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Yorioka H, Otsu Y, Suzuki R, Matsunaga S, Nakano T, Abe S, Sasaki H. The influence of immediate occlusal loading on micro/nano-structure of peri-implant jaw bone in rats. Int J Implant Dent 2024; 10:24. [PMID: 38722448 PMCID: PMC11082111 DOI: 10.1186/s40729-024-00538-x] [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: 08/25/2023] [Accepted: 04/10/2024] [Indexed: 05/12/2024] Open
Abstract
PURPOSE The objective of the present study was to ascertain the effect of immediate occlusal loading after implant placement on osseointegration and the micro/nanostructure of the surrounding bone. METHODS After extraction of a rat maxillary right second molar, an implant was placed immediately with initial fixation (2 N< ). The implants were placed to avoid occlusal loading due to mastication, and in the loaded group, a superstructure was fabricated and subjected to occlusal loading. Bone morphometry, collagen fiber anisotropy, and biological apatite (BAp) crystallite alignment were quantitatively evaluated in both groups after extraction and fixation of the jaw bone at Days 7 and 21 after surgery. RESULTS Osseointegration was observed in both groups. Bone morphometry showed significant differences in bone volume, trabecular number, trabecular thickness and bone mineral density (BMD) at Days 21 postoperatively (P < 0.05). A significant difference was also found in the trabecular separation at Days 7 postoperatively (P < 0.05). In the evaluation of collagen fiber anisotropy, collagen fiber bundles running differently from the existing bone were observed in both groups. In terms of BAp crystallite alignment, a specific structure was observed in the reconstructed new bone after implantation, and preferential orientation of BAp crystallite alignment was observed in the longitudinal direction of the implants in the Day 21 postoperative loaded group. CONCLUSION When sufficient initial fixation is achieved at the time of dental implant placement, then the applied masticatory load may contribute to rapidly achieving not only bone volume, but also adequate bone quality after implant placement.
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Affiliation(s)
- Hiroaki Yorioka
- Department of Oral and Maxillofacial Implantology, Tokyo Dental College, 2-9-18 Kandamisaki-cho, Chiyoda-ku, 101-0061, Tokyo, Japan
- Oral Health Science Center, Tokyo Dental College, 2-9-18 Kandamisaki-cho, Chiyoda-ku, 101-0061, Tokyo, Japan
| | - Yuto Otsu
- Department of Oral and Maxillofacial Implantology, Tokyo Dental College, 2-9-18 Kandamisaki-cho, Chiyoda-ku, 101-0061, Tokyo, Japan
- Oral Health Science Center, Tokyo Dental College, 2-9-18 Kandamisaki-cho, Chiyoda-ku, 101-0061, Tokyo, Japan
| | - Ryu Suzuki
- Department of Anatomy, Tokyo Dental College, 2-9-18 Kandamisaki-cho, Chiyoda-ku, 101-0061, Tokyo, Japan
| | - Satoru Matsunaga
- Oral Health Science Center, Tokyo Dental College, 2-9-18 Kandamisaki-cho, Chiyoda-ku, 101-0061, Tokyo, Japan.
- Department of Anatomy, Tokyo Dental College, 2-9-18 Kandamisaki-cho, Chiyoda-ku, 101-0061, Tokyo, Japan.
| | - Takayoshi Nakano
- Division of Materials and Manufacturing Science, Graduate School of Engineering, Osaka University, 2-1, Yamada-oka, 565-0871, Suita, Osaka, Japan
| | - Shinichi Abe
- Oral Health Science Center, Tokyo Dental College, 2-9-18 Kandamisaki-cho, Chiyoda-ku, 101-0061, Tokyo, Japan
- Department of Anatomy, Tokyo Dental College, 2-9-18 Kandamisaki-cho, Chiyoda-ku, 101-0061, Tokyo, Japan
| | - Hodaka Sasaki
- Department of Oral and Maxillofacial Implantology, Tokyo Dental College, 2-9-18 Kandamisaki-cho, Chiyoda-ku, 101-0061, Tokyo, Japan
- Oral Health Science Center, Tokyo Dental College, 2-9-18 Kandamisaki-cho, Chiyoda-ku, 101-0061, Tokyo, Japan
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Lin X, Yu X, Wang F, Wu Y. Marginal bone level change of immediately restored implants with simultaneous guided bone regeneration: A systematic review. Clin Implant Dent Relat Res 2023; 25:1112-1137. [PMID: 37555385 DOI: 10.1111/cid.13255] [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: 06/02/2023] [Revised: 07/14/2023] [Accepted: 07/18/2023] [Indexed: 08/10/2023]
Abstract
AIM To assess marginal bone level change (MBLc), clinical outcomes for soft tissue, and survival rates for immediately restored implants with simultaneous guided bone regeneration (GBR). MATERIALS AND METHODS Electronic and manual searches were conducted in PubMed/MEDLINE, EMBASE, and CENTRAL for studies that investigated immediately restored implants in simultaneously grafted sites with a mean follow-up of over 12 months. MBLc was the primary outcome. Soft tissue clinical parameters and implant survival rate (ISR) were the secondary outcomes. RESULTS Twenty-five studies (5 randomized controlled trials, 6 prospective studies, 2 retrospective studies, and 12 case series) were included, from which 692 immediately restored implants were analyzed. For studies that investigated bone grafts in the gap between the implant and the peripheral bone wall, the weighted mean MBLc was -0.73 ± 1.52 mm (range: -1.50 to 0.26 mm) for 475 implants. Pink esthetic score (PES) was improved in eight studies and the weighted cumulative ISR was 98.99% (Median: 100%) in 622 implants. Mean MBLc was -1.19 ± 0.26 mm for 30 implants in studies that reported gap with dehiscence and/or fenestration augmentation. Weighted cumulative ISR was 97.25% in 70 implants. A meta-analysis was not possible due to the lack of studies with an eligible control group. Therefore, the data should be interpreted with caution. CONCLUSION Less marginal bone loss and more predictable soft tissue parameters can be achieved for immediately restored implants with simultaneous peri-implant gap filling compared with gap with dehiscence/fenestration grafting. Increased ISR for implants with gap filling was observed. However, more evidence is needed to confirm whether immediate provisional prostheses should be utilized when bone defects are simultaneously augmented around the implants.
