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Han J, Andrée L, Deng D, van Oirschot BAJA, Plachokova AS, Leeuwenburgh SCG, Yang F. Biofunctionalization of dental abutments by a zinc/chitosan/gelatin coating to optimize fibroblast behavior and antibacterial properties. J Biomed Mater Res A 2024; 112:1873-1892. [PMID: 38725302 DOI: 10.1002/jbm.a.37734] [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: 02/12/2024] [Revised: 04/07/2024] [Accepted: 04/30/2024] [Indexed: 09/03/2024]
Abstract
Tightly sealed peri-implant gingival tissue provides a barrier against oral bacterial invasion, protecting the alveolar bone and maintaining long-term implant survival. To investigate if zinc can enhance the integration between peri-implant gingival tissue and abutment surface, we herein present novel zinc/chitosan/gelatin (Zn/CS/Gel) coatings prepared using the electrophoretic deposition (EPD) technique. The effect of these coatings on human gingival fibroblasts (hGFs) was investigated by culturing these cells on top of the EPD coatings. Surface characterization demonstrated that Zn2+ were released in a sustained and pH-responsive manner. The preclinical cell culture evaluation of these coatings indicated that the zinc-containing coatings enhanced cell migration, adhesion and collagen secretion of hGFs. Moreover, the zinc-containing coatings exhibited antibacterial efficacy by inhibiting the growth of Porphyromonas gingivalis and reducing attachment of Staphylococcus aureus. Notably, zinc-free CS/Gel coatings prevented attachment of P. gingivalis as well. The coatings were also shown to be cytocompatible with epithelial cells and osteoblasts, which are other relevant cell types which surround dental implants after clinical placement. Based on our findings, it can be concluded that Zn-containing coatings hold promise to enhance the adhesion of gingival tissue to the implant surface, which may potentially contribute to the formation of a robust peri-implant soft sealing counteracting bacterial invasion.
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Affiliation(s)
- Jing Han
- Department of Dentistry - Regenerative Biomaterials, Research Institute for Medical Innovation, Radboudumc, Nijmegen, The Netherlands
| | - Lea Andrée
- Department of Dentistry - Regenerative Biomaterials, Research Institute for Medical Innovation, Radboudumc, Nijmegen, The Netherlands
| | - Dongmei Deng
- Department of Preventive Dentistry, Academic Center for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Bart A J A van Oirschot
- Department of Dentistry - Regenerative Biomaterials, Research Institute for Medical Innovation, Radboudumc, Nijmegen, The Netherlands
| | - Adelina S Plachokova
- Department of Dentistry - Regenerative Biomaterials, Research Institute for Medical Innovation, Radboudumc, Nijmegen, The Netherlands
| | - Sander C G Leeuwenburgh
- Department of Dentistry - Regenerative Biomaterials, Research Institute for Medical Innovation, Radboudumc, Nijmegen, The Netherlands
| | - Fang Yang
- Department of Dentistry - Regenerative Biomaterials, Research Institute for Medical Innovation, Radboudumc, Nijmegen, The Netherlands
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Lakkasetter Chandrashekar B, Biguetti CC, Arteaga A, Miramontes AJ, Rios E, Rodrigues DC. A microtomographic and histopathological evaluation of dental cements as late-stage peri-implant complication in a rat model. Sci Rep 2024; 14:16441. [PMID: 39013937 PMCID: PMC11252325 DOI: 10.1038/s41598-024-66353-x] [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: 01/04/2024] [Accepted: 07/01/2024] [Indexed: 07/18/2024] Open
Abstract
Cement mediated peri-implantitis accounts for 1.9-75% of dental implant failures associated with peri-implant diseases. This study evaluated the biological impact of dental cements on osseointegrated implants using Lewis rats. Twenty-two rats were distributed into 6 groups: negative control (NC) soft diet (SD), and hard diet (HD); positive control SD and HD (n = 3); Implant + bio-ceramic Cement (BC) SD and HD which included contralateral Sham sites (n = 5). Titanium implants were placed on either side of the maxillae and allowed to heal for 14 days. Later, both sides of experimental groups underwent a re-entry surgery to simulate clinical cementation. The right side received 0.60 mg of BC. At 14 days post cement application, maxillae were harvested for clinical, microtomographic, and histological evaluations. Clinical and microtomographic evaluations indicated evidence of extensive inflammation and circumferential bone resorption around BC implants in comparison to NC. Histology revealed cement particles surrounded by inflammatory infiltrate in the implant area accompanied by biofilm for SD groups. Both sides of BC indicated intensive bone resorption accompanied by signs of osteolysis when compared to NC. Cemented groups depicted significantly lower bone to implant contact when compared to NC. In conclusion, residual cement extravasation negatively impacted osseointegrated implants after re-entry surgeries.
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Affiliation(s)
| | - Claudia C Biguetti
- Department of Bioengineering, University of Texas at Dallas (UTD), 800 W. Campbell Rd, Richardson, TX, 75080, USA
- School of Podiatric Medicine, The University of Texas Rio Grande Valley, Harlingen, TX, 78550, USA
| | - Alexandra Arteaga
- Department of Bioengineering, University of Texas at Dallas (UTD), 800 W. Campbell Rd, Richardson, TX, 75080, USA
| | - Andres J Miramontes
- Department of Bioengineering, University of Texas at Dallas (UTD), 800 W. Campbell Rd, Richardson, TX, 75080, USA
| | - Evelin Rios
- Department of Bioengineering, University of Texas at Dallas (UTD), 800 W. Campbell Rd, Richardson, TX, 75080, USA
| | - Danieli C Rodrigues
- Department of Bioengineering, University of Texas at Dallas (UTD), 800 W. Campbell Rd, Richardson, TX, 75080, USA.
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Orishko A, Imber JC, Roccuzzo A, Stähli A, Salvi GE. Tooth- and implant-related prognostic factors in treatment planning. Periodontol 2000 2024; 95:102-128. [PMID: 39234949 DOI: 10.1111/prd.12597] [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: 02/08/2024] [Revised: 06/21/2024] [Accepted: 07/03/2024] [Indexed: 09/06/2024]
Abstract
Following a comprehensive patient examination, including the assessment of periodontal and peri-implant diseases as well as considering the patient's needs, a pretherapeutic prognosis for each tooth and implant is given. Teeth and implants with a secure pretherapeutic prognosis require simple procedures and may be regarded as secure abutments for function and with a doubtful pretherapeutic prognosis usually need a comprehensive therapy. Such teeth and implants must be brought into the category with a secure prognosis by means of additional therapy such as endodontic, restorative, and surgical procedures. Teeth and implants with a hopeless pretherapeutic prognosis should be extracted/explanted during the initial phase of cause-related therapy (i.e., infection control). For example, teeth with vertical root fracture or unrestorable caries and implants with mobility or unrestorable malposition fall into the category of hopeless units. The primary goal of periodontal and peri-implant therapy should be to arrest disease progression. The latest consensus statement highlights that periodontitis can be successfully controlled and treated teeth can be retained for life. Nevertheless, for patients with uncontrolled contributing factors, the endpoints might not always be achievable, and low disease activity may be an acceptable therapeutic goal. Similarly, the management of peri-implantitis frequently requires surgical intervention following nonsurgical therapy due to incomplete treatment outcomes. Different surgical modalities can be effective and lead to significant improvement; however, achieving complete resolution of peri-implantitis is challenging, not always predictable, and can depend on multiple baseline factors. Therefore, this review aims at summarising available evidence on the rationale for incorporating systemic, lifestyle-related, clinical, and radiographic prognostic factors into treatment planning of patients diagnosed with periodontal and peri-implant diseases.
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Affiliation(s)
- Anastasiya Orishko
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
- Periodontology Unit, University College London, Eastman Dental Institute, London, UK
| | - Jean-Claude Imber
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Andrea Roccuzzo
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Alexandra Stähli
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Giovanni E Salvi
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
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Solderer A, Hicklin SP, Aßenmacher M, Ender A, Schmidlin PR. Influence of an allogenic collagen scaffold on implant sites with thin supracrestal tissue height: a randomized clinical trial. Clin Oral Investig 2024; 28:313. [PMID: 38748295 PMCID: PMC11096242 DOI: 10.1007/s00784-024-05716-0] [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: 03/09/2024] [Accepted: 05/08/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVES This randomized clinical trial focused on patients with thin peri-implant soft-tissue height (STH) (≤ 2.5 mm) and investigated the impact of an allogenic collagen scaffold (aCS) on supracrestal tissue height and marginal bone loss (MBL). MATERIAL & METHODS Forty patients received bone level implants and were randomly assigned to the test group with simultaneous tissue thickening with aCS or the control group. After three months, prosthetic restoration occurred. STH measurements were taken at baseline (T0) and reopening surgery (TR), with MBL assessed at 12 months (T1). Descriptive statistics were calculated for continuous variables, and counts for categorical variables (significance level, p = 0.05). RESULTS At T1, 37 patients were available. At T0, control and test groups had mean STH values of 2.3 ± 0.3 mm and 2.1 ± 0.4 mm. TR revealed mean STH values of 2.3 ± 0.2 mm (control) and 2.6 ± 0.7 mm (test), with a significant tissue thickening of 0.5 ± 0.6 mm in the test group (p < 0.03). At T1, control and test groups showed MBL mean values of 1.1 ± 0.8 mm and 1.0 ± 0.6 mm, with a moderate but significant correlation with STH thickening (-0.34), implant position (0.43), history of periodontitis (0.39), and smoking status (0.27). CONCLUSION The use of an aCS protocol resulted in soft tissue thickening but did not reach a threshold to reliably reduce MBL compared to the control group within the study's limitations. CLINICAL RELEVANCE Peri-implant STH is crucial for maintaining peri-implant marginal bone stability. Marginal bone stability represents a crucial factor in prevention of peri-implantitis development. German register of clinical trial registration number DRKS00033290.
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Affiliation(s)
- A Solderer
- Clinic of Conservative and Preventive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland.
| | - S P Hicklin
- Clinic of Conservative and Preventive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - M Aßenmacher
- Department of Statistics, LMU Munich, Munich, Germany
- Munich Center for Machine Learning (MCML), LMU Munich, Munich, Germany
| | - A Ender
- Clinic of Conservative and Preventive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - P R Schmidlin
- Clinic of Conservative and Preventive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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Tommasato G, Del Fabbro M, Oliva N, Khijmatgar S, Grusovin MG, Sculean A, Canullo L. Autogenous graft versus collagen matrices for peri-implant soft tissue augmentation. A systematic review and network meta-analysis. Clin Oral Investig 2024; 28:300. [PMID: 38704784 DOI: 10.1007/s00784-024-05684-5] [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: 11/20/2023] [Accepted: 04/24/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVE The primary objective of this review is to compare autogenous soft tissue grafts (connective tissue graft - CTG and free gingival graft-FGG) with different type of matrices (acellular dermal matrix-ADM, xenograft collagen matrix-XCM, volume-stable collagen matrix-VCMX) used to increase peri-implant soft tissues. MATERIALS AND METHODS A search on electronic databases was performed to identify randomized and non-randomized controlled trials (RCTs and CCTs, respectively) with either parallel or split-mouth design, and treating ≥ 10 patients. A network meta-analysis (NMA) was used to compare different matrices. Soft tissue thickness dimensional changes and keratinized width (KMW) changes were the primary outcome measures. The secondary outcomes were to evaluate: a) PROMs; b) volumetric changes; c) surgical operating time; and d) different periodontal measurements. RESULTS A total of 23 studies were included in the qualitative analysis, and 16 studies (11 RCTs and 5 CCTs) in the quantitative analysis. A total of N = 573 sites were evaluated for NMA. CTG resulted the best material for increasing peri-implant soft tissue thickness, at 180 and 360 days after surgery. The use of an ADM showed good results for buccal thickness increase, primarily in the first three months after surgery. Vestibuloplasty + FGG resulted in the most effective technique for peri-implant KMW augmentation, after 180 days. CONCLUSIONS While CTG demonstrated better performance in all the comparison and FGG showed to be the best graft to increase keratinized mucosa up to 90 days, ADM and VCMX may be used to increase soft tissue horizontal thickness with lower patients' morbidity. LIMITATIONS The limits of this NMA are the following: a) limited number of included studies; b) high heterogeneity among them (number of patients, treatment sites, surgical techniques, outcome measures, and follow-ups). CLINICAL RELEVANCE Many studies compared the efficacy of autogenous and non-autogenous grafts in terms of gingival thickness, volume, and keratinized width increase. However, there is still not clear overall evidence on this topic. This NMA helps clinicians to choose the right material in different peri-implant soft tissue procedures. Recommendations for future studies are mandatory.
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Affiliation(s)
- Grazia Tommasato
- Department of Biomedical, Surgical and Dental Sciences, Università Degli Studi Di Milano, Milan, Italy.
