One Piece CAD/CAM Abutment for Screw-Retained Single-Tooth Restorations: A 5-Year Prospective Cohort Study.

BACKGROUND: The use of ceramic-coated patient-specific CAD/CAM titanium abutments represents a therapeutic option for the rehabilitation of single tooth. The utilization of highly customized abutments enables the accurate three-dimensional positioning of the prosthetic emergence. This study evaluates the clinical performance of implant-prosthetic rehabilitations carried out using ceramic-coated CAD/CAM titanium abutments. MATERIALS AND METHODS: Thirty implants were placed in thirty patients and rehabilitated with thirty single crowns attached to CAD/CAM titanium abutments. A conventional procedure was applied, with implant placement after post-extraction socket healing and prosthetic restoration after implant healing. Implants of lengths ranging from 6-15 mm and widths of 3.6, 4.2, and 4.8 mm were used in this study. At the time of prosthesis delivery (T0), after two years (T1), and after five years (T2), plaque (PI) and bleeding (BoP) indices, probing depths (PPD), marginal bone levels (MBL), and PES/WES were evaluated for each implant. RESULTS: No patient dropped out of the study during the follow-up period. All thirty implants were clinically successful at five years post-prosthesis delivery (survival rate: 100%) and showed no signs of peri-implant infection. Peri-implant soft tissues were in good health (BoP at T2: 0% in 73% of patients; 25% in 13% of patients; 50% in 10% of patients; and 75% in 3% of patients). The mean PPD was 2.05±0.56 mm at T0, 1.992±0.6 mm at T1, and 1.867±0.439 mm at T2. The mean MBL at T0 was 0.413±0.440 mm, at T1 was 0.306±0.388 mm, and at T2 was 0.263±0.368 mm. The mean PES, WES, and PES/WES indices, 7.43±1.04, 7.57±0.82, and 15.00±1.17, respectively, indicate good integration of soft tissues, satisfactory aesthetics, and an overall positive outcome. CONCLUSIONS: The success rates, maintenance of marginal bone levels, and periodontal and aesthetic indices suggest the validity of implant-prosthetic rehabilitations with CAD/CAM abutments in cases of single crowns.

Lower Jaw Full-Arch Restoration: A Completely Digital Approach to Immediate Load.

The digital transformation has revolutionized various sectors, including dentistry. Dentistry has emerged as a pioneer in embracing digital technologies, leading to advancements in surgical and prosthetic oral healthcare. Immediate loading for full-arch edentulous dental implants, once debated, is now widely accepted. This case report describes a 74-year-old patient with dental mobility and significant bone loss who was rehabilitated using a Toronto Bridge protocol on four dental implants with immediate loading. Digital planning, surgical guides, 3D printing, and precision techniques were employed. The surgery involved implant placement and prosthetic procedures. The patient reported minimal post-operative discomfort, and after four months, the definitive prosthesis was successfully placed. This case demonstrates the efficacy of immediate loading in complex dental scenarios with digital innovation, resulting in improved patient outcomes. The full digital workflow, including 3D printing and the use of modern materials, enhances the efficiency and predictability of oral rehabilitation, marking a transformative era in dental care. The integration of digital technology in all phases of treatment, from diagnosis to finalization, makes this approach safer, reliable, and efficient, thereby benefiting both patients and clinicians.

Conometric Connection for Implant-Supported Crowns: A Prospective Clinical Cohort Study.

BACKGROUND: Traditional screw or cemented connections in dental implants present limitations, prompting the exploration of alternative methods. This study assesses the clinical outcomes of single crowns and fixed partial prostheses supported by conometric connections after one year of follow-up. METHODS: Twenty-two patients received 70 implants, supporting 33 rehabilitations. Biological responses and prosthodontic complications were evaluated at baseline, 6 months, and 12 months. RESULTS: All implants exhibited successful osseointegration, with no losses or peri-implant inflammation. Marginal bone levels showed minimal changes, well below pathological thresholds. The difference in marginal bone loss (MBL) was -0.27 ± 0.79 mm between T0 and T1, and -0.51 ± 0.93 mm between T0 and T2. No abutment screw loosening or crown chipping occurred. However, coupling stability loss was observed in nine cases. CONCLUSIONS: The conometric connection demonstrated successful integration and minimal complications after one year. This alternative shows promise, particularly in simplifying handling and improving marginal adaptation. Further research with larger sample sizes and longer follow-up is warranted for comprehensive validation.