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Affiliation(s)
- Xinyan Lin
- Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Shanghai Research Institute of Stomatology, Shanghai, China
- Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, China
| | - Xinbo Yu
- Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Shanghai Research Institute of Stomatology, Shanghai, China
- Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, China
| | - Feng Wang
- Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Shanghai Research Institute of Stomatology, Shanghai, China
- Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, China
| | - Yiqun Wu
- Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Shanghai Research Institute of Stomatology, Shanghai, China
- Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, China
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Skiba THI, Kalil EC, Piattelli A, Shibli JA. Human Histological Analysis of Early Bone Response to Immediately Loaded Narrow Dental Implants with Biphasic Calcium Phosphate ® Grid-Blasted Surface Treatment: A Case Report. Dent J (Basel) 2023; 11:177. [PMID: 37504243 PMCID: PMC10377936 DOI: 10.3390/dj11070177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 06/29/2023] [Accepted: 07/17/2023] [Indexed: 07/29/2023] Open
Abstract
Implant surface topography using bioactive material provides faster bone-to-implant healing. This histological report described the analysis of human bone tissue around an immediately loaded implant, with BPC® (Biphasic Calcium Phosphate) grit-blasted surface treatment, after two months of healing. Two temporary mini-implants (2.8 × 10 mm) with BPC® grit-blasting surfaces were placed and immediately loaded to retain a complete interim denture. After a 60-day healing period, one mini-implant was removed for histologic analysis. The ground section showed the whole implant surrounded by healthy peri-implant tissues. Implant surface presented a close contact with newly formed bone, showing some areas of osteoblasts secreting mineral matrix. The ground section depicted a bone contact of 60.3 + 8.5%. The BPC® grit-blasted surface was biocompatible and enabled the osseointegration process after a short-term period.
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Affiliation(s)
| | - Eduardo C Kalil
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos 07023-040, SP, Brazil
| | - Adriano Piattelli
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos 07023-040, SP, Brazil
- School of Dentistry, Saint Camillus International University of Health and Medical Sciences, Via di Sant'Alessandro 8, 00131 Rome, Italy
| | - Jamil Awad Shibli
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos 07023-040, SP, Brazil
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Sargolzaie N, Zarch HH, Arab H, Koohestani T, Ramandi MF. Marginal bone loss around crestal or subcrestal dental implants: prospective clinical study. J Korean Assoc Oral Maxillofac Surg 2022; 48:159-166. [PMID: 35770357 PMCID: PMC9247445 DOI: 10.5125/jkaoms.2022.48.3.159] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/01/2022] [Accepted: 05/09/2022] [Indexed: 11/07/2022] Open
Abstract
Objectives The stability of crestal bone has been reported as a major factor in the success of dental implants. Implants can be placed in an equicrestal (crestal) or subcrestal position. The aim of this study was to evaluate the effect of implant depth placement on marginal bone loss. Materials and Methods The study was created in a split-mouth design. Immediately after implant surgery, digital parallel radiographs were prepared and levels of bone were measured where marginal bone loss and bone level changes occurred. These measurements were repeated at 3-month and 6-month follow-up periods. Results In this interventional study, 49 implants were evaluated in 18 patients. Primary bone height was not significant between the intervention and control groups in both mesial and distal aspects at 3 months and 6 months from the baseline. The mean marginal bone loss on the mesial side was 1.03 mm in the subcrestal group and 0.83 mm in the crestal group. In addition, mean marginal bone loss on the distal side was 0.88 mm and 0.81 mm in the subcrestal and crestal groups, respectively. Marginal bone loss was not significantly different between sexes, the maxilla or mandible, and in the anterior or posterior regions as well as between different lengths and diameters of implants. Conclusion Based on the results of this study, there was no significant difference in terms of marginal bone loss between crestal and subcrestal implants.
