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Atieh MA, Shah M, Hakam A, AlAli F, Aboushakra I, Alsabeeha NHM. Alveolar ridge preservation versus early implant placement in single non-molar sites: A systematic review and meta-analysis. Clin Oral Implants Res 2024; 35:1055-1071. [PMID: 38850092 DOI: 10.1111/clr.14314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/16/2024] [Accepted: 05/26/2024] [Indexed: 06/09/2024]
Abstract
OBJECTIVES The aim of this systematic review and meta-analyses was to evaluate the outcomes of alveolar ridge preservation (ARP) following extraction of non-molar teeth in comparison to early implant placement (EIP) in terms of clinical and radiographic changes, need for additional augmentation at the time of implant placement, patient-reported outcomes, and implant failure rate. METHODS Electronic databases were searched to identify randomized and non-randomized studies that compared ARP to EIP. The risk of bias was assessed using the Cochrane Collaboration's Risk of Bias tool. Data were analyzed using a statistical software program. RESULTS A total of 106 studies were identified, of which five studies with 198 non-molar extraction sockets in 198 participants were included. Overall meta-analysis showed significant differences in changes in midfacial mucosal margin (mean difference (MD) -0.09; 95% confidence interval (CI) -0.17 to -0.01; p = .03) and ridge width (MD -1.70; 95% CI -3.19 to -0.20; p = .03) in favor of ARP. The use of ARP was also associated with less need for additional augmentation at implant placement, but the difference was not statistically significant. CONCLUSIONS Within the limitation of this review, ARP following extraction of non-molar teeth has short-term positive effects on soft tissue contour, mucosal margin and thickness, and alveolar ridge width and height. It can also simplify future implant treatment by minimizing the need for additional augmentation.
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Affiliation(s)
- Momen A Atieh
- Mohammed Bin Rashid University of Medicine and Health Sciences, Hamdan Bin Mohammed College of Dental Medicine, Dubai Healthcare City, Dubai, United Arab Emirates
- Faculty of Dentistry, Sir John Walsh Research Institute, University of Otago, Dunedin, New Zealand
- School of Dentistry, University of Jordan, Amman, Jordan
| | - Maanas Shah
- Mohammed Bin Rashid University of Medicine and Health Sciences, Hamdan Bin Mohammed College of Dental Medicine, Dubai Healthcare City, Dubai, United Arab Emirates
| | - Abeer Hakam
- Mohammed Bin Rashid University of Medicine and Health Sciences, Hamdan Bin Mohammed College of Dental Medicine, Dubai Healthcare City, Dubai, United Arab Emirates
| | - Fawaghi AlAli
- Mohammed Bin Rashid University of Medicine and Health Sciences, Hamdan Bin Mohammed College of Dental Medicine, Dubai Healthcare City, Dubai, United Arab Emirates
| | - Ibrahim Aboushakra
- Mohammed Bin Rashid University of Medicine and Health Sciences, Hamdan Bin Mohammed College of Dental Medicine, Dubai Healthcare City, Dubai, United Arab Emirates
| | - Nabeel H M Alsabeeha
- Department of Dental Services, Emirates Health Services, Dubai, United Arab Emirates
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Zuiderveld EG, Meijer HJA, Gareb B, Vissink A, Raghoebar GM. Single immediate implant placement in the maxillary aesthetic zone with and without connective tissue grafting: Results of a 5-year randomized controlled trial. J Clin Periodontol 2024; 51:487-498. [PMID: 38228860 DOI: 10.1111/jcpe.13918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/29/2023] [Accepted: 12/02/2023] [Indexed: 01/18/2024]
Abstract
AIM To assess the 5-year effects of grafting connective tissue while undertaking single immediate implant placement and provisionalization at the mid-buccal mucosa level (MBML). Secondary outcomes were buccal bone wall thickness (BBT), marginal bone level (MBL) and patient satisfaction. MATERIALS AND METHODS Sixty patients with a single failing tooth in the maxillary anterior region were provided with an immediately placed and provisionalized implant. At implant placement, the patients randomly received either a connective tissue graft from the maxillary tuberosity (n = 30, test group) or no graft (n = 30, control group). The alveolar socket classification was mainly Type 2A. Data were collected before removing the failing tooth (T0 ), and at 1 (T1 ), 12 (T12 ) and 60 (T60 ) months after final crown placement. The primary outcome was the change in MBML compared with the pre-operative situation. Additionally, the change in BBT, MBL, aesthetics (using the Pink Aesthetic Score-White Aesthetic Score), soft-tissue peri-implant parameters and patient satisfaction were assessed. RESULTS At the 5-year follow-up, 27 patients could be analysed from each group. In each group, one implant was lost during the osseointegration period, within 3 months of placement, resulting in an implant survival rate of 96.7% in both groups. MBML change at T60 was -0.6 (-1.1 to -0.1) mm in the control group and 0.1 (-0.4 to 0.5) mm in the test group (p = .008). BBT and MBL, aesthetics, soft-tissue peri-implant parameters and patient satisfaction showed stable results and satisfied patients, without clinically relevant differences between the groups. CONCLUSIONS This 5-year follow-up study shows that grafting connective tissue when replacing a single failing tooth with immediately placed and provisionalized implant results in favourable peri-implant tissues and fewer MBML changes.