Fully digital workflow for implant-supported fixed restorations consisting of a titanium primary structure and a zirconia secondary structure.

PURPOSE: To describe a fully digital workflow for an implant-supported fixed hybrid restoration that involves a double CAD/CAM structure and to highlight the benefits of this type of restoration. MATERIALS AND METHODS: Using a fully digital workflow, starting from intraoral scans, the necessary steps for producing the final hybrid prosthesis are described. The prosthesis consists of a titanium primary structure and a zirconia secondary structure that is cemented onto the primary structure in the laboratory. A clinical case is presented to illustrate the steps required for prosthetic rehabilitation. RESULTS: This technique enables the fabrication of clinically valid and passive prostheses using a fully digital workflow. CONCLUSION: In just three clinical sessions, a fully digital workflow makes it possible to produce robust implant-supported fixed hybrid prostheses, comprising a titanium primary structure and an outer secondary structure made of zirconia. This procedure can be applied to a wide range of cases from simple to extended, including full-arch restorations.

One-Year Multicenter Randomised Controlled Trial Comparing OT Equator® and Locator Attachments to Retain an Early Loaded Implant Overdenture on Two Implants.

This investigation aimed to compare the effectiveness of the OT Equator® (Rhein, Bologna, Italy) and the Locator attachment systems used to retain early loaded implant-retained overdentures. This study was designed as a multicenter randomised controlled trial of parallel groups. After implant placement, the patients were randomised to receive OT Equator® attachments in the test group or Locator attachments in the control group. The outcome measures were implant and prosthetic success and survival rates, any biological and technical complication, marginal bone loss, patients' satisfaction, and periodontal parameters. Overall, 42 patients were consecutively enrolled and treated. One implant was lost in the control group, while no implants were lost in the test group. No prostheses failed in both groups. Only a few complications were experienced in both groups. The main was represented by loss of retention of the attachments (retentive caps). The OT Equator® attachment showed statistically lower periodontal parameters. In conclusion, both attachment systems were suitable for overdenture implant retention.

Full-Arch Guided Restoration and Bone Regeneration: A Complete Digital Workflow Case Report.

OBJECTIVE: complex rehabilitations present multiple difficulties, regarding both the planification of the surgery and the design of the prothesis. A digital approach can support the workflow, as well as the degree of intraoperative precision, and improve the long-term prognosis. METHODS: A surgical guide was designed for implant placement. An extensive regeneration of the upper jaw was performed with contextual implant insertion, and a delayed load rehabilitation was chosen. After four months, a second surgery and a simultaneous soft tissue augmentation was performed, and a 3D-printed temporary restoration was placed. After another two months, new dental and facial scans, smile design, and facial bite registrations were obtained. Upper and lower dentures were built using an exclusively digital workflow. Both metal substructures were passivated and cemented in one session; in the following appointment, the aesthetic and occlusal checks were carried out. During the third visit, both prostheses were delivered. RESULTS: Careful case planning and the surgical guide made it possible to achieve primary stability and acceptable emergence profiles in an extremely reabsorbed upper jaw. Leukocyte-Platelet Rich Fibrin (L-PRF) made the extensive bone regeneration more approachable and lowered the post-operative pain and swelling, while speeding up the soft tissue healing process. During the re-entry surgery, the volumes of soft tissues were increased to improve aesthetics, and the amount of keratinized gingiva around the six implants was also increased. Smile design and facial scans have provided the means to create acceptable aesthetics and function in a few sessions with minimal patient discomfort. CONCLUSIONS: Computer-assisted implantology is a safe and precise method of performing dental implant surgery. Preliminary studies have a high degree of accuracy, but further studies are needed to arrive at a fully digital clinical protocol at all stages.

