Cytokine, chemokine, and growth factor levels in peri‐implant sulcus during wound healing and osseointegration after piezosurgical versus conventional implant site preparation: Randomized, controlled, split‐mouth trial

One-time definitive attachment connection versus healing abutment placement for an implant-retained mandibular overdenture: Peri-implant metabolic activity

STATEMENT OF PROBLEM

Unscrewing the healing abutment can affect the soft tissue integration and apical migration of the biological width, which may compromise the integrity of peri-implant soft tissue.

PURPOSE

The purpose of this clinical study was to determine the level of glycosaminoglycan (GAG) detected in the peri-implant crevicular fluid (PICF) between the test group (1-time abutment) and control group (healing abutment) for implant-retained mandibular overdentures.

MATERIAL AND METHODS

Two dental implants were installed in the canine regions of the mandibular ridge of 18 healthy completely edentulous participants using 2-stage surgery and a delayed loading protocol. At the second stage surgery, the implant on the right side was exposed, and a healing abutment was screwed onto the implant (control group), while on the left side the definitive ball abutment was screwed onto the implant (test group). After 10 days, the healing abutment in the control group was unscrewed and replaced with the definitive ball abutment. For both groups, the ball attachment was directly picked up to incorporate the attachment house to the mandibular denture. PICF samples were collected from the participants at 7 days, 3 months, and 6 months after overdenture use. Statistical analysis was done with an independent samples t test (α=.05).

RESULTS

A significant difference was found in the volume of PICF and the level of GAG between the test and control groups at the 7-day evaluation period (P=.008, P=.002, respectively), while the volumes of PICF and the levels of GAG were not significantly different (P>.05) at the other evaluation periods.

CONCLUSIONS

The 1-time abutment protocol offers biochemical and economic advantages compared with the conventional method of using the healing abutment before placement of the definitive attachment for an implant-retained overdenture with single attachments.

Evaluation of implant site preparation with piezosurgery versus conventional drills in terms of operation time, implant stability and bone density (randomized controlled clinical trial- split mouth design)

BACKGROUND

The preparation of the implant bed has a major influence on the success rate and long-term survival of dental implants. Piezoelectric devices and special implant drilling inserts are now emerging to replace conventional drills showing improved bone response and healing around implants. The purpose of this study is to compare the piezoelectric inserts versus the traditional drills for implant site preparation.

METHODS

Twelve male patients who received a total of twenty-four dental implants have been selected to participate in this split-mouth clinical trial. Each patient received two implants; one installed after piezosurgery assisted osteotomy, while the contralateral side received the implant with the original drilling protocol. The timing of surgery, implant stability, and bone density around the installed dental implants have been evaluated during a follow-up period extended to 4 months.

RESULTS

a significant difference in terms of time of surgery (p < 0.005) and in implant stability at 4 months (p = 0.024) on the study side, while a non-statistical significance in terms of bone density was detected (p = 0.468).

CONCLUSION

The piezoelectric implant site drilling protocol seemed to be a reliable and repeatable technique. Despite the limited sample size and lengthier operative time, the piezoelectric inserts enhanced bone quality and implant stability. Clinical trial registration Current Controlled Trials (ClinicalTrials.gov) https://clinicaltrials.gov/ct2/show/NCT05512273 ; the date of registration: 23/08/2022. Retrospectively registered.

Piezoelectric tools versus traditional oscillating saw for distal linear osteotomy in hallux valgus correction: Triple-blinded, randomized controlled study

BACKGROUND

The main goal of the surgical correction of the hallux valgus is the morphological correction associated with the functional rebalancing of the first ray. The aim of this triple-blinded, randomized controlled study was to show the efficacy of piezosurgery in performing distal linear osteotomy of the first metatarsal bone in HV correction, in terms of clinical and radiological outcomes at 1-year final follow up.

