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Strauss FJ, Gil A, Smirani R, Rodriguez A, Jung R, Thoma D. The use of digital technologies in peri-implant soft tissue augmentation - A narrative review on planning, measurements, monitoring and aesthetics. Clin Oral Implants Res 2024; 35:922-938. [PMID: 38308466 DOI: 10.1111/clr.14238] [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: 09/03/2023] [Revised: 11/21/2023] [Accepted: 01/11/2024] [Indexed: 02/04/2024]
Abstract
OBJECTIVE To identify the different uses and modalities of digital technologies to diagnose, plan and monitor peri-implant soft tissue conditions and aesthetics. METHODS A comprehensive narrative review of pertinent literature was conducted, critically appraising key digital technologies that may assist peri-implant soft tissue augmentation and assessment. An electronic search on four databases including studies published prior to 1st July 2023 was performed and supplemented by a manual search. RESULTS Predominantly, tools such as cone beam computed tomography (CBCT), intraoral scanning (iOS), intraoral ultrasonography and digital spectrophotometry were commonly to assess and monitor peri-implant soft tissues. The main clinical and research applications included: (i) initial assessment of mucosal thickness, supra-crestal tissue height and keratinized mucosa width, (ii) evaluation of peri-implant soft tissue health and inflammation, (iii) monitoring profilometric changes and midfacial mucosal margin stability over time and (iv) aesthetic evaluation through colour assessment. While evidence for some digital tools may be limited, the integration of digital technologies into peri-implant soft tissue management holds great promise. These technologies offer improved precision, comfort and speed in assessment, benefiting both patients and clinicians. CONCLUSION As digital technologies progress, their full potential in peri-implant soft tissue augmentation and their value will become more evident with ongoing research. Embracing these innovations and their potential benefits is recommended to ensure that during progress in implant dentistry, patient care is not hindered.
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Affiliation(s)
- Franz Josef Strauss
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
- Department of Conservative Dentistry, Faculty of Dentistry, University of Chile, Santiago, Chile
| | - Alfonso Gil
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Rawen Smirani
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
- Univ. Bordeaux, INSERM, BioTis, U1026, Bordeaux, France
- CHU de Bordeaux, Service de Médecine Bucco-Dentaire, Bordeaux, France
| | - Amanda Rodriguez
- Department of Periodontics and Oral Medicine, Dental School, University of Michigan, Ann Arbor, Michigan, USA
| | - Ronald Jung
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Daniel Thoma
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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Mello HN, Bonadiman EA, Bruneli GL, Pitol GA, de-Azevedo-Vaz SL. Influence of CBCT filters and contrast adjustments on peri-implant buccal bone thickness measurement and blooming expression. Clin Oral Investig 2024; 28:315. [PMID: 38748313 DOI: 10.1007/s00784-024-05712-4] [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: 01/11/2024] [Accepted: 05/07/2024] [Indexed: 07/03/2024]
Abstract
OBJECTIVES To assess whether filter and contrast adjustments can improve the accuracy of CBCT in measuring the buccal bone thickness (BBT) adjacent to dental implants by reducing blooming artifacts. MATERIALS AND METHODS Homogeneous bone blocks with peri-implant BBT of 0.3 mm, 0.5 mm, and 1 mm were scanned using the Orthophos SL system. Three dentists measured the BBT in 234 CBCT scans under different settings of contrast adjustments and 'Sharpen' filter activation. Additionally, implant diameter measurements were taken to assess blooming artifact expression. The differences between tomographic and actual measurements of BBT and implant diameter [(CBCT - actual) * 100 / actual] were subjected to Mixed ANOVA (α = 0.05). RESULTS The group with the thinnest BBT (0.3 mm) had the greatest difference between tomographic and actual measurements (79.9% ± 29.0%). Conversely, the 0.5 mm (36.1% ± 38.4%) and 1 mm (29.4% ± 12.3%) groups exhibited lower differences (p < 0.05). 'Sharpen' filter activation reduced blooming expression since it resulted in a lower difference for implant diameter (p < 0.05), but it did not influence BBT measurements (p = 0.673). Contrast settings had no impact on BBT (p = 0.054) or implant diameter measurements (p = 0.079). CONCLUSION Although filter activation reduced blooming artifacts, neither filter nor contrast adjustments improved the accuracy of CBCT in measuring peri-implant BBT; actual BBT influenced this task. CLINICAL RELEVANCE When assessing the peri-implant buccal bone plate in the CBCT system studied, dental surgeons may find it beneficial to adjust contrast and apply filters according to their preferences, since such adjustments were found to have no adverse effects on the diagnostic accuracy of this task. The use of the 'Sharpen' filter may lead to improved representation of implant dimensions.
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Affiliation(s)
| | | | | | | | - Sergio Lins de-Azevedo-Vaz
- Dental Sciences Graduate Program, Federal University of Espírito Santo (UFES), Av. Marechal Campos 1468, Maruípe Vitória, ES, 29043900, Brazil.
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Lee D, Lee J, Seol YJ, Lee YM, Koo KT. Effect of polydeoxyribonucleotide on early bone formation in lateral bone augmentation with immediate implant placement: an experimental in vivo study. Sci Rep 2023; 13:16853. [PMID: 37803058 PMCID: PMC10558504 DOI: 10.1038/s41598-023-43213-8] [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: 02/27/2023] [Accepted: 09/21/2023] [Indexed: 10/08/2023] Open
Abstract
This study investigated early bone formation using collagenated biphasic calcium phosphate (CBCP) with or without polynucleotide (PDRN). Third (P3) or fourth (P4) premolars of six male beagle dogs were extracted and 5-mm-high dehiscence defects were created, followed by 3D-printed implant placement. The buccal bone defects were grafted with (i) CBCP and collagen membrane or (ii) CBCP soaked in polydeoxyribonucleotide (CBCP/PDRN) and collagen membrane. Samples of the experimental sites were harvested at 2- and 6-weeks post-surgery. The specimens were evaluated with radiologic and histomorphometric analysis. No significant differences were found between the CBCP and CBCP/PDRN groups in the micro-CT analysis at 2 or 6 weeks. No significant differences were observed in bone-to-implant contact (BIC) or bone area fraction occupancy (BAFO) in buccal augmented and lingual non-augmented areas. In the qualitative analysis, the new bone (NB) area and NB proportion in buccal augmented areas showed significantly higher values in the CBCP/PDRN group than in the CBCP group at 2 and 6 weeks. Peri-implant buccal dehiscence defects with immediate 3D-printed implant placement were corrected using a collagen membrane and CBCP or CBCP/PDRN. PDRN might have the potential to facilitate early bone formation with sufficient stability over time in dehiscence defects.
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Affiliation(s)
- Dongseob Lee
- Department of Periodontology, School of Dentistry and Dental Research Institute, Seoul National University and Seoul National University Dental Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
- National Dental Care Center for Persons with Special Needs, Seoul National University Dental Hospital, Seoul, 03080, Republic of Korea
| | - Jungwon Lee
- Department of Periodontology, School of Dentistry and Dental Research Institute, Seoul National University and Seoul National University Dental Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
- One-Stop Specialty Center, Seoul National University Dental Hospital, Seoul, 03080, Republic of Korea.
| | - Yang-Jo Seol
- Department of Periodontology, School of Dentistry and Dental Research Institute, Seoul National University and Seoul National University Dental Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
- Department of Periodontology, Seoul National University Dental Hospital, Seoul, 03080, Republic of Korea
| | - Yong-Moo Lee
- Department of Periodontology, School of Dentistry and Dental Research Institute, Seoul National University and Seoul National University Dental Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
- Department of Periodontology, Seoul National University Dental Hospital, Seoul, 03080, Republic of Korea
| | - Ki-Tae Koo
- Department of Periodontology, School of Dentistry and Dental Research Institute, Seoul National University and Seoul National University Dental Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
- Department of Periodontology, Seoul National University Dental Hospital, Seoul, 03080, Republic of Korea.
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Yu SH, Saleh MHA, Wang HL. Simultaneous or staged lateral ridge augmentation: A clinical guideline on the decision-making process. Periodontol 2000 2023; 93:107-128. [PMID: 37529966 DOI: 10.1111/prd.12512] [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: 01/29/2023] [Revised: 06/30/2023] [Accepted: 07/11/2023] [Indexed: 08/03/2023]
Abstract
Lateral ridge augmentation is a standard surgical procedure that can be performed prior to (staged) or simultaneously with implant placement. The decision between a simultaneous or staged approach involves considering multiple variables. This paper proposed a decision-making process that serves as a guideline for choosing the best treatment choice based on the available evidence and the author's clinical experience.
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Affiliation(s)
- Shan-Huey Yu
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
- Private Practice, Vienna, Virginia, USA
| | - Muhammad H A Saleh
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
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Calciolari E, Corbella S, Gkranias N, Viganó M, Sculean A, Donos N. Efficacy of biomaterials for lateral bone augmentation performed with guided bone regeneration. A network meta-analysis. Periodontol 2000 2023; 93:77-106. [PMID: 37752820 DOI: 10.1111/prd.12531] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/29/2023] [Accepted: 09/04/2023] [Indexed: 09/28/2023]
Abstract
Bone regeneration is often required concomitant with implant placement to treat a bone fenestration, a dehiscence, and for contouring. This systematic review assessed the impact of different biomaterials employed for guided bone regeneration (GBR) simultaneous to implant placement on the stability of radiographic peri-implant bone levels at ≥12 months of follow-up (focused question 1), as well as on bone defect dimension (width/height) changes at re-assessment after ≥4 months (focused question 2). Only randomized controlled trials (RCTs) and controlled clinical trials (CCTs) that compared different biomaterials for GBR were considered. A Bayesian network meta-analysis (NMA) was performed using a random-effects model. A ranking probability between treatments was obtained, as well as an estimation of the surface under the cumulative ranking value (SUCRA). Overall, whenever the biological principle of GBR was followed, regeneration occurred in a predictable way, irrespective of the type of biomaterial used. A lower efficacy of GBR treatments was suggested for initially large defects, despite the trend did not reach statistical significance. Regardless of the biomaterial employed, a certain resorption of the augmented bone was observed overtime. While GBR was shown to be a safe and predictable treatment, several complications (including exposure, infection, and soft tissue dehiscence) were reported, which tend to be higher when using cross-linked collagen membranes.
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Affiliation(s)
- Elena Calciolari
- Centre for Oral Clinical Research, Institute of Dentistry, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
- Dental School, Department of Medicine and Dentistry, Università di Parma, Parma, Italy
| | - Stefano Corbella
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
- IRCCS, Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Nikolaos Gkranias
- Centre for Oral Clinical Research, Institute of Dentistry, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Marco Viganó
- Medacta International SA, Castel San Pietro, Switzerland
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Nikolaos Donos
- Centre for Oral Clinical Research, Institute of Dentistry, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
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Donos N, Akcali A, Padhye N, Sculean A, Calciolari E. Bone regeneration in implant dentistry: Which are the factors affecting the clinical outcome? Periodontol 2000 2023; 93:26-55. [PMID: 37615306 DOI: 10.1111/prd.12518] [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: 02/10/2023] [Revised: 07/08/2023] [Accepted: 08/01/2023] [Indexed: 08/25/2023]
Abstract
The key factors that are needed for bone regeneration to take place include cells (osteoprogenitor and immune-inflammatory cells), a scaffold (blood clot) that facilitates the deposition of the bone matrix, signaling molecules, blood supply, and mechanical stability. However, even when these principles are met, the overall amount of regenerated bone, its stability over time and the incidence of complications may significantly vary. This manuscript provides a critical review on the main local and systemic factors that may have an impact on bone regeneration, trying to focus, whenever possible, on bone regeneration simultaneous to implant placement to treat bone dehiscence/fenestration defects or for bone contouring. In the future, it is likely that bone tissue engineering will change our approach to bone regeneration in implant dentistry by replacing the current biomaterials with osteoinductive scaffolds combined with cells and mechanical/soluble factors and by employing immunomodulatory materials that can both modulate the immune response and control other bone regeneration processes such as osteogenesis, osteoclastogenesis, or inflammation. However, there are currently important knowledge gaps on the biology of osseous formation and on the factors that can influence it that require further investigation. It is recommended that future studies should combine traditional clinical and radiographic assessments with non-invasive imaging and with patient-reported outcome measures. We also envisage that the integration of multi-omics approaches will help uncover the mechanisms responsible for the variability in regenerative outcomes observed in clinical practice.