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Affiliation(s)
- Elise G Zuiderveld
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Henny J A Meijer
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Prosthodontics, Center for Dentistry and Oral Hygiene, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Barzi Gareb
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gerry M Raghoebar
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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El Ebiary SO, Atef M, Abdelaziz MS, Khashaba M. Guided immediate implant with and without using a mixture of autogenous and xeno bone grafts in the dental esthetic zone. A randomized clinical trial. BMC Res Notes 2023; 16:331. [PMID: 37957760 PMCID: PMC10644537 DOI: 10.1186/s13104-023-06612-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 11/03/2023] [Indexed: 11/15/2023] Open
Abstract
PURPOSE This in vivo study aims to assess the pink esthetic score in the anterior maxilla after computer-guided immediate implant installation and fully digital immediate temporalization with and without grafting the jumping gap with a mixture of 1:1 autogenous and xenograft particulates. MATERIALS AND METHODS Twenty-four patients with non-restorable upper anterior teeth in the aesthetic zone have undergone a traumatic extraction for the non-restorable tooth followed by immediate implant placement using a 3D-printed surgical guide according to prosthetically driven implant placement. The patients were divided into two groups. The study group received the dental implant after grafting the jumping gap with 1:1 autogenous and xenograft particulates, while the control group received the dental implant without grafting the jumping gap. Each patient received a digitally fabricated, immediate, nonfunctional temporary prosthesis. The esthetic outcome was compared between the two groups using the pink esthetic score at implant insertion and after 6 months of follow-up. Statistical comparisons were carried out between the studied groups using the Mann-Whitney U test. RESULTS Immediately postoperatively, there was no statistically significant difference between the median PES in the two groups (P-value = 0.746). After six months, the study group showed a statistically significantly higher median PES than the control group (P-value = 0.048). CONCLUSIONS Grafting the jumping distance in the immediate implant protocol helps achieve a better esthetic outcome. CLINICAL RELEVANCE The use of immediate guided implant placement along with grafting the jumping gap followed by immediate digital temporalization guarantees a better esthetic outcome while preserving time, cost, and the number of clinical visits. TRIAL REGISTRATION The study was registered on clinicaltrials.gov with registration number NCT04096209. (19/9/2019).
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Affiliation(s)
- Sherine Osama El Ebiary
- Department of Prosthodontics, Faculty of Oral and Dental Medicine, Cairo University, Giza, Egypt
| | - Mohammed Atef
- Department of Oral and Maxillofacial Surgery, Faculty of Oral and Dental Medicine, Cairo University, Giza, Egypt
| | - Medhat Sameh Abdelaziz
- Department of Prosthodontics, Faculty of Oral and Dental Medicine, Future University in Egypt, Fifth Settlement, End of 90 street, New Cairo, Cairo, Egypt.