METHODS AND MATERIALS

This study was performed collecting prospectively pre-operative and post-operative data for all patients. 34 patients were included in the trial and were randomly allocated (1:1) in a Piezoelectric Group (PG) that involved the use of piezoelectric tools and in a Control Group (CG) that provided for the use of a traditional oscillating saw. In both groups, all patients were treated with a distal linear osteotomy of the first metatarsal bone. Clinical and radiographic assessments were performed.

RESULTS

The AOFAS score between the two groups was similar pre-operatively and during the follow-up period, with a slight superiority in the PG at each evaluation. The osteotomy surgical time was registered for both groups. Among the endpoints of the study, the radiological bone healing time was independently assessed by a radiologist that reported a lower mean value in the piezoelectric group compared with the control group.

CONCLUSIONS

This trial has shown that piezoelectric surgery is not inferior to traditional methods from the clinical-functional point of view, but can even lead to an evident reduction of bone healing time with a statistical significance.

LEVEL OF EVIDENCE

Level I.

Necrotizing Gingivitis: Microbial Diversity and Quantification of Protein Secretion in Necrotizing Gingivitis

Necrotizing gingivitis (NG) is a necrotizing periodontal disease that differs from chronic gingivitis (CG). To date, both the microbiological causes and the involved host cytokine response of NG still remain unclear. Here, we investigated corresponding interdental plaque and serum samples from two groups of Chinese patients with CG (n = 21) or NG (n = 21). The microbiota were studied by 16S rRNA Illumina MiSeq sequencing of the microbial metagenome and by assessing quantitatively the abundance of the phylum Bacteroidetes, the genus Prevotella and the species T. forsythia, P. endodontalis, and P. gingivalis using fluorescence in situ hybridization (FISH). With respect to the associated host response, the levels of 30 inflammatory mediators were quantified by multiplex immunoassay analysis. Differential microbial abundance analysis of the two disease groups revealed at the phylum level that Proteobacteria accounted for 67% of the differentially abundant organisms, followed by organisms of Firmicutes (21%) and Actinobacteria (9%). At the species level, significant differences in abundance were seen for 75 species of which 58 species were significantly more abundant in CG patients. Notably, the FISH analysis revealed that Bacteroidetes was the most prevalent phylum in NG. The multiplex cytokine assay showed significant quantitative differences between the disease groups for eight analytes (GM–CSF, G–CSF, IFN–α, IL–4, IL–13, TNF–α, MIG, and HGF). The G–CSF was found to be the most significantly increased inflammatory protein marker in NG. The next-generation sequencing (NGS) data supported the understanding of NG as a multi-microbial infection with distinct differences to CG in regard to the microbial composition.

The effect of new anti-adhesive and antibacterial dental resin filling materials on gingival fibroblasts

OBJECTIVE

Aim of this study was to evaluate the biocompatibility of four experimental antiadhesive and antibacterial dental filling composites on human gingival fibroblasts (HGFs).

METHODS

For these experimental resin composites a delivery system based on novel polymeric hollow beads, loaded with Tego Protect (Aa1), Dimethicone (Aa2), Irgasan (Ab1) and methacrylated polymerizable Irgasan (Ab2) as active agents was used. The cultured HGFs' cell integrity, proliferation, viability, collagen synthesis and cytokine release were measured. For this purpose, human gingival fibroblasts were treated with eluates from all four composites and compared with an experimental standard composite (ST). Eluate extraction times 24 h and 168 h were chosen.

RESULTS

Statistical analysis was conducted via a mixed model. Both antibacterial composites reduced proliferation, collagen and cytokine synthesis significantly (p < 0.05), increasing with time of elution. Ab1 did also have a damaging effect on the membrane and on cell viability.

SIGNIFICANCE

Overall, it can be concluded that the antiadhesive composites showed clear advantages over the antibacterial composites in terms of biocompatibility. This study also continues to show the potential of the new poly-pore system, as it can be used for a variety of other applications in future composite mixtures.

Stability and marginal bone loss in implants placed using piezoelectric osteotomy versus conventional drilling: systematic review and meta-analysis

Background

The main objective of this systematic review was to compare primary and secondary implant stability between placement with piezoelectric osteotomy and conventional drilling, comparing marginal bone losses as a secondary objective.