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences, Università Degli Studi Di Milano, Milan, Italy
| | - Nadim Oliva
- Department of Biomedical, Surgical and Dental Sciences, Università Degli Studi Di Milano, Milan, Italy
| | - Shahnawaz Khijmatgar
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Policlinico of Milan (Policlinico Di Milano Ospedale Maggiore | Fondazione IRCCS Ca' Granda), Milan, Italy.
| | | | - Anton Sculean
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - Luigi Canullo
- Department of Surgical Sciences (DISC), Division of Prosthodontics and Implant Prosthodontics, University of Genoa, Rome, Italy
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Shrivas S, Samaur H, Yadav V, Boda SK. Soft and Hard Tissue Integration around Percutaneous Bone-Anchored Titanium Prostheses: Toward Achieving Holistic Biointegration. ACS Biomater Sci Eng 2024; 10:1966-1987. [PMID: 38530973 DOI: 10.1021/acsbiomaterials.3c01555] [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] [Indexed: 03/28/2024]
Abstract
A holistic biointegration of percutaneous bone-anchored metallic prostheses with both hard and soft tissues dictates their longevity in the human body. While titanium (Ti) has nearly solved osseointegration, soft tissue integration of percutaneous metallic prostheses is a perennial problem. Unlike the firm soft tissue sealing in biological percutaneous structures (fingernails and teeth), foreign body response of the skin to titanium (Ti) leads to inflammation, epidermal downgrowth and inferior peri-implant soft tissue sealing. This review discusses various implant surface treatments/texturing and coatings for osseointegration, soft tissue integration, and against bacterial attachment. While surface microroughness by SLA (sandblasting with large grit and acid etched) and porous calcium phosphate (CaP) coatings improve Ti osseointegration, smooth and textured titania nanopores, nanotubes, microgrooves, and biomolecular coatings encourage soft tissue attachment. However, the inferior peri-implant soft tissue sealing compared to natural teeth can lead to peri-implantitis. Toward this end, the application of smart multifunctional bioadhesives with strong adhesion to soft tissues, mechanical resilience, durability, antibacterial, and immunomodulatory properties for soft tissue attachment to metallic prostheses is proposed.
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Affiliation(s)
- Sangeeta Shrivas
- Department of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, Khandwa Road, Simrol, Indore 453552, India
| | - Harshita Samaur
- Department of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, Khandwa Road, Simrol, Indore 453552, India
| | - Vinod Yadav
- Department of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, Khandwa Road, Simrol, Indore 453552, India
| | - Sunil Kumar Boda
- Department of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, Khandwa Road, Simrol, Indore 453552, India
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Villalobos V, Silva I, Morales D, Canelo J, Garrido M, Carreño LJ, Cavalla F, Dutzan N, Caceres M. Topological insight of immune-vascular distribution in peri-implantitis lesions. Oral Dis 2024. [PMID: 38566281 DOI: 10.1111/odi.14935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 01/31/2024] [Accepted: 03/10/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE To characterize the distribution of macrophages, neutrophils, NK cells, and blood vessels in peri-implantitis compared to healthy aged gingiva samples. MATERIALS AND METHODS This observational study included eight gingival samples from peri-implantitis and eight from periodontally healthy individuals. By immunofluorescence were identified neutrophils, NK cells, macrophages, and their pro-inflammatory or pro-healing phenotypes, and blood vessels. Two ROIs were designated as zone 1, connective tissue closest to the epithelium and zone 2, connective tissue over 200 microns from the rete ridges. Immune cells and vascular structures were quantified and characterized according to their distribution in both zones. RESULTS Two peri-implantitis zones were characterized by unique macrophage phenotypes and blood vessel architecture. Blood vessels were larger in zone 2 in peri-implantitis. A greater number of NK cells and macrophages were found in peri-implantitis compared to healthy aged samples. A higher presence of pro-inflammatory macrophages was found in zone 1 compared to zone 2. A similar proportion of pro-inflammatory and pro-healing macrophages were found in zone 2. CONCLUSION A specific distribution for pro-inflammatory macrophages and vascular architecture is observed in peri-implantitis. TNF-α colocalizes with macrophages in the connective tissue near rete ridges. NK cells are more abundant in peri-implantitis than in healthy samples.
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Affiliation(s)
- Veronica Villalobos
- Program of Molecular and Cell Biology, Faculty of Medicine, Institute of Biomedical Sciences (ICBM), Universidad de Chile, Santiago, Chile
- Millennium Institute on Immunology and Immunotherapy (IMII), Universidad de Chile, Santiago, Chile
| | - Ian Silva
- Program of Molecular and Cell Biology, Faculty of Medicine, Institute of Biomedical Sciences (ICBM), Universidad de Chile, Santiago, Chile
- Millennium Institute on Immunology and Immunotherapy (IMII), Universidad de Chile, Santiago, Chile
| | - Diego Morales
- Program of Molecular and Cell Biology, Faculty of Medicine, Institute of Biomedical Sciences (ICBM), Universidad de Chile, Santiago, Chile
| | - Javiera Canelo
- Program of Molecular and Cell Biology, Faculty of Medicine, Institute of Biomedical Sciences (ICBM), Universidad de Chile, Santiago, Chile
| | - Mauricio Garrido
- Millennium Institute on Immunology and Immunotherapy (IMII), Universidad de Chile, Santiago, Chile
- Faculty of Dentistry, Department of Conservative Dentistry, Universidad de Chile, Santiago, Chile
| | - Leandro J Carreño
- Millennium Institute on Immunology and Immunotherapy (IMII), Universidad de Chile, Santiago, Chile
- Program of Immunology, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Franco Cavalla
- Faculty of Dentistry, Department of Conservative Dentistry, Universidad de Chile, Santiago, Chile
- Faculty of Dentistry, Andres Bello University, Santiago, Chile
| | - Nicolas Dutzan
- Faculty of Dentistry, Department of Conservative Dentistry, Universidad de Chile, Santiago, Chile
| | - Monica Caceres
- Program of Molecular and Cell Biology, Faculty of Medicine, Institute of Biomedical Sciences (ICBM), Universidad de Chile, Santiago, Chile
- Millennium Institute on Immunology and Immunotherapy (IMII), Universidad de Chile, Santiago, Chile
- Millennium Nucleus of Ion Channel-Associated Diseases (MiNICAD), Santiago, Chile
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Laforì A, Sailer I, Fehmer V, Mojon P, Burkhardt F, Pitta J. Influence of sterilization on the retention forces of lithium disilicate and polymer-infiltrated ceramic-network crowns bonded to titanium base abutments: An in-vitro study. Clin Oral Implants Res 2024; 35:377-385. [PMID: 38170349 DOI: 10.1111/clr.14234] [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: 07/25/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVES The aim of this study was to evaluate the effect of sterilization on the retention forces of lithium disilicate (LD) and polymer-infiltrated ceramic network (PICN) crowns bonded to titanium base (Ti-base) abutments. MATERIALS AND METHODS Forty LD and 40 PICN crowns were milled and then bonded to 80 Ti-bases with two resin composite cements: Multilink Hybrid Abutment (mh) and Panavia V5 (pv) for a total of 8 groups (n = 10). Half of the specimens (test) underwent an autoclaving protocol (pressure 1.1 bar, 121°C, 20.5 min) and the other half not (control). Restorations were screw-retained to implants, and retention forces (N) were measured with a pull-off testing machine. The surfaces of the Ti-bases and the crowns were inspected for the analysis of the integrity of the marginal bonding interface and failure mode. Student's t-test, chi-square test, and univariate linear regression model were performed to analyze the data (α = 0.05). RESULTS The mean pull-off retention forces ranged from 487.7 ± 73.4 N to 742.2 ± 150.3 N. Sterilized groups showed statistically significant overall higher maximum retention forces (p < .05), except for one combination (LD + mh). Sterilization led to an increased presence of marginal gaps and deformities compared to no-sterilization (p < .001), while no statistically significant relationship was found between failure mode and sterilization (p > .05). CONCLUSIONS Sterilization may have a beneficial effect on the retention forces of LD and PICN crowns bonded to titanium base abutments, although it may negatively influence the integrity of the marginal bonding interface.
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Affiliation(s)
- Andreina Laforì
- Division of Fixed Prosthodontics and Biomaterials, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Irena Sailer
- Division of Fixed Prosthodontics and Biomaterials, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Vincent Fehmer
- Division of Fixed Prosthodontics and Biomaterials, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Philippe Mojon
- Division of Fixed Prosthodontics and Biomaterials, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Felix Burkhardt
- Division of Fixed Prosthodontics and Biomaterials, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - João Pitta
- Division of Fixed Prosthodontics and Biomaterials, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
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Alzaibak LMA, Tawfik MAM, Elgohary NM, Abdel-Rahman FH. Immediate Implant Placement with Different Interradicular Osteotomies in the Mandible: A Randomized Clinical Study. J Contemp Dent Pract 2024; 25:303-312. [PMID: 38956843 DOI: 10.5005/jp-journals-10024-3674] [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] [Indexed: 07/04/2024]
Abstract
AIM To assess the implant stability and amount of marginal bone loss in immediate implant placement (IIP) in mandibular molars by using pre-extractive interradicular implant bed preparation vs conventional post-extractive interradicular implant bed preparation. MATERIALS AND METHODS This randomized clinical trial was conducted on fourteen patients who had an immediate dental implant at the mandibular molar area by two different techniques. All patients were divided randomly into two equal groups: Group I (control) was treated with conventional post-extractive interradicular implant bed preparation, and group II (test) was treated by pre-extractive interradicular implant bed preparation All surgeries were performed by the same surgeon. All patients were followed up clinically at immediate post-surgery (T0), 7 days (T1), 3 weeks (T2), 90 days (T3), and 3 months after loading (T6) for healing and to evaluate the marginal bone loss radiographically at T0, T3 and T6. Descriptive and bivariate statistics were computed using the SPSS version (SPSS, IBM Inc., Chicago, IL), and p ≤ 0.05 was considered an indicator of statistical significance. RESULTS A total of 7 female and 7 male patients with a mean age of 32.07 ± 5.87 years. Radiographically, there is no significant statistical difference in comparing between two groups for the marginal bone loss. However, there was a highly significant statistical difference (p < 0.001) in each group between different interval periods (T0, T3, T6) with mean start 5.27 ± 0.53, and 5.19 ± 0.72 at (T0) reaching 7.60 ± 0.89 and 7.09 ± 0.96 at (T3) and slightly decrease of 7.52 ± 0.79 and 7.02 ± 0.79 in (T6) with radiographic evaluation, and it represented clinically in each group with mean 3.57 ± 0.313 and 4.0 ± 0.58 at (T0) increase to 6.55 ± 0.395 and 6.52 ± 0.45 at (T6) for both group respectively. There is no statistically significant difference in soft tissue healing with an average mean of 4.57 ± 0.24 and 3.57 ± 0.509 (p = 0.001) when comparing between both groups respectively. CONCLUSION Both techniques seem useful for dental implant placement in badly decayed mandibular molars. However, pre-extracted interradicular implant bed preparation for IIP might offer advantages in terms of primary implant stability and bone preservation. However, further studies are needed to confirm these findings. CLINICAL SIGNIFICANCE Both techniques are alternative methods for the treatment of badly decayed mandibular molars by immediate dental implant except for minor complications that do not interfere with dental implant placement. How to cite this article: Alzaibak LMA, Abdel-Monem TM, Elgohary NM, et al. Immediate Implant Placement with Different Interradicular Osteotomies in the Mandible: A Randomized Clinical Study. J Contemp Dent Pract 2024;25(4):303-312.
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Affiliation(s)
- Lama Mohd Abdulaziz Alzaibak
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mansoura University, Mansoura, Egypt, Phone: +20 1032135667, e-mail: , Orcid: https://orcid.org/0009-0003-0937-1852
| | - Mohamed Abdel-Monem Tawfik
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mansoura University, Mansoura, Egypt, Orcid: https://orcid.org/0000-0001-7897-5535
| | - Nesma Mohammed Elgohary
- Faculty of Dentistry, Department of Fixed Prosthodontic, Mansoura University, Mansoura, Egypt, Orcid: https://orcid.org/0000-0001-6966-6888
| | - Fakhreldin Hassan Abdel-Rahman
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mansoura University, Mansoura, Egypt, Orcid: https://orcid.org/0000-0003-4654-2078
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10
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Riberti N, D’Amico E, Pierfelice TV, Furlani M, Giuliani A, Piattelli A, Iezzi G, Comuzzi L. Case Report of a Dental Implant with Conometric Abutment-Prosthetic Cap Connection: Advanced High-Resolution Imaging and Peri-Implant Connective Tissue Performance. Clin Pract 2024; 14:556-569. [PMID: 38666801 PMCID: PMC11049280 DOI: 10.3390/clinpract14020043] [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: 02/26/2024] [Revised: 03/19/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
Background: In recent years, the use of conometric systems to connect dental implant abutments and prosthetic caps has been advocated because they seem to eliminate the side effects reported when using screw- and cement-connected prosthetic restorations. Objectives: The present case study is focused on conometric connection characterization and its performance in terms of the microarchitecture of peri-implant soft tissues by using a cross-linked approach based on optical microscopy and three-dimensional imaging. Methods: Two dental implants were characterized using micro-CT and another identical one was implanted into a patient; the latter was retrieved 45 days later due to changes in prosthetic needs. Afterward, the peri-implant soft tissues were investigated using synchrotron-based phase contrast imaging, histology, and polarized light microscopy. Results: Micro-CT analysis showed perfect adhesion between the abutment and prosthetic cap; histology and polarized light microscopy showed that connective tissue was richly present around the abutment retrieved from the patient. Moreover, the quantitative evaluation of connective tissues using synchrotron imaging, supported by artificial intelligence, revealed that this tissue was rich in mature collagen, with longitudinal and transverse collagen bundles intertwined. The number and connectivity of transverse bundles were consistently greater than those of the longitudinal bundles. Conclusion: It was found that the peri-implant soft tissue was already mature and well organized after only 45 days of implantation, supporting the hypothesis that conometric connections contribute to the significant stabilization of peri-implant soft tissues.