| | - Mohammed Khashaba
- Department of Oral and Maxillofacial Surgery, Faculty of Oral and Dental Medicine, Cairo University, Giza, Egypt
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Fischer KR, Solderer A, Arlt K, Heumann C, Liu CC, Schmidlin PR. Bone envelope for implant placement after alveolar ridge preservation: a systematic review and meta-analysis. Int J Implant Dent 2022; 8:56. [PMID: 36477662 PMCID: PMC9729513 DOI: 10.1186/s40729-022-00453-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 10/17/2022] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To assess the dimensional establishment of a bony envelope after alveolar ridge preservation (ARP) with deproteinized bovine bone mineral (DBBM) in order to estimate the surgical feasibility of standard diameter implants placement without any additional augmentation methods. METHODS PubMed, Embase and CENTRAL databases were searched for suitable titles and abstracts using PICO elements. Inclusion criteria were as follows: randomized controlled trials (RCTs) comprising at least ten systemically healthy patients; test groups comprised placement of (collagenated) DBBM w/o membrane and control groups of no grafting, respectively. Selected abstracts were checked regarding their suitability, followed by full-text screening and subsequent statistical data analysis. Probabilities and number needed to treat (NNT) for implant placement without any further need of bone graft were calculated. RESULTS The initial database search identified 2583 studies. Finally, nine studies with a total of 177 implants placed after ARP with DBBM and 130 implants after SH were included for the quantitative and qualitative evaluation. A mean difference of 1.13 mm in ridge width in favour of ARP with DBBM could be calculated throughout all included studies (95% CI 0.28-1.98, t2 = 1-1063, I2 = 68.0%, p < 0.01). Probabilities for implant placement with 2 mm surrounding bone requiring theoretically no further bone augmentation ranged from 6 to 19% depending on implant diameter (3.25: 19%, RD = 0.19, C = 0.06-0.32, p < 0.01/4.0: 14%, RD = 0.14, C = 0.05-0.23, p < 0.01/5.0: 6%, RD = 0.06, C = 0.00-0.12, p = 0.06). CONCLUSION ARP employing DBBM reduces ridge shrinkage on average by 1.13 mm and improves the possibility to place standard diameter implants with up to 2 mm circumferential bone housing; however, no ARP would have been necessary or additional augmentative bone interventions are still required in 4 out of 5 cases.
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Affiliation(s)
- Kai R. Fischer
- grid.7400.30000 0004 1937 0650Clinic of Conservative & Preventive Dentistry, Division of Periodontology & Peri-Implant Diseases, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032 Zurich, Switzerland
| | - Alex Solderer
- grid.7400.30000 0004 1937 0650Clinic of Conservative & Preventive Dentistry, Division of Periodontology & Peri-Implant Diseases, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032 Zurich, Switzerland
| | - Kristina Arlt
- grid.7400.30000 0004 1937 0650Clinic of Conservative & Preventive Dentistry, Division of Periodontology & Peri-Implant Diseases, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032 Zurich, Switzerland
| | - Christian Heumann
- grid.5252.00000 0004 1936 973XDepartment of Statistics, Ludwig-Maximilian-University, Munich, Germany
| | - Chun Ching Liu
- grid.7400.30000 0004 1937 0650Clinic of Conservative & Preventive Dentistry, Division of Periodontology & Peri-Implant Diseases, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032 Zurich, Switzerland
| | - Patrick R. Schmidlin
- grid.7400.30000 0004 1937 0650Clinic of Conservative & Preventive Dentistry, Division of Periodontology & Peri-Implant Diseases, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032 Zurich, Switzerland
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Mangano C, Luongo G, Luongo F, Lerner H, Margiani B, Admakin O, Mangano F. Custom-made computer-aided-design/ computer-assisted-manufacturing (CAD/CAM) synthetic bone grafts for alveolar ridge augmentation: A retrospective clinical study with 3 years of follow-up. J Dent 2022; 127:104323. [PMID: 36241044 DOI: 10.1016/j.jdent.2022.104323] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/22/2022] [Accepted: 09/27/2022] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To report on the results obtained with computer-aided-design/ computer-assisted-manufacturing (CAD/CAM) custom-made synthetic hydroxyapatite/beta-tricalcium-phosphate (HA/beta-TCP) bone grafts in alveolar ridge augmentation for dental implant placement. METHODS The procedure included: (1) cone-beam computed tomography (CBCT) of the bone defect; (2) virtual design of the custom-made onlay bone grafts; (3) milling of grafts from a pre-formed block of synthetic HA/beta-TCP; and (4) bone reconstructive surgery. Implants were placed 8 months later. The patients were followed for 3 years. The study outcomes were: (1) intra- and immediate post-operative complications; (2) 8-month vertical and horizontal bone gain; (3) implant survival; (4) implant-crown success; and (5) peri-implant marginal bone loss (MBL). RESULTS Twenty-six patients underwent ridge augmentation with custom-made CAD/CAM HA/beta-TCP onlay grafts. Eight months later, these patients were rehabilitated with dental implants. During surgery, 25/26 (96.1%) of the grafts adapted well to the bone defect. Immediate post-operative complications were pain and swelling (2/26 patients: 7.6%), and bone graft exposure (3/26: 11.5%); one exposure led to infection, removal of the graft, and failure of the procedure. Excellent integration of the other grafts was observed 8 months after the regenerative procedure, with mean vertical and horizontal bone gains of 2.10 mm (± 0.35) and 2.96 mm (± 0.45), respectively. Twenty-five implants were placed and restored with single crowns. Three years later, all implants were in function. The 3-year implant crown success rate and peri-implant MBL were 92.0% and 0.7 mm (±0.19), respectively. CONCLUSIONS With custom-made CAD/CAM synthetic HA/beta-TCP onlay grafts reconstruction of small vertical and/or horizontal defects of the alveolar ridge was obtained; this enabled implant placement, with high implant-crown success rate after 3 years. Further studies are needed to validate this technique. STATEMENT OF CLINICAL RELEVANCE Custom-made CAD/CAM synthetic HA/beta-TCP onlay grafts may represent an option for regeneration of small bone defects prior to implant placement.