Long-term results of autologous periosteum-derived micro-grafts with poly(lactic-go-glycolic acid) in sinus lift augmentation surgeries: A 7-years follow-up observational study.

INTRODUCTION AND IMPORTANCE: The study aimed to present the long-term results of autologous and homologous micrografts for bone regeneration aimed at positioning dental implants after sinus lift augmentation surgeries, by combining autologous Rigenera® micrografts with poly(lactic-go-glycolic acid). CASE PRESENTATION: A total of 5 patients (2 males and 3 females) from 36 to 71 years were involved in the observational study. All the patients showed a good health status system (ASA1 and 2), according to their clinical history with neither system diseases, nor under medication able to interfere with osseointegration. CLINICAL DISCUSSION: The radiographic evaluations, after the implant placement and during the continuous follow-up upto 7 years, were carried out through periapical endoral x-rays. The survival and implant success rate was 100 %. Histological analyses were performed after 3 and 7 months after the surgical procedure. CONCLUSION: No adverse events have been observed that can be traced back to the use of autologous micrografts with poly(lactic-go-glycolic acid), showing safety and predictable results even in long term.

Excess Mortality among Physicians and Dentists during COVID-19 in Italy: A Cross-Sectional Study Related to a High-Risk Territory.

BACKGROUND: Many studies previously reported epidemiological data on mortality due to COVID-19 among health workers. All these studies included a partial sample of the population with a substantial selection bias. The present study evaluates the trend of mortality among physicians and dentists operating in an area considered to be at high risk during the COVID-19 pandemic. METHODS: Data relating to all physicians and dentists registered in the province of Pavia (Italy), a sample consisting of 5454 doctors in 2020 was analyzed. The mortality rates obtained were compared with those related to the 5-year period preceding the pandemic and with those related to the general population. RESULTS: In the area considered, a mortality rate of 0.83% (+69% compared to 2015-2019) was observed in the entire sample in 2020 and 0.43% (-11% compared to 2015-2019) in 2021; among physicians, there was a mortality rate of 0.76% (+53% compared to 2015-2019) in 2020 and 0.35% (-29% compared to 2015-2019) in 2021; for dentists, there was a mortality rate of 1.27% (+185% compared to 2015-2019) in 2020 and 1.01% (+127% compared to 2015-2019) in 2021. CONCLUSIONS: These data report the global impact of the SARS-CoV-2 pandemic on physicians and dentists in a high-risk territory. In 2020, a significant increase in the mortality rate compared to the previous 5 years was observed for both physicians and dentists; in 2021, a significant increase in the mortality rate was observed only for dentists. These data are also significant in evaluating the impact of vaccination on physicians and dentists and indicate that dentists were among the professions most at risk during the pandemic.

Correlation between the Mandibular Lingula Position and Some Anatomical Landmarks in Cone Beam CT.

BACKGROUND: the position of the mandibular lingula (Li) affects the success rate of the inferior alveolar nerve block (IANB) and ramus osteotomies. This study evaluated the position of the Li, to investigate the anatomical relationship between the Li and some anatomical measurements using cone beam computed tomography (CBCT). METHODS: 201 hemimandibular CBCTs of 111 patients (43 males and 68 females; 18 to 88 years old) were retrospectively evaluated. The Li location was determined from the lingula tip to: the occlusal plane, the anterior and posterior borders of the mandibular ramus, the lower border of the mandible, the distal surface of the mandibular second molar, and the mandibular notch. We evaluated the correlations between the Li and the anteroposterior diameter of the mandibular ramus; the vertical distance between condyle and mandibular angle; the mesial-distal diameter of the first, second, and third mandibular molar, the intercanine distance, the intermolar distances among the first, second, and third mandibular molars; the distance between the intermolar line of the first molar and midline, and the length of the mandibular body. RESULTS: the vertical distance of the Li from the occlusal plane was 11.22 ± 4.27 mm. Some parameters significantly correlated with the anatomical measurements taken into consideration. CONCLUSIONS: the present study provides new information concerning the Li and mandibular anatomy in the Italian population. Moreover, by correlating some anatomic measurements to the Li position, the localization of the Li is made possible, indirectly through the measurement of some distances between anatomical landmarks.