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Affiliation(s)
- Naser Sargolzaie
- Dental Research Center, School of Dentistry, Mashhad University of Medical Sciences, Iran
| | - Hosein Hoseini Zarch
- Department of Oral and Maxillofacial Radiology, School of Dentistry and Dental Research Center, Mashhad University of Medical Sciences, Iran
| | - Hamidreza Arab
- Dental Research Center, School of Dentistry, Mashhad University of Medical Sciences, Iran
| | | | - Mahdiye Fasihi Ramandi
- Department of Periodontics, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
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Influence of Bone-Level Dental Implants Placement and of Cortical Thickness on Osseointegration: In Silico and In Vivo Analyses. J Clin Med 2022; 11:jcm11041027. [PMID: 35207298 PMCID: PMC8879296 DOI: 10.3390/jcm11041027] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/09/2022] [Accepted: 02/15/2022] [Indexed: 01/04/2023] Open
Abstract
The purpose of this research is to study the biomechanical response of dental implants in bone-level type locations, 0.5 mm above and below the bone level. In addition, the influence of the thickness of the cortical bone on osseointegration is determined due to the mechanical loads transfer from the dental implant to the cortical and trabecular bone. The thicknesses studied were 1.5 mm and 2.5 mm. Numerical simulations were performed using a finite element method (FEM)-based model. In order to verify the FEM model, the in silico results were compared with the results obtained from a histological analysis performed in an in vivo study with 30 New Zealand rabbits. FEM was performed using a computerized 3D model of bone-level dental implants inserted in the lower jawbone with an applied axial load of 100 N. The analysis was performed using different distances from the bone level and different thicknesses of cortical bone. The interface area of bone growth was evaluated by analyzing the bone–implant contact (BIC), region of interest (ROI) and total bone area (BAT) parameters obtained through an in vivo histological process and analyzed by scanning electron microscopy (SEM). Bone-level implants were inserted in the rabbit tibiae, with two implants placed per tibia. These parameters were evaluated after three or six weeks of implantation. FEM studies showed that placements 0.5 mm below the bone level presented lower values of stress distribution compared to the other studied placements. The lower levels of mechanical stress were then correlated with the in vivo studies, showing that this position presented the highest BIC value after three or six weeks of implantation. In this placement, vertical bone growth could be observed up the bone level. The smallest thickness of the study showed a better transfer of mechanical loads, which leads to a better osseointegration. In silico and in vivo results both concluded that the implants placed 0.5 mm below the cortical bone and with lower thicknesses presented the best biomechanical and histological behavior in terms of new bone formation, enhanced mechanical stability and optimum osseointegration.
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Romanos GE, Fischer GA, Delgado-Ruiz R. Titanium Wear of Dental Implants from Placement, under Loading and Maintenance Protocols. Int J Mol Sci 2021; 22:1067. [PMID: 33494539 PMCID: PMC7865642 DOI: 10.3390/ijms22031067] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/05/2021] [Accepted: 01/19/2021] [Indexed: 12/13/2022] Open
Abstract
The objective of this review was to analyze the process of wear of implants leading to the shedding of titanium particles into the peri-implant hard and soft tissues. Titanium is considered highly biocompatible with low corrosion and toxicity, but recent studies indicate that this understanding may be misleading as the properties of the material change drastically when titanium nanoparticles (NPs) are shed from implant surfaces. These NPs are immunogenic and are associated with a macrophage-mediated inflammatory response by the host. The literature discussed in this review indicates that titanium NPs may be shed from implant surfaces at the time of implant placement, under loading conditions, and during implant maintenance procedures. We also discuss the significance of the micro-gap at the implant-abutment interface and the effect of size of the titanium particles on their toxicology. These findings are significant as the titanium particles can have adverse effects on local soft and hard tissues surrounding implants, implant health and prognosis, and even the health of systemic tissues and organs.
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Affiliation(s)
- Georgios E. Romanos
- Department of Periodontology, Laboratory for Periodontal-, Implant-, Phototherapy (LA-PIP), School of Dental Medicine, Stony Brook University, 106 Rockland Hall, Stony Brook, NY 11794-8700, USA;
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, Johann Wolfgang Goethe University, 60590 Frankfurt, Germany
| | - Gerard A. Fischer
- Department of Periodontology, Laboratory for Periodontal-, Implant-, Phototherapy (LA-PIP), School of Dental Medicine, Stony Brook University, 106 Rockland Hall, Stony Brook, NY 11794-8700, USA;
| | - Rafael Delgado-Ruiz
- Department of Prosthodontics and Digital Technology, School of Dental Medicine, Stony Brook University, Stony Brook, NY 11794-8700, USA;
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Daher FI, Abi-Aad HL, Dimassi HI, Baba NZ, Majzoub ZA. Factors Affecting Implant Stability Quotients at Immediately and Conventionally Loaded Implants in the Posterior Maxilla: A Split-Mouth Randomized Controlled Trial. J Prosthodont 2021; 30:590-603. [PMID: 33215755 DOI: 10.1111/jopr.13296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2020] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To assess primary and secondary stability of variable-thread tapered implants in the posterior maxilla and analyze the impact of various factors on implant stability quotients (ISQs). MATERIALS AND METHODS Twenty-six subjects received 3-4 adjacent implants in the maxillary premolar-molar sextants to replace bilateral tooth loss. The implants on one side were immediately loaded with a provisional fixed prosthesis regardless of their primary stability. The contralateral control implants were conventionally loaded. Bone quality was subjectively recorded and primary stability was assessed by means of insertion torque values (ITVs) and ISQs in 4 directions. Secondary stability was measured by ISQ at definitive prosthesis delivery (3-3.5 months postoperatively), and 12 months after definitive loading. The impact of measurement direction, loading protocol, time, site-related (bone quality, implant position, crestal buccal bone thickness, apical cortical anchorage), and implant-related (implant dimensions, abutment height) variables on ISQs was assessed. RESULTS For logistic reasons, ISQs were obtained for only 18 patients with 60 test and 60 control implants. Most of the implants (82%) at baseline had their lowest ISQ on the buccal aspect. There were no significant differences between ISQs measured in the buccal and palatal directions, or between ISQs in the mesial and distal directions. The mean of buccal and palatal ISQs was significantly lower than the mean of the 2 interproximal measurements at all evaluation periods. ISQs were not significantly different between the 2 loading groups at any time point. All implants showed a time-dependent increase in ISQs. Baseline ISQ correlated weakly with bone quality and ITV. None of the variables had a significant impact on baseline ISQs, except for implants in second molar sites which showed poorer primary stability than first premolars. CONCLUSION Measurement direction and time are the most significant parameters affecting ISQs of variable-thread tapered implants in the posterior maxilla.