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Affiliation(s)
- Nicole Riberti
- Neuroscience, Imaging and Clinical Sciences Department, University of Chieti-Pescara, 66100 Chieti, Italy;
| | - Emira D’Amico
- Medical, Oral and Biotechnological Sciences Department, University of Chieti-Pescara, 66100 Chieti, Italy; (E.D.); (T.V.P.); (G.I.)
| | - Tania Vanessa Pierfelice
- Medical, Oral and Biotechnological Sciences Department, University of Chieti-Pescara, 66100 Chieti, Italy; (E.D.); (T.V.P.); (G.I.)
| | - Michele Furlani
- Odontostomatologic and Specialized Clinical Sciences Department, Polytechnic University of Marche, Via Brecce Bianche, 60131 Ancona, Italy;
| | - Alessandra Giuliani
- Odontostomatologic and Specialized Clinical Sciences Department, Polytechnic University of Marche, Via Brecce Bianche, 60131 Ancona, Italy;
| | - Adriano Piattelli
- School of Dentistry, Saint Camillus International University for Health Sciences (Unicamillus), 00131 Rome, Italy;
| | - Giovanna Iezzi
- Medical, Oral and Biotechnological Sciences Department, University of Chieti-Pescara, 66100 Chieti, Italy; (E.D.); (T.V.P.); (G.I.)
| | - Luca Comuzzi
- Independent Researcher, Via Raffaello 36/a, 31020 San Vendemiano (TV), Italy;
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11
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Elaskary A, Ghallab N, Thabet A, Shemais N. The bone shielding versus dual-zone concept in treating thin-walled fresh extraction sockets with immediate implant placement: Soft and hard tissue changes. A randomized clinical trial. Clin Implant Dent Relat Res 2024; 26:66-77. [PMID: 37669913 DOI: 10.1111/cid.13275] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 08/02/2023] [Accepted: 08/24/2023] [Indexed: 09/07/2023]
Abstract
OBJECTIVES To evaluate the ridge alterations and esthetic outcome 1 year after immediate implant placement using the dual-zone (DZ) technique versus the bone shielding concept in patients with intact thin-walled sockets in the esthetic zone. MATERIAL AND METHODS This randomized clinical trial included 26 patients with nonrestorable maxillary teeth in the esthetic zone who were randomly assigned to two groups (n = 13 each) to receive immediate implants using either the bone shielding concept or DZ. Definitive restorations were delivered after 2 months. Pink esthetic scores (PESs), vertical soft tissue alterations, and bucco-palatal ridge dimensional changes were measured and assessed using intra-oral digital scans at baseline and 1 year post-procedure. Labial bone thickness was measured using cone beam computed tomography scans at baseline and after 1 year. RESULTS The bone shielding group provided bucco-palatal ridge thickness stability after 1 year (9.43 mm) compared to baseline values (9.82 mm), while DZ showed a significant loss in the bucco-palatal ridge thickness after 1 year (7.83) compared to baseline values (9.49). No significant difference was reported in the baseline bucco-palatal ridge thickness between the two groups (p = 0.6). After 1 year, the bone shielding group demonstrated 0.38 mm ridge shrinkage which was statistically significant (p = 0.0002) compared to 1.67 mm ridge shrinkage in the DZ group. In addition, the average total PES in the bone shielding group was 12.04 versus 10.28 in the DZ group. No significant difference was reported in the mesial papilla length between the DZ and the bone shielding group after 1 year (p > 0.05). However, the midfacial gingival margin (p = 0.026) and distal papilla were significantly higher in the DZ group (p = 0.0025). There was no significant difference in the mean ± SD mm bone gain at the apical level between the two studied groups after 1 year (p = 0.06) showing 0.85 ± 0.23 and 0.64 ± 0.32 mm, respectively. However, the bone shielding concept showed a statistically significant more bone gain mm (p < 0.001) at the (0.56 ± 0.43) and crestal (0.03 ± 0.8) levels after 1 year compared to DZ which revealed 0.18 ± 0.5 and 0.38 ± 0.29 mm bone loss, respectively. CONCLUSION The bone shielding concept might offer a reliable alternative for restoring thin-walled sockets by minimizing postextraction ridge dimensional alterations effect following immediate implant placement in the esthetic zone. Nevertheless, the study suffers from confounding bias since there are two systematic differences between the groups, the barrier membrane type, and the level of bone filling. "This clinical trial was not registered prior to participant recruitment and randomization." CLINICAL TRIAL REGISTRATION NCT05381467.
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Affiliation(s)
| | - Noha Ghallab
- Professor of Oral Medicine and Periodontology, Faculty of Dentistry, Cairo University, Giza, Egypt
| | - Abdelrahman Thabet
- Endodontology Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Nesma Shemais
- Lecturer of Oral Medicine and Periodontology, Faculty of Dentistry, Cairo University, Giza, Egypt
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12
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Roccuzzo A, Mancini L, Marruganti C, Ramieri G, Salvi GE, Sculean A, Roccuzzo M. Long-term treatment outcomes of single maxillary buccal peri-implant soft tissue dehiscences: A 10-year prospective study. Clin Implant Dent Relat Res 2024; 26:150-157. [PMID: 37691144 DOI: 10.1111/cid.13273] [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: 06/01/2023] [Revised: 08/17/2023] [Accepted: 08/21/2023] [Indexed: 09/12/2023]
Abstract
INTRODUCTION To evaluate the 10-year clinical outcomes following surgical treatment of shallow isolated peri-implant soft-tissue dehiscences (PSTD) at single tissue level dental implants. METHODS The baseline population included 16 patients (16 implants) displaying an isolated peri-implant maxillary buccal soft-tissue dehiscence. The recipient bed was prepared with a minimally-invasive split-thickness flap limited to the buccal aspect to stabilize the tuberosity connective tissue graft (CTG) onto the periosteum. At the end of treatment, patients were enrolled in an individualized supportive peri-implant care (SPC) program. The aesthetic outcome was evaluated on photographs by three clinicians using a visual analog scale (VAS). RESULTS SPC during the 10-years proceeded uneventfully in all patients. A total of 12 patients completed the 10-year examination, as 3 patients dropped-out and 1 implant was lost. Complete PSTD coverage was obtained at 7 implant sites (i.e., 58%) while the mean PSTD coverage amounted to 89.6% ± 17.1% without statistically significant differences between 1 and 10 years (p > 0.05). Stable peri-implant parameters (i.e., PD and BoP) and full-mouth scores (i.e., FMPS, FMBS) were recorded throughout the observation period (p > 0.05). The aesthetic improvements obtained in the short-term were maintained up to 10 years. CONCLUSION Within their limits, the present results indicate that the proposed surgical technique is a simple and reliable treatment option for the treatment of single maxillary buccal PSTDs in selected cases with positive results up to 10 years in patients under regular SPC (NCT04983758-this clinical trial was not registered prior to participant recruitment).
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Affiliation(s)
- Andrea Roccuzzo
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
- Department of Oral and Maxillofacial Surgery, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Leonardo Mancini
- Center for Clinical Research and Evidence Synthesis in Oral Tissue Regeneration (CRITERION), Boston, Massachusetts, USA
| | - Crystal Marruganti
- Department of Medical Biotechnologies, Unit of Periodontology, Endodontology and Restorative Dentistry, University of Siena, Siena, Italy
| | - Guglielmo Ramieri
- Division of Maxillofacial Surgery, University of Torino, Torino, Italy
| | - Giovanni E Salvi
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Mario Roccuzzo
- Division of Maxillofacial Surgery, University of Torino, Torino, Italy
- Department of Periodontics and Oral Medicine, University of Michigan, Michigan, USA
- Private Practice, Torino, Italy
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13
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Romito GA, Fonseca MA, Soares HH, de Oliveira Lazarin R, Sapata VM, Nishyama R, Conde MC, Hammerle CHF, Schwarz F, Villar CC. Clinical outcomes following atrophic alveolar ridge reconstruction using collagenated xenogeneic bone block or autogenous bone block: One-year follow-up of a randomized controlled clinical. J Clin Periodontol 2024; 51:14-23. [PMID: 37846853 DOI: 10.1111/jcpe.13891] [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: 06/28/2023] [Revised: 09/21/2023] [Accepted: 10/03/2023] [Indexed: 10/18/2023]
Abstract
AIM This investigation aimed to evaluate the 1-year survival of implants placed after staged lateral alveolar ridge augmentation using equine-derived collagenated xenogeneic bone blocks (CXBBs) or autogenous bone block (ABB). MATERIALS AND METHODS Fifty patients who underwent lateral augmentation in a previous trial were included. The primary outcome measure was implant survival at the 1-year follow-up, and secondary outcomes included implant success, peri-implant clinical and volumetric parameters, pink aesthetic scores (PES) and patient-reported outcome measures. Data analysis involved Fisher's exact test, the Mann-Whitney U-test and the Wilcoxon signed-rank test. RESULTS In this study, no late implant failures were observed. The cumulative survival rates were 78.6% for the CXBB group and 90.9% for the ABB group, with no difference between the groups. Similarly, the success rates were 53.6% and 63.6%, respectively, showing no significant difference. Peri-implant clinical and volumetric parameters indicated the presence of healthy peri-implant tissues surrounding implants placed in both CXBB- and ABB-augmented sites. PES were 8.5 and 11.0 for implants placed in CXBB- and ABB-augmented sites, respectively. Furthermore, patient satisfaction rates were high and similar between the groups. CONCLUSIONS Dental implants placed in both CXBB- and ABB-augmented ridges demonstrated no statistically significant differences in clinical, volumetric and aesthetic outcomes, along with high patient satisfaction rates.
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Affiliation(s)
| | | | - Herbert Horiuti Soares
- Discipline of Periodontics, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | | | - Vitor Marques Sapata
- Discipline of Periodontics, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Roger Nishyama
- Discipline of Prosthodontics, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Marina Clemente Conde
- Discipline of Periodontics, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | | | - Frank Schwarz
- Department of Oral Surgery and Implantology, Carolinum, Johann Wolfgang Goethe-University Frankfurt, Frankfurt, Germany
| | - Cristina Cunha Villar
- Discipline of Periodontics, School of Dentistry, University of São Paulo, São Paulo, Brazil
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14
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Asparuhova MB, Song X, Riedwyl D, van Geest G, Bosshardt DD, Sculean A. Differential molecular profiles and associated functionalities characterize connective tissue grafts obtained at different locations and depths in the human palate. Int J Oral Sci 2023; 15:57. [PMID: 38072943 PMCID: PMC10711016 DOI: 10.1038/s41368-023-00260-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 12/18/2023] Open
Abstract
The present study aimed to assess the molecular profiles of subepithelial connective tissue grafts (CTGs) obtained at different locations and depths in the human palate. Sixty-four CTGs belonging to anterior deep (AD), anterior superficial (AS), posterior deep (PD), and posterior superficial (PS) groups were subjected to RNA-Sequencing and their transcriptomes were analyzed computationally. Functional correlations characterizing the CTG groups were validated by cell biological experiments using primary human palatal fibroblasts (HPFs) extracted from the CTGs. A clearly more pronounced location-dependent than depth-dependent difference between the grafts, with a minimal number of genes (4) showing no dependence on the location, was revealed. Epithelial, endothelial, and monocytic cell migration was strongly (P < 0.001) potentiated by AD- and PS-HPFs. Moreover, significantly increased expression of genes encoding C-C and C-X-C motif chemokine ligands as well as significantly (P < 0.01) activated p38 signaling suggested immunomodulatory phenotype for AD- and PS-HPFs. Increased growth factor gene expression and significantly activated (P < 0.001) Erk and Akt signaling in HPFs originating from A-CTGs implied their involvement in cell survival, proliferation, and motility. Prominent collagen-rich expression profile contributing to high mechanical stability, increased osteogenesis-related gene expression, and strongly activated (P < 0.001) Smad1/5/8 signaling characterized HPFs originating from P-CTGs. The present data indicate that in humans, differences between palatal CTGs harvested from different locations and depths appear to be location- rather than depth-dependent. Our findings provide the basis for future personalization of the therapeutic strategy by selecting an optimal graft type depending on the clinical indications.