The Impact of Nandrolone Decanoate in the Osseointegration of Dental Implants in a Rabbit Model: Histological and Micro-Radiographic Results.

Despite high rates of osseointegration in healthy patients, complex cases present an increased risk of osseointegration failure when treated with dental implants. Furthermore, if immediate loading of the implants is used, maximizing the response of the host organism would be desirable. Anabolic steroids, such as Nandrolone Decanoate (ND), are reported to have beneficial clinical effects on various bone issues such as osteoporosis and bone fractures. However, their beneficial effects in promoting osseointegration in dental implant placement have not been documented. The study aimed to examine histological changes induced by ND in experimental dental implants in rabbit models. Two dental implants were placed in the tibias of 24 adult rabbits. Rabbits were allocated to one of two groups: control group or test group. Rabbits in the latter group were given nandrolone decanoate (15 mg/kg, immediately after implant placement and after 1 week). Micro-radiographic and histological analyses were assessed to characterize the morphological changes promoted by the nandrolone decanoate use. Total bone volume and fluorescence were significantly higher in the control group after 2 weeks. Such a difference between the two groups might indicate that, initially, nandrolone lengthens the non-specific healing period characteristic of all bone surgeries. However, after the beginning of the reparative processes, the quantity of newly formed bone appears to be significantly higher, indicating a positive stimulation of the androgen molecule on bone metabolism. Based on micro-radiology and fluorescence microscopy, nandrolone decanoate influenced bone regeneration in the implant site. The anabolic steroid nandrolone decanoate affects the healing processes of the peri-implant bone and therefore has the potential to improve the outcomes of implant treatment in medically complex patients.

Biomimetic Effect of Nano-Hydroxyapatite in Demineralized Enamel before Orthodontic Bonding of Brackets and Attachments: Visual, Adhesion Strength, and Hardness in In Vitro Tests.

Dietary habits with high consumption of acidic food can induce in orthodontic patients an increased risk of demineralization lesions around orthodontic brackets and bands. The purpose of the present laboratory study is to assess the in vitro visual efficacy of a biomimetic nano-hydroxyapatite remineralizing solution in a hypomineralized enamel surface and its effect on adhesion of fixed orthodontic appliances and on enamel microhardness. Intact teeth were demineralized, and subsequently the areas of demineralization were visually recorded using a 0-100 scale. Subsequently, a remineralizing solution (Biorepair® Repair Shock Treatment) was applied for ten minutes once a day/for one week per month for a total remineralizing treatment of 3 months. Visual effects were recorded. Moreover, bond strength was recorded and adhesive remnant index scores were measured for both orthodontic brackets and composite attachments both before demineralization and after demineralization and application of remineralizing solution. Also, Vickers microhardness was measured. All data were submitted to statistical analysis. The application of remineralizing solution induced a significant in vitro reduction of demineralized areas after the first week of application. No significant differences between untreated enamel surfaces and remineralized surfaces were detected after 2 months of remineralizing treatment. Bond strength values were significantly reduced for both brackets and attachments after remineralizing treatment. However, attachments showed higher adhesion values than brackets in both conditions tested. Remineralized enamel showed significantly higher microhardness values than demineralized enamel and lower values than intact enamel.

Detection of peri-implant inflammation by the use of a matrix metalloproteinase-8 chair-side test.