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Affiliation(s)
- Fadi I Daher
- Department of Periodontics, Lebanese University, Faculty of Dental Medicine, Hadath, Lebanon
| | - Habib L Abi-Aad
- Department of Periodontics, Lebanese University, Faculty of Dental Medicine, Hadath, Lebanon
| | - Hani I Dimassi
- School of Pharmacy, Department of Pharmaceutical Sciences, Lebanese American University, Byblos, Lebanon
| | - Nadim Z Baba
- Advanced Dental Education Program in Implant Dentistry, Loma Linda University, School of Dentistry, Loma Linda, CA
| | - Zeina Ak Majzoub
- Department of Periodontics, Lebanese University, Faculty of Dental Medicine, Hadath, Lebanon
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Ye M, Liu W, Cheng S, Yan L. Immediate vs conventional loading of mandibular overdentures: A comprehensive systematic review and meta-analysis of randomized controlled trials. J ORAL IMPLANTOL 2020; 48:64-73. [PMID: 33206979 DOI: 10.1563/aaid-joi-d-20-00265] [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] [Indexed: 11/22/2022]
Abstract
Clinicians treating overdenture patients need to know if immediate loading and conventional loading results in similar outcomes. This study aimed to perform a systematic literature search of studies comparing immediate and conventional loading of mandibular overdentures irrespective of the number of implants and conduct a meta-analysis of implant failure and marginal bone loss (MBL). A literature search of PubMed, ScienceDirect, Ovoid, Springer, and Google Scholar databases was performed for randomized controlled trials (RCTs) comparing immediate vs conventional loading of mandibular overdentures. The primary outcome was implant failure and the secondary outcome was marginal bine loss (MBL). A descriptive analysis was performed for other outcomes. Thirteen trials were included. Only one trial compared the immediate and delayed loading of single implant-supported overdenture. Seven trials used two implants, one trial used three implants while four trials used four implants. Meta-analysis indicated no statistically significant difference in implant failure and MBL between immediate and conventional loading of two-implant and four-implant supported overdentures. Descriptive analysis indicated no difference in peri-implant tissue indices, implant stability, and quality of life outcomes between the two loading protocols.There may be no difference in implant failure and MBL with immediate loading or conventional loading of two and four-implant supported mandibular overdentures. Literature review indicates that there may be no difference in peri-implant tissue indices, implant stability, and QoL outcomes between the two loading protocols. The overall quality of evidence is moderate. Further, adequately powered RCTs are required to strengthen the evidence.