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Affiliation(s)
- Maria B Asparuhova
- Laboratory of Oral Cell Biology, School of Dental Medicine, University of Bern, Bern, Switzerland.
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.
| | - Xiaoqing Song
- Laboratory of Oral Cell Biology, School of Dental Medicine, University of Bern, Bern, Switzerland
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Dominic Riedwyl
- Laboratory of Oral Cell Biology, School of Dental Medicine, University of Bern, Bern, Switzerland
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Geert van Geest
- Interfaculty Bioinformatics Unit, University of Bern, Bern, Switzerland
| | - Dieter D Bosshardt
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
- Robert K. Schenk Laboratory of Oral Histology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
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15
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Lim HC, Kim CH, Yoon H, Lee S, Chung JH, Shin SY. Keratinized tissue augmentation using collagen-based soft tissue substitute with/without epidermal growth factor on buccally positioned implants: a pilot preclinical study. Clin Oral Investig 2023; 27:7899-7908. [PMID: 37989966 DOI: 10.1007/s00784-023-05382-8] [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: 05/06/2023] [Accepted: 11/11/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVES To investigate the effect of epithelial growth factor (EGF) with collagen matrix (CM) on the gain of KT for buccally positioned implants in dogs. MATERIALS AND METHODS In five dogs, four implants were placed buccally with the whole part of KT excision on the buccal side (two implants per each hemi-mandible). After one month, KT augmentation was performed: 1) free gingival grafts (FGG), 2) collagen matrix (CM) only, 3) CM soaked with 1 μg/g of EGF, and 4) CM soaked with 10 μg/g of EGF (n = 5 in each group). The experimental animals were sacrificed three months post-KT augmentation. Clinical, histologic, and histomorphometric analyses were performed. RESULTS The clinical KT zone was the highest in group FGG (5.16 ± 1.63 mm). Histologically, all groups presented buccal bony dehiscence. Regarding newly formed KT, no specific difference was found among the groups, but robust rete pegs formation in some specimens in group FGG. Histomorphometric KT height (4.66 ± 1.81 mm) and length (5.56 ± 2.25 mm) were the highest in group FGG, whereas similar increases were noted in the rest. The buccal soft tissue thickness at the coronal part of the implant did not exceed 2 mm in all groups. CONCLUSION All groups presented increased KT zone, but FGG treatment was more favored. The addition of EGF to CM appeared not to enhance KT formation. CLINICAL RELEVANCE FGG treatment was more favorable to re-establish the KT zone than other treatment modalities.
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Affiliation(s)
- Hyun-Chang Lim
- Department of Periodontology, Periodontal Implant Clinical Research Institute, Kyung Hee University College of Dentistry, Kyung Hee University Medical Center, Seoul, Korea.
| | - Chang-Hoon Kim
- Department of Dentistry, Graduate School, Kyung Hee University, Seoul, Korea
| | - Heejun Yoon
- Department of Periodontology, Periodontal Implant Clinical Research Institute, Kyung Hee University College of Dentistry, Kyung Hee University Medical Center, Seoul, Korea
| | - Sunmin Lee
- Department of Dentistry, Graduate School, Kyung Hee University, Seoul, Korea
| | - Jong-Hyuk Chung
- Department of Periodontology, Periodontal Implant Clinical Research Institute, Kyung Hee University College of Dentistry, Kyung Hee University Medical Center, Seoul, Korea
| | - Seung-Yun Shin
- Department of Periodontology, Periodontal Implant Clinical Research Institute, Kyung Hee University College of Dentistry, Kyung Hee University Medical Center, Seoul, Korea
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16
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Alrmali A, Stuhr S, Saleh MHA, Latimer J, Kan J, Tarnow DP, Wang HL. A decision-making tree for evaluating an esthetically compromised single dental implant. J ESTHET RESTOR DENT 2023; 35:1239-1248. [PMID: 37449656 DOI: 10.1111/jerd.13100] [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: 05/29/2023] [Revised: 06/17/2023] [Accepted: 06/22/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE To develop a comprehensive decision-making tree for evaluating mid-facial peri-implant soft tissue dehiscence in the esthetic zone and provide a systematic approach for assessing various clinical case scenarios, determining appropriate treatment strategies, and considering factors such as the need for soft tissue augmentation, prosthetic changes, or implant removal. CLINICAL CONSIDERATIONS This clinical decision tree illustrates numerous case scenarios with various esthetic complications around an esthetically compromised, but clinically healthy single implant and provides clinicians with possible solutions as a predictable map for horizontal and vertical soft tissue augmentation in order to manage different clinical circumstances. According to current evidence, the key to treating such esthetic complications is the use of an adequate pre-surgical prosthetic interdisciplinary approach with proper surgical techniques in order to optimize soft tissue dimensions and create better esthetic results. This may be accomplished through a purely surgical, combination of surgical and prosthetic, or purely prosthetic approaches. CONCLUSIONS The present report describes a series of successfully treated peri-implant esthetic complication cases in accordance with the decision-making tree that the authors recommend in order to achieve better long-term esthetic outcomes. CLINICAL SIGNIFICANCE The combination of adequate pre-surgical prosthetic interdisciplinary collaboration and proper surgical technique is critical in the optimization of sufficient soft tissue dimensions and contributes to a more highly esthetic result. This study demonstrates a clinical decision-making tree to provide comprehensive, effective therapy of an esthetically compromised dental implant by using one of the following approaches: purely prosthetic, purely surgical, or a combination of surgical and prosthetic with or without abutment removal.
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Affiliation(s)
- Abdusalam Alrmali
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
- Department of Oral Pathology, Oral Medicine and Oral & Maxillofacial Surgery, University of Tripoli, School of Dentistry, Tripoli, Libya
| | - Sandra Stuhr
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Muhammad H A Saleh
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Jessica Latimer
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Joseph Kan
- Department of Prosthodontics and Implant Surgery, Loma Linda University School of Dentistry, Loma Linda, California, USA
| | - Dennis P Tarnow
- Department of Periodontics, Columbia University College of Dental Medicine, New York, New York, USA
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
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17
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La Monaca G, Di Giorgio G, Pranno N, Serafini G, De Biase A, Cristalli MP. Implant-Prosthetic Rehabilitation of Mandibular Posttraumatic Severe Dentoalveolar Loss With a Reconstructive Staged Approach: A Clinical Report With 3-Year Follow-Up. J ORAL IMPLANTOL 2023; 49:567-572. [PMID: 38279654 DOI: 10.1563/aaid-joi-d-23-00143] [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] [Indexed: 01/28/2024]
Abstract
This clinical report describes the oral rehabilitation of a 25-year-old male patient who lost the lower incisors, right canine, and a significant amount of anterior mandibular bony and soft tissue following severe dentoalveolar trauma due to a car accident. The patient's young age, anterior esthetic zone in the lower jaw, previous mandibular fracture, and extended bony and soft-tissue defect hindering ideal 3-dimensional implant placement oriented the therapeutic plan toward a staged approach, with several reconstructive surgical procedures before implant rehabilitation. The treatment involved deepening the labiobuccal vestibule and lingual sulcus to correct cicatricial shrinkage due to previous surgical fixation of the mandibular fracture, vertical guided bony augmentation to regenerate adequate volumes of bone, free gingival graft to achieve sufficient height and thickness of peri-implant soft tissues, and a prosthetic-driven surgical procedure to place the implants in a good functional and esthetic position. This therapeutic approach restored function and esthetics and achieved outcome stability at 3-year follow-up.
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Affiliation(s)
- Gerardo La Monaca
- Department of Oral and Maxillo-Facial Sciences, Sapienza, University of Rome, Rome, Italy
| | - Gianni Di Giorgio
- Department of Oral and Maxillo-Facial Sciences, Sapienza, University of Rome, Rome, Italy
| | - Nicola Pranno
- Department of Oral and Maxillo-Facial Sciences, Sapienza, University of Rome, Rome, Italy
| | - Giorgio Serafini
- Department of Oral and Maxillo-Facial Sciences, Sapienza, University of Rome, Rome, Italy
| | - Alberto De Biase
- Department of Oral and Maxillo-Facial Sciences, Sapienza, University of Rome, Rome, Italy
| | - Maria Paola Cristalli
- Department of Oral and Maxillo-Facial Sciences, Sapienza, University of Rome, Rome, Italy
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18
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Chankhore P, Khubchandani SR, Reche A, Paul P. Prosthetic Design Factors Influencing Peri-Implant Disease: A Comprehensive Review. Cureus 2023; 15:e48737. [PMID: 38699657 PMCID: PMC11065393 DOI: 10.7759/cureus.48737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 11/13/2023] [Indexed: 05/05/2024] Open
Abstract
Peri-implant disease, encompassing peri-implant mucositis and peri-implantitis, presents a growing challenge in implant dentistry. This comprehensive review explores the intricate interplay between prosthetic design factors and the development of peri-implant disease. By analyzing the impact of prosthetic components on microbial colonization, mechanical stress, and soft tissue health, the review highlights their crucial role in disease prevention and management. Additionally, it emphasizes the significance of maintenance protocols, prosthetic adjustments, and patient education in ensuring favorable long-term outcomes. The review underscores the potential for future advancements in prosthetic design, including innovative materials and digital technologies, and stresses the importance of interdisciplinary collaboration in optimizing patient care. Overall, the review underscores the critical role of prosthetic design in addressing the complexities of peri-implant disease, offering insights for clinicians and researchers to enhance the success and longevity of implant-supported restorations.
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Affiliation(s)
- Pallavi Chankhore
- Public Health Dentistry, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sheetal R Khubchandani
- Prosthodontist and Implantologist, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Amit Reche
- Public Health Dentistry, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Priyanka Paul
- Public Health Dentistry, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Solderer A, Widmer N, Gubler A, Fischer KR, Hicklin SP, Schmidlin PR. Properties of three collagen scaffolds in comparison with native connective tissue: an in-vitro study. Int J Implant Dent 2023; 9:36. [PMID: 37819469 PMCID: PMC10567619 DOI: 10.1186/s40729-023-00504-z] [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: 05/31/2023] [Accepted: 10/04/2023] [Indexed: 10/13/2023] Open
Abstract
PURPOSE To evaluate collagen scaffolds (CS) in terms of their in vitro resorption behavior, surface structure, swelling behavior, and mechanical properties in physiologically simulated environments, compared with porcine native connective tissue. MATERIALS AND METHODS Three test materials-one porcine collagen matrix (p-CM), two acellular dermal matrices (porcine = p-ADM, allogenic = a-ADM)-and porcine native connective tissue (p-CTG) as a control material were examined for resorption in four solutions using a high-precision scale. The solutions were artificial saliva (AS) and simulated body fluid (SBF), both with and without collagenase (0.5 U/ml at 37 °C). In addition, the surface structures of CS were analyzed using a scanning electron microscope (SEM) before and after exposure to AS or SBF. The swelling behavior of CS was evaluated by measuring volume change and liquid absorption capacity in phosphate-buffered saline (PBS). Finally, the mechanical properties of CS and p-CTG were investigated using cyclic compression testing in PBS. RESULTS Solutions containing collagenase demonstrated high resorption rates with significant differences (p < 0.04) between the tested materials after 4 h, 8 h and 24 h, ranging from 54.1 to 100% after 24 h. SEM images revealed cross-linked collagen structures in all untreated specimens. Unlike a-ADM, the scaffolds of p-CM and p-ADM displayed a flake-like structure. The swelling ratio and fluid absorption capacity per area ranged from 13.4 to 25.5% among the test materials and showed following pattern: p-CM > a-ADM > p-ADM. P-CM exhibited higher elastic properties than p-ADM, whereas a-ADM, like p-CTG, were barely compressible and lost structural integrity under increasing pressure. CONCLUSIONS AND CLINICAL IMPLICATIONS Collagen scaffolds vary significantly in their physical properties, such as resorption and swelling behavior and elastic properties, depending on their microstructure and composition. When clinically applied, these differences should be taken into consideration to achieve the desired outcomes.