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Affiliation(s)
- Nikolaos Donos
- Centre for Oral Clinical Research, Institute of Dentistry, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Aliye Akcali
- Centre for Oral Clinical Research, Institute of Dentistry, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
- Department of Periodontology, Faculty of Dentistry, Dokuz Eylul University, Izmir, Turkey
| | - Ninad Padhye
- Centre for Oral Clinical Research, Institute of Dentistry, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Elena Calciolari
- Centre for Oral Clinical Research, Institute of Dentistry, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
- Department of Medicine and Dentistry, Dental School, University of Parma, Parma, Italy
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7
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Strasding M, Jeong Y, Marchand L, Hicklin SP, Sailer I, Sun M, Lee H. Three-Dimensional Peri-Implant Tissue Changes in Immediately vs. Early Placed Tapered Implants Restored with Two Different Ceramic Materials-1 Year Results. MATERIALS (BASEL, SWITZERLAND) 2023; 16:5636. [PMID: 37629928 PMCID: PMC10456968 DOI: 10.3390/ma16165636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/19/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND A prospective multi-center randomized controlled clinical trial was performed to digitally analyze tissue volume changes in immediately and early placed implants with simultaneous bone augmentation restored with two different all-ceramic materials. METHODS A total of 60 patients received 60 bone-level tapered implants (BLT, Straumann AG) immediately (n = 30) or early placed, 8-10 weeks after tooth extraction, (n = 30). Implants were restored with all-ceramic single crowns fabricated out of zirconia (Lava Plus, 3M), or lithium disilicate (E.max CAD, Ivoclar Vivadent AG) bonded to titanium base abutments (Variobase for Cerec, Straumann AG). Impressions were taken at baseline (BL), 6 and 12 months, and STL data were used to define an area of interest (AOI) to analyze peri-implant volume changes and midfacial recessions. RESULTS For immediate placement, a mean volume loss of -5.56 mm3 (±5.83 mm3) was found at 6 months, and of -6.62 mm3 (±6.56 mm3) at 12 months. For early placement, a mean volume loss of -1.99 mm3 (±5.82 mm3) at 6 months, and of -3.7 mm3 (±5.62 mm3) at 12 months was found. The differences in volume loss at 12 months between the two implant placement protocols were significant (p = 0.005). In both groups, mean midfacial recessions of 0.48 mm (±0.52) occurred. CONCLUSIONS A more pronounced peri-implant volume loss can be expected 12 months after immediate implant placement compared with early placement.
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Affiliation(s)
- Malin Strasding
- Division of Fixed Prosthodontics and Biomaterials, University Clinic of Dental Medicine, University of Geneva, Rue Michel-Servet 1, 1211 Geneva, Switzerland (I.S.)
| | - Yuwon Jeong
- Department of Prosthodontics, College of Dentistry, Yonsei University, Seoul 03722, Republic of Korea; (Y.J.); (M.S.)
| | - Laurent Marchand
- Division of Fixed Prosthodontics and Biomaterials, University Clinic of Dental Medicine, University of Geneva, Rue Michel-Servet 1, 1211 Geneva, Switzerland (I.S.)
| | - Stefan P. Hicklin
- Clinic of Conservative and Preventive Dentistry, Division of Periodontology and Peri-Implant Diseases, Center of Dental Medicine, University of Zürich, 8032 Zürich, Switzerland;
- Clinic of General, Special Care and Geriatric Dentistry, Center of Dental Medicine, University of Zürich, 8032 Zürich, Switzerland
| | - Irena Sailer
- Division of Fixed Prosthodontics and Biomaterials, University Clinic of Dental Medicine, University of Geneva, Rue Michel-Servet 1, 1211 Geneva, Switzerland (I.S.)
| | - Minji Sun
- Department of Prosthodontics, College of Dentistry, Yonsei University, Seoul 03722, Republic of Korea; (Y.J.); (M.S.)
| | - Hyeonjong Lee
- Department of Prosthodontics, College of Dentistry, Yonsei University, Seoul 03722, Republic of Korea; (Y.J.); (M.S.)
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Bernatskiy BS, Puišys A. A Novel Approach for Implant Rehabilitation Combined with Immediate Bone and Soft-Tissue Augmentation in a Compromised Socket—A B2S Approach: Case Report with a 2-Year Follow-Up. Case Rep Dent 2023; 2023:1376588. [PMID: 37025607 PMCID: PMC10072960 DOI: 10.1155/2023/1376588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 02/20/2023] [Accepted: 02/28/2023] [Indexed: 03/30/2023] Open
Abstract
In this case report, we aimed to describe a novel approach for aesthetic rehabilitation of the anterior maxilla that combined immediate implant installation with the “Bone2Soft Tissue Reconstruction” (B2S technique), which involves the use of a triple graft harvested from the maxillary tuberosity. The regeneration potential of a tuberosity graft appeared to surpass that of corticocancellous bone grafts harvested from other intraoral donor sites and allowed for quicker regeneration of both bone and soft tissue. The B2S technique extended the indications for immediate implant placement and ridge augmentation to cases involving severe bone resorption and other complex clinical scenarios. Owing to the good visualization facilitated by open-flap access, the surgical procedures can be completed in a single intervention, which will be beneficial for both doctors and patients.
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Volumetric Evaluations of Full-Arch Implant Supported Restorations and Their Role on Patients’ Quality of Life: A Mixed-Model Analysis. BIOMED RESEARCH INTERNATIONAL 2022; 2022:3640435. [PMID: 35983248 PMCID: PMC9381270 DOI: 10.1155/2022/3640435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 07/15/2022] [Accepted: 07/26/2022] [Indexed: 11/25/2022]
Abstract
Introduction Full-arch, implant-supported hybrid restorations, employing tilted implants, can offer an efficient way of treating edentulous patients. Several factors, such as the timing of implant placement and the inclination of the fixture, can have a detrimental effect on their stability. This retrospective study is aimed at discerning the role played by those factors. Materials and Methods Patients treated with full-arch, implant supported restorations were selected for this study; cone-beam computed tomography (CBCT) images, taken 3 months and 3 years after delivery of the final restoration, as well as peri-implant values, were obtained and compared; bone loss was measured on four sites for each implant and then averaged. These patients were recalled, and the OHIP-5 questionnaire was administered. Results 21 patients, with a mean age of 53 years, were included in the present analysis. 108 implants were placed, and 25 Toronto prostheses were delivered. According to a mixed-model analysis, tilted implants (0.51, p < 0.001) had a higher rate of bone loss, while implants placed in a healed ridge suffered less bone loss than immediate implants (-0.21, p < 0.001). Patient-level variables have a significant effect on this variable, as implants coming from the same subject share a similar risk of bone loss. The mean response to the self-administered OHIP-5 questionnaire was 1.53 ± 0.29; other variables did not have a statistically significant effect on this outcome. Discussion/Conclusions. The results of the present study show that Toronto bridges prostheses are an efficient procedure for treating edentulous patients, as their oral-related quality of life is reported as satisfactory even 7 years after delivery of the restoration. Tilted and immediate implants are more at risk of bone loss. Implants coming from the same subject share a similar risk of bone loss.
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Smeets R, Matthies L, Windisch P, Gosau M, Jung R, Brodala N, Stefanini M, Kleinheinz J, Payer M, Henningsen A, Al-Nawas B, Knipfer C. Horizontal augmentation techniques in the mandible: a systematic review. Int J Implant Dent 2022; 8:23. [PMID: 35532820 PMCID: PMC9086020 DOI: 10.1186/s40729-022-00421-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 04/25/2022] [Indexed: 12/15/2022] Open
Abstract
Purpose Placement of dental implants has evolved to be an advantageous treatment option for rehabilitation of the fully or partially edentulous mandible. In case of extensive horizontal bone resorption, the bone volume needs to be augmented prior to or during implant placement in order to obtain dental rehabilitation and maximize implant survival and success. Methods Our aim was to systematically review the available data on lateral augmentation techniques in the horizontally compromised mandible considering all grafting protocols using xenogeneic, synthetic, or allogeneic material. A computerized and manual literature search was performed for clinical studies (published January 1995 to March 2021). Results Eight studies ultimately met the inclusion criteria comprising a total of 276 procedures of xenogeneic, allogeneic, or autogenous bone graft applications in horizontal ridge defects. Particulate materials as well as bone blocks were used as grafts with a mean follow-up of 26.0 months across all included studies. Outcome measures, approaches and materials varied from study to study. A gain of horizontal bone width of the mandible with a mean of 4.8 mm was observed in seven of eight studies. All but one study, reported low bone graft failure rates of 4.4% in average. Conclusions Only limited data are available on the impact of different horizontal augmentation strategies in the mandible. The results show outcomes for xenogeneic as well as autologous bone materials for horizontal ridge augmentation of the lower jaw. The use of allogeneic bone-block grafts in combination with resorbable barrier membranes must be re-evaluated. Randomized controlled clinical trials are largely missing. Supplementary Information The online version contains supplementary material available at 10.1186/s40729-022-00421-7.
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Feher B, Frommlet F, Ulm C, Gruber R, Kuchler U. Preoperative buccal bone volume predicts long-term graft retention following augmentation in the esthetic zone: a retrospective case series. Clin Oral Implants Res 2022; 33:492-500. [PMID: 35194845 PMCID: PMC9314910 DOI: 10.1111/clr.13909] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 01/25/2022] [Accepted: 02/17/2022] [Indexed: 11/27/2022]
Abstract
Objectives Buccal bone augmentation in the esthetic zone is routinely used to achieve optimal clinical outcomes. Nonetheless, long‐term data are sparse, and it is unknown how baseline buccal bone volume affects the retention of the augmented volume over time. Material and methods This is a long‐term follow‐up retrospective case series. After a preoperative computed tomography scan, implants were placed in the anterior maxilla following guided bone regeneration, autogenous block grafting, or both. At the follow‐up, patients received a computed tomography scan and a clinical examination. Buccal bone volume was the primary outcome. Buccal bone thickness, peri‐implant, and esthetic parameters were secondary outcomes. Results After a median follow‐up of 6.7 years (interquartile range: 4.9–9.4), 28 implants in 19 patients (median age at augmentation: 43.3 years, interquartile range: 34.4–56.7, 53% female) were followed up. Preoperative buccal bone volume at baseline (V0) showed a moderate correlation to final buccal bone volume (Vt, rs = .43) but a strong correlation to the absolute volumetric change (ΔV = Vt–V0, rs = −.80). A linear mixed model for Vt had a large intercept of 91.39 (p < .001) and a rather small slope of .11 for V0 (p = .11). Observed differences between treatments were not statistically significant in the mixed model. V0 above 105 mm3 predicted a negative volume change (ΔV < 0) with a specificity of 100% and a sensitivity of 96%. Conclusions The results suggest higher gains in sites with lower V0 and point to a cutoff V0 above which the augmented volume is not retained long‐term.