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Affiliation(s)
- Mingfu Ye
- Stomatological Hospital of Xiamen Medical College, Xiamen Key Laboratory of Stomatological Disease Diagnosis and Treatment Department of Oral Implantology No. 1309, Lvling Road CHINA Xiamen Fujian 361008 Department of Oral Implantology, Stomatological Hospital of Xiamen Medical College, Xiamen Key Laboratory of Stomatological Disease Diagnosis and Treatment
| | - Wenjun Liu
- Department of Oral Implantology, Stomatological Hospital of Xiamen Medical College, Xiamen Key Laboratory of Stomatological Disease Diagnosis and Treatment
| | - Shaolong Cheng
- Department of Oral Implantology, Stomatological Hospital of Xiamen Medical College, Xiamen Key Laboratory of Stomatological Disease Diagnosis and Treatment
| | - Lihui Yan
- Department of Oral Implantology, Stomatological Hospital of Xiamen Medical College, Xiamen Key Laboratory of Stomatological Disease Diagnosis and Treatment
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Schuster AJ, Marcello-Machado RM, Bielemann AM, Possebon APDR, Chagas Júnior OL, Faot F. Immediate vs conventional loading of Facility-Equator system in mandibular overdenture wearers: 1-year RCT with clinical, biological, and functional evaluation. Clin Implant Dent Relat Res 2020; 22:270-280. [PMID: 32363765 DOI: 10.1111/cid.12902] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 01/20/2020] [Accepted: 03/10/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND The use of immediate loading (IML) is still poorly explored in elderly patients and implant-retained mandibular overdenture (IMO) wearers. For this reason, more comparisons to conventional loading (CL) are required. PURPOSE To evaluate the clinical, biological, functional, and oral health-related quality of life (OHRQOL) influence of CL and IML loading on elders wearing IMO retained by the Facility-Equator system up to 1 year after implant installation. MATERIAL AND METHODS Twenty edentulous patients received two narrow diameter implants in the mandible; the loading type (CL or IML) was randomized. The clinical parameters were monitored along with prosthetic events, marginal bone loss (MBL) and bone level change (BLC), implant stability quotients (ISQ), masticatory performance outcomes, and Interleukin 1 beta (IL-1β) and tumor necrosis factor alpha (TNF-α) levels in the peri-implant crevicular fluid during the first year of loading. The OHRQoL was assessed via the Oral Health Impact Profile-EDENT questionnaire. Data were analyzed by the Mann-Whitney, χ2 , Wilcoxon paired, and McNemar tests. RESULTS After 1 year, MBL, BLC and ISQ were statistically identical (P > .05) in the CL and IML groups. The probing depth at 12 months in the CL group (2.19 mm) was higher than in the IML group (1.29 mm; P ≤ .0001). TNF-α was 33.6% higher in the CL group at 6 months (P = .043), while IL-1β was significantly higher in the IML group up to 6 months. The survival rate was 90% in the CL group and 85% in the IML group; 33 prosthetic events occurred in CL group and 23 in IML group. CONCLUSIONS After 12 months, both loading protocols are viable and result in similar clinical, biological, functional, and OHRQOL outcomes. However, IML generates better adaptation of the peri-implant tissues, faster improvement in OHRQoL and fewer prosthetic intercurrences than CL.
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Affiliation(s)
- Alessandra J Schuster
- Graduate Program in Dentistry, School of Dentistry, Federal University of Pelotas, Rio Grande do Sul, Brazil
| | - Raissa M Marcello-Machado
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, State University of Campinas, Piracicaba, São Paulo, Brazil
| | - Amália M Bielemann
- Graduate Program in Dentistry, School of Dentistry, Federal University of Pelotas, Rio Grande do Sul, Brazil
| | - Anna Paula da Rosa Possebon
- Graduate Program in Dentistry, School of Dentistry, Federal University of Pelotas, Rio Grande do Sul, Brazil
| | - Otacílio L Chagas Júnior
- Department of Oral and Maxillofacial Surgery and Maxillofacial Prosthodontics, School of Dentistry, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Fernanda Faot
- Department of Restorative Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
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10
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Romanos GE, Delgado-Ruiz R, Sculean A. Concepts for prevention of complications in implant therapy. Periodontol 2000 2019; 81:7-17. [PMID: 31407435 DOI: 10.1111/prd.12278] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The use of dental implants is nowadays a well-accepted and highly predictable treatment modality for restoring the dentition and reestablishing the masticatory function of edentulous and partially edentulous patients. Despite the high predictability and excellent long-term survival rates reported for implant therapy, complications may still occur and can jeopardize both short- and long-term success. The present paper provides an overview on the most important aspects related to the etiology, prevention, and management of complications associated with implant therapy. Data from the literature indicate that a number of factors, such as surgical trauma, implant diameter, type of implant-abutment connection, abutment disconnection and reconnection, presence of microgap, and implant malpositioning, can substantially influence the biologic processes of bone remodeling and biofilm formation, thus increasing the rate of short- and long-term hard- and soft-tissue complications. Other factors, such as excess cement at cement-retained prosthetic restorations, abutment mobility, and infections (e.g. peri-implant mucositis and peri-implantitis) caused by bacterial biofilm, are further causes for complications and failures. More recent evidence also indicates that besides the need for sufficient bone volume surrounding the implant, the presence of an adequate width and thickness of attached mucosa may improve biofilm control and limit crestal bone resorption. Furthermore, emerging evidence points also to the pivotal role of human factors as one of the most important causes of complications in implant dentistry. It can be concluded that clinicians need to consider all biologic and biomechanical factors affecting implant placement and survival, as well as undergo adequate training to improve their surgical skills to control and prevent implant complications. Careful patient selection and control of environmental and systemic factors, such as smoking, diabetes etc., coupled with an accurate surgical and prosthetic planning, enable a better prevention and control of infections.
