Healing of Alveolar Sockets Treated with Concentrated Growth Factors: A Split-Mouth Study.

Background: tooth extraction is a common procedure in oral surgery. The socket healing process involves hard and soft tissues and is characterized by intense remodeling, which may determine consistent dimension changes. Several autologous platelet concentrates (APCs) proved to be effective for enhancing alveolar socket healing after tooth extraction, accelerating socket closure and countering alveolar bone resorption. Concentrated growth factors (CGFs) are one of the most recently developed APCs, and their effect on the socket healing process still needs to be confirmed. Aim: The aim of the present split-mouth study was to evaluate the effectiveness of CGFs in enhancing the healing process in the postextraction alveolar socket and reducing postoperative pain. Methods: One hundred and fifty-four extractions were performed. One of the extraction sockets of each patient was treated with CGFs (test site), and the other socket was unfilled (control site). The main outcomes were: healing index, alveolar dimensions at the crestal level, socket closure, and pain perception. Descriptive statistics of the results were analyzed. Follow-up data were compared to baseline using paired tests. Results: The healing index on day 7 was significantly better (p < 0.001) in the test group (5.01 ± 1.30) as compared to the control group (6.65 ± 1.41). The mean visual analog scale for pain (VAS) was significantly higher for the control group when compared to the CGF group in the first 5 days postextraction. There was a trend toward greater socket closure in the CGF group, indicating faster healing, as compared to the control group at 7, 14, and 21 days. Conclusions: CGFs can represent a useful adjunctive tool, considering their mechanical and biological properties, for improving alveolar socket healing and reducing postoperative patient discomfort.

Dental Implants with a Calcium Ions-Modified Surface and Platelet Concentrates for the Rehabilitation of Medically Compromised Patients: A Retrospective Study with 5-Year Follow-Up.

BACKGROUND: Platelet concentrates are biological, autologous products obtained from the patient's whole blood, consisting of a supraphysiological concentration of platelets and growth factors, that have proved beneficial in different applications in the medical and dental fields. They are used in several medical and dental applications to enhance tissue healing. Previous evidence shows that platelet concentrates may be beneficial in patients with compromised systemic conditions, in which the healing process is impaired. AIM: To evaluate the 5-year clinical outcome of implant treatment using acid-etched implants with calcium ions-modified surface in association with plasma rich in growth factors, in patients with systemic diseases of a different nature. METHODS: Charts of 99 medically compromised patients, who had received a total of 224 dental implants from January 2013 to June 2013, were retrospectively evaluated. Patients were divided into four groups, according to their condition: diabetes (n = 39 patients), osteoporosis (n = 36), lupus erythematosus systemic (n = 5), rheumatoid arthritis (n = 19). The main outcomes were implant survival, marginal bone level (MBL) change and complications throughout follow-up. RESULTS: Mean follow-up was 63.06 ± 1.90 months (range 60.1 to 66.4 months). In total, eight implants failed in 6 diabetic patients and 4 in 3 patients with rheumatoid arthritis. Overall 5-year implant survival was 94.6%. In total, 30 complications occurred in 24 patients, mostly transient, and no severe adverse event occurred. Overall MBL change was 0.45 ± 0.12 mm, with no significant differences among groups. CONCLUSIONS: In the present sample of medically compromised patients, rehabilitation with calcium ions-modified surface implants associated with plasma rich in growth factors proved to be a safe and effective treatment. The satisfactory results achieved after 5-year follow-up are comparable to those historically reported for healthy patients.

In vitro standardization of two different removal devices in cemented implant prosthesis.

OBJECTIVES: The purpose of this study was to describe the force generated by two different removal devices used to retrieve cemented crowns on implant abutments. The influence of six different operators was evaluated. MATERIAL AND METHODS: Three replicated Coronaflex(®) (Kaltenbach & Voigt GmbH, KaVo Dental GmbH) and reverse hammer setups were tested. The experimental setup has employed a screw bearing a diametral hole through which a loop holder passed. The screw was attached to a force transducer (Brüel & Kjaer, type 8201), and the loop holder arm was kept perpendicular to the transducer axis. The results were statistically evaluated with ANOVA. RESULTS: The operator has resulted to play significant influence with reference to reverse hammer (coefficient of variation 43.3%) rather than with Coronaflex(®) (9.8%). Evaluating every single operator, more variation can still be found by considering each reverse hammer (37.5%) rather than each Coronaflex(®) (8.8%). CONCLUSION: Coronaflex(®) device was found to systematically reach a more repeatable and higher peak amplitude of forces compared with reverse hammer, both by experienced and inexperienced operators.