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Affiliation(s)
- Alex Solderer
- Division for Periodontology and Peri-Implant Diseases, Clinic of Conservative and Preventive Dentistry, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032, Zurich, Switzerland.
| | - Nicole Widmer
- Division for Periodontology and Peri-Implant Diseases, Clinic of Conservative and Preventive Dentistry, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032, Zurich, Switzerland
| | - Andrea Gubler
- Division for Periodontology and Peri-Implant Diseases, Clinic of Conservative and Preventive Dentistry, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032, Zurich, Switzerland
| | - Kai R Fischer
- Division for Periodontology and Peri-Implant Diseases, Clinic of Conservative and Preventive Dentistry, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032, Zurich, Switzerland
| | - Stefan P Hicklin
- Division for Periodontology and Peri-Implant Diseases, Clinic of Conservative and Preventive Dentistry, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032, Zurich, Switzerland
| | - Patrick R Schmidlin
- Division for Periodontology and Peri-Implant Diseases, Clinic of Conservative and Preventive Dentistry, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032, Zurich, Switzerland
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20
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Jose EP, Paul P, Reche A. Soft Tissue Management Around the Dental Implant: A Comprehensive Review. Cureus 2023; 15:e48042. [PMID: 38034248 PMCID: PMC10688389 DOI: 10.7759/cureus.48042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/31/2023] [Indexed: 12/02/2023] Open
Abstract
In the modern world, there is an increasing concern among people regarding dental esthetics. Edentulism can impact one's appearance, affect the regular bite, and can even affect mental well-being. There are various options to replace the missing teeth, such as removable dentures, fixed crown and bridge prostheses, and resin-retained bridges. Various factors are evaluated before giving a suitable prosthesis for missing teeth. Implant installation is highly desired by patients as it has a high success and long-term survival rate when used to replace lost teeth. However, several difficulties relating to errors in treatment planning, surgery, soft tissue, and hard tissue care, and infections may compromise the efficacy of implant therapy. An increasing body of research indicates that long-term clinical stability and esthetics may be significantly impacted by the stability of the soft tissues around osseointegrated dental implants. Consequently, when implant therapy is planned, the dental surgeon has to have the necessary expertise to appropriately handle any possible causes of difficulties in addition to being able to carry out the necessary actions to maintain or develop stable soft tissue. Various augmentation procedures can be done for the correction of any deformity or inadequacy of soft tissues. Osseointegration is a fundamental part of the success of the implant treatment. It is the formation of a biological and functional connection between the bone and the implant increasing the stability of implant prosthesis. After the treatment, the patient should be counseled for regular and proper oral hygiene practices suitable for the implant. A proper follow-up has to be done after implant treatment in regular intervals. Any postoperative soft tissue complications, such as peri-implantitis or peri-implant mucositis, should be addressed immediately, and appropriate treatment has to be given. This article reviews about the procedures before and after the implant placement to prevent or treat soft tissue complications, ultimately leading to the success of the implant.
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Affiliation(s)
- Elizabeth P Jose
- Public Health Dentistry, Sharad Pawar Dental College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Priyanka Paul
- Public Health Dentistry, Sharad Pawar Dental College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Amit Reche
- Public Health Dentistry, Sharad Pawar Dental College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Xu L, Zhang S, Chen Y, Yu F, Han C, Wu D, He D. The relationship between labial soft tissue changes and jumping spaces after immediate implant placement and restoration in the anterior maxilla: A prospective study. BIOMOLECULES & BIOMEDICINE 2023; 23:848-865. [PMID: 37004240 PMCID: PMC10494844 DOI: 10.17305/bb.2023.8652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/20/2023] [Accepted: 03/20/2023] [Indexed: 05/02/2023]
Abstract
Oral implants have been increasingly used in the treatment of edentulous patients or those with dentition defects due to reliable treatment procedure and favorable long-term prognosis. We investigated the changes of labial soft tissue contours with different jumping spaces after immediate implant placement and restoration (IIPR) in the maxillary esthetic area and also provided a long-term stability measurement for the changing trend of soft tissue contour. All patients had been separated into three groups based on the jumping space: group A (horizontal defect dimension [HDD] 2 mm), group B (2 mm < HDD 3 mm), and group C (HDD > 3 mm) and the digital impressions were obtained in the first, third, and sixth month after the operation. The changes of gingival mucosa levels, the average thickness of soft tissue contour volume, and the linear change of submarginal level decreased gradually across the three groups, with the largest change of submarginal level being at 5mm. The size of the jumping space was moderately negatively correlated with the level and average thickness of gingival mucosa and the linear changes of 3 mm and 5 mm under gingival margin, while there was no significant correlation with pink esthetic score (PES) and the linear change of the 1 mm under the gingival margin. Generally, IIPR of upper anterior teeth can achieve esthetic satisfaction, and the level of soft tissue around the implant can be well preserved.
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Affiliation(s)
- Linkun Xu
- Department of Implantology, Shanxi Medical University School and Hospital of Stomatology, Taiyuan, China
| | - Sui Zhang
- Department of Oral Implantology, Xiangyang Stomatological Hospital, Xiangyang, China
| | - Yue Chen
- Department of Implantology, Shanxi Medical University School and Hospital of Stomatology, Taiyuan, China
| | - Feiyan Yu
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan, China
| | - Chong Han
- Department of Implantology, Shanxi Medical University School and Hospital of Stomatology, Taiyuan, China
| | - Dongchao Wu
- Department of Implantology, Shanxi Medical University School and Hospital of Stomatology, Taiyuan, China
| | - Dongning He
- Department of Implantology, Shanxi Medical University School and Hospital of Stomatology, Taiyuan, China
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Liu Z, Li C, Liu Y, Zeng J, Chu H, Chen P, Zhou T, Yin W, Rong M. The clinical significance and application of the peri-implant phenotype in dental implant surgery: a narrative review. ANNALS OF TRANSLATIONAL MEDICINE 2023; 11:351. [PMID: 37675312 PMCID: PMC10477659 DOI: 10.21037/atm-23-1752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 08/10/2023] [Indexed: 09/08/2023]
Abstract
Background and Objective In recent years, the concept of the peri-implant phenotype has become a new standard for the clinical evaluation of the soft and hard tissues surrounding dental implants. Improving this phenotype enhances the likelihood of achieving long-term favorable results and is a necessary consideration during implant planning. Stable peri-implant tissue support is also crucial for the functional and aesthetic value of implant restoration. Herein, the authors review the clinical significance of the peri-implant phenotype and assess the timing of treatment strategies for improving peri-implant phenotype elements. Methods A literature search was performed to retrieve papers on peri-implant tissue management and clinical outcomes published up to November 24th, 2022 in PubMed, Web of Science, EMBASE, and Scopus. Key Content and Findings The optimal time to improve peri-implant bone thickness (PBT) is with augmentation procedures before implant surgery or at the same time as first-stage surgery. Similarly, issues associated with keratinized mucosa width (KMW) and mucosal thickness (MT) should be addressed before final restoration. The establishment of supracrestal tissue height (STH) depends on the MT and implant depth of the patient. Furthermore, special attention should be paid to the effect of the peri-implant phenotype on the prognosis of immediate implant placement in the aesthetic zone. Conclusions The long-term success of implant restoration depends on careful planning that considers appropriate interventions for improving the peri-implant phenotype at different stages of treatment to reduce iatrogenic variables.
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Affiliation(s)
- Ziyi Liu
- Department of Periodontology and Oral Implantology, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, China
| | - Cong Li
- Department of Stomatology, Dongguan Maternal and Child Health Care Hospital, Dongguan, China
| | - Yushan Liu
- Department of Periodontology and Oral Implantology, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, China
| | - Jincheng Zeng
- Department of Stomatology, Dongguan Maternal and Child Health Care Hospital, Dongguan, China
- Dongguan Key Laboratory of Medical Bioactive Molecular Developmental and Translational Research, Guangdong Provincial Key Laboratory of Medical Molecular Diagnostics, Guangdong Medical University, Dongguan, China
- Dongguan Metabolite Analysis Engineering Technology Center of Cells for Medical Use, Guangdong Xinghai Institute of Cell, Dongguan, China
| | - Hongxing Chu
- Department of Periodontology and Oral Implantology, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, China
| | - Pei Chen
- Department of Periodontology and Oral Implantology, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, China
| | - Tengfei Zhou
- Department of Periodontology and Oral Implantology, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, China
| | - Wuwei Yin
- Department of Periodontology and Oral Implantology, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, China
| | - Mingdeng Rong
- Department of Periodontology and Oral Implantology, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, China
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Sharon E, Pietrokovski Y, Engel I, Assali R, Houri-Haddad Y, Beyth N. Biocompatibility, Surface Morphology, and Bacterial Load of Dental Implant Abutments following Decontamination Protocols: An In-Vitro Study. MATERIALS (BASEL, SWITZERLAND) 2023; 16:ma16114080. [PMID: 37297212 DOI: 10.3390/ma16114080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/14/2023] [Accepted: 05/16/2023] [Indexed: 06/12/2023]
Abstract
The long-term success of dental implant rehabilitation depends significantly on proper peri-implant soft tissue integration. Therefore, decontamination of abutments prior to their connection to the implant is beneficial to enhance soft tissue attachment and to aid in maintaining marginal bone around the implant. Consequently, different implant abutment decontamination protocols were evaluated regarding biocompatibility, surface morphology, and bacterial load. The protocols evaluated were autoclave sterilization, ultrasonic washing, steam cleaning, chlorhexidine chemical decontamination, and sodium hypochlorite chemical decontamination. The control groups included: (1) implant abutments prepared and polished in a dental lab without decontamination and (2) unprepared implant abutments obtained directly from the company. Surface analysis was performed using scanning electron microscopy (SEM). Biocompatibility was evaluated using XTT cell viability and proliferation assays. Biofilm biomass and viable counts (CFU/mL) (n = 5 for each test) were used for surface bacterial load evaluation. Surface analysis revealed areas of debris and accumulation of materials, such as iron, cobalt, chromium, and other metals, in all abutments prepared by the lab and with all decontamination protocols. Steam cleaning was the most efficient method for reducing contamination. Chlorhexidine and sodium hypochlorite left residual materials on the abutments. XTT results showed that the chlorhexidine group (M = 0.7005, SD = 0.2995) had the lowest values (p < 0.001) (autoclave: M = 3.6354, SD = 0.1510; ultrasonic: M = 3.4077, SD = 0.3730; steam: M = 3.2903, SD = 0.2172; NaOCl: M = 3.5377, SD = 0.0927; prep non-decont.: M = 3.4815, SD = 0.2326; factory: M = 3.6173, SD = 0.0392). Bacterial growth (CFU/mL) was high in the abutments treated with steam cleaning and ultrasonic bath: 2.93 × 109, SD = 1.68 × 1012 and 1.83 × 109, SD = 3.95 × 1010, respectively. Abutments treated with chlorhexidine showed higher toxicity to cells, while all other samples showed similar effects to the control. In conclusion, steam cleaning seemed to be the most efficient method for reducing debris and metallic contamination. Bacterial load can be reduced using autoclaving, chlorhexidine, and NaOCl.
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Affiliation(s)
- Esi Sharon
- Department of Prosthodontics, Hadassah Medical Center, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Yoav Pietrokovski
- Department of Prosthodontics, Hadassah Medical Center, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Ilana Engel
- Department of Prosthodontics, Hadassah Medical Center, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Rula Assali
- Department of Prosthodontics, Hadassah Medical Center, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Yael Houri-Haddad
- Department of Prosthodontics, Hadassah Medical Center, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Nurit Beyth
- Department of Prosthodontics, Hadassah Medical Center, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
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Chen D, Li Z, Li Z, Sun Y, Liu Q, Yang J, Song J, Cai H, Feng Z, Chen Z, Huang B. Transcriptome analysis of human peri-implant soft tissue and periodontal gingiva: a paired design study. Clin Oral Investig 2023:10.1007/s00784-023-05017-y. [PMID: 37060358 DOI: 10.1007/s00784-023-05017-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 04/02/2023] [Indexed: 04/16/2023]
Abstract
OBJECTIVES Limited information is available about the biological characterization of peri-implant soft tissue at the transcriptional level. The aim of this study was to investigate the effect of dental implant on the soft tissue in vivo by using paired samples and compare the differences between peri-implant soft tissue and periodontal gingiva at the transcriptional level. METHODS Paired peri-implant soft tissue and periodontal gingiva tissue from 6 patients were obtained, and the pooled RNAs were analyzed by deep sequencing. Venn diagram was used to further screen out differentially expressed genes in every pair of samples. Annotation and enrichment analysis was performed. Further verification was done by quantitative real-time PCR. RESULTS Totally 3549 differentially expressed genes (DEGs) were found between peri-implant and periodontal groups. The Venn diagram further identified 185 DEGs in every pair of samples, of which the enrichment analysis identified significant enrichment for cellular component was associated with external side of plasma membrane, for molecular function was protein binding, for biological process was immune system process, and for KEGG pathway was cytokine-cytokine receptor interaction. Among the DEGs, CST1, SPP1, AQP9, and SFRP2 were verified to be upregulated in peri-implant soft tissue. CONCLUSIONS Peri-implant soft tissue showed altered expressions of several genes related to the cell-ECM interaction compared to periodontal gingiva. CLINICAL RELEVANCE Compared to periodontal gingiva, altered cell-ECM interactions in peri-implant may contribute to the susceptibility of peri-implant diseases. At the transcriptional level, periodontal gingiva is generally considered the appropriate control for peri-implantitis, except regarding the cell-ECM interactions.