Material and Methods

An electronic search was conducted using PubMed (MEDLINE), Scopus, and Cochrane Library (Wiley) databases, besides a manual search.

Results

A total of 153 articles were retrieved, 39 from Pubmed, 44 from Scopus, and 70 from the Cochrane Library. After removing duplicates, 112 articles (1 from the manual search) were screened, and 9 were finally selected for qualitative and statistical analyses.

Conclusions

Piezoelectric surgery is a predictable alternative to conventional drilling for dental implant placement. Medium/long-term survival rates and marginal bone losses are similar between piezoelectric osteotomy and conventional drilling, and there is no difference in ISQ values for primary stability. However, implants placed with ultrasound showed a lower decrease in implant stability quotient (ISQ) during the osseointegration period and a higher ISQ value for secondary stability. This study contributes further information on peri-implant bone tissue at 3 and 6 months after implant placement with piezoelectric osteotomy or conventional drilling and provides an updated meta-analysis of comparative studies.

Key words:Piezosurgery, piezoelectric surgery, conventional drill, implant site preparation, dental implant, implant stability, marginal bone loss.

Healthcare Challenges and Future Solutions in Dental Practice: Assessing Oral Antibiotic Resistances by Contemporary Point-Of-Care Approaches

Antibiotic resistance poses a global threat, which is being acknowledged at several levels, including research, clinical implementation, regulation, as well as by the World Health Organization. In the field of oral health, however, the issue of antibiotic resistances, as well as of accurate diagnosis, is underrepresented. Oral diseases in general were ranked third in terms of expenditures among the EU-28 member states in 2015. Yet, the diagnosis and patient management of oral infections, in particular, still depend primarily on empiric means. On the contrary, on the global scale, the field of medical infections has more readily adopted the integration of molecular-based systems in the diagnostic, patient management, and antibiotic stewardship workflows. In this perspective review, we emphasize the clinical significance of supporting in the future antibiotic resistance screening in dental practice with novel integrated and point-of-care operating tools that can greatly support the rapid, accurate, and efficient administration of oral antibiotics.

Healing at implants installed in osteotomies prepared either with a piezoelectric device or drills: an experimental study in dogs

OBJECTIVE

To compare osseointegration and marginal bone level at implants placed in osteotomies prepared with either conventional drills or a piezoelectric device.

MATERIAL AND METHODS

Three months after the extraction of all mandibular premolars and first molars, two recipient sites were selected. The osteotomies were randomly prepared with either conventional drills (drill sites) or a piezoelectric device (piezoelectric sites). Implants were installed and a submerged healing was allowed. The animals were euthanized in groups of six after 4 and 8 weeks of healing. Biopsies were obtained for histological preparation. Coronal level of osseointegration (bone level) and bone-to-implant contact percentage (BIC%) were evaluated.

RESULTS

After 4 weeks of healing, the bone level was 0.6 ± 0.9 mm for the piezoelectric sites and 1.6 ± 0.7 mm for the drill sites (p = 0.173). After 8 weeks, the respective measures were 0.9 ± 0.3 mm and 1.0 ± 1.1 mm (p = 0.917). After 4 weeks of healing, a new bone apposed onto the implant surface was found at fractions of 54.9 ± 6.7% and 55.1 ± 16.6% for the piezoelectric and the drill sites, respectively (p = 0.674). The respective total bone fractions, including new and old bone, was 64.0 ± 4.8% and 63.4 ± 20.4% (p = 0.917). After 8 weeks, a new bone increased to 67.4 ± 6.7% and 62.9 ± 12.5% for the piezoelectric and the drill sites, respectively (p = 0.463). The respective total bone fractions were 70.4 ± 5.5% and 67.8 ± 12.1% (p = 0.753).

CONCLUSIONS

The use of a piezoelectric device for implant site preparation is a safe procedure that allows a proper integration since the early periods of healing similar to that observed using conventional drills.