BACKGROUND: Active matrix metalloproteinase-8 (MMP-8) enzymes are associated with inflammation and the degradation of implant-supporting tissues. A high concentration of these enzymes in the peri-implant sulcular fluid (PISF) has been associated with a pathological condition. The aim of the present study was to evaluate the ability of a chair-side MMP-8 test to individuate pathological peri-implant site. The working hypothesis is that positive response to MMP-8 test corresponds to pathological values of periodontal indexes. A secondary working hypothesis is that PISF sampling method influences the test accuracy. METHODS: Fifty implants from 50 patients were evaluated during scheduled follow-up appointments in a clinical setting using the MMP-8 chair-side test and periodontal indices (probing depth, bleeding on probing, plaque index and peri-implant inflammation index). Two methods of PISF sampling were tested. RESULTS: The MMP-8 test demonstrated significant diagnostic capacity and good sensitivity and accuracy regarding indices of bleeding on probing, plaque index, and peri-implant inflammation index but fair agreement. CONCLUSIONS: Further studies should be performed to better define the interpretation of the MMP-8 chair-test results and their correlation to peri-implant indexes.

Covalently-Linked Hyaluronan versus Acid Etched Titanium Dental Implants: A Crossover RCT in Humans.

Biochemical modification of titanium surfaces (BMTiS) entails immobilization of biomolecules to implant surfaces in order to induce specific host responses. This crossover randomized clinical trial assesses clinical success and marginal bone resorption of dental implants bearing a surface molecular layer of covalently-linked hyaluronan in comparison with control implants up to 36 months after loading. Patients requiring bilateral implant rehabilitation received hyaluronan covered implants in one side of the mouth and traditional implants in the other side. Two months after the first surgery, a second surgery was undergone to uncover the screw and to place a healing abutment. After two weeks, the operator proceeded with prosthetic procedures. Implants were evaluated by periapical radiographs and the crestal bone level was recorded at mesial and distal sites-at baseline and up to 36 months. One hundred and six implants were positioned, 52 HY-coated, and 48 controls were followed up. No differences were observed in terms of insertion and stability, wound healing, implant success, and crestal bone resorption at any time considered. All interventions had an optimal healing, and no adverse events were recorded. This trial shows, for the first time, a successful use in humans of biochemical-modified implants in routine clinical practice and in healthy patients and tissues with satisfactory outcomes.

Multicenter Retrospective Analysis of Implant Overdentures Delivered with Different Design and Attachment Systems: Results Between One and 17 Years of Follow-Up.

PURPOSE: To analyze implant and prosthetic survival rates, complications, patient satisfaction, and biological parameters of patients rehabilitated with implant overdentures (IOV) on splinted and nonsplinted implants and different attachment systems, in function for one to 17 years. METHODS: This retrospective study evaluated data collected from patients rehabilitated with implant overdentures between January 2001 and December 2016 in nine different centers. Outcome measures were implant and prosthetic success rates, mechanical complications, marginal bone loss (MBL), oral health impact profile (OHIP), bleeding on probing, and plaque index. RESULTS: A total of 581 implants were installed in 194 patients. Patients were followed for a mean period of 60.6 months (range 6⁻206). Eighty-nine patients received 296 low profile attachment (OT Equator), 62 patients received 124 ball attachments, and 43 patients received 107 Locator attachments. In eighty-three patients the implants were splinted with computer aided design/computer aided manufacturing (CAD/CAM) or casted bar. At the last follow-up, 10 implants failed in eight patients. Statistical significance was found for failed prostheses (P = 0.0723) and complications (P = 0.0165), with better values for splinted implants. No statistically significant differences were found in proportion of implant and prosthetic failure (P > 0.05). At a five-year follow-up, proportion of complications (P = 0.0289) and failed prostheses (P = 0.0069) were statistically higher for IOV on Locator attachments. No difference was founded in MBL at one- and two-year follow-up between different attachment systems (P > 0.05). Statistically significant improvement in all the OHIP categories was reported in all the patients, after one year of function. CONCLUSIONS: Implant overdenture showed high implant and prosthetic survival rates, low complications, high patient satisfaction, and good biological parameters in the long-term follow-up. Splinting the implants may reduce number of mechanical complications. Locator attachments showed higher number of complications. Further studies are needed to confirm these preliminary results.