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Affiliation(s)
- Balazs Feher
- Department of Oral Surgery, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria.,Department of Oral Biology, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Florian Frommlet
- Institute of Medical Statistics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Christian Ulm
- Department of Oral Surgery, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Reinhard Gruber
- Department of Oral Biology, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria.,Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Ulrike Kuchler
- Department of Oral Surgery, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
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12
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Jung RE, Kovacs MN, Thoma DS, Hämmerle CHF. Guided bone regeneration with and without rhBMP-2: 17-year results of a randomized controlled clinical trial. Clin Oral Implants Res 2021; 33:302-312. [PMID: 34958487 PMCID: PMC9305166 DOI: 10.1111/clr.13889] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 11/08/2021] [Accepted: 11/18/2021] [Indexed: 11/30/2022]
Abstract
Objectives To assess long‐term outcomes of implants placed in conjunction with guided bone regeneration (GBR) with or without recombinant human bone morphogenetic protein‐2 (rhBMP‐2). Materials and Methods Eleven patients with at least two lateral bone defects (split‐mouth design) received a total of 34 implants. The defects were treated with a xenogenic bone substitute with (test) or without (control) rhBMP‐2 and covered with a collagen membrane. Eight patients could be reexamined after at least 17 years. Wilcoxon signed‐rank tests were performed to assess differences between test and control groups. Results The implant survival rate was 100% for all test and control sites. Mean marginal bone levels were 2.51 mm (SD ±1.64) (mesial test), 1.83 mm (SD ±0.93) (mesial control) (p = .055), 2.36 mm (SD ±1.70) (distal test), and 2.13 mm (SD ±0.84) (distal control) (p = 1.000). Compared with the mean values at baseline, a mean bone loss of 1.16 mm (SD ±1.60) (test) and 0.70 mm (SD ±1.02) (control) was found. The mean buccal bone gain after 17 years was 5.38 mm (test) and 3.14 mm (control) based on the comparison between the measurements at the cone beam CT after 17 years and the data from the intraoperative measurements at baseline. Further, mean values for (i) bone thickness ranged from 1.36 to 3.09 mm (test) and 1.18 to 3.39 mm (control) and for (ii) mucosal thickness of 1.24 mm (test) and 1.26 mm (control). Conclusion Implants placed in conjunction with GBR applying a xenogenic bone substitute and a collagen membrane with and without the addition of rhBMP‐2 demonstrate excellent clinical and radiographic results after at least 17 years.
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Affiliation(s)
- Ronald E Jung
- Clinic of Reconstructive Dentistry, University of Zürich, Plattenstrasse 11, 8032, Zürich, Switzerland
| | | | - Daniel S Thoma
- Clinic of Reconstructive Dentistry, University of Zürich, Plattenstrasse 11, 8032, Zürich, Switzerland
| | - Christoph H F Hämmerle
- Clinic of Reconstructive Dentistry, University of Zürich, Plattenstrasse 11, 8032, Zürich, Switzerland
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Peri-Implantitis: A Clinical Update on Prevalence and Surgical Treatment Outcomes. J Clin Med 2021; 10:jcm10051107. [PMID: 33800894 PMCID: PMC7962026 DOI: 10.3390/jcm10051107] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 02/06/2023] Open
Abstract
Dental implants may be considered a reliable routine procedure in clinical practice for the replacement of missing teeth. Results from long-term studies indicate that implant-supported dental prostheses constitute a predictable treatment method for the management of fully and partially edentulous patients. Implants and their restorations, however, are not free from biological complications. In fact, peri-implantitis, defined as progressive bone loss associated to clinical inflammation, is not a rare finding nowadays. This constitutes a concern for clinicians and patients given the negative impact on the quality of life and the sequelae originated by peri-implantitis lesions. The purpose of this narrative review is to report on the prevalence of peri-implantitis and to overview the indications, contraindications, complexity, predictability and effectiveness of the different surgical therapeutic modalities to manage this disorder.
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A retrospective cohort study of how alveolar ridge preservation affects the need of alveolar ridge augmentation at posterior tooth implant sites. Clin Oral Investig 2021; 25:4643-4649. [PMID: 33432420 PMCID: PMC8310513 DOI: 10.1007/s00784-021-03778-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 01/04/2021] [Indexed: 11/06/2022]
Abstract
Objectives The aim of this study was to assess whether alveolar ridge preservation (ARP) can reduce the need of ridge augmentation at posterior tooth sites. Material and methods This study enrolled patients who received dental implants at posterior tooth sites during 2013–2019. Demographic data and dental treatment histories were collected. Based on healing patterns after tooth extraction, patients were divided into ARP and spontaneous healing (SH) groups. Three surgical treatment plans were devised according to the alveolar bone volume on cone-beam computed tomography (CBCT). The three treatment plans were to perform implant alone, simultaneous guided bone regeneration (GBR) and implantation, and staged GBR before implantation. Statistical analyses were performed to determine relationships. Results There were 92 implant records in the ARP group and 249 implant records in the SH group. A significant intergroup difference was observed regarding the frequency distribution of the treatment modality of staged GBR before implant (χ2 = 15.07, p = 0.0005). Based on the implant alone treatment modality and simple logistic regression, the SH pattern was related to staged GBR before implant (SH vs. ARP: crude odds ratio (OR) = 4.65, 95% confidence interval (CI) = 2.15–11.61, p = 0.0003). After adjusting confounding factors, the risk was still significant (adjusted OR = 5.02, 95% CI = 2.26–12.85, p = 0.0002). Conclusions The study results suggested that ARP is more likely to lead to the treatment modality of implant alone and reduce the need for staged GBR before implantation. Clinical relevance This study describes ARP capable of minimizing the need for staged GBR before implantation and shortening the treatment duration.
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Contour changes of peri-implant tissues are minimal and similar for a one- and a two-piece implant system over 12 years. Clin Oral Investig 2020; 25:719-727. [PMID: 33063219 PMCID: PMC7819926 DOI: 10.1007/s00784-020-03638-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 10/07/2020] [Indexed: 01/23/2023]
Abstract
Objectives To assess contour changes of peri-implant tissues comparing a one- and a two-piece dental implant system over 12 years. Materials and methods Patients seeking implant therapy were enrolled and randomly allocated to receive implants (a one-piece (STM) or a two-piece (BRA) system). Impressions were taken at the time of insertion of the final reconstruction (BL), after 1 year (FU-1), 5 years (FU-5), and at 12 years (FU-12). Thirty patients were included in the analysis (STM, 16; BRA, 14). Digital scans of casts were superimposed and analyzed in an image analysis program. Measurements included changes of the crown height, contour changes on the buccal side of the implants and the contralateral teeth (control). Results Contour changes at implant sites revealed a loss of − 0.29 mm (STM) and − 0.46 mm (BRA) during an observation period of 12 years. Contour changes at the corresponding tooth sites amounted to − 0.06 mm (STM) and − 0.12 mm (BRA) during the same time period. The implant crown gained 0.25 mm (STM) and 0.08 mm (BRA) in height due to recession of the marginal mucosa. The corresponding gain in crown height at the contralateral tooth sites amounted to 0.36 mm (STM) and 0.10 mm (BRA). Interproximal marginal bone level changes measured − 0.28 mm (STM) and − 1.11 mm (BRA). The mean BOP amounted to 38.8% (STM) and 48.7% (BRA) at the 12-year follow-up (FU-12). Conclusion Minimal changes of the peri-implant soft tissue contour were observed at implant sites over the period of 12 years irrespective of the use of a one- or a two-piece implant system. The differences between the implant sites and corresponding teeth were clinically negligible. Clinical relevance Peri-implant soft tissue stability is of high clinical relevance when monitoring dental implant sites on the long run. Clinical data on the extent of soft tissue changes around different implant systems are scarce. The present RCTs demonstrate minimal changes of the peri-implant soft tissue contour 12 years after implant insertion independent of the use of a one- or a two-piece implant system.
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Windisch P, Orban K, Salvi GE, Sculean A, Molnar B. Vertical-guided bone regeneration with a titanium-reinforced d-PTFE membrane utilizing a novel split-thickness flap design: a prospective case series. Clin Oral Investig 2020; 25:2969-2980. [PMID: 33040203 PMCID: PMC8060182 DOI: 10.1007/s00784-020-03617-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 10/01/2020] [Indexed: 12/01/2022]
Abstract
Objectives To evaluate the feasibility of a newly proposed minimally invasive split-thickness flap design without vertical-releasing incisions for vertical bone regeneration performed in either a simultaneous or staged approach and to analyze the prevalence of adverse events during postoperative healing. Materials and methods Following preparation of a split-thickness flap and bilaminar elevation of the mucosa and underlying periosteum, the alveolar bone was exposed over the defects, vertical GBR was performed by means of a titanium-reinforced high-density polytetrafluoroethylene membrane combined with particulated autogenous bone (AP) and bovine-derived xenograft (BDX) in 1:1 ratio. At 9 months after reconstructive surgery, vertical and horizontal hard tissue gain was evaluated based on clinical and radiographic examination. Results Twenty-four vertical alveolar ridge defects in 19 patients were treated with vertical GBR. In case of 6 surgical sites, implant placement was performed at the time of the GBR (simultaneous group); in the remaining 18 surgical, sites implant placement was performed 9 months after the ridge augmentation (staged group). After uneventful healing in 23 cases, hard tissue fill was detected in each site. Direct clinical measurements confirmed vertical and horizontal hard tissue gain averaging 3.2 ± 1.9 mm and 6.5 ± 0.5 mm respectively, in the simultaneous group and 4.5 ± 2.2 mm and 8.7 ± 2.3 mm respectively, in the staged group. Additional radiographic evaluation based on CBCT data sets in the staged group revealed mean vertical and horizontal hard tissue fill of 4.2 ± 2.0 mm and 8.5 ± 2.4 mm. Radiographic volume gain was 1.1 ± 0.4 cm3. Conclusion Vertical GBR consisting of a split-thickness flap and using titanium-reinforced non-resorbable membrane in conjunction with a 1:1 mixture of AP+BDX may lead to a predictable vertical and horizontal hard tissue reconstruction. Clinical relevance The used split-thickness flap design may represent a valuable approach to increase the success rate of vertical GBR, resulting in predicable hard tissue regeneration, and favorable wound healing with low rate of membrane exposure. Electronic supplementary material The online version of this article (10.1007/s00784-020-03617-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Peter Windisch
- Faculty of Dentistry, Department of Periodontology, Semmelweis University, Budapest, Hungary
| | - Kristof Orban
- Faculty of Dentistry, Department of Periodontology, Semmelweis University, Budapest, Hungary
| | - Giovanni E Salvi
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland.