An alumina toughened zirconia composite for dental implant application: in vivo animal results.

Ceramic materials are widely used for biomedical applications because of their remarkable biological and mechanical properties. Composites made of alumina and zirconia are particularly interesting owing to their higher toughness with respect to the monolithic materials. On this basis, the present study is focused on the in vivo behavior of alumina toughened zirconia (ATZ) dental implants treated with a hydrothermal process. A minipig model was implemented to assess the bone healing through histology and mRNA expression at different time points (8, 14, 28, and 56 days). The novel ATZ implant was compared to a titanium clinical standard. The implants were analyzed in terms of microstructure and surface roughness before in vivo tests. The most interesting result deals with a statistically significant higher digital histology index for ATZ implants with respect to titanium standard at 56 days, which is an unprecedented finding, to the authors' knowledge. Even if further investigations are needed before proposing the clinical use in humans, the tested material proved to be a promising candidate among the possible ceramic dental implants.

Comparison of primary stability of straight-walled and tapered implants using an insertion torque device.

PURPOSE: Implant geometry has a major impact on insertion torque values and primary stability, and bone engagement during implant insertion differs according to implant morphology. Primary stability of straight-walled and tapered implants was compared using insertion torque monitoring. MATERIALS AND METHODS: A total of 57 implants (36 straight-walled OSSEOTITE and 21 tapered OSSEOTITE NT) were inserted in 20 patients. Implant torque values and insertion times were recorded, and the data were processed and interpolated to determine torque as a function of time. RESULTS: Tapered implants required less insertion time and a higher insertion torque than straight-walled implants; this provided better primary stability, although the success rate was 86% for tapered and 100% for straight-walled implants. CONCLUSIONS: Tapered implants showed better primary stability than straight-walled implants but had a lower success rate. The authors suggest that in low-density bone, in which only a thin dense cortical layer can contribute to primary stability, a higher insertion torque can lead to the destruction of peri-implant bone, compromising osseointegration.

A preliminary in vivo trial of load transfer in mandibular implant-retained overdentures anchored in 2 different ways: allowing and counteracting free rotation.

This in vivo pilot methodologic study used 3 patients to investigate load transfer in mandibular implant-retained overdentures anchored in 2 different ways: allowing (gap condition) and counteracting (contact condition) free rotation. Load cells and strain-gauged abutments were used to evaluate occlusal load, load transmitted to the nonworking-side mucosa, and stress on the working-side abutment, in both contact and gap conditions. The occlusal load was reduced and load was shifted from abutments to mucosa in the gap versus the contact condition. In the contact condition, patients reported more comfort and felt that they could exert greater occlusal force.

Mandibular implant-retained overdentures with 2 different prosthetic designs: a retrospective pilot study on maintenance interventions.

This retrospective study aimed to investigate whether a mandibular implant-retained overdenture designed to counteract the rotation of the denture might influence the clinical outcome, as evaluated through the prosthetic maintenance interventions. The amount of repairs and relines of the mandibular and maxillary dentures required in an experimental group (6 patients wearing an implant-retained overdenture with a metal frame counteracting the rotation) and a control group (6 patients wearing an implant-retained overdenture allowing the rotation) was compared. Both mandibular and maxillary dentures needed few repairs or relines. The 2 types of dentures showed a similar number of maintenance interventions.

Tooth-implant connection: some biomechanical aspects based on finite element analyses.

This study investigated, with the use of two- and three-dimensional finite element analysis, the peri-implant stress that occurred during loading of a tooth that was rigidly connected to a distally placed implant. A fixed bond between the bone and the implant was assumed, while the periodontal ligament was represented by means of three-dimensional nonlinear visco-elastic spring elements. Two different loading conditions were compared in the study: i) an axially directed static load of 50 kg that was applied to the tooth for 10 s, and ii) a transitional load of 50 kg that was applied for 5 milliseconds. Load duration appeared to have a greater influence than load intensity on the stress distribution in the bone around an implant and a rigidly connected tooth. Static load is, therefore, potentially more harmful for peri-implant bone than transitional load. The periodontal ligament seems to play a key role in the stress distribution between a tooth and a rigidly connected implant.