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Affiliation(s)
| | | | | | - Henriette Lerner
- Academic Teaching and Research Institution of Johann Wolfgang Goethe University, Frankfurt, Germany.
| | - Bidzina Margiani
- Department of Department of Pediatric, Preventive Dentistry and Orthodontics, Sechenov First State Medical University, Moscow, Russia.
| | - Oleg Admakin
- Department of Department of Pediatric, Preventive Dentistry and Orthodontics, Sechenov First State Medical University, Moscow, Russia.
| | - Francesco Mangano
- Department of Department of Pediatric, Preventive Dentistry and Orthodontics, Sechenov First State Medical University, Moscow, Russia.
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Chandran S, Sers L, Picciocchi G, Luongo F, Lerner H, Engelschalk M, Omar S. Guided implant surgery with R2Gate®: A multicenter retrospective clinical study with 1 year of follow-up. J Dent 2022; 127:104349. [PMID: 36283626 DOI: 10.1016/j.jdent.2022.104349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/18/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To present the results obtained with a novel sleeveless and keyless guided implant surgery system. METHODS Inclusion criteria for this multicenter clinical retrospective study were fully or partially edentulous patients who had been treated with a sleeveless and keyless guided implant surgery system (R2Gate®, Megagen), and who had been rehabilitated with fixed restorations, with a minimum follow-up of 1 year. All surgeries and prosthetic procedures were conducted following the same protocol, and data were obtained from the patients' medical records. The outcomes were the fit and stability of the surgical guide, any intra-operative and immediate post-operative complications, any biologic and prosthetic complications that occurred during the 1-year follow-up period, implant survival, and prosthetic success. RESULTS Sixty patients were selected for the installation of 124 implants, through a guided procedure: 66 sleeveless, keyless surgical guides were manufactured. The incidence of immediate intra-operative (lack of space: 12.1%; lack of implant stability 2.6%) and immediate post-operative (pain and discomfort: 6.6%; mild swelling 3.3%) complications was low. In total, 112/124 implants (90.3%) were successfully placed with a guided procedure, in 52 patients; among them, 82 (73.2%) were placed with a flapless procedure. Thirty fixtures supported single crowns (SCs), 42 fixed partial dentures (FPDs) and 52 full-arch (FA) restorations. Sixty-two fixed prosthetic restorations (30 SCs, 22 FPDs and 10 FAs) were delivered; among these restorations, 15 (24.1%) were subjected to immediate functional loading. All implants (100%) survived. Two implants had peri‑implant mucositis (1.6%), two SCs had abutment screw loosenings (1.6%), two FAs and one FPD had ceramic chipping/fracture (2.4%), for an overall prosthetic success amounting to 88.7%. CONCLUSIONS Within the limits of this study, this novel guided surgery system appeared to be clinically reliable; further studies are needed to confirm these results. STATEMENT OF CLINICAL RELEVANCE The use of sleveless and keyless surgical guides can be clinically reliable and may be represent a valid option for the surgeon.