| | - Balint Molnar
- Faculty of Dentistry, Department of Periodontology, Semmelweis University, Budapest, Hungary
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Shahdad S, Gamble E, Matani J, Zhang L, Gambôa A. Randomized clinical trial comparing PEG‐based synthetic to porcine‐derived collagen membrane in the preservation of alveolar bone following tooth extraction in anterior maxilla. Clin Oral Implants Res 2020; 31:1010-1024. [PMID: 32799365 DOI: 10.1111/clr.13648] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 05/23/2020] [Accepted: 05/23/2020] [Indexed: 02/05/2023]
Affiliation(s)
- Shakeel Shahdad
- Barts Health NHS Trust The Royal London Dental Hospital London UK
- Barts and The London School of Medicine and Dentistry Queen Mary University of London London UK
| | - Eugene Gamble
- Barts Health NHS Trust The Royal London Dental Hospital London UK
| | - Jay Matani
- Barts and The London School of Medicine and Dentistry Queen Mary University of London London UK
| | - Liang Zhang
- Barts and The London School of Medicine and Dentistry Queen Mary University of London London UK
- State Key Laboratory of Oral Diseases Department of Oral Implantology National Clinical Research Center for Oral Diseases West China Hospital of Stomatology Sichuan University Chengdu China
| | - Ana Gambôa
- University of Bristol School of Oral and Dental Sciences Bristol UK
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Domic D, Bertl K, Ahmad S, Schropp L, Hellén-Halme K, Stavropoulos A. Accuracy of cone-beam computed tomography is limited at implant sites with a thin buccal bone: A laboratory study. J Periodontol 2020; 92:592-601. [PMID: 32846005 PMCID: PMC8247288 DOI: 10.1002/jper.20-0222] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 08/04/2020] [Accepted: 08/04/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND To evaluate whether buccal bone thickness (BBT), implant diameter, and abutment/crown material influence the accuracy of cone-beam computed tomography (CBCT) to determine the buccal bone level at titanium implants. METHODS Two implant beds (i.e., narrow and standard diameter) were prepared in each of 36 porcine bone blocks. The implant beds were positioned at a variable distance from the buccal bone surface; thus, resulting in three BBT groups (i.e., >0.5 to 1.0; >1.0 to 1.5; >1.5 to 2.0 mm). In half of the blocks, a buccal bone dehiscence of random extent ("depth") was created and implants were mounted with different abutment/crown material (i.e., titanium abutments with a metal-ceramic crown and zirconia abutments with an all-ceramic zirconia crown). The distance from the implant shoulder to the buccal bone crest was measured on cross-sectional CBCT images and compared with the direct measurements at the bone blocks. RESULTS While abutment/crown material and implant diameter had no effect on the detection accuracy of the buccal bone level at dental implants in CBCT scans, BBT had a significant effect. Specifically, when BBT was ≤1.0 mm, a dehiscence was often diagnosed although not present, that is, the sensitivity was high (95.8%), but the specificity (12.5%) and the detection accuracy (54.2%) were low. Further, the average measurement error of the distance from the implant shoulder to the buccal bone crest was 1.6 mm. CONCLUSIONS Based on the present laboratory study, BBT has a major impact on the correct diagnosis of the buccal bone level at dental titanium implants in CBCT images; in cases where the buccal bone is ≤1 mm thick, detection of the buccal bone level is largely inaccurate.
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Affiliation(s)
- Danijel Domic
- Department of Periodontology, Faculty of Odontology, University of Malmö, Malmö, Sweden.,Division of Oral Surgery, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Kristina Bertl
- Department of Periodontology, Faculty of Odontology, University of Malmö, Malmö, Sweden.,Division of Oral Surgery, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Salman Ahmad
- Department of Periodontology, Faculty of Odontology, University of Malmö, Malmö, Sweden
| | - Lars Schropp
- Section of Oral Radiology, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Kristina Hellén-Halme
- Department of Oral and Maxillofacial Radiology, Faculty of Odontology, University of Malmö, Malmö, Sweden
| | - Andreas Stavropoulos
- Department of Periodontology, Faculty of Odontology, University of Malmö, Malmö, Sweden.,Division of Conservative Dentistry and Periodontology, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria.,Division of Regenerative Dentistry and Periodontology, University Clinics of Dental Medicine (CUMD), University of Geneva, Geneva, Switzerland
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Jung RE, Mihatovic I, Cordaro L, Windisch P, Friedmann A, Blanco Carrion J, Sanz Sanchez I, Hallman M, Quirynen M, Hammerle CHF. Comparison of a polyethylene glycol membrane and a collagen membrane for the treatment of bone dehiscence defects at bone level implants-A prospective, randomized, controlled, multicenter clinical trial. Clin Oral Implants Res 2020; 31:1105-1115. [PMID: 32875638 DOI: 10.1111/clr.13657] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 07/30/2020] [Accepted: 08/02/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The aim of the present randomized, controlled clinical multicenter trial was to compare a polyethylene glycol (PEG) and a native collagen membrane (BG) for simultaneous guided bone regeneration at bony dehiscence-type defects around bone level titanium implants. MATERIAL AND METHODS The study enrolled 117 patients requiring implant treatment in the posterior maxilla or mandible with expected buccal bony dehiscence-type defects at the placed titanium implants. According to a parallel groups design, defects were filled with a synthetic bone filler and randomly assigned to either PEG or BG membrane. As primary parameter, the relative vertical bone fill was assessed at baseline and at re-entry after 6 months of healing. As secondary parameters, the marginal bone level (MBL) was assessed radiographically and soft tissue conditions were recorded up to 18 months postloading. RESULTS Both groups showed comparable vertical bone fill revealing a relative change in defect height of 59.7% (PEG) and 64.4% (BG). The absolute mean reduction in defect size was 2.5 mm in the PEG group and 3.2 mm in the BG group. Although both groups revealed a statistically significant mean defect reduction (p < .001), a comparison between the two groups did not show statistical significances. The non-inferiority test with inferiority limit of -5% could not be rejected, based on the 90% confidence interval of the differences of the two means with lower limit -15.4%. After 18 months, an MBL increase of 0.45 ± 0.43 mm in the PEG group and 0.41 ± 0.81 mm in the BG group was detected (p < .001). Soft tissue complications were observed in both groups without showing statistical significance. CONCLUSIONS Both membranes supported bone regeneration at dehiscence-type defects and obtained vertical bone fill with a relative change in defect height of 59.7% (PEG) and 64.4% (BG); however, the non-inferiority of PEG could not be shown.
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Affiliation(s)
- Ronald Ernst Jung
- Clinic of Reconstructive Dentistry, University of Zurich, Zurich, Switzerland
| | - Ilja Mihatovic
- Department of Oral Surgery, Heinrich Heine University, Düsseldorf, Germany
| | - Luca Cordaro
- Department of Periodontics and Prosthodontics, Policlinico Umberto I, Eastman Dental Hospital, Rome, Italy
| | - Péter Windisch
- Department of Periodontology, Semmelweis University, Budapest, Hungary
| | - Anton Friedmann
- Department of Periodontology, School of Dentistry, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Juan Blanco Carrion
- Periodontology Unit, School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Ignacio Sanz Sanchez
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, University Complutense, Madrid, Spain
| | - Mats Hallman
- Department of Oral and Maxillofacial Surgery, Public Health Service, Gävle, Sweden
| | - Marc Quirynen
- Section of Periodontology, Department of Oral Health Sciences, KU Leuven, Leuven, Belgium
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Bone Regeneration and Soft Tissue Enhancement Around Zygomatic Implants: Retrospective Case Series. MATERIALS 2020; 13:ma13071577. [PMID: 32235372 PMCID: PMC7178084 DOI: 10.3390/ma13071577] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/26/2020] [Indexed: 01/17/2023]
Abstract
Purpose: To present a case series of zygomatic implants combined with bone regeneration and soft tissue enhancement techniques to reduce the risk of biological delayed complications such as maxillary sinusitis and soft tissue recession. Materials and methods: Zygomatic implants placed simultaneously with different bone regeneration techniques (buccal, palatal and buccal-palatal bone regeneration) and soft tissue enhancement techniques (pediculate and free connective tissue graft) were followed for at least 12 months. The following information was collected: patient age and sex, number of zygomatic implants, zygomatic implant success rate, zygomatic implant position according to classification of the Zygomatic Anatomy Guide Approach (ZAGA), sinus membrane perforation, type and outcome of the bone regeneration or the soft tissue enhancement technique, bone gain (width and length along the zygomatic implant) and keratinized buccal mucosa width, duration of follow-up, loading protocol (immediate or delayed) and biological complications (maxillary sinusitis and soft tissue recession). Results: Thirty-one zygomatic implants placed in 19 patients were included. All implants were successful and none of the implants presented biological complications. The bone regeneration technique was successful in 30 of 31 cases with a mean palatal bone width of 3 mm, buccal bone width of 2.65 mm, palatal bone length of 6.5 mm and buccal bone length of 8.3 mm. The success rate of soft tissue enhancement was 100% and it established at least 2 mm of keratinized buccal mucosa width in all implants. Conclusions: Within the limitations of the present study, bone regeneration and soft tissue enhancement techniques were useful to establish more favorable conditions of the peri-implant tissues around zygomatic implants. This could prevent biological complications such as maxillary sinusitis and soft tissue recessions. Prospective and randomized controlled clinical trials with longer follow-up periods are advisable.
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Kobayashi T, Nakano T, Ono S, Matsumura A, Yamada S, Yatani H. Quantitative evaluation of connective tissue grafts on peri-implant tissue morphology in the esthetic zone: A 1-year prospective clinical study. Clin Implant Dent Relat Res 2020; 22:311-318. [PMID: 32212303 DOI: 10.1111/cid.12898] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 02/12/2020] [Accepted: 03/10/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND In the treatment of anterior implants, few studies have quantitatively evaluated the effects of connective tissue grafts on labial bone resorption and soft tissue recession. PURPOSE To evaluate the influence of connective tissue grafting (CTG) on the peri-implant tissue morphology by quantitatively measuring change over time the tissue surrounding the implant in the anterior esthetic zone. MATERIAL AND METHODS Twenty-six patients who received implants with platform shifting in the anterior esthetic region were included in this follow-up study. Patients were classified as those who received CTG [CTG (+) group] and those who did not [CTG (-) group]. The vertical and horizontal dimensions of the buccal alveolar bone of the implant and its surrounding soft tissues were evaluated using cone-beam computed tomography. RESULTS At 1 year after connection of the superstructure, labial soft tissue recession was on average 0.64 mm in the CTG (-) group and 0.09 mm in the CTG (+) group, and this difference was significant (P < .001). Furthermore, mean labial bone resorption was 0.65 mm in the CTG (-) group and 0.13 mm in the CTG (+) group, and also this difference was significant (P = .003). CONCLUSIONS Within the limitations of this study, these findings suggest that CTG may be effective in both reducing labial bone resorption around the implant and reducing the recession of the soft tissue.
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Affiliation(s)
- Tomoyuki Kobayashi
- Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Tamaki Nakano
- Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Shinji Ono
- Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Atsushi Matsumura
- Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Shuhei Yamada
- Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Hirofumi Yatani
- Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry, Osaka, Japan
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Waller T, Herzog M, Thoma DS, Hüsler J, Hämmerle CHF, Jung RE. Long-term clinical and radiographic results after treatment or no treatment of small buccal bone dehiscences at posterior dental implants: A randomized, controlled clinical trial. Clin Oral Implants Res 2020; 31:517-525. [PMID: 32011015 DOI: 10.1111/clr.13588] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 01/22/2020] [Accepted: 01/22/2020] [Indexed: 12/19/2022]
Abstract
AIM To test whether or not buccal vertical bone dehiscences (≤5 mm) around posterior implants left for spontaneous healing (SH) result in the same clinical and radiologic outcome as dehiscences treated with guided bone regeneration (GBR) at 7.5 years after implant placement (IMPL). MATERIALS AND METHODS Twenty-two patients receiving 28 posterior implants with a small non-contained buccal bone dehiscence (≤5 mm) were randomly assigned to the SH or the GBR group. Implants were loaded at 6 months. Clinical parameters (probing depths, sulcus bleeding index, plaque index) and approximal marginal radiographic bone levels were assessed regularly up to at least 6.8 years. The vertical extension of the dehiscences was measured clinically at IMPL and abutment connection and radiographically on cone beam computed tomographys at a mean follow-up time of 7.5 years. RESULTS Twenty patients with a total of 26 implants were recalled at 7.5 years (9.1% dropout). The implant/crown survival rates were 100% in both groups. Stable peri-implant tissues were observed in both groups showing only minimal signs of inflammation. During the entire study period (IMPL-7.5-year follow-up), the median buccal vertical bone gain measured 1.61 mm for the GBR group and 0.62 for the SH group showing no significant difference between the groups. Also, at 7.5 years, the median approximal marginal bone levels (GBR: 0.53; SH: 0.68) were not significantly different between the two groups (p = .61) while the remaining median buccal vertical dehiscences were larger in the SH group (2.51 mm) compared to the GBR group (1.66 mm; p = .02). CONCLUSIONS Implants with small non-contained buccal bone dehiscences exhibited high implant survival rates and healthy peri-implant tissues at 7.5 years. In the GBR group, the buccal vertical bone levels were higher compared to the SH group but remained stable over the entire study period for both treatments.