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Affiliation(s)
- Georgios E Romanos
- Department of Periodontology, School of Dental Medicine, Stony Brook University, Stony Brook, New York, USA
| | - Rafael Delgado-Ruiz
- Department of Prosthodontics and Digital Technology, School of Dental Medicine, Stony Brook University, Stony Brook, New York, USA
| | - Anton Sculean
- Department of Periodontology, University of Bern, Bern, Switzerland
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11
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Pellicer-Chover H, Díaz-Sanchez M, Soto-Peñaloza D, Peñarrocha-Diago MA, Canullo L, Peñarrocha-Oltra D. Impact of crestal and subcrestal implant placement upon changes in marginal peri-implant bone level. A systematic review. Med Oral Patol Oral Cir Bucal 2019; 24:e673-e683. [PMID: 31433391 PMCID: PMC6764703 DOI: 10.4317/medoral.23006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 05/27/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND To systematically assess studies analyzing peri-implant bone loss in implants placed in crestal and subcrestal position. MATERIAL AND METHODS Following the recommended methods for systematic reviews and meta-analyses (PRISMA), an electronic search was conducted in the PubMed (MEDLINE), EMBASE and LILACS databases to identify all relevant articles published up until April 2017. The search included human studies comparing marginal bone loss (MBL) between a control group and a study group with a minimum of 10 patients and a minimum follow-up of 6 months after prosthetic loading with rough neck implants. Two independent reviewers assessed the risk of bias in the selected studies based on the Newcastle-Ottawa scale for observational studies and the Cochrane Collaboration for clinical trials. RESULTS Of 342 potentially eligible items, 7 complied with the inclusion criteria. One article was retrieved through the manual search. Eight articles were finally included: five experimental and three observational studies. The risk of bias assessed by the Cochrane Collaboration and Newcastle-Ottawa showed a high risk of bias. The mean follow-up period was 21 months (range 6-36 months). In four studies, implants placed in a crestal position presented higher MBL than subcrestal implants - the differences being significant in one study, while in three studies, implants placed in a subcrestal position presented greater MBL than crestal implants, with significant differences in only one study. CONCLUSION Despite its limitations, the present systematic review did not find better outcomes between crestal and subcrestal implant placement, however, new studies will be needed, involving improved designs and the standardization of protocols to allow statistical comparisons and the drawing of firm conclusions.
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Affiliation(s)
- H Pellicer-Chover
- Universidad de Valencia, Clínica Odontológica, Unidad de Cirugía Bucal, Gascó Oliag 1, 46021 - Valencia, (Spain),
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Kutkut A, Rezk M, Zephyr D, Dawson D, Frazer R, Al-Sabbagh M. Immediate Loading of Unsplinted Implant Retained Mandibular Overdenture: A Randomized Controlled Clinical Study. J ORAL IMPLANTOL 2019; 45:378-389. [PMID: 31389755 DOI: 10.1563/aaid-joi-d-18-00202] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This clinical study aimed to clinically and radiographically compare the implant survival rate and peri-implant tissue response between immediate and delayed loading protocols for unsplinted implant retained mandibular overdentures. Twenty patients were enrolled to participate in this study. Each subject was randomly assigned to 1 of 2 treatment groups: test group patients' implants (n = 10), which were immediately loaded, and control group patients' implants (n = 10), which were conventionally loaded. Locator abutments were torqued to 15 Ncm at delivery. Attachments were picked up intraorally immediately after implant placement for the test group and at 3 months for the control group, and 3-lb retention inserts were placed. Marginal bone levels based on cone beam computed tomography fixed reference points were recorded at baseline and 12 months. Modified plaque index, gingival index, and implant stability quotients were recorded at baseline, 3 months, and 12 months. After 12 months, implant survival rate was 100% in both groups. Marginal bone levels, keratinized mucosa, modified plaque index, and gingival index were significantly different among the groups at 3- and 12-month intervals, whereas no significant differences were found in implant stability quotients between the groups. The fact that implant survival rate was 100% in both treatment groups suggests that, within the limitations of this study, immediate loading protocol for unsplinted implant retained mandibular complete overdenture is as predictable, safe, and successful as the delayed loading protocol. Implementing the immediate loading protocol for mandibular implant retained overdentures could shorten treatment time, which could lead to better patient's satisfaction.
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Affiliation(s)
- Ahmad Kutkut
- Division of Restorative Dentistry, College of Dentistry, University of Kentucky, Lexington, Ky
| | - Mohamed Rezk
- Division of Periodontology, College of Dentistry, University of Kentucky, Lexington, Ky
| | - Dominique Zephyr
- College of Public Health Public, University of Kentucky, Lexington, Ky
| | - Dolphus Dawson
- Division of Periodontology, College of Dentistry, University of Kentucky, Lexington, Ky
| | - Robert Frazer
- Division of Prosthodontics, College of Dentistry, University of Kentucky, Lexington, Ky
| | - Mohanad Al-Sabbagh
- Division of Periodontology, College of Dentistry, University of Kentucky, Lexington, Ky
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Vogl S, Stopper M, Hof M, Theisen K, Wegscheider WA, Lorenzoni M. Immediate occlusal vs nonocclusal loading of implants: A randomized prospective clinical pilot study and patient centered outcome after 36 months. Clin Implant Dent Relat Res 2019; 21:766-774. [PMID: 31062517 PMCID: PMC6767417 DOI: 10.1111/cid.12770] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 03/06/2019] [Accepted: 03/06/2019] [Indexed: 11/30/2022]
Abstract
Background Immediate provisionalization reduces chair time and improves patient comfort. Purpose To analyze immediate functional loading vs nonfunctional loading with restorations in the posterior mandible for marginal bone defects, implant success/survival, and patient satisfaction. Materials and Methods A randomized controlled clinical trial was designed to assess these parameters based on 20 adult patients who underwent implant surgery, followed by immediate delivery of screw‐retained or cemented single or splinted restorations in full occlusal contact or in infraocclusion (test and control group). A questionnaire with visual analog scales was used to assess patient satisfaction. Results Following 36‐month data were evaluable for 9 patients (21 implants) in the study group (immediate functional loading) and for 10 patients (31 implants) in the control group (immediate nonfunctional loading). One implant in the control group was lost, hence the overall implant survival and success rate was 98.2%. Marginal bone defects were consistent with previous studies and comparable in both groups. Periotest values did not significantly change from baseline and the 12‐month follow‐up (Friedmann test). Patient satisfaction was high and did not involve any significant intergroup differences (Mann‐Whitney U‐test). Conclusions Both types of immediate provisional restorations are viable in selected patients. Larger randomized controlled trials are needed to establish immediate functional loading as a standard treatment for partially edentulous jaws.