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Affiliation(s)
- Danying Chen
- Hospital of Stomatology, Sun Yat-Sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
- Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, China
| | - Zhixin Li
- Hospital of Stomatology, Sun Yat-Sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
- Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, China
| | - Zhipeng Li
- Hospital of Stomatology, Sun Yat-Sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
- Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, China
| | - Yue Sun
- Hospital of Stomatology, Sun Yat-Sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
- Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, China
| | - Qifan Liu
- Hospital of Stomatology, Sun Yat-Sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
- Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, China
| | - Jieting Yang
- Hospital of Stomatology, Sun Yat-Sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
- Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, China
| | - Jiaying Song
- Hospital of Stomatology, Sun Yat-Sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
- Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, China
| | - Huaxiong Cai
- Hospital of Stomatology, Sun Yat-Sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
- Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, China
| | - Zhicai Feng
- Hospital of Stomatology, Sun Yat-Sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
- Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, China
| | - Zhuofan Chen
- Hospital of Stomatology, Sun Yat-Sen University, Guangzhou, China.
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China.
- Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, China.
| | - Baoxin Huang
- Hospital of Stomatology, Sun Yat-Sen University, Guangzhou, China.
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China.
- Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, China.
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Comparing the Long-Term Success Rates of Tooth Preservation and Dental Implants: A Critical Review. J Funct Biomater 2023; 14:jfb14030142. [PMID: 36976066 PMCID: PMC10055991 DOI: 10.3390/jfb14030142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 02/23/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
Implant therapy is considered a predictable, safe, and reliable rehabilitation method for edentulous patients in most clinical scenarios. Thus, there is a growing trend in the indications for implants, which seems attributable not only to their clinical success but also to arguments such as a more “simplified approach” based on convenience or the belief that dental implants are as good as natural teeth. Therefore, the objective of this critical literature review of observational studies was to discuss the evidence concerning the long-term survival rates and treatment outcomes, comparing endodontically or periodontally treated teeth with dental implants. Altogether, the evidence suggests that the decision between keeping a tooth or replacing it with an implant should carefully consider the condition of the tooth (e.g., amount of remaining tooth and degree of attachment loss and mobility), systemic disorders, and patient preference. Although observational studies revealed high success rates and long-term survival of dental implants, failures and complications are common. For this reason, attempts should be made to first save maintainable teeth over the long-term, instead of immediately replacing teeth with dental implants.
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26
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Oral Cell Lysates Reduce the Inflammatory Response of Activated Macrophages. J Clin Med 2023; 12:jcm12041701. [PMID: 36836236 PMCID: PMC9962209 DOI: 10.3390/jcm12041701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/13/2023] [Accepted: 02/18/2023] [Indexed: 02/23/2023] Open
Abstract
Necrotic cell damage occurs as a consequence of invasive dental procedures. Loss of membrane integrity being the hallmark of necrotic cells leads to the release of cytoplasmic and membranous components. Macrophages are predestined to respond to lysates originating from necrotic cells. Here, we implement necrotic lysates from human gingival fibroblasts, HSC2, and TR146 oral epithelial cell lines, and RAW264.7 macrophage cell lines to be tested for their potential to modulate the inflammatory response of macrophages. To this aim, necrotic cell lysates were prepared by sonication or freezing/thawing of the respective cell suspension. Necrotic cell lysates were tested for their potential to modulate the lipopolysaccharide (LPS)-induced expression of inflammatory cytokines using RAW264.7 macrophages as a bioassay. We show here that all necrotic cell lysates, independent of the origin and the preparation way, reduced the expression of IL1 and IL6 in LPS-induced RAW264.7 macrophages, most obviously shown for TR146 cells. This finding was supported in a bioassay when macrophages were exposed to poly (I:C) HMW, an agonist of TLR-3. Consistently, all necrotic lysates from gingival fibroblasts, HSC2, TR146, and RAW264.7 cells reduced the nuclear translocation of p65 in LPS-exposed macrophages. This screening approach supports the overall concept that necrotic cell lysates can modulate the inflammatory capacity of macrophages.
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27
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Tang P, Meng Z, Song X, Huang J, Su C, Li L. Influence of different mucosal phenotype on early and long-term marginal bone loss around implants: a systematic review and meta-analysis. Clin Oral Investig 2023; 27:1391-1407. [PMID: 36800027 DOI: 10.1007/s00784-023-04902-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 02/03/2023] [Indexed: 02/18/2023]
Abstract
OBJECTIVES To investigate the influence of different mucosal phenotypes on peri-implant marginal bone loss. MATERIALS AND METHODS The search was conducted in five databases including PubMed, Embase, Cochrane, Scopus, and Web of Science (until 1st Sept. 2022) to identify relevant clinical studies. Potentially relevant journals were also manually searched. Two reviewers independently screened studies, extracted data, and evaluated the quality of the studies. Prospective clinical trials and observational studies investigating peri-implant marginal bone loss in thick-mucosa and thin-mucosa groups were included. RESULTS A total of 14 studies were included in this systematic review. Results of the meta-analysis revealed a weighted mean difference of 0.38 mm for marginal bone loss between thick- and thin-mucosa groups (95% confidence interval = 0.02-0.74, P = 0.002). Statistical significance existed in short-term (follow-up ≤ 1 year) data (WMD = 0.41 mm, 95%CI = 0.11-0.70, P = 0.007), but not in long term (follow-up ≥ 3 y) data (WMD = 0.17 mm, 95%CI = - 0.02-0.36, P = 0.07). Survival rate revealed no difference between thick and thin mucosa groups. In subgroup analyses, a positive association between thick mucosa and less marginal bone loss was found in the non-submerged group, cement-retained group, and bone-level group. CONCLUSIONS A significantly less marginal bone loss occurred in implants with thick mucosa than with thin mucosa in the short term, whereas no significant difference was observed in the long term. Due to the substantial heterogeneity and limited long-term data, further high-quality evidence is warranted to confirm the results. CLINICAL RELEVANCE Clinicians are advised to use caution in treating patients with thin mucosa and adhere closely to indications and protocols to minimize marginal bone loss.
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Affiliation(s)
- Pengzhou Tang
- Department of Periodontics, Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, 210029, China
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing, 210029, China
- Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, 210029, China
| | - Ziyan Meng
- Department of Periodontics, Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, 210029, China
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing, 210029, China
- Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, 210029, China
| | - Xiao Song
- Department of Periodontics, Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, 210029, China
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing, 210029, China
- Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, 210029, China
| | - Jiaxin Huang
- Department of Periodontics, Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, 210029, China
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing, 210029, China
- Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, 210029, China
| | - Chuan Su
- State Key Laboratory of Reproductive Medicine, Center of Global Health, Nanjing Medical University, Nanjing, 210029, China
- Key Laboratory of Pathogen Biology of Jiangsu Province, Department of Pathogen Biology, Nanjing Medical University, Nanjing, 210029, China
| | - Lu Li
- Department of Periodontics, Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, 210029, China.
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing, 210029, China.
- Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, 210029, China.
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Khorshed A, Vilarrasa J, Monje A, Nart J, Blasi G. Digital evaluation of facial peri-implant mucosal thickness and its impact on dental implant aesthetics. Clin Oral Investig 2023; 27:581-590. [PMID: 36260169 DOI: 10.1007/s00784-022-04753-x] [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: 03/13/2022] [Accepted: 10/07/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The aim of the present study was to describe and compare the features of the buccal peri-implant mucosa to natural gingiva in the aesthetic area. MATERIAL AND METHODS Forty-nine periodontally healthy patients were included in this cross-sectional study. Mucosal and gingival dimensions at the mid-facial aspect were evaluated clinically and radiographically. Color assessments were performed using a reflectance spectrophotometer, and patient aesthetic satisfaction was further checked. RESULTS Implant sites revealed significant thicker mucosa when compared to tooth sites both at 1.5 (p < 0.001) and 3 mm (p < 0.001) apical to the mucosal margin. Both conventional and digital methods presented a good reliability. The spectrophotometric data revealed a statistically significant color difference between the peri-implant mucosa and the gingiva. However, there was no further significant relation between these color changes and the mucosal thickness. CONCLUSIONS Peri-implant mucosa revealed a darkish, greenish, and bluish discoloration when compared to the gingiva. More satisfactory patient´s aesthetic evaluation was reported in sites with thicker and comparatively lighter mucosa when compared to the adjacent dentition. CLINICAL RELEVANCE This article focuses on variables affecting color stability and aesthetics around dental implants. These can be assessed to identify the need for peri-implant phenotypic modification.
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Affiliation(s)
- Amr Khorshed
- Department of Periodontology, Universitat Internacional de Catalunya, C/ Josep Trueta s/n, 08195 - Sant Cugat del Vallès, Barcelona, Spain.,School of Dental Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Javi Vilarrasa
- Department of Periodontology, Universitat Internacional de Catalunya, C/ Josep Trueta s/n, 08195 - Sant Cugat del Vallès, Barcelona, Spain
| | - Alberto Monje
- Department of Periodontology, Universitat Internacional de Catalunya, C/ Josep Trueta s/n, 08195 - Sant Cugat del Vallès, Barcelona, Spain.,Department of Periodontology, School of Dental Medicine, University of Michigan, Ann Arbor, USA
| | - Jose Nart
- Department of Periodontology, Universitat Internacional de Catalunya, C/ Josep Trueta s/n, 08195 - Sant Cugat del Vallès, Barcelona, Spain.
| | - Gonzalo Blasi
- Department of Periodontology, Universitat Internacional de Catalunya, C/ Josep Trueta s/n, 08195 - Sant Cugat del Vallès, Barcelona, Spain.,Division of Periodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, Baltimore School of Dentistry, Baltimore, MD, USA
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29
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Bianchini MA, Junior NDB, Dedavid BA, De Aza PN, Gehrke SA. Comparative analysis of the mechanical limits of resistance in implant/abutment set of a new implant design: An in vitro study. PLoS One 2023; 18:e0280684. [PMID: 36662887 PMCID: PMC9858081 DOI: 10.1371/journal.pone.0280684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 01/05/2023] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE The aim of the present in vitro study was to evaluate the resistance on quasi-static forces and in the fatigue mechanical cycling of a new implant design compared to two other conventional implant designs. MATERIALS AND METHODS Eighty-eight implants with their respective abutments were tested and distributed into four groups (n = 22 per group): Morse taper connection implant (MT group), conventional external hexagon implant (EH con group), new Collo implant of external hexagon with the smooth portion out of the bone insertion (EH out group), and new Collo implant of external hexagon with the implant platform inserted to the bone level (EH bl group). All the sets were subjected to quasi-static loading in a universal testing machine, and we measured the maximum resistance force supported by each sample. Another 12 samples from each group were submitted to the cyclic fatigue test at 4 intensities of forces (n = 3 per force): 80%, 60%, 40%, and 20%. The number of cycles supported by each sample at each force intensity was evaluated. RESULTS The three groups of implants with external hexagon connection had similar maximum strength values of the sets (p > 0.05). Meanwhile, samples from the MT group showed the highest resistance values in comparison to the other three groups (p < 0.05). In the fatigue test, the Collo out group supported a smaller number of cycles that led to the fracture than the other 3 groups proposed at loads of 80%, 60%, and 40%, and only at the load value of 20% all groups had the same performance. CONCLUSIONS Within the limitations of the present in vitro study, the results showed that the new Collo implant performs better when installed at bone level.
