Clinical outcomes of fully and partially threaded zygomatic implants in a cohort of patients with minimum 7.5-year follow-up.

OBJECTIVE: The aim of this retrospective case series report was to evaluate the results of oral rehabilitation with extra-sinus zygomatic implant surgery with a minimum follow-up of 7.5 years. PATIENTS AND METHODS: A total of 35 patients with 87 zygomatic implants were included. The mean follow-up period of the patients was 93 months. The zygomatic implant survival and complications were evaluated as criteria for success. RESULTS: There were no implant failures. Overall success rate without complications for zygomatic implant was 88.5%. Complications developed in 4 patients (1 cutaneous fistula and 3 mucositis). According to the results on an implant basis, patients with previously failed conventional implants had greater probability of complications. Patients with quad zygomatic implants had higher incidence of complications than those with two zygomatic implants. Fully threaded implant design was associated with higher incidence of mucositis than partially threaded design. No relation was found between implant success and smoking, prosthesis type, and antagonist dentition. When conducting the analysis using the patient as unit, only the antagonist dentition showed significant difference, the worst outcome being associated with the Toronto resin prosthesis. CONCLUSIONS: Zygomatic implants can be considered as a safe alternative to conventional implant insertions and bone grafting procedures in oral rehabilitation of patients with severely atrophic maxillary bone.

Dental implants survival rate in controlled type I diabetic patients: a prospective longitudinal study with a 2-year follow-up.

The aim of the study was to evaluate implant treatment for partial edentulism in a population of controlled type I diabetic patients. The research hypothesis was that implant survival rate, prevalence of peri-implant tissue infection and marginal bone loss at 2 years follow-up would not differ from a non diabetic population. A total of 106 patients (47=women, 59=men, mean age 38.36 years) presented with partially edentulous jaws. All patients underwent a two stage implant surgery (105 maxillary, 100 mandibular). Diabetic type I patients (53) were scheduled in Group A, while 53 healthy patients formed the Control Group. Clinical and radiological controls were performed from baseline up to 24 months and implants survival rate, presence of peri-implant tissue infections and marginal bone loss were assessed in all ptients. Group A and Control Group were compared by analyzing data at implant level, through either an independent sample t-test, with respect to bone loss, or Fisher Exact tests, with respect to (a) peri-implant mucositis, (b) peri-implantitis, and (c) post-operative wound infection. At the 24-month follow-up, 5 and 3 implants failed in diabetic and non-diabetic patients, respectively. No statistically significant difference was found in implant survival rate between the two groups (Group A: 95.19%; Control Group: 97.03%). Moreover, no statistical significant differences were found in infections occurrence, nor in marginal bone loss. The preliminary results of this prospective study showed how implant treatment for partial edentulism may a be safe and predictable procedure for diabetic type I patients, provided controlled glycemic levels and regular professional oral hygiene sessions.

Experimental analysis of the influence of cortical bone layers and bone quantity on implant primary stability.

The systematic analysis of parameters impacting implant primary stability is difficult to achieve with human cadavers or animal models, particularly for complex trans-sinus procedures to determine the effects of cortical layers and bone engagement on implant stability before and after a simulated load in vitro. Solid rigid polyurethane blocks, partially intersected by an 8-mm-thick space, were created to imitate tri-cortical situations, the presence of the sinus cavity, and the posterior maxilla with different degrees of bone atrophy. Implants were inserted through the cavity at an angle of 30˚ (scenarios 1 and 2) to imitate the clinical protocol. Controls simulating uni-cortical anchorage and no sinus cavity were also included (controls 1 and 2). Four parameters were measured: peak insertion torque, insertion work, resistance to lateral bending loads and extraction torque. Scenarios 1 and 2 displayed similar peak insertion torque to control 2, where all three groups anchored equal amounts of bone surrogate. The distribution of surrogate bone in contact with trans-cavity implants influenced both extraction torque and the degree of lateral bending. Sufficient peak insertion torque can be attained with a trans-sinus tricortical implant anchorage providing sufficient apical and coronal bone is engaged.

Role of induced pluripotent stem cells (IPSCS) in bone tissue regeneration in dentistry: a narrative review.

Several conditions as trauma, cancer surgical resection, fractures, congenital malformations and periodontitis could bring alveolar bone defects. To avoid more invasive and less predictable regenerative procedures, Stem cells of different origins as pluripotent Embryonic Stem Cells (ESCs), undifferentiated multipotent Mesenchymal Stem Cells (MSCs) and Induced Pluripotent Stem Cells (iPSCs) were proposed as possible alternative. IPSCs have potential for proliferation and differentiate into all derivatives of the three primary germ layers: ectoderm, endoderm and mesoderm. According with their ability to involve in several cells type, Induced Pluripotent Stem Cells (iPSCs) could be proposed as alternative in regeneration either of mineralized tooth components or supporting tissue. The aim of this brief review is to describe clinical applications of Induced Pluripotent Stem Cells (iPSCs) in oral bone regeneration to employ their use in tissue regeneration in dentistry.

Oral microbiome and mucosal trauma as risk factors for oral cancer: beyond alcohol and tobacco. A literature review.