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Affiliation(s)
- Susanne Vogl
- Division of Operative dentistry, Periodontology and Prosthodontics, Department of Dental Medicine and Oral Health, Medical University of Graz, Graz, Austria
| | - Marlene Stopper
- Division of Operative dentistry, Periodontology and Prosthodontics, Department of Dental Medicine and Oral Health, Medical University of Graz, Graz, Austria
| | - Markus Hof
- Department of Oral Surgery, Dental Clinics, Faculty of Medicine at the Sigmund Freud University, Vienna, Austria
| | - Kerstin Theisen
- Division of Operative dentistry, Periodontology and Prosthodontics, Department of Dental Medicine and Oral Health, Medical University of Graz, Graz, Austria
| | - Walther A Wegscheider
- Division of Operative dentistry, Periodontology and Prosthodontics, Department of Dental Medicine and Oral Health, Medical University of Graz, Graz, Austria
| | - Martin Lorenzoni
- Division of Operative dentistry, Periodontology and Prosthodontics, Department of Dental Medicine and Oral Health, Medical University of Graz, Graz, Austria
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Prosthetic Rehabilitation of Edentulous Patients With Implants Based on Facial Profile Assessment: A Case Report. IMPLANT DENT 2019; 28:91-98. [PMID: 30640310 DOI: 10.1097/id.0000000000000856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To introduce a user-friendly protocol for implant-retained prosthetic rehabilitation of fully edentulous patients based on facial profile and the cephalometric intermaxillary relationship. MATERIALS AND METHODS The prosthetic rehabilitation of edentulous patients with implants based on facial profile assessment protocol commences with a clinical and cephalometric analysis, followed by a preliminary projection to obtain a harmonious interarch relationship, eventually stabilized by the preplanned prosthesis. The protocol is divided into the following 5 phases: esthetic evaluation; cephalometric-occlusal assessment; surgery; provisionalization; and definitive prosthesis. Evaluation of patient's satisfaction from the treatment provided was performed through a preoperative and postoperative visual analogue scale scores. RESULTS The patient was granted immediate function and superior esthetics at day 1 of the treatment. These results were re-evaluated on an interval of 18 months and continued to be stable. The overall treatment time was significantly reduced. CONCLUSION Our recommended protocol gives the clinician a chance to grasp results beyond the offered by traditional protocols by using a wider perspective of rehabilitation, involving the patient's facial profile, thus fulfilling the integration of both occlusal and cephalometric parameters in a unified surgical-prosthetic approach.
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Kulakov AA, Kasparov AS, Porfenchuk DA. [Factors affecting osteointegration and the use of early functional load to reduce the duration of treatment in dental implantation]. STOMATOLOGIIA 2019; 98:107-115. [PMID: 31513161 DOI: 10.17116/stomat201998041107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The article presents literature data on the impact of the surface and shape of dental implants and early functional load with aesthetic and functional rehabilitation on osteointegration and stability of implants at various implantation terms.