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Affiliation(s)
- Marco Aurélio Bianchini
- Post-Graduate Program in Implant Dentistry (PPGO), Federal University of Santa Catarina (UFSC), Florianópolis, Brazil
| | | | - Berenice Anina Dedavid
- Department of Materials Engineering, Pontificial Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Piedad N. De Aza
- Instituto de Bioingenieria, Universidad Miguel Hernández, Elche (Alicante), Spain
| | - Sergio Alexandre Gehrke
- Department of Materials Engineering, Pontificial Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
- Instituto de Bioingenieria, Universidad Miguel Hernández, Elche (Alicante), Spain
- Department of Biotechnology, Universidad Católica de Murcia (UCAM), Murcia, Spain
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Qiu X, Li X, Li F, Hu D, Wen Z, Wang Y, Zhang J. Xenogeneic collagen matrix versus free gingival graft for augmenting keratinized mucosa around posterior mandibular implants: a randomized clinical trial. Clin Oral Investig 2023; 27:1953-1964. [PMID: 36637519 DOI: 10.1007/s00784-022-04853-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 12/28/2022] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To assess the clinical efficacy of xenogeneic collagen matrix (XCM) plus apically positioned flap (APF) in augmenting the keratinized mucosa (KM) width (KMW) and thickness (KMT) around posterior mandibular implants and compare it with free gingival graft (FGG) plus APF. MATERIAL AND METHODS Thirty patients with KMW ≤ 2 mm in the posterior mandibular implant site were randomly allocated to the FGG group (FGG plus APF) or the XCM group (XCM plus APF). Clinical assessments, including KMW and KMT, shrinkage rate of established KM, and peri-implant soft tissue health, were evaluated during a 6-month follow-up. Additionally, the esthetic outcomes and patient-reported postoperative morbidity were investigated. RESULTS At 6 months, the KMW measured 3.60 ± 0.79 mm in the FGG group and 3.28 ± 0.96 mm in the XCM group (p = 0.186). Both groups showed a tendency for graft contraction (FGG, 42.11%; XCM, 53.22%). The KMT measured 1.24 ± 0.34 mm in the FGG group and 0.95 ± 0.29 mm in the XCM group, with statistical difference (p = 0.002). No difference in the peri-implant soft tissue health was observed between the two groups (p > 0.05), but the esthetic outcomes were better in the XCM group (p < 0.05). CONCLUSIONS XCM plus APF rendered a similar clinical efficacy in augmenting KMW as that with FGG plus APF, but with higher shrinkage. XCM plus APF was inferior with respect to FGG plus APF in augmenting KMT. The esthetic outcomes were better with XCM plus APF than FGG plus APF. Clinical relevance XCM plus APF graft was inferior with respect to FGG plus APF in augmenting KMT. TRIAL REGISTRATION Trial registration number: ChiCTR2200058027 and date: 03/27/2022.
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Affiliation(s)
- Xiaohai Qiu
- Department of Oral Implantology, Shenzhen Stomatology Hospital (Pingshan) of Southern Medical University, Shenzhen, China
| | - Xuejing Li
- Department of Prosthodontics, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Stomatological Hospital and Dental School of Tongji University, Shanghai, China
| | - Fengzhou Li
- Department of Oral Implantology, Shenzhen Stomatology Hospital (Pingshan) of Southern Medical University, Shenzhen, China
| | - Dandan Hu
- Department of Prosthodontics, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Stomatological Hospital and Dental School of Tongji University, Shanghai, China
| | - Zhuo Wen
- Department of Prosthodontics, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Stomatological Hospital and Dental School of Tongji University, Shanghai, China
| | - Yanying Wang
- Department of Oral Implantology, Tianjin Stomatological Hospital, Nankai University, Tianjin, China.
| | - Jian Zhang
- Department of Oral Implantology, Tianjin Stomatological Hospital, Nankai University, Tianjin, China.
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31
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Wu XY, Acharya A, Shi JY, Qian SJ, Lai HC, Tonetti MS. Surgical interventions for implant placement in the anterior maxilla: A systematic scoping review with evidence mapping. Clin Oral Implants Res 2023; 34:1-12. [PMID: 36245267 DOI: 10.1111/clr.14013] [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: 06/08/2022] [Revised: 08/26/2022] [Accepted: 09/18/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Simplification and standardization of interventions are critical challenges to improving performance in implant dentistry. This study aimed to systematically identify and schematically present the evidence base of the implant dentistry surgical interventions for the anterior maxilla as a basis for further development and standardization. METHODS Electronic searches were conducted in PubMed, Embase and Cochrane CENTRAL. Primary clinical studies reporting surgical interventions in the anterior maxilla, with a sample size of at least ten patients, were included. Bibliometric information and study details were extracted. Descriptive analysis and a mind map approach were used to describe the documentation of different surgical interventions. RESULTS Two hundred and seventy-two studies reporting on 9001 patients were included. Within the past two decades, the number of literatures on implant placement in the anterior maxilla has increased dramatically (7 studies before 2005, 151 studies after 2016). Overall, the evidence map identified six primary operations and 33 variations. For hopeless tooth extraction, immediate implant placement was the most frequently reported (141 studies, 4670 patients); flapless implant placement with hard tissue augmentation and immediate provisionalization was the most commonly reported variation (33 studies, 987 patients). Type 3/4 implant placement (62 studies, 1902 patients) and implant site augmentation (33 studies, 788 patients) were frequently reported for missing teeth. Geographical differences were observed, with type 2 placement studies almost exclusively from Europe. CONCLUSIONS Research on immediate implant placement was the most reported surgical intervention in the anterior maxilla. Hard tissue augmentation was frequently reported simultaneously with or before implant placement. Immediate provisionalization was mainly used for type 1 implant placement. The finding that six primary operations with 33 variations have been reported indicates the need for additional research to simplify and consolidate the surgical approach.
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Affiliation(s)
- Xin-Yu Wu
- Shanghai PerioImplant Innovation Center, Department of Oral and Maxillofacial Implantology, 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
| | - Aneesha Acharya
- Department of Periodontology, Dr D Y Patil Dental College & Hospital, Pimpri, India.,Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - Jun-Yu Shi
- Shanghai PerioImplant Innovation Center, Department of Oral and Maxillofacial Implantology, 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
| | - Shu-Jiao Qian
- Shanghai PerioImplant Innovation Center, Department of Oral and Maxillofacial Implantology, 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
| | - Hong-Chang Lai
- Shanghai PerioImplant Innovation Center, Department of Oral and Maxillofacial Implantology, 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
| | - Maurizio S Tonetti
- Shanghai PerioImplant Innovation Center, Department of Oral and Maxillofacial Implantology, 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.,European Research Group on Periodontology, Genoa, Italy
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Spitznagel FA, Hoppe JS, Bonfante EA, Campos TMB, Langner R, Gierthmuehlen PC. Failure Load and Fatigue Behavior of Monolithic and Bi-Layer Zirconia Fixed Dental Prostheses Bonded to One-Piece Zirconia Implants. MATERIALS (BASEL, SWITZERLAND) 2022; 15:8465. [PMID: 36499960 PMCID: PMC9740162 DOI: 10.3390/ma15238465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/19/2022] [Accepted: 11/23/2022] [Indexed: 06/17/2023]
Abstract
No evidence-based prosthetic treatment concept for 3-unit fixed-dental-prostheses (FDPs) on ceramic implants is currently available. Therefore, the aim of this in vitro study was to investigate the failure load and fatigue behavior of monolithic and bi-layer zirconia FDPs supported by one-piece ceramic implants. Eighty 3-unit FDPs supported by 160 zirconia-implants (ceramic.implant; vitaclinical) were divided into 4 groups (n = 20 each): Group Z-HT: 3Y-TZP monolithic-zirconia (Vita-YZ-HT); Group Z-ST: 4Y-TZP monolithic-zirconia (Vita-YZ-ST); Group FL: 3Y-TZP zirconia (Vita-YZ-HT) with facial-veneer (Vita-VM9); Group RL (Rapid-layer): PICN “table-top” (Vita-Enamic), 3Y-TZP-framework (Vita-YZ-HT). Half of the test samples (n = 10/group) were fatigued in a mouth-motion chewing-simulator (F = 98 N, 1.2 million-cycles) with simultaneous thermocycling (5−55 °C). All specimens (fatigued and non-fatigued) were afterwards exposed to single-load-to-failure-testing (Z010, Zwick). Statistical analysis was performed using ANOVA, Tukey’s post-hoc tests and two-sample t-tests (p < 0.05, Bonferroni-corrected where appropriate). All specimens withstood fatigue application. While the effect of fatigue was not significant in any group (p = 0.714), the choice of material had a significant effect (p < 0.001). Material FL recorded the highest failure loads, followed by Z-ST, Z-HT and RL, both with and without fatigue application. Taken together, all tested FDP material combinations survived chewing forces that exceeded physiological levels. Bi-Layer FL and monolithic Z-ST showed the highest resilience and might serve as reliable prosthetic reconstruction concepts for 3-unit FDPs on ceramic implants.
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Affiliation(s)
- Frank A. Spitznagel
- Department of Prosthodontics, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Johanna S. Hoppe
- Department of Prosthodontics, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Estevam A. Bonfante
- Department of Prosthodontics and Periodontology; Bauru School of Dentistry, University of Sao Paulo, Bauru 17012-230, SP, Brazil
| | - Tiago M. B. Campos
- Department of Prosthodontics and Periodontology; Bauru School of Dentistry, University of Sao Paulo, Bauru 17012-230, SP, Brazil
| | - Robert Langner
- Institute of Systems Neuroscience, Medical Faculty, Heinrich-Heine-University, 40225 Düsseldorf, Germany
- Institute of Neuroscience and Medicine, Brain and Behavior (INM-7), Research Center Jülich, 52425 Jülich, Germany
| | - Petra C. Gierthmuehlen
- Department of Prosthodontics, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University, Moorenstraße 5, 40225 Düsseldorf, Germany
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Kämmerer PW, Tunkel J, Götz W, Würdinger R, Kloss F, Pabst A. The allogeneic shell technique for alveolar ridge augmentation: a multicenter case series and experiences of more than 300 cases. Int J Implant Dent 2022; 8:48. [PMID: 36316597 PMCID: PMC9622968 DOI: 10.1186/s40729-022-00446-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 10/05/2022] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Allogeneic cortical bone plates (CP) might be used for alveolar ridge augmentation as an alternative to autogenous grafts (AG) and bone substitutes (BS). We report about a multicenter case series and our experiences of more than 300 cases using CP and the shell technique for reconstruction of the alveolar process to illustrate surgical key steps, variations, and complication management. METHODS Different types of alveolar ridge defects were augmented using the shell technique via CP. The space between the CP and the alveolar bone was filled with either autogenous or allogeneic granules (AUG, ALG) or a mixture of both. Implants were placed after 4-6 months. Microscopic and histological assessments were performed. In addition, space filling using AUG, ALG and bovine BS was discussed. RESULTS Scanning electron microscopy demonstrated the compact cortical structure of CP and the porous structure of ALG allowing micro-vessel ingrowth and bone remodeling. Histological assessment demonstrated sufficient bone remodeling and graft resorption after 4-6 months. In total, 372 CP cases and 656 implants were included to data analysis. The mean follow-up period was about 3.5 years. Four implants failed, while all implant failures were caused by peri-implantitis. Next, 30 CP complications were seen, while in 26 CP complications implant placement was possible. CP rehydration, stable positioning by adjusting screws, smoothing of sharp edges, and a tension-free wound closure were identified as relevant success factors. Space filling using ALG and a mixture of AUG/ALG resulted in sufficient bone remodeling, graft resorption and stability of the augmented bone. CONCLUSIONS CP and the shell technique is appropriate for alveolar ridge augmentation with adequate bone remodeling and low complication rates. Allografts can prevent donor site morbidity and therefore may decrease discomfort for the patient.
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Affiliation(s)
- Peer W. Kämmerer
- grid.410607.4Department of Oral and Maxillofacial Surgery, University Medical Center Mainz, Augustusplatz 2, 55131 Mainz, Germany
| | - Jochen Tunkel
- Private Practice for Oral Surgery and Periodontology, Königstraße 19, 32545 Bad Oeynhausen, Germany
| | - Werner Götz
- grid.15090.3d0000 0000 8786 803XDepartment of Orthodontics, University Hospital Bonn, Welschnonnenstr. 17, 53111 Bonn, Germany
| | - Robert Würdinger
- Private Practice for Oral Surgery and Periodontology, Frankfurter Str. 6, 35037 Marburg, Germany
| | - Frank Kloss
- Private Practice for Oral and Maxillofacial Surgery, Kärtnerstraße 62, 9900 Lienz, Austria
| | - Andreas Pabst
- Department of Oral and Maxillofacial Surgery, Federal Armed Forces Hospital, Rübenacherstraße 170, 56072 Koblenz, Germany
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Memè L, Sartini D, Pozzi V, Emanuelli M, Strappa EM, Bittarello P, Bambini F, Gallusi G. Epithelial Biological Response to Machined Titanium vs. PVD Zirconium-Coated Titanium: An In Vitro Study. MATERIALS (BASEL, SWITZERLAND) 2022; 15:ma15207250. [PMID: 36295315 PMCID: PMC9610795 DOI: 10.3390/ma15207250] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/25/2022] [Accepted: 10/12/2022] [Indexed: 05/28/2023]
Abstract
The aim of this study was to compare the epithelial biological response to machined titanium Ti-6Al-4V grade 5 and titanium Ti-6Al-4V grade 5 coated with zirconia (ZrN) by physical vapor deposition (PVD). Human keratinocytes were cultured in six-well plates. Machined titanium TiAl4V4 grade 5 (T1) and ZrN-coated titanium TiAl4V4 grade 5 (T2) discs were placed in two different wells. The remaining two wells served as control (C). Scanning electron microscopy (SEM) and energy-dispersive spectroscopy (EDS) were performed to compare the T1 and T2 surfaces. Subsequent analyses were performed to explore the effect of T1 and T2 contact with human keratinocyte HUKE cell lines. Cell viability was evaluated using a trypan blue exclusion test and MTT assay. Cell lysates from C, T1, and T2 were Western blotted to evaluate E-cadherin and Integrin-α6β4 expression. SEM revealed that T2 was smoother and more homogeneous than T1. EDS showed homogeneous and uniform distribution of ZrN coating on T2. Cell viability analyses did not show significant differences between T1 and T2. Furthermore, E-cadherin and Integrin-α6β4 expressions of the epithelial cells cultured in T1 and T2 were similar. Therefore, titanium Ti-6Al-4V grade 5 surfaces coated with ZrN by PVD seem to be similar substrates to the uncoated surfaces for keratinocyte adhesion and proliferation.