Oral and oropharyngeal cancer represents the sixth more common type of cancer affecting the worldwide population. It has been estimated the number of 650,000 new cases per year globally and a greater prevalence has been registered among men. The main risk factors for oral cancer such as tobacco smoking and alcohol are uncontroversial and have been deeply investigated and evidenced in the scientific literature. Recently, viral infections related to Human Papilloma Virus (HPV), with the genotype 16 and 32, have shown a correlation mainly with oropharyngeal cancer (OPC) especially in the non-smoking and non-drinkers young adults. Its transmission is mainly related to sexually transmitted diseases (STDs) although its involvement in oral squamous cell carcinoma (OSCC) is still unclear. This review aims to explore the hypotheses of the OSCC etiology and other possible risk factors, such as chronic traumatisms, chronic periodontitis, and poor oral hygiene that affect directly the oral mucosa and might trigger the carcinogenesis process that should not be underestimated. Furthermore, in the last 10 years, the role of oral microbiome gained attention as a predicting biomarker, for a possible bacterial, viral, and fungal involvement in tumorigenesis.

The smokeless tobacco: a survey in a cohort of young Italians through a social-media questionnaire.

This observational survey aimed to demonstrate the use of the Snus kind of smokeless tobacco, among young Italian adults from alpine areas. A customized anonymous questionnaire was purposely created using the Google Forms platform and made it available for 4 weeks through social media supports to a cohort of young adults living in a mountain area in Italy. Out of four hundred recipients, 332 interviewees returned the survey. Participants had a mean age of 22.8, range 17-40 years. One hundred fifty regular consumers used Snus for more than 5 years. Gingival changes were reported in 92 subjects, associated with gingival bleeding in 14 subjects. 79 subjects reported discoloration of the mucosa. The 50% of the habitual users developed an addiction to Snus and 90% didn't smoke conventional cigarettes. In Italian young adults the use of Snus tobacco could be an adjunctive risk factor for the oral mucosa. It is essential to extend and spread the awareness about this addictive habit among dental professionals, to give to the patients a reliable and effective oral and systemic education.

Immediate full-arch rehabilitation of the severely atrophic maxilla supported by zygomatic implants: a prospective clinical study with minimum follow-up of 6 years.

The aim of this study was to evaluate the outcomes of immediate full-arch prostheses supported by zygomatic implants alone or in combination with standard fixtures after a minimum of 6 years of loading. From October 2008 to April 2010, 15 patients with severely atrophic maxillae were treated using four zygomatic implants or two zygomatic implants in conjunction with two conventional fixtures. All subjects received a fixed screw-retained prosthesis within 3hours of surgery, while the final restoration was delivered after 6 months. Follow-up examinations were scheduled to evaluate zygomatic implant survival, conventional dental implant success, prosthetic success, plaque and bleeding scores, marginal bone loss for conventional dental implants, and patient satisfaction. Forty-two zygomatic fixtures and 18 standard implants were placed. Patients were followed up for a minimum of 79 months (range 79-97 months, average 90.61 months). No implant was lost, leading to implant and prosthetic survival rates of 100%. Bone loss for conventional implants averaged 1.39±0.10mm after 6 years of function, leading to a 100% implant success rate. High levels of patient satisfaction were recorded. These medium-term results indicate that immediate full-arch rehabilitation supported by zygomatic implants could be considered a viable treatment modality for the severely atrophic maxilla.

A modified technique for using the endoscope in periradicular surgery. A case report.

The aim of this case report was to describe a modified endoscopic technique for enhancing visualization in endodontic microsurgery. Tooth treated surgically showed a periradicular lesion of strictly endodontic origin. Following the reflection of a full mucoperiosteal papilla base incision flap, surgical access to the root was made through the cortical bone. The periradicular lesion was curetted, root-end was resected, and root-end cavity was prepared with a zirconium nitrate tip driven by ultrasonic device unit. Finally zinc oxide EBA-reinforced cement root-end filling was placed. Root-end management procedure was performed using an endoscope. Diving the endoscope lens in the bone cavity filled with saline solution contributed to improve visualization and keep clear the lens. Following clinical and radiographic assessment at 12 months postsurgery, the case was evaluated successfully. Thus, in conclusion, the endoscope provided excellent visualization of the surgical field during root-end cavity preparation.

Immediate loading in the fully edentulous maxilla without bone grafting: the V-II-V technique.

AIM: The aim of this prospective study was to evaluate a new surgical approach for the immediate rehabilitation of fully edentulous maxilla without any type of bone grafting. METHODS: The technique named ''V-II-V'' consists of an immediately loaded full-arch bridge supported by six implants. Two distal implants engage the posterior wall of the maxillary sinus, being tilted 30-45 degrees relative to the occlusal plane. Two other tilted implants engage the anterior wall of the sinus, and finally two axial implants are inserted in the anterior maxilla. An acrylic provisional restoration is delivered within 4 hours of implant placement. At each follow-up, plaque and bleeding indexes were scored, marginal bone level change around tilted and axial implants were evaluated, and a questionnaire was compiled to assess patient's satisfaction for function and aesthetics. RESULTS: Twenty-one patients were rehabilitated. A total of 126 implants were inserted. Nineteen prostheses were in function for more than 12 months. The average follow-up was 20 months (range 4-35 months). No implant failure occurred to date, leading to 100% survival rate and 100% prosthesis success. No complication was recorded. Peri-implant bone loss at axial and tilted fixtures was similar at one year, being 0.8 mm (SD 0.4, N.=28) and.0.9 mm (SD 0.5 mm, N.=56) respectively (P>0.05). RESULTS: The ''V-II-V'' technique is a viable treatment modality for the immediate rehabilitation of the edentulous maxilla, avoiding bone grafting or sinus augmentation. Long-term evaluation is needed to confirm these encouraging preliminary