Maxillary Sinus Lift Using Autologous Periosteal Micrografts: A New Regenerative Approach and a Case Report of a 3-Year Follow-Up.

This case report discusses about an innovative bone regeneration method that involves the use of autologous periosteal micrografts, which were used for a maxillary sinus floor lift in a 52-year-old female patient. This method allows for harvesting of a graft that is to be seeded on a PLGA scaffold and involves collection of a very little amount of palatal periosteal tissue in the same surgical site after elevation of a flap and disaggregation of it by using a Rigenera® filter. Histological samples collected at the time of implant installation demonstrate a good degree of bone regeneration. The clinical and radiographic outcomes at the 3-year follow-up visit showed an adequate stability of hard and soft tissues around the implants. This report demonstrates the possibility to obtain a sufficient quality and quantity of bone with a progenitor cell-based micrograft and in turn make the site appropriate for an implant-supported rehabilitation procedure, with stable results over a period of two years.

Geometric distortion of panoramic reconstruction in third molar tilting assessments: a comprehensive evaluation.

OBJECTIVES:: To evaluate the geometric distortion of tilting of mandibular third molars with respect to second molars on panoramic reconstruction. METHODS:: Cone-beam CT (CBCT) reconstructions of 160 third molars, obtained due to an indication of risk of inferior alveolar nerve damage during surgery, were used. CBCT-reconstructed panoramic images were used as bi-dimensional (2D) images, to avoid distortions other than geometric distortions. The angle between the second and the third molar was measured in 2D and three-dimensional (3D) images. Student's t-test was used to assess the null-hypothesis of no difference between 2D and 3D measurements. RESULTS:: A significant mean difference (-2.3° ± 6.3°) between 2D and 3D measurements was found, with an absolute error of 3.6° ± 5.7° and a relative error of 10%. These findings comprehensively explain the geometric distortion on panoramic radiographs. CONCLUSIONS:: Although a widely used and undoubtedly useful tool for diagnosis and surgical planning of mandibular third molar extractions, panoramic reconstruction are biased from geometric distortion that may influence surgical planning.

Evaluation of Poly(Lactic-co-glycolic) Acid Alone or in Combination with Hydroxyapatite on Human-Periosteal Cells Bone Differentiation and in Sinus Lift Treatment.

Most recent advances in tissue engineering in the fields of oral surgery and dentistry have aimed to restore hard and soft tissues. Further improvement of these therapies may involve more biological approaches and the use of dental tissue stem cells in combination with inorganic/organic scaffolds. In this study, we analyzed the osteoconductivity of two different inorganic scaffolds based on poly (lactic-co-glycolic) acid alone (PLGA-Fisiograft) or in combination with hydroxyapatite (PLGA/HA-Alos) in comparison with an organic material based on equine collagen (PARASORB Sombrero) both in vitro and in vivo. We developed a simple in vitro model in which periosteum-derived stem cells were grown in contact with chips of these scaffolds to mimic bone mineralization. The viability of cells and material osteoconductivity were evaluated by osteogenic gene expression and histological analyses at different time points. In addition, the capacity of scaffolds to improve bone healing in sinus lift was examined. Our results demonstrated that the osteoconductivity of PLGA/HA-Alos and the efficacy of scaffolds in promoting bone healing in the sinus lift were increased. Thus, new clinical approaches in sinus lift follow-up should be considered to elucidate the clinical potential of these two PLGA-based materials in dentistry.

Autologous Periosteum-Derived Micrografts and PLGA/HA Enhance the Bone Formation in Sinus Lift Augmentation.