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Affiliation(s)
- Tobias Waller
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | | | - Daniel S Thoma
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Jürg Hüsler
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Christoph H F Hämmerle
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Ronald E Jung
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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Walker-Finch K, Ucer C. Five-year survival rates for implants placed using digitally-designed static surgical guides: a systematic review. Br J Oral Maxillofac Surg 2020; 58:268-276. [PMID: 31917014 DOI: 10.1016/j.bjoms.2019.12.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 12/13/2019] [Indexed: 01/10/2023]
Abstract
Digitally-designed static surgical guides provide an acceptable level of accuracy and predictability for the placement of dental implants. However, to our knowledge, few published studies have compared the long-term survival of implants placed in this way with those placed using other methods. A systematic search of electronic databases using a population, intervention, comparison, and outcome (PICO) framework was conducted of Medline and EMBASE, as well as grey literature and hand searches, to obtain all relevant work pertaining to the survival of dental implants placed by guided surgery. The studies were required to have at least 10 patients with a follow up of at least five years. A total of 621 titles were screened. Four studies met the inclusion criteria for quantitative analysis, and they all reported the exclusive use of Nobel Biocare implants and the NobelGuide system (Nobel Biocare Services). Cumulative survival rates ranged from 94.5% to 100% over five years. The survival rates of implants placed using digitally-designed static surgical guides are comparable to the estimated overall survival rate (95.6% over five years), despite the complex nature of the treatments done with guided surgery. Clinicians who do these operations should, however, have the experience and ability to revert to conventional freehand techniques if complications arise.
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Affiliation(s)
- K Walker-Finch
- Lindley Dental Centre, Huddersfield, West Yorkshire, UK.
| | - C Ucer
- Department of Dental Implantology, Salford University, Manchester, Greater Manchester, UK
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Benic GI, Eisner BM, Jung RE, Basler T, Schneider D, Hämmerle CHF. Hard tissue changes after guided bone regeneration of peri‐implant defects comparing block versus particulate bone substitutes: 6‐month results of a randomized controlled clinical trial. Clin Oral Implants Res 2019; 30:1016-1026. [DOI: 10.1111/clr.13515] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 06/01/2019] [Accepted: 07/03/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Goran I. Benic
- Clinic of Reconstructive Dentistry, Center of Dental Medicine University of Zurich Zurich Switzerland
| | - Barbara M. Eisner
- Clinic of Reconstructive Dentistry, Center of Dental Medicine University of Zurich Zurich Switzerland
| | - Ronald E. Jung
- Clinic of Reconstructive Dentistry, Center of Dental Medicine University of Zurich Zurich Switzerland
| | - Tobias Basler
- Clinic of Reconstructive Dentistry, Center of Dental Medicine University of Zurich Zurich Switzerland
| | - David Schneider
- Clinic of Reconstructive Dentistry, Center of Dental Medicine University of Zurich Zurich Switzerland
| | - Christoph H. F. Hämmerle
- Clinic of Reconstructive Dentistry, Center of Dental Medicine University of Zurich Zurich Switzerland
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25
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Urban IA, Wessing B, Alández N, Meloni S, González-Martin O, Polizzi G, Sanz-Sanchez I, Montero E, Zechner W. A multicenter randomized controlled trial using a novel collagen membrane for guided bone regeneration at dehisced single implant sites: Outcome at prosthetic delivery and at 1-year follow-up. Clin Oral Implants Res 2019; 30:487-497. [PMID: 30927498 DOI: 10.1111/clr.13426] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 02/22/2019] [Accepted: 03/05/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To compare clinical performance of a novel resorbable non-cross-linked collagen membrane (CXP) with a reference membrane (non-cross-linked resorbable membrane; BG) for simultaneous implant placement and guided bone regeneration (GBR) at dehisced single implant sites. MATERIALS AND METHODS Preliminary data from this randomized controlled trial were reported previously; this is the 12-month report. The primary outcome measure was defected height at 6 months post-GBR. Secondary outcomes included implant cumulative survival rate (CSR) and success rate since placement; bone level changes, pink esthetic score (PES), and patient satisfaction since definitive prosthesis delivery; patient quality of life since pretreatment; and the 1-year bleeding index. Non-parametric statistical analyses were performed. RESULTS Among patients, 24 were treated with CXP and 25 with BG. The 1-year implant CSR and success rate were 100% (n = 42). Bone level change between definitive prosthetic delivery and 1 year was not significantly different between the CXP and BG groups (BG + 0.42 mm, CXP + 0.01 mm). The PES increased from 7.55 to 8.10 for the CXP group and from 6.48 to 7.48 for the BG group; 1-year bleeding indices were 0 (16 CXP, 18 BG) and 1 (4 CXP, 2 BG). Patient quality of life changed from an OHIP-14 score of 6.5 at pretreatment to 1.9 at 1 year. Overall satisfaction (visual analogue score) with function and esthetics was 9.9 and 9.7, respectively. Inter-group differences were not significant for assessed outcomes. No device-related adverse events were reported. CONCLUSIONS The use of CXP and BG for simultaneous implant placement and GBR at dehisced implant sites similarly reduced defect height and improved secondary measures, indicating non-inferiority.
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Affiliation(s)
- Istvan A Urban
- Department of Periodontics and Oral Medicine School of Dentistry, University of Michigan, Ann Arbor, Michigan.,Graduate Implant Dentistry, Loma Linda University, Loma Linda, California.,Urban Regeneration Institute, Budapest, Hungary
| | | | | | - Silvio Meloni
- Department of Surgical, Microsurgical, and Medical Sciences, Dentistry Unit, University Hospital of Sassari, Sassari, Italy
| | | | | | - Igancio Sanz-Sanchez
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, University Complutense, Madrid, Spain
| | - Eduardo Montero
- Section of Graduate Periodontology, Faculty of Odontology, University Complutense of Madrid, Madrid, Spain
| | - Werner Zechner
- Department of Oral Surgery, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
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26
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Can the Macrogeometry of Dental Implants Influence Guided Bone Regeneration in Buccal Bone Defects? Histomorphometric and Biomechanical Analysis in Beagle Dogs. J Clin Med 2019; 8:jcm8050618. [PMID: 31067735 PMCID: PMC6572352 DOI: 10.3390/jcm8050618] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 05/05/2019] [Accepted: 05/05/2019] [Indexed: 12/12/2022] Open
Abstract
The aim of this experimental animal study was to assess guided bone regeneration (GBR) and implant stability (ISQ) around two dental implants with different macrogeometries. Forty eight dental implants were placed within six Beagle dogs. The implants were divided into two groups (n = 24 per group): G1 group implants presented semi-conical macrogeometry, a low apical self-tapping portion, and an external hexagonal connection (whereby the cervical portion was bigger than the implant body). G2 group implants presented parallel walls macrogeometry, a strong apical self-tapping portion, and an external hexagonal connection (with the cervical portion parallel to the implant body). Buccal (mouth-related) defects of 2 mm (c2 condition) and 5 mm (c3 condition) were created. For the control condition with no defect (c1), implants were installed at crestal bone level. Eight implants in each group were installed under each condition. The implant stability quotient (ISQ) was measured immediately after implant placement, and on the day of sacrifice (3 months after the implant placement). Histological and histomorphometric procedures and analysis were performed to assess all samples, measuring crestal bone loss (CBL) and bone-to-implant contact (BIC). The data obtained were compared with statistical significance set at p < 0.05. The ISQ results showed a similar evolution between the groups at the two evaluation times, although higher values were found in the G1 group under all conditions. Within the limitations of this animal study, it may be concluded that implant macrogeometry is an important factor influencing guided bone regeneration in buccal defects. Group G1 showed better buccal bone regeneration (CBL) and BIC % at 3 months follow up, also parallel collar design can stimulate bone regeneration more than divergent collar design implants. The apical portion of the implant, with a stronger self-tapping feature, may provide better initial stability, even in the presence of a bone defect in the buccal area.
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27
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Mertens C, Braun S, Krisam J, Hoffmann J. The influence of wound closure on graft stability: An in vitro comparison of different bone grafting techniques for the treatment of one-wall horizontal bone defects. Clin Implant Dent Relat Res 2019; 21:284-291. [PMID: 30741470 DOI: 10.1111/cid.12728] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 09/25/2018] [Accepted: 01/08/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The aim of this preclinical study was to analyze and compare different grafting techniques with respect to volume stability after wound closure. MATERIALS AND METHODS Four different grafting techniques were evaluated in vitro for volume stability in a one-wall horizontal defect configuration. Group 1: guided bone regeneration (GBR) with collagen membrane, particulated xenograft; group 2: GBR with collagen membrane, particulated xenograft, pins; group 3: GBR with titanium-reinforced membrane, particulated xenograft, pins; group 4: autogenous block graft, particulated xenograft, collagen membrane. Cone beam computed tomography scans were performed before and after wound closure, and the horizontal bone dimensions were analyzed for stability at 0-5 mm apical to the implant shoulder (H0-H5). RESULTS At H0-H2, wound closure induced a statistically significant change in bone dimensions in groups 1 and 2. In group 3, only the change in H0 was significant, and for group 4, only H2 was significant. CONCLUSION Wound closure has a significant impact on graft stability in a one-wall horizontal defect configuration. GBR with additional membrane fixation showed better results than without. Titanium-reinforced membranes and autogenous blocks showed significantly greater volume stability than GBR with collagen membrane, especially in the coronal portion.
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Affiliation(s)
- Christian Mertens
- Department of Oral- and Cranio-Maxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Sebastian Braun
- Department of Oral- and Cranio-Maxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Johannes Krisam
- Institute of Medical Biometry and Informatics, University Heidelberg, Heidelberg, Germany
| | - Jürgen Hoffmann
- Department of Oral- and Cranio-Maxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany
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28
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Santana R, Gyurko R, Kanasi E, Xu WP, Dibart S. Synthetic polymeric barrier membrane associated with blood coagulum, human allograft, or bovine bone substitute for ridge preservation: a randomized, controlled, clinical and histological trial. Int J Oral Maxillofac Surg 2018; 48:675-683. [PMID: 31014520 DOI: 10.1016/j.ijom.2018.02.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 02/11/2018] [Accepted: 02/26/2018] [Indexed: 10/27/2022]
Abstract
During the normal healing process, an extraction site may lose significant bone volume, making implant placement problematic. Quantitative evaluations of the amount of bone maintained by socket preservation with various materials are limited. The objective of this study was to evaluate, both clinically and histologically, the extent of alveolar bone preservation by blood coagulum (BC) and the potential additional benefits of bone allograft material (AL) versus the state-of-the-art bovine bone mineral (BB), covered by a polyethylene glycol (PEG) barrier, in extraction socket grafting procedures. Adult patients (n=32) with single-rooted teeth indicated for extraction were treated (45 sites). After atraumatic extraction, the sockets were filled with BC, AL, or BB and covered with a synthetic PEG barrier membrane. Changes in bone height and width were measured clinically and the amount of bone formed and residual graft particles were measured histologically after 6 months. Changes in ridge width at 6 months were -1.5mm for AL versus -2.5mm for BB and -2.3mm for BC. New bone formation amounted to 47.8%, 33.3%, and 28.2% at BC-, AL-, and BB-treated sites, respectively. Using AL with the PEG barrier preserved the ridge width at 6 months better than BB or BC and resulted in similar amounts of bone histologically to BB.
