS and LS surfaces were statistically superior to MS at the 4-week period. Statistical analysis of the NBA of the implants showed difference between the LHS and MS in the period of 2 weeks. (4) Conclusions: The modifications of the LSs and LHSs provided important physicochemical modifications that favored the deposition of bone tissue on the surface of the implants.