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Affiliation(s)
- A A Kulakov
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - A S Kasparov
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - D A Porfenchuk
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
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Bielemann AM, Marcello‐Machado RM, Schuster AJ, Chagas Júnior OL, Del Bel Cury AA, Faot F. Healing differences in narrow diameter implants submitted to immediate and conventional loading in mandibular overdentures: A randomized clinical trial. J Periodontal Res 2018; 54:241-250. [DOI: 10.1111/jre.12624] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 08/25/2018] [Accepted: 09/30/2018] [Indexed: 02/06/2023]
Affiliation(s)
| | | | | | - Otacílio Luiz Chagas Júnior
- Department of Oral and Maxillofacial Surgery and Maxillofacial ProsthodonticsSchool of DentistryFederal University of Pelotas Pelotas Brazil
| | - Altair Antoninha Del Bel Cury
- Department of Prosthodontics and PeriodontologyPiracicaba Dental SchoolState University of Campinas Piracicaba Brazil
| | - Fernanda Faot
- Department of Restorative DentistrySchool of DentistryFederal University of Pelotas Pelotas Brazil
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Mangano FG, Iezzi G, Shibli JA, Pires JT, Luongo G, Piattelli A, Mangano C. Early bone formation around immediately loaded implants with nanostructured calcium-incorporated and machined surface: a randomized, controlled histologic and histomorphometric study in the human posterior maxilla. Clin Oral Investig 2017; 21:2603-2611. [PMID: 28154996 DOI: 10.1007/s00784-017-2061-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 01/25/2017] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The aim of this randomized, controlled histologic/histomorphometric study was to compare the early bone formation around immediately loaded implants with nanostructured calcium-incorporated (NCI) and machined (MA) surface, placed in the human posterior maxilla. MATERIALS AND METHODS Fifteen fully edentulous patients (six males; nine females; mean age 57.9 ± 6.7 years) were selected for this study. Each patient was installed with two temporary transmucosal implants, with different surfaces: one NCI (test) and one MA (control) implant. All temporary implants were placed in the posterior maxilla, according to a split-mouth design, to help to support an interim complete maxillary denture. After 8 weeks, all temporary transmucosal implants were retrieved for histologic/histomorphometric evaluation. The bone-to-implant contact (BIC%) and the bone density (BD%) were calculated. The Wilcoxon matched-pairs signed-rank test was used to evaluate differences (BIC%, BD%) between the surfaces. The level of significance was set at 0.05. RESULTS Eight weeks after placement, 24 clinically stable implants (12 test, 12 control) were subjected to histologic/histomorphometric evaluation. In the MA implants, the histomorphometric evaluation revealed a mean BIC(±SD)% and BD(±SD)% of 21.2(±4.9)% and 29.8(±7.8)%, respectively. In the NCI implants, the histomorphometric analysis revealed a mean BIC(±SD)% and BD(±SD)% of 39.7(±8.7)% and 34.6(±7.2)%, respectively. A statistically significant difference was found between the two surfaces with regard to BIC% (p < 0.001), while no significant difference was found with regard to BD% (p = 0.09). CONCLUSIONS The NCI surface seems to increase the peri-implant endosseous healing properties in the native bone of the posterior maxilla, under immediate loading conditions, when compared with the MA surface. CLINICAL RELEVANCE Under immediate loading conditions in the human posterior maxilla, the nanostructured calcium-incorporated surface has led to better histologic and histomorphometric results than the machined surface; therefore, the clinical use of implants with nanostructured calcium-incorporated surface may be beneficial in the posterior maxilla, under immediate loading protocol.
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Affiliation(s)
- Francesco Guido Mangano
- Department of Surgical and Morphological Science, Dental School, University of Varese, 21100, Varese, Italy. .,, Piazza Trento 4, 22015, Gravedona, Como, Italy.
| | - Giovanna Iezzi
- Department of Medical, Oral, and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
| | - Jamil Awad Shibli
- Department of Periodontology, Oral Implantology Clinic, Dental Research Division, Guarulhos University, Sao Paulo, Brazil
| | - Jefferson Trabach Pires
- Department of Periodontology, Oral Implantology Clinic, Dental Research Division, Guarulhos University, Sao Paulo, Brazil
| | - Giuseppe Luongo
- Department of Oral and Maxillofacial Surgery, University of Naples, Naples, Italy
| | - Adriano Piattelli
- Department of Medical, Oral, and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
| | - Carlo Mangano
- Department of Dental Sciences, University Vita Salute S. Raffaele, Milan, Italy
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Sculean A, Chapple ILC, Giannobile WV. Wound models for periodontal and bone regeneration: the role of biologic research. Periodontol 2000 2015; 68:7-20. [PMID: 25867976 PMCID: PMC4441284 DOI: 10.1111/prd.12091] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2015] [Indexed: 12/24/2022]
Abstract
The ultimate goals of periodontal therapy remain the complete regeneration of those periodontal tissues lost to the destructive inflammatory-immune response, or to trauma, with tissues that possess the same structure and function, and the re-establishment of a sustainable health-promoting biofilm from one characterized by dysbiosis. This volume of Periodontology 2000 discusses the multiple facets of a transition from therapeutic empiricism during the late 1960s, toward regenerative therapies, which is founded on a clearer understanding of the biophysiology of normal structure and function. This introductory article provides an overview on the requirements of appropriate in vitro laboratory models (e.g. cell culture), of preclinical (i.e. animal) models and of human studies for periodontal wound and bone repair. Laboratory studies may provide valuable fundamental insights into basic mechanisms involved in wound repair and regeneration but also suffer from a unidimensional and simplistic approach that does not account for the complexities of the in vivo situation, in which multiple cell types and interactions all contribute to definitive outcomes. Therefore, such laboratory studies require validatory research, employing preclinical models specifically designed to demonstrate proof-of-concept efficacy, preliminary safety and adaptation to human disease scenarios. Small animal models provide the most economic and logistically feasible preliminary approaches but the outcomes do not necessarily translate to larger animal or human models. The advantages and limitations of all periodontal-regeneration models need to be carefully considered when planning investigations to ensure that the optimal design is adopted to answer the specific research question posed. Future challenges lie in the areas of stem cell research, scaffold designs, cell delivery and choice of growth factors, along with research to ensure appropriate gingival coverage in order to prevent gingival recession during the healing phase.
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