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Affiliation(s)
- R Santana
- Department of Periodontology, Henry M. Goldman School of Dental Medicine, Boston University, Boston, Massachusetts, USA; Department of Periodontology, Federal Fluminense University, Dental School, Niteroi, Rio de Janeiro, Brazil
| | - R Gyurko
- Periodontology Department, Tufts University School of Dental Medicine, Boston, Massachusetts, USA
| | - E Kanasi
- Department of Periodontology, Henry M. Goldman School of Dental Medicine, Boston University, Boston, Massachusetts, USA
| | - W P Xu
- Department of Periodontology, Henry M. Goldman School of Dental Medicine, Boston University, Boston, Massachusetts, USA
| | - S Dibart
- Department of Periodontology, Henry M. Goldman School of Dental Medicine, Boston University, Boston, Massachusetts, USA.
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29
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Sanz-Sánchez I, Carrillo de Albornoz A, Figuero E, Schwarz F, Jung R, Sanz M, Thoma D. Effects of lateral bone augmentation procedures on peri-implant health or disease: A systematic review and meta-analysis. Clin Oral Implants Res 2018; 29 Suppl 15:18-31. [PMID: 29498126 DOI: 10.1111/clr.13126] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2017] [Indexed: 12/24/2022]
Abstract
OBJECTIVES This systematic review evaluated the evidence on the effect of the interventions aimed for lateral ridge augmentation (both simultaneously with implant placement or as a staged procedure) on peri-implant health or disease. METHODS A protocol was developed to answer the following PICO question: "In patients with horizontal alveolar ridge deficiencies (population), what is the effect of lateral bone augmentation procedures (intervention and comparison) on peri-implant health (outcome)?" Included studies were randomised controlled trials or controlled clinical trials with a follow-up of at least 12 months after implant loading. Meta-analyses were performed whenever possible, including subgroup analysis based on follow-up. RESULTS Twelve final publications from eight investigations were included. The results from the meta-analysis indicated that irrespective of the type of intervention, the inflammatory changes, based on bleeding on probing (%) were minimal, both at short- (n = 1; weighted mean difference [WMD] = -1.00; 95% CI [-14.04; 12.04]; p = .881) and long-term (n = 5; WMD = -5.63; 95% CI [-18.42; 7.16]; p = .881). When comparing different treatment modalities, no significant differences were observed (n = 6; WMD = -3.36; 95% CI [-12.49; 5.77]; p < .471). Similarly, changes in probing pocket depth and marginal bone levels were not significantly different among groups. The incidence of peri-implantitis was evaluated in three investigations and varied from 16% to 26% after a follow-up period of 6-8 years. CONCLUSIONS The results from this systematic review and meta-analysis have shown that lateral ridge augmentation procedures can maintain peri-implant health over time with low mucosal inflammatory changes and a relatively small incidence of peri-implant bone loss.
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Affiliation(s)
- Ignacio Sanz-Sánchez
- Section of Graduate Periodontology, University Complutense, Madrid, Spain.,ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, University Complutense, Madrid, Spain
| | | | - Elena Figuero
- Section of Graduate Periodontology, University Complutense, Madrid, Spain.,ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, University Complutense, Madrid, Spain
| | - Frank Schwarz
- Department of Oral Surgery, Universitätsklinikum Düsseldorf, Düsseldorf, Germany.,Department of Oral Surgery and Implantology, Carolinum, Johann Wolfgang Goethe-University Frankfurt, Frankfurt, Germany
| | - Ronald Jung
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, University of Zurich, Zurich, Switzerland
| | - Mariano Sanz
- Section of Graduate Periodontology, University Complutense, Madrid, Spain.,ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, University Complutense, Madrid, Spain
| | - Daniel Thoma
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, University of Zurich, Zurich, Switzerland
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30
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Sapata VM, Sanz-Martín I, Hämmerle CHF, Cesar Neto JB, Jung RE, Thoma DS. Profilometric changes of peri-implant tissues over 5 years: A randomized controlled trial comparing a one- and two-piece implant system. Clin Oral Implants Res 2018; 29:864-872. [DOI: 10.1111/clr.13308] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 02/01/2018] [Accepted: 04/07/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Vitor Marques Sapata
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; University of Zurich; Zurich Switzerland
- Discipline of Periodontics, School of Dentistry; University of São Paulo; São Paulo Brazil
| | - Ignacio Sanz-Martín
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; University of Zurich; Zurich Switzerland
| | - Christoph H. F. Hämmerle
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; University of Zurich; Zurich Switzerland
| | - João B. Cesar Neto
- Discipline of Periodontics, School of Dentistry; University of São Paulo; São Paulo Brazil
| | - Ronald E. Jung
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; University of Zurich; Zurich Switzerland
| | - Daniel S. Thoma
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; University of Zurich; Zurich Switzerland
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31
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Bornstein MM, Horner K, Jacobs R. Use of cone beam computed tomography in implant dentistry: current concepts, indications and limitations for clinical practice and research. Periodontol 2000 2018; 73:51-72. [PMID: 28000270 DOI: 10.1111/prd.12161] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Diagnostic radiology is an essential component of treatment planning in the field of implant dentistry. This narrative review will present current concepts for the use of cone beam computed tomography imaging, before and after implant placement, in daily clinical practice and research. Guidelines for the selection of three-dimensional imaging will be discussed, and limitations will be highlighted. Current concepts of radiation dose optimization, including novel imaging modalities using low-dose protocols, will be presented. For preoperative cross-sectional imaging, data are still not available which demonstrate that cone beam computed tomography results in fewer intraoperative complications such as nerve damage or bleeding incidents, or that implants inserted using preoperative cone beam computed tomography data sets for planning purposes will exhibit higher survival or success rates. The use of cone beam computed tomography following the insertion of dental implants should be restricted to specific postoperative complications, such as damage of neurovascular structures or postoperative infections in relation to the maxillary sinus. Regarding peri-implantitis, the diagnosis and severity of the disease should be evaluated primarily based on clinical parameters and on radiological findings based on periapical radiographs (two dimensional). The use of cone beam computed tomography scans in clinical research might not yield any evident beneficial effect for the patient included. As many of the cone beam computed tomography scans performed for research have no direct therapeutic consequence, dose optimization measures should be implemented by using appropriate exposure parameters and by reducing the field of view to the actual region of interest.
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32
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Kawasaki T, Ohba S, Nakatani Y, Asahina I. Clinical study of guided bone regeneration with resorbable polylactide-co-glycolide acid membrane. Odontology 2018; 106:334-339. [PMID: 29429055 DOI: 10.1007/s10266-018-0349-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 12/15/2017] [Indexed: 11/25/2022]
Abstract
The guided bone regeneration (GBR) technique is often applied to provide sufficient bone for ideal implant placement. The objective of this study was to evaluate whether GC membrane®, which has already been used for guided tissue regeneration (GTR), can also be available for GBR. Twenty-three implants in 18 patients were evaluated in the study. All patients underwent implant placement with GBR using GC membrane®. Cone-beam computed tomography was performed at 13-30 weeks after surgery and the amount of augmented bone was assessed. The implant stability quotient (ISQ) was measured at the second operation to evaluate implant stability. Although wound dehiscence was observed at 4 of 23 regions (17.4%), all wounds closed quickly without any events by additional antibiotic administration. GBR-induced bone augmentation of 0.70-2.56 mm horizontally and 0-6.82 mm vertically. Only 0.18 mm of bone recession was observed at 16-24 months after implant placement. GBR with GC membrane® induced sufficient bone augmentation, leading to successful implant treatment. The present results suggest that GC membrane® is available not only for GTR, but also for GBR.
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Affiliation(s)
- Takako Kawasaki
- Department of Regenerative Oral Surgery, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8588, Japan
| | - Seigo Ohba
- Department of Regenerative Oral Surgery, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8588, Japan.
| | - Yuya Nakatani
- Department of Regenerative Oral Surgery, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8588, Japan
| | - Izumi Asahina
- Department of Regenerative Oral Surgery, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8588, Japan
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33
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Jonker BP, Wolvius EB, van der Tas JT, Pijpe J. The effect of resorbable membranes on one-stage ridge augmentation in anterior single-tooth replacement: A randomized, controlled clinical trial. Clin Oral Implants Res 2017; 29:235-247. [PMID: 29266485 DOI: 10.1111/clr.13106] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2017] [Indexed: 11/28/2022]
Abstract
AIM To evaluate the effect of resorbable membranes on one-stage ridge augmentation procedures in small (2-4 mm) buccal bony dehiscences in anterior maxillary single-tooth replacement. MATERIALS AND METHODS Patients with a buccal bony dehiscence after implant placement in the esthetic zone were randomly allocated to one-stage ridge augmentation with (M+) or without a membrane (M-). Second-phase surgery was performed after 8 weeks, and follow-up was performed 1, 6, and ≥12 months after loading. Outcomes included implant survival and success, complications, clinical and radiographic parameters, esthetic results and patient satisfaction. RESULTS Fifty-two patients were randomized to one-stage ridge augmentation with (n = 25) or without use of a membrane (n = 27). No significant differences in implant survival and success have been observed. The risk of having a small mucosal dehiscence was more than six times higher in the M+ group than in the M- group (RR 6.24, 95% CI 0.81 to 48.21). At the last follow-up, the bleeding index (BI) was marginally higher in the M+ group (14/9/2/0) compared to the M- group (24/2/0/0) (U = 205, Z = -2.97, p = .003, r = .42). The median change in marginal bone level was statistically lower in the M+ group (0.06 mm) than the M- group (0.60 mm) at last follow-up (U = 120, Z = -2.73 a p = .006 r = .42). Total pink esthetic index (PES) and white esthetic score (WES) and combined PES/WES were not significantly different between treatment groups at more than 12 months after loading. Only the subcategory root convexity/soft tissue color scored significantly lower in the M+ group (1.5) compared to the M- group (2.0) at the last follow-up (U = 172, Z = -2.34, p = .019 r = .34). No differences were found in patient satisfaction. CONCLUSION The use of a resorbable membrane in small buccal bony dehiscences in anterior maxillary single-tooth replacement resulted in less marginal bone loss, but showed more mucosal dehiscences, higher bleeding scores and lower scores on root convexity and soft tissue color after at least one year of loading. No effect was seen on implant survival and success, overall esthetic results, and patient satisfaction. The research protocol was registered at the Dutch Trial Register (NTR) with ID NTR6137.
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Affiliation(s)
- Brend P Jonker
- Department of Oral & Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Eppo B Wolvius
- Department of Oral & Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus University Medical Center, Rotterdam, The Netherlands.,St. Anna Hospital, Geldrop, The Netherlands
| | - Justin T van der Tas
- Department of Oral & Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Justin Pijpe
- Department of Oral & Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus University Medical Center, Rotterdam, The Netherlands.,Catharina Hospital, Eindhoven, The Netherlands
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34
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Accuracy of Bone Measurements in the Vicinity of Titanium Implants in CBCT Data Sets: A Comparison of Radiological and Histological Findings in Minipigs. BIOMED RESEARCH INTERNATIONAL 2017; 2017:3848207. [PMID: 28798929 PMCID: PMC5536141 DOI: 10.1155/2017/3848207] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 05/30/2017] [Accepted: 06/12/2017] [Indexed: 02/07/2023]
Abstract
Purpose The aim of this animal study was the determination of accuracy of bone measurements in CBCT (cone-beam computed tomography) in close proximity to titanium implants. Material and Methods Titanium implants were inserted in eight Göttingen minipigs. 60 implants were evaluated histologically in ground section specimen and radiologically in CBCT in regard to thickness of the buccal bone. With random intercept models, the difference of histologic measurements and CBCT measurements of bone thickness was calculated. Results The mean histological thickness of the buccal bone was 5.09 mm (CI 4.11–6.08 mm). The four raters measured slightly less bone in CBCT than it was found in histology. The random effect was not significant (p value 1.000). Therefore, the Intraclass Correlation Coefficient (ICC) was 98.65% (CI 100.00–96.99%). Conclusion CBCT is an accurate technique to measure even thin bone structures in the vicinity of titanium implants.