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Affiliation(s)
- Segin Chandran
- Research Fellow, Santosh University, No.1 Santosh Nagar, Pratap Vihar, Ghaziabad, Uttar Pradesh 201009, India
| | - Laurent Sers
- Private Practitioner, 54 Rue d'Antibes, Cannes 06400, France
| | - Guido Picciocchi
- Private Practitioner, via Brigata Liguria 3, Genova 16121, Italy
| | | | - Henriette Lerner
- Department of Oral, Maxillofacial and Plastic Surgery, Goethe University, Frankfurt, Germany
| | | | - Sam Omar
- Private Practitioner, OneDay Clinic, Shalz Mall, G2C4 2nd floor, El Sheikh Zayed City 7th District, Mogawra 2, Giza, Governorate 12593, Egypt; OneDay Digital Academy, Shalz Mall, G2C13 2nd Floor, El Sheikh Zayed City 7th District, Mogawra 2, Giza, Governorate 12593, Egypt.
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YU XINBO, TENG FEI, ZHAO ANDA, WU YIQUN, YU DEDONG. EFFECTS OF POST-EXTRACTION ALVEOLAR RIDGE PRESERVATION VERSUS IMMEDIATE IMPLANT PLACEMENT: A SYSTEMATIC REVIEW AND META-ANALYSIS. J Evid Based Dent Pract 2022; 22:101734. [DOI: 10.1016/j.jebdp.2022.101734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 04/02/2022] [Accepted: 04/19/2022] [Indexed: 10/18/2022]
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Pitman J, Seyssens L, Christiaens V, Cosyn J. Immediate implant placement with or without immediate provisionalization: a systematic review and meta-analysis. J Clin Periodontol 2022; 49:1012-1023. [PMID: 35734911 DOI: 10.1111/jcpe.13686] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/05/2022] [Accepted: 06/15/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To assess the effect of immediate provisionalization (IP) on soft tissue changes, hard tissue changes and clinical parameters following single immediate implant placement (IIP). MATERIALS AND METHODS Two independent reviewers conducted an electronic literature search in Pubmed, Web of Science, Embase and Cochrane databases as well as a manual search to identify eligible clinical studies up to September 2021. Randomized Controlled Trials (RCTs) comparing IIP with IP (test) to IIP without IP (control) were included for a qualitative and quantitative analysis. The primary outcome was vertical midfacial soft tissue changes. Secondary outcomes included horizontal midfacial soft tissue changes, implant survival, mesial and distal papillary changes, Pink Esthetic Score (PES) at final follow-up, marginal bone level changes, probing depth at final follow-up, and bleeding on probing at final follow-up. RESULTS Out of 8213 records, 7 RCTs were selected reporting on 323 patients who received 323 single immediate implants (IIP + IP: 161 implants in 161 patients; IIP: 162 implants in 162 patients) with a mean follow-up ranging from 12 to 60 months. Risk of bias assessment yielded some concerns for 5 RCTs and high risk for 2 RCTs. Meta-analysis on the cases with intact alveoli demonstrated 0.87 mm (95 % CI [0.57; 1.17], p < 0.001) less apical migration of the midfacial soft tissue level for IIP + IP when compared to IIP alone. Implant survival, papillary changes, marginal bone level changes, probing depth and bleeding on probing were not significantly affected by IP. Insufficient data were available for meta-analyses on horizontal midfacial soft tissue changes and PES. CONCLUSION IP may contribute to midfacial soft tissue stability at immediate implants. However, high-quality RCTs are needed since the strength of this conclusion is currently rated as low according to GRADE guidelines. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Jeremy Pitman
- Ghent University, Faculty of Medicine and Health Sciences, Oral Health Sciences, Department of Periodontology and Oral Implantology, C. Heymanslaan 10, Ghent, Belgium
| | - Lorenz Seyssens
- Ghent University, Faculty of Medicine and Health Sciences, Oral Health Sciences, Department of Periodontology and Oral Implantology, C. Heymanslaan 10, Ghent, Belgium
| | - Véronique Christiaens
- Ghent University, Faculty of Medicine and Health Sciences, Oral Health Sciences, Department of Periodontology and Oral Implantology, C. Heymanslaan 10, Ghent, Belgium
| | - Jan Cosyn
- Ghent University, Faculty of Medicine and Health Sciences, Oral Health Sciences, Department of Periodontology and Oral Implantology, C. Heymanslaan 10, Ghent, Belgium
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