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Affiliation(s)
- Lucia Memè
- Department of Clinical Sciences and Stomatology, Polytechnic University of Marche, 60126 Ancona, Italy
| | - Davide Sartini
- Department of Clinical Sciences, Polytechnic University of Marche, 60126 Ancona, Italy
| | - Valentina Pozzi
- Department of Clinical Sciences, Polytechnic University of Marche, 60126 Ancona, Italy
| | - Monica Emanuelli
- Department of Clinical Sciences, Polytechnic University of Marche, 60126 Ancona, Italy
| | - Enrico M. Strappa
- Department of Health Technologies, IRCCS Ospedale Galeazzi-Sant’Ambrogio, University of Milan, 20157 Milan, Italy
| | | | - Fabrizio Bambini
- Department of Clinical Sciences and Stomatology, Polytechnic University of Marche, 60126 Ancona, Italy
| | - Gianni Gallusi
- Department of Clinical Sciences and Translational Medicine, University Tor Vergata, 00133 Rome, Italy
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Ashurko I, Tarasenko S, Esayan A, Kurkov A, Mikaelyan K, Balyasin M, Galyas A, Kustova J, Taschieri S, Corbella S. Connective tissue graft versus xenogeneic collagen matrix for soft tissue augmentation at implant sites: a randomized-controlled clinical trial. Clin Oral Investig 2022; 26:7191-7208. [PMID: 36029335 DOI: 10.1007/s00784-022-04680-x] [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: 03/15/2022] [Accepted: 08/10/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The purpose of this randomized clinical trial (RCT) is to compare xenogeneic collagen matrix (XCM) versus subepithelial connective tissue graft (SCTG) to increase soft tissue thickness at implant site. MATERIALS AND METHODS The study was a randomized, parallel-group controlled investigation. Thirty patients underwent buccal soft tissue thickness augmentation at the stage of implant placement by two different methods: SCTG (control group) and XCM (test group). Primary outcome was the amount of buccal soft tissue thickness gain, 3 months after the intervention. Secondary outcomes were the operation time, the amount of keratinized mucosa (KM), pain syndrome (PS), and patients' quality of life (QL). Histologic evaluation was also performed. RESULTS The amount of soft tissue thickness gain was 1.55±0.11 mm in SCTG group, and 1.18±0.11mm in XCM group. The difference between the SCTG and XCM was -0.366 (-0.66 to -0.07; p=0.016). Operation time with XCM was 8.4 (3.737 to 13.06) min shorter than that with the SCTG (p=0.001). KT, PS, and QL for both groups were not statistically significantly different at any time point (p>0.05). At histological examination, the general picture in both groups was similar. No significant differences between the studied groups in most indices, except for the average and maximum formation thickness, cellularity of the basal, mitotic activity and also maximum length of rete ridges. CONCLUSION Within limitations, this study demonstrates that the use of SCTG provides a statistically significant superior soft tissue thickness gain than XCM for soft tissue augmentation procedures around implants. CLINICAL RELEVANCE XCM can be used as the method of choice for increasing the thickness of soft tissues.
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Affiliation(s)
- Igor Ashurko
- Department of Oral Surgery of the Institute of Dentistry, I.M. Sechenov First Moscow State Medical University (Sechenov University), 11 Mozhaisky Val Street, Moscow, 119048, Russian Federation.
| | - Svetlana Tarasenko
- Department of Oral Surgery of the Institute of Dentistry, I.M. Sechenov First Moscow State Medical University (Sechenov University), 11 Mozhaisky Val Street, Moscow, 119048, Russian Federation
| | - Aleksandr Esayan
- Department of Oral Surgery of the Institute of Dentistry, I.M. Sechenov First Moscow State Medical University (Sechenov University), 11 Mozhaisky Val Street, Moscow, 119048, Russian Federation
| | - Alexandr Kurkov
- Department of Oral Surgery of the Institute of Dentistry, I.M. Sechenov First Moscow State Medical University (Sechenov University), 11 Mozhaisky Val Street, Moscow, 119048, Russian Federation
| | - Karen Mikaelyan
- Department of Oral Surgery of the Institute of Dentistry, I.M. Sechenov First Moscow State Medical University (Sechenov University), 11 Mozhaisky Val Street, Moscow, 119048, Russian Federation
| | - Maxim Balyasin
- Peoples Friendship University of Russia, Moscow, Russian Federation
| | - Anna Galyas
- Department of Oral Surgery of the Institute of Dentistry, I.M. Sechenov First Moscow State Medical University (Sechenov University), 11 Mozhaisky Val Street, Moscow, 119048, Russian Federation
| | - Julia Kustova
- Department of Oral Surgery of the Institute of Dentistry, I.M. Sechenov First Moscow State Medical University (Sechenov University), 11 Mozhaisky Val Street, Moscow, 119048, Russian Federation
| | - Silvio Taschieri
- Department of Oral Surgery of the Institute of Dentistry, I.M. Sechenov First Moscow State Medical University (Sechenov University), 11 Mozhaisky Val Street, Moscow, 119048, Russian Federation
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Department of Biomedica, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
| | - Stefano Corbella
- Department of Oral Surgery of the Institute of Dentistry, I.M. Sechenov First Moscow State Medical University (Sechenov University), 11 Mozhaisky Val Street, Moscow, 119048, Russian Federation
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Department of Biomedica, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
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Nisanci Yilmaz MN, Koseoglu Secgin C, Ozemre MO, İnonu E, Aslan S, Bulut S. Assessment of gingival thickness in the maxillary anterior region using different techniques. Clin Oral Investig 2022; 26:6531-6538. [PMID: 35796801 DOI: 10.1007/s00784-022-04602-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 06/20/2022] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Gingival phenotype is closely related to treatment success and aesthetic results in the maxillary anterior region. Several methods were proposed to measure the dimensions of the gingival tissue. This study aimed to evaluate the gingival thickness using clinical and radiographic techniques and to explore the association between gingival thickness and gingival phenotypes classified by color-coded phenotype probes. MATERIALS AND METHODS The gingival thickness of 86 periodontally healthy maxillary anterior teeth was assessed using transgingival probing (TGP) and cone-beam computed tomography (CBCT). The gingival phenotype was classified as thin, medium, thick, or very thick by transparency of the color-coded probes through the gingival sulcus. The labial alveolar bone thickness was measured on CBCT images. The keratinized tissue width (KTW) was recorded. RESULTS Good to excellent agreement was found between TGP and CBCT regarding the thickness of the gingiva (p<0.001). There was a very high correlation between the phenotypes determined by color-coded probes and the gingival thickness measured by TGP (r=0.953, p<0.001). KTW was significantly higher in thick and very thick phenotype groups compared with thin phenotype group. CONCLUSION Cone-beam computed tomography images and the probe transparency method with color-coded probes are reliable for identifying the gingival phenotype in the maxillary anterior region, based on comparisons to direct transgingival probing. CLINICAL RELEVANCE The assessment of the gingival phenotype is essential, especially in the aesthetic zone, to obtain predictable and favorable clinical outcomes in various dental procedures. The newly introduced color-coded probes comprise a non-invasive and reliable method for this.
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Affiliation(s)
| | - Cansu Koseoglu Secgin
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Baskent University, Ankara, Turkey
| | - Mehmet Ozgur Ozemre
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Mersin University, Mersin, Turkey
| | - Elif İnonu
- Department of Periodontology, Faculty of Dentistry, Baskent University, Ankara, Turkey
| | - Serhat Aslan
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.,Private Office Dr. Aslan, İzmir, Turkey
| | - Sule Bulut
- Department of Periodontology, Faculty of Dentistry, Baskent University, Ankara, Turkey
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Guerrero A, Heitz-Mayfield LJA, Beuer F, Blanco J, Roccuzzo M, Ruiz-Magaz V, Sanz-Martín I, Schlee M, Schliephake H, Soetebeer M, Sculean A, Zabalegui I, Zucchelli G, Al-Nawas B. Occurrence, associated factors and soft tissue reconstructive therapy for buccal soft tissue dehiscence at dental implants: Consensus report of group 3 of the DGI/SEPA/Osteology Workshop. Clin Oral Implants Res 2022; 33 Suppl 23:137-144. [PMID: 35763017 DOI: 10.1111/clr.13952] [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: 04/25/2022] [Accepted: 05/01/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To systematically assess the literature and report on (1) the frequency of occurrence of buccal soft tissue dehiscence (BSTD) at implants, (2) factors associated with the occurrence of BSTD and (3) treatment outcomes of reconstructive therapy for the coverage of BSTD. MATERIALS AND METHODS Two systematic reviews addressing focused questions related to implant BSTD occurrence, associated factors and the treatment outcomes of BSTD coverage served as the basis for group discussions and the consensus statements. The main findings of the systematic reviews, consensus statements and implications for clinical practice and for future research were formulated within group 3 and were further discussed and reached final approval within the plenary session. RESULTS Buccally positioned implants were the factor most strongly associated with the risk of occurrence of BSTD, followed by thin tissue phenotype. At immediate implants, it was identified that the use of a connective tissue graft (CTG) may act as a protective factor for BSTD. Coverage of BSTD may be achieved with a combination of a coronally advanced flap (CAF) and a connective tissue graft, with or without prosthesis modification/removal, although feasibility of the procedure depends upon multiple local and patient-related factors. Soft tissue substitutes showed limited BSTD coverage. CONCLUSION Correct three-dimensional (3D) positioning of the implant is of utmost relevance to prevent the occurrence of BSTD. If present, BSTD may be covered by CAF +CTG, however the evidence comes from a low number of observational studies. Therefore, future research is needed for the development of further evidence-based clinical recommendations.
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Affiliation(s)
| | - Lisa J A Heitz-Mayfield
- International Research Collaborative - Oral Health and Equity, School of Anatomy, Physiology and Human Biology, The University of Western Australia, West Perth, WA, Australia
| | - Florian Beuer
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Juan Blanco
- Department of Surgery and Medical-Surgical Specialties, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Mario Roccuzzo
- Division of Maxillofacial Surgery, University of Torino, Torino, Italy
| | - Vannesa Ruiz-Magaz
- Department of Periodontology, School of Dentistry, International University of Cataluña (UIC), Barcelona, Spain
| | | | - Markus Schlee
- Private practice and Department of Maxillofacial surgery, Goethe Universität Frankfurt am Main, Germany
| | - Henning Schliephake
- Department of Oral and Maxillofacial Surgery, University of Göttingen, Göttingen, Germany
| | - Maren Soetebeer
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | | | - Giovanni Zucchelli
- Department of Biomedical and Neuromotor Sciences University of Bologna, Bologna, Italy
| | - Bilal Al-Nawas
- Department for Oral and Maxillofacial Surgery, Plastic Surgery, University Medical Center of the J. Gutenberg University Mainz, Mainz, Germany
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Abstract
Healthy peri-implant tissues have become synonymous with implant success and a major challenge in contemporary implant dentistry. Numerous local and systemic factors, as well as iatrogenic and other hitherto underappreciated factors of potential clinical relevance may influence the outcome of implant therapy. In this volume of Periodontology 2000, a group of outstanding experts has elaborated on the latest insights on the prevention and management of major surgical, biological and technical complications, to facilitate the establishment and maintenance of peri-implant health. This volume focusses on factors affecting early and late implant loss and the potential role of systemic diseases and local conditions. It comprehensively discusses the implementation of guided implant surgery to facilitate the cleansibility of implant-supported restorations, as well as iatrogenic factors related to bone augmentation/sinus grafting procedures. The challenges associated with soft-tissue grafting and the prevention of esthetic complications are also reviewed as the paradigm of success in implant dentistry shifts from implant survival towards a greater focus on patient-reported outcomes. Prosthetic failures remain a significant challenge and are discussed in light of new evidence, as is the relevance of the structural dimensions of the peri-implant mucosa. The volume closes with detailed and well-illustrated appraisals of the surgical management of peri-implantitis, the management and sequelae of dental implant removal, and the latest evidence for the oral health related quality of life in patients treated with dental implants.
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Affiliation(s)
- Frank Schwarz
- Department of Oral Surgery and Implantology, Carolinum, Goethe University, Frankfurt, Germany
| | - Ausra Ramanauskaite
- Department of Oral Surgery and Implantology, Carolinum, Goethe University, Frankfurt, Germany
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