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35
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Benic GI, Thoma DS, Sanz-Martin I, Munoz F, Hämmerle CH, Cantalapiedra A, Fischer J, Jung RE. Guided bone regeneration at zirconia and titanium dental implants: a pilot histological investigation. Clin Oral Implants Res 2017; 28:1592-1599. [DOI: 10.1111/clr.13030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Goran I. Benic
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; Center of Dental Medicine; University of Zurich; Zurich Switzerland
| | - Daniel S. Thoma
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; Center of Dental Medicine; University of Zurich; Zurich Switzerland
| | | | - Fernando Munoz
- Faculty of Veterinary; University of Santiago de Compostela; Santiago Spain
| | - Christoph H.F. Hämmerle
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; Center of Dental Medicine; University of Zurich; Zurich Switzerland
| | | | - Jens Fischer
- Division of Dental Materials and Engineering; University of Basel; Basel Switzerland
| | - Ronald E. Jung
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; Center of Dental Medicine; University of Zurich; Zurich Switzerland
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36
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Benic GI, Thoma DS, Jung RE, Sanz-Martin I, Unger S, Cantalapiedra A, Hämmerle CH. Guided bone regeneration with particulate vs. block xenogenic bone substitutes: a pilot cone beam computed tomographic investigation. Clin Oral Implants Res 2017; 28:e262-e270. [DOI: 10.1111/clr.13011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Goran I. Benic
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; Center of Dental Medicine; University of Zurich; Zurich Switzerland
| | - Daniel S. Thoma
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; Center of Dental Medicine; University of Zurich; Zurich Switzerland
| | - Ronald E. Jung
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; Center of Dental Medicine; University of Zurich; Zurich Switzerland
| | | | - Silvan Unger
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; Center of Dental Medicine; University of Zurich; Zurich Switzerland
| | | | - Christoph H.F. Hämmerle
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; Center of Dental Medicine; University of Zurich; Zurich Switzerland
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37
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Trends in maxillofacial imaging. Clin Radiol 2017; 73:4-18. [PMID: 28341434 DOI: 10.1016/j.crad.2017.02.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 01/23/2017] [Accepted: 02/09/2017] [Indexed: 11/20/2022]
Abstract
Maxillofacial imaging encompasses radiology of the teeth and jaws, including the temporomandibular joints. Modalities used include intra-oral radiographs, panoramic tomography, cephalograms, cone-beam computed tomography, computed tomography, magnetic resonance imaging, ultrasound, and radionuclide imaging. Common indications for imaging are impacted and supernumerary teeth, dental implants, inflammatory dental disease, and fibro-osseous lesions, cysts, and masses of the jaws. Osteonecrosis of the jaws may follow radiotherapy or the use of bisphosphonates and other drugs. Imaging of the temporomandibular joints and the potential role of imaging in obstructive sleep apnoea are also discussed.
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38
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Benic GI, Bernasconi M, Jung RE, Hämmerle CHF. Clinical and radiographic intra-subject comparison of implants placed with or without guided bone regeneration: 15-year results. J Clin Periodontol 2017; 44:315-325. [DOI: 10.1111/jcpe.12665] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Goran I. Benic
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; Center of Dental Medicine; University of Zurich; Zurich Switzerland
| | | | - Ronald E. Jung
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; Center of Dental Medicine; University of Zurich; Zurich Switzerland
| | - Christoph H. F. Hämmerle
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; Center of Dental Medicine; University of Zurich; Zurich Switzerland
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Thoma DS, Weber FE, Bienz SP, Ge Y, Hämmerle CHF, Jung RE. Biodegradation and tissue integration of various polyethylene glycol matrices: a comparative study in rabbits. Clin Oral Implants Res 2017; 28:e244-e251. [PMID: 28111809 DOI: 10.1111/clr.13004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To test whether or not chemical and/or physical modifications of polyethylene glycol (PEG) hydrogels influence degradation time, matrix/membrane stability, and integration into surrounding hard and soft tissues. MATERIAL AND METHODS In 28 rabbits, six treatment modalities were randomly applied to six sites on the rabbit skull: a dense network PEG hydrogel (PEG HD), a medium-dense network PEG hydrogel (PEG MD), a medium-dense network PEG hydrogel modified with an RGD sequence (PEG MD/RGD), a medium-dense network PEG hydrogel modified with RGD with reduced carboxymethyl cellulose (PEG MD/RGD_LV), a loose network PEG hydrogel modified with RGD (PEG LD/RGD), and a collagen membrane (BG). Descriptive histology and histomorphometry were performed at 1, 2, 4, and 6 weeks. RESULTS PEG HD revealed the highest percentage of residual matrix at all time points starting with 47.2% (95% CI: 32.8-63.8%) at 1 week and ending with 23.4% (95% CI: 10.3-49.8%) at 6 weeks. The hydrogel with the loosest network (PEG LD/RGD) was stable the first 2 weeks and then degraded continuously with a final area of 8.3% (95% CI: 3.2-21.2%). PEG HD was the most stable and densely stained membrane, whereas PEG MD and PEG LD matrices integrated faster, but started to degrade to a higher degree between 2 and 4 weeks. PEG MD degradation was dependent on the addition of RGD and the amount of CMC. CONCLUSIONS Chemical and/or physical modifications of PEG hydrogels influenced matrix stability. PEG MD/RGD demonstrated an optimal balance between degradation time and integration into the surrounding soft and hard tissues.
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Affiliation(s)
- Daniel S Thoma
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, University of Zurich, Zurich, Switzerland
| | - Franz E Weber
- Center of Dental Medicine, Oral Biotechnology & Bioengineering, University of Zurich, Zurich, Switzerland
| | - Stefan P Bienz
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, University of Zurich, Zurich, Switzerland
| | - Yanjun Ge
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, University of Zurich, Zurich, Switzerland
| | - Christoph H F Hämmerle
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, University of Zurich, Zurich, Switzerland
| | - Ronald E Jung
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, University of Zurich, Zurich, Switzerland
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Zhao N, Wang Y, Qin L, Guo Z, Li D. Effect of composition and macropore percentage on mechanical and in vitro cell proliferation and differentiation properties of 3D printed HA/β-TCP scaffolds. RSC Adv 2017. [DOI: 10.1039/c7ra07204j] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
HA/β-TCP scaffolds were fabricated by 3D printing and exhibited desirable biocompatibilityin vitro.
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Affiliation(s)
- Ningbo Zhao
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research
- College of Stomatology
- Xi'an Jiaotong University
- Xi'an
- People's Republic of China
| | - Yanen Wang
- The Key Lab of Contemporary Design and Integrated Manufacturing Technology of Ministry of Education
- Northwestern Polytechnical University
- Xi'an 710072
- People's Republic of China
| | - Lei Qin
- State Key Laboratory of Military Stomatology
- Department of Oral Implants
- School of Stomatology
- Fourth Military Medical University
- Xi'an 710032
| | - Zhengze Guo
- State Key Laboratory of Military Stomatology
- Department of Oral Implants
- School of Stomatology
- Fourth Military Medical University
- Xi'an 710032
| | - Dehua Li
- State Key Laboratory of Military Stomatology
- Department of Oral Implants
- School of Stomatology
- Fourth Military Medical University
- Xi'an 710032
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Troeltzsch M, Troeltzsch M, Kauffmann P, Gruber R, Brockmeyer P, Moser N, Rau A, Schliephake H. Clinical efficacy of grafting materials in alveolar ridge augmentation: A systematic review. J Craniomaxillofac Surg 2016; 44:1618-1629. [PMID: 27622971 DOI: 10.1016/j.jcms.2016.07.028] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 06/22/2016] [Accepted: 07/29/2016] [Indexed: 12/29/2022] Open
Abstract
PURPOSE To evaluate the efficacy of grafting materials in lateral and vertical ridge augmentations. MATERIALS AND METHODS A systematic review of the literature on the clinical use of grafting materials of the years 1995 to April 2015 was conducted using electronic search of PubMed and Cochrane libraries and hand search of eight print journals. A total of 184 papers were included, comprising 6182 patients. Parameters evaluated were observation period [months], bone formation [histologic area%], defect fill [%], horizontal and vertical gain [mm], loss of augmented volume [mm], complication rate [%], and implant survival rate [%]. Results are expressed as weighted means ± SD. RESULTS Results were obtained after a weighted mean observation period of 27.4 months (range 3-168 months). Bone formation in the augmented areas varied from 33.2 ± 14.9% for allogeneic grafts to 56.0 ± 25.6% for mixtures of autogenous and other grafting materials. Defect fill in dehiscence defects ranged from 51.0 ± 13.6% (synthetic) to 85.8 ± 13.4% (xenogeneic) for the different materials, with an overall weighted mean of 79.8 ± 18.7%. Weighted mean horizontal gain for all particulate grafting materials was 3.7 ± 1.2 mm, with variation between 2.2 ± 1.2 mm (synthetic) and 4.5 ± 1.0 mm (mixtures of autogenous bone with allogeneic/xenogeneic grafting material) without statistical significance. Weighted overall mean vertical gain was 3.7 ± 1.4 mm. Vertical gain was substantially higher when space-making barrier materials such as titanium meshes were used; however this was also associated with strong increase in complication rate. Block grafts achieved higher horizontal gain by approximately 1 mm. The use of block grafts achieved significantly increased vertical gain compared to particulate material only when autogenous block grafts from extraoral donor sites were used. CONCLUSION Horizontal and vertical gain by 3.7 mm on average can be achieved using particulate materials. This can be increased by using titanium meshes. Substantial vertical gains beyond this dimension require the use of extraoral bone block grafts.
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Affiliation(s)
- Markus Troeltzsch
- Department of Maxillofacial Surgery (Head: Prof. Dr. Dr. H. Schliephake), University of Goettingen, Germany.
| | - Matthias Troeltzsch
- Department of Maxillofacial Surgery, Ludwig - Maximilians - University of Munich, Germany
| | - Philipp Kauffmann
- Department of Maxillofacial Surgery (Head: Prof. Dr. Dr. H. Schliephake), University of Goettingen, Germany
| | - Rudolph Gruber
- Department of Maxillofacial Surgery (Head: Prof. Dr. Dr. H. Schliephake), University of Goettingen, Germany
| | - Phillipp Brockmeyer
- Department of Maxillofacial Surgery (Head: Prof. Dr. Dr. H. Schliephake), University of Goettingen, Germany
| | - Norman Moser
- Department of Maxillofacial Surgery (Head: Prof. Dr. Dr. H. Schliephake), University of Goettingen, Germany
| | - Anna Rau
- Department of Anesthesiology, University of Goettingen, Germany
| | - Henning Schliephake
- Department of Maxillofacial Surgery (Head: Prof. Dr. Dr. H. Schliephake), University of Goettingen, Germany
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Pang KM, Um IW, Kim YK, Woo JM, Kim SM, Lee JH. Autogenous demineralized dentin matrix from extracted tooth for the augmentation of alveolar bone defect: a prospective randomized clinical trial in comparison with anorganic bovine bone. Clin Oral Implants Res 2016; 28:809-815. [PMID: 27279547 DOI: 10.1111/clr.12885] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of this study was to prospectively evaluate the clinical efficacy and histological outcome of the autogenous tooth graft material (AutoBT) compared to that of anorganic bovine bone (Bio-Oss® , Geistlich, Switzerland) in post-extraction alveolar bone augmentation. PATIENTS AND METHODS A total of 33 graft sites in 24 patients were included in this study. AutoBT was used in 21 sites of 15 patients and Bio-Oss® was used in 12 sites of 9 patients for alveolar bone augmentation 2-4 weeks after dental extraction. Vertical dimension of grafted bone was measured both at the time of graft placement and at implant fixture placement after 6 months. Trephine cores were harvested for the histomorphometric evaluations during implant placement when feasible. The primary stability of implant fixture was also measured. RESULTS Infection of graft material or graft bed was not observed and graft sites healed without any notable complications in both groups. The vertical dimensions of alveolar bone increased by 5.38 ± 2.65 mm in AutoBT group and 6.56 ± 3.54 mm in Bio-Oss® group at 6 months post-extraction. Histomorphometrically, new bone formation of AutoBT-grafted site was 31.24 ± 13.87% while that of Bio-Oss® was 35.00 ± 19.33%. The implant stability quotient (ISQ) of implants placed in AutoBT-grafted sites measured 72.80 ± 10.81 while those placed in Bio-Oss® -grafted sites measured 70.0 ± 12.86. There were no statistically significant differences between measurements of the two groups. CONCLUSION Autogenous demineralized dentin matrix from extracted tooth grafted to extraction sockets for the augmentation of vertical dimension was as effective as augmentation using anorganic bovine bone. Both groups showed favorable wound healing, similar amount of implant stability, and histologically confirmed new bone formation. Thus, the results of this study suggest that autogenous tooth graft material is a viable option for alveolar bone augmentation following dental extraction.