Sinus lift augmentation is a procedure required for the placement of a dental implant, whose success can be limited by the quantity or quality of available bone. To this purpose, the first aim of the current study was to evaluate the ability of autologous periosteum-derived micrografts and Poly(lactic-co-glycolic acid) (PLGA) supplemented with hydroxyl apatite (HA) to induce bone augmentation in the sinus lift procedure. Secondly, we compared the micrograft's behavior with respect to biomaterial alone, including Bio-Oss® and PLGA/HA, commercially named Alos. Sinus lift procedure was performed on 24 patients who required dental implants and who, according to the study design and procedure performed, were divided into three groups: group A (Alos + periosteum-derived micrografts); group B (Alos alone); and group C (Bio-Oss® alone). Briefly, in group A, a small piece of periosteum was collected from each patient and mechanically disaggregated by Rigenera® protocol using the Rigeneracons medical device. This protocol allowed for the obtainment of autologous micrografts, which in turn were used to soak the Alos scaffold. At 6 months after the sinus lift procedure and before the installation of dental implants, histological and radiographic evaluations in all three groups were performed. In group A, where sinus lift augmentation was performed using periosteum-derived micrografts and Alos, the bone regeneration was much faster than in the control groups where it was performed with Alos or Bio-Oss® alone (groups B and C, respectively). In addition, the radiographic evaluation in the patients of group A showed a radio-opacity after 4 months, while after 6 months, the prosthetic rehabilitation was improved and was maintained after 2 years post-surgery. In summary, we report on the efficacy of periosteum-derived micrografts and Alos to augment sinus lift in patients requiring dental implants. This efficacy is supported by an increased percentage of vital mineralized tisssue in the group treated with both periosteum-derived micrografts and Alos, with respect to the control group of Alos or Bio-Oss® alone, as confirmed by histological analysis and radiographic evaluations at 6 months from treatment.

Emerging Perspectives in Scaffold for Tissue Engineering in Oral Surgery.

Bone regeneration is currently one of the most important and challenging tissue engineering approaches in regenerative medicine. Bone regeneration is a promising approach in dentistry and is considered an ideal clinical strategy in treating diseases, injuries, and defects of the maxillofacial region. Advances in tissue engineering have resulted in the development of innovative scaffold designs, complemented by the progress made in cell-based therapies. In vitro bone regeneration can be achieved by the combination of stem cells, scaffolds, and bioactive factors. The biomimetic approach to create an ideal bone substitute provides strategies for developing combined scaffolds composed of adult stem cells with mesenchymal phenotype and different organic biomaterials (such as collagen and hyaluronic acid derivatives) or inorganic biomaterials such as manufactured polymers (polyglycolic acid (PGA), polylactic acid (PLA), and polycaprolactone). This review focuses on different biomaterials currently used in dentistry as scaffolds for bone regeneration in treating bone defects or in surgical techniques, such as sinus lift, horizontal and vertical bone grafts, or socket preservation. Our review would be of particular interest to medical and surgical researchers at the interface of cell biology, materials science, and tissue engineering, as well as industry-related manufacturers and researchers in healthcare, prosthetics, and 3D printing, too.

Differences between panoramic and Cone Beam-CT in the surgical evaluation of lower third molars.

BACKGROUND: The aim of this study was to evaluate the ability to identify the contiguity between the root of the mandibular third molar and the mandibular canal (MC) in panoramic radiographs compared with Cone Beam-CT. MATERIAL AND METHODS: Panoramic radiographs of 326 third molars and CBCT radiographs of 86 cases indicated for surgery and considered at risk were evaluated. The following signs were assessed in panoramic radiographs as risk factors: radiolucent band, loss of MC border, change in MC direction, MC narrowing, root narrowing, root deviation, bifid apex, superimposition, and contact between the root third molar and the MC. RESULTS: Radiographic signs associated with absence of MC cortical bone are: radiolucent band, loss of MC border, change in MC direction, and superimposition. The number of risk factors was significantly increased with an increasing depth of inclusion. CBCT revealed a significant association between the absence of MC cortical bone and a lingual or interradicular position of the MC. CONCLUSIONS: In cases in which panoramic radiographs do not exclude contiguity between the MC and tooth, careful assessment the signs and risks on CBCT radiographs is indicated for proper identification of the relationships between anatomic structures. Key words:Panoramic radiography, Cone-Beam computed tomography, third molar, mandibular nerve.