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Affiliation(s)
- Kang-Mi Pang
- Department of Oral and Maxillofacial Surgery, Seoul National University Gwanak Dental Hospital, Seoul, Korea
| | - In-Woong Um
- R&D Department, Korea Tooth Bank, Seoul, Korea
| | - Young-Kyun Kim
- Department of Oral and Maxillofacial Surgery, Seoul National University Bundang Hospital, Seoul, Korea
| | - Jae-Man Woo
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, Korea
| | - Soung-Min Kim
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, Korea
| | - Jong-Ho Lee
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, Korea.,Clinical Trial Center, Seoul National University Dental Hospital, Seoul, Korea
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Thoma DS, Jung UW, Park JY, Bienz SP, Hüsler J, Jung RE. Bone augmentation at peri-implant dehiscence defects comparing a synthetic polyethylene glycol hydrogel matrix vs. standard guided bone regeneration techniques. Clin Oral Implants Res 2016; 28:e76-e83. [PMID: 27206342 DOI: 10.1111/clr.12877] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2016] [Indexed: 01/25/2023]
Abstract
OBJECTIVES The aim of the study was to test whether or not the use of a polyethylene glycol (PEG) hydrogel with or without the addition of an arginylglycylaspartic acid (RGD) sequence applied as a matrix in combination with hydroxyapatite/tricalciumphosphate (HA/TCP) results in similar peri-implant bone regeneration as traditional guided bone regeneration procedures. MATERIAL AND METHODS In 12 beagle dogs, implant placement and peri-implant bone regeneration were performed 2 months after tooth extraction in the maxilla. Two standardized box-shaped defects were bilaterally created, and dental implants were placed in the center of the defects with a dehiscence of 4 mm. Four treatment modalities were randomly applied: i)HA/TCP mixed with a synthetic PEG hydrogel, ii)HA/TCP mixed with a synthetic PEG hydrogel supplemented with an RGD sequence, iii)HA/TCP covered with a native collagen membrane (CM), iv)and no bone augmentation (empty). After a healing period of 8 or 16 weeks, micro-CT and histological analyses were performed. RESULTS Histomorphometric analysis revealed a greater relative augmented area for groups with bone augmentation (43.3%-53.9% at 8 weeks, 31.2%-42.8% at 16 weeks) compared to empty controls (22.9% at 8 weeks, 1.1% at 16 weeks). The median amount of newly formed bone was greatest in group CM at both time-points. Regarding the first bone-to-implant contact, CM was statistically significantly superior to all other groups at 8 weeks. CONCLUSIONS Bone can partially be regenerated at peri-implant buccal dehiscence defects using traditional guided bone regeneration techniques. The use of a PEG hydrogel applied as a matrix mixed with a synthetic bone substitute material might lack a sufficient stability over time for this kind of defect.
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Affiliation(s)
- Daniel S Thoma
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, University of Zurich, Zurich, Switzerland
| | - Ui-Won Jung
- Department of Periodontology, Research Institute for Periodontal Regeneration, College of Dentistry, Yonsei University, Seoul, South Korea
| | - Jin-Young Park
- Department of Periodontology, Research Institute for Periodontal Regeneration, College of Dentistry, Yonsei University, Seoul, South Korea
| | - Stefan P Bienz
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, University of Zurich, Zurich, Switzerland
| | - Jürg Hüsler
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, University of Zurich, Zurich, Switzerland
| | - Ronald E Jung
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, University of Zurich, Zurich, Switzerland
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Schwarz F, Schmucker A, Becker J. Long-term outcomes of simultaneous guided bone regeneration using native and cross-linked collagen membranes after 8 years. Clin Oral Implants Res 2016; 28:779-784. [DOI: 10.1111/clr.12881] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Frank Schwarz
- Department of Oral Surgery; Universitätsklinikum Düsseldorf; Düsseldorf Germany
| | - Andrea Schmucker
- Department of Oral Surgery; Universitätsklinikum Düsseldorf; Düsseldorf Germany
| | - Jürgen Becker
- Department of Oral Surgery; Universitätsklinikum Düsseldorf; Düsseldorf Germany
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Three-dimensional maxillary and mandibular regional superimposition using cone beam computed tomography: a validation study. Int J Oral Maxillofac Surg 2016; 45:662-9. [DOI: 10.1016/j.ijom.2015.12.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Revised: 10/27/2015] [Accepted: 12/08/2015] [Indexed: 11/21/2022]
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Mir-Mari J, Benic GI, Valmaseda-Castellón E, Hämmerle CH, Jung RE. Influence of wound closure on the volume stability of particulate and non-particulate GBR materials: an in vitro
cone-beam computed tomographic examination. Part II. Clin Oral Implants Res 2016; 28:631-639. [DOI: 10.1111/clr.12845] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Javier Mir-Mari
- Oral Surgery and Implantology Department; Dental School; University of Barcelona; Barcelona Spain
| | - Goran I. Benic
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; Center of Dental Medicine; University of Zurich; Zurich Switzerland
| | | | - Christoph H.F. Hämmerle
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; Center of Dental Medicine; University of Zurich; Zurich Switzerland
| | - Ronald E. Jung
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; Center of Dental Medicine; University of Zurich; Zurich Switzerland
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Benic GI, Ge Y, Gallucci GO, Jung RE, Schneider D, Hämmerle CHF. Guided bone regeneration and abutment connection augment the buccal soft tissue contour: 3-year results of a prospective comparative clinical study. Clin Oral Implants Res 2016; 28:219-225. [DOI: 10.1111/clr.12786] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Goran I. Benic
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; Center of Dental Medicine; University of Zurich; Zurich Switzerland
| | - Yanjun Ge
- Department of Prosthodontics; Hospital of Stomatology; Peking University; Beijing China
| | - German O. Gallucci
- Department of Restorative Dentistry and Biomaterials Sciences; Harvard School of Dental Medicine; Boston MA USA
| | - Ronald E. Jung
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; Center of Dental Medicine; University of Zurich; Zurich Switzerland
| | - David Schneider
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; Center of Dental Medicine; University of Zurich; Zurich Switzerland
| | - Christoph H. F. Hämmerle
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; Center of Dental Medicine; University of Zurich; Zurich Switzerland
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Benic GI, Scherrer D, Sancho-Puchades M, Thoma DS, Hämmerle CHF. Spectrophotometric and visual evaluation of peri-implant soft tissue color. Clin Oral Implants Res 2016; 28:192-200. [PMID: 26849000 DOI: 10.1111/clr.12781] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2015] [Indexed: 12/01/2022]
Abstract
AIM To spectrophotometrically and visually test whether the peri-implant mucosal color differs from the color of the natural gingiva. MATERIAL AND METHODS Forty single implants in the incisor and premolar region of 40 patients were assessed 3-7 years after implant placement. The differences of the color components lightness, chroma along red-green axis, chroma along yellow-blue axis, and the total color difference ΔE between peri-implant mucosa and natural gingiva were measured with a spectrophotometer. The color difference between peri-implant mucosa and natural gingiva was visually evaluated by clinicians and rated as "clinically visible" or "clinically invisible" from speaking distance. The dimensions of peri-implant mucosa and gingiva at the mid-buccal aspect were evaluated by using cone-beam CT. Spearman analysis was performed to detect correlations between different variables. Two-sided t-test, ANOVA, Mann-Whitney, and Kruskal-Wallis tests were applied to detect differences between the groups. RESULTS The spectrophotometrically assessed color difference ΔE between peri-implant mucosa and natural gingiva amounted to 7.0 ± 3.9. The peri-implant mucosa presented a significant dark, greenish and bluish discoloration in comparison with gingiva at control teeth. Clinical investigation revealed that in 60% of sites the color difference between peri-implant mucosa and natural gingiva was clinically visible from speaking distance. The threshold value ΔE for the extraoral clinical distinction of mucosal color differences measured 7.5. When comparing the groups with visible and invisible color differences with respect to the three color components, a significant difference was found only for chroma along yellow-blue axis. In the group with visible color difference, mucosa presented a bluish discoloration. Correlation analysis indicated that with an increase in mucosal thickness, a trend for smaller ΔE was found. CONCLUSION The spectrophotometrically assessed color of the peri-implant mucosa revealed more dark, green and blue components compared to the natural gingiva. At 60% of the implants, peri-implant mucosal discoloration was visible from speaking distance. The sites with visible and those with invisible mucosal discolorations differed significantly only regarding the chroma along yellow-blue axis.
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Affiliation(s)
- Goran I Benic
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | | | - Manuel Sancho-Puchades
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Daniel S Thoma
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Christoph H F Hämmerle
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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A spatial association between odontomas and the gubernaculum tracts. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 121:91-5. [PMID: 26679362 DOI: 10.1016/j.oooo.2015.10.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 10/02/2015] [Accepted: 10/12/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The purpose of this study was to identify the spatial relationship and/or association between odontomas and the gubernaculum tract or the dental sac and the characteristic findings for radiographic diagnosis of odontomas. STUDY DESIGN The visualizations of the odontomas and the gubernaculum tract were retrospectively analyzed using cone beam computed tomography or multidetector computed tomography. RESULTS Most of odontomas were within the gubernaculum tract or dental sac of unerupted permanent teeth on computed tomography. In some odontomas, the gubernaculum tract existed as a well-defined low density tract extending from the top of odontomas on computed tomography. CONCLUSIONS A close spatial relationship and/or association between odontomas and the gubernaculum tract or dental sac on computed tomography may be used as one of the criteria for radiographic diagnosis of odontomas. Development of odontomas may be associated with the gubernaculum tract or dental sac of unerupted permanent teeth.
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Lutz R, Neukam FW, Simion M, Schmitt CM. Long-term outcomes of bone augmentation on soft and hard-tissue stability: a systematic review. Clin Oral Implants Res 2015; 26 Suppl 11:103-22. [DOI: 10.1111/clr.12635] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Rainer Lutz
- Department of Oral and Maxillofacial Surgery; University of Erlangen-Nürnberg; Erlangen Germany
| | - Friedrich W. Neukam
- Department of Oral and Maxillofacial Surgery; University of Erlangen-Nürnberg; Erlangen Germany
| | - Massimo Simion
- Department of Periodontology; Dental School; University of Milan; Milan Italy
| | - Christian M. Schmitt
- Department of Oral and Maxillofacial Surgery; University of Erlangen-Nürnberg; Erlangen Germany
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