Rocchietta, Isabella

The goal of this multicenter randomized controlled study was to evaluate the effectiveness of a newly developed ionic-sonic electric toothbrush in terms of plaque removal and reduction of gingival inflammation. A total of 78 subjects from three dental centers were invited to join the study. They were randomized to receive either a manual toothbrush (control group) or an ionic-sonic electric brush (test group). Full-mouth prophylaxis and oral hygiene instructions based on the stationary bristle technique were provided 1 week prior to the baseline visit. At baseline and at each follow-up appointment, Plaque Index (PI) and Gingival Index (GI) were recorded. In addition, probing depth (PD) and bleeding on probing were recorded at baseline and at the last appointment (week 5). At completion of the study, subjects in the test group were given a questionnaire regarding their satisfaction with the toothbrush. Sixty-four subjects completed the study (control: 28; test: 36). The mean age of the subjects was 36.90 ± 12.19 years. No significant difference between the baseline and 5-week PD was found. Plaque removal efficacy and reduction in gingival inflammation were more significant for the test group at week 2. Both the control and test groups showed statistically significant improvement in PI and GI from baseline to week 5. The ionic-sonic toothbrush was more effective than manual toothbrush after a 1-week application.

This investigation was designed to evaluate the reestablishment of bone-toimplant contact on infected dental implant surfaces following decontamination with an erbium, chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser and reconstructive therapy. Three patients presenting with at least one failing implant each were enrolled and consented to treatment with the Er,Cr:YSGG laser surface decontamination and reconstruction with a bone replacement allograft and a collagen membrane. The laser treatment was carried out at a setting of 1.5 W, air/water of 40%/50%, and pulse rate of 30 Hz. At 6 months, all three patients returned for the study. En bloc biopsy samples of four implants were obtained and analyzed. Two patients had excellent clinical outcomes, while one patient with two adjacent failing implants experienced an early implant exposure during the follow-up period. There was histologic evidence of new bone formation with two implant specimens and less bone gain with the others. Despite the small sample size, these were optimistic findings that suggested a positive role of Er,Cr:YSGG laser in debridement of a titanium implant surface to facilitate subsequent regenerative treatment. This investigation provides histologic evidence as well as encouraging clinical results that use of the Er,Cr:YSGG laser can be beneficial for treatment of peri-implantitis, but further long-term clinical studies are needed to investigate the treatment outcome obtained.

The objective of this proof-of-principle multicenter case series was to examine the bone regenerative potential of a newly introduced equine-derived bone mineral matrix (Equimatrix) to provide human sinus augmentation for the purpose of implant placement in the posterior maxilla. There were 10 patients requiring 12 maxillary sinus augmentations enrolled in this study. Histologic results at 6 months demonstrated abundant amounts of vital new bone in intimate contact with residual graft particles. Active bridging between residual graft particles with newly regenerated bone was routinely observed in intact core specimens. A mean value of 23.4% vital bone formation was observed at 6 months. This compared favorably with previous results using xenografts to produce bone in the maxillary sinus for the purpose of dental implant placement. Both the qualitative and quantitative results of this case series suggest comparable bone regenerative results at 6 months to bovine-derived xenografts.

Soft tissue augmentation around dental implants in the esthetic region remains a challenging and unpredictable procedure. The ideal surgical technique would include of an off-the-shelf product to minimize morbidity after autogenous grafting procedures. The aim of this study was to use a resorbable collagen matrix (Mucograft) to serve as a scaffold to recombinant human platelet-derived growth factor BB (rhPDGF-BB) to increase peri-implant soft tissue volume in anterior maxillary sites. A total of six patients who had previously undergone a bone regeneration procedure were included in this study. The collagen matrix was applied during stage-two surgery (expanded polytetrafluoroethylene membrane removal and implant placement). Measurements were performed through customized stents by means of endodontic files, and at abutment connection, a soft tissue biopsy specimen was harvested for histologic examination. The healing period was uneventful in all six patients. Measurements were taken apically, centrally, and occlusally for each site. The mean gains in volume from baseline to the 4-month measurement at the apical, central, and occlusal aspects were 0.87 ± 2.13 mm, 2.14 ± 3.27 mm, and 0.35 ± 3.20 mm, respectively. The results showed a moderate increase in the soft tissue volume in esthetic peri-implant sites when applying a collagen matrix infused with rhPDGF-BB. However, the measuring techniques available need to be further improved to record exact changes in the soft tissue volume.

Autogenous soft tissue augmentation procedures around natural teeth and dental implants are performed daily by clinicians. However, patient morbidity is often associated with the second surgical site; hence, research is moving toward an era where matrices may substitute autogenous grafts. The aim of this study was to assess the soft tissue response to a collagen matrix in an animal model. Nine pigs were included in this study. Each animal received four collagen matrices, two for each mandible. Three cohorts were included in the study: group A, where the matrix was applied as an onlay on a partial-thickness flap; group B, where the matrix was inserted under a partial-thickness flap; and group C, where the matrix was inserted in an inverted position under a full-thickness flap. Sacrifice occurred at 7, 15, and 30 days postoperatively for histologic assessment. The collagen matrix was seen in place for the first 2 weeks, and it was completely replaced by healthy connective tissue within 30 days in the inlay cohorts. No inflammatory adverse reactions were noticed in any specimen, resulting in optimal integration of the device. This study showed an optimal integration within 30 days postoperative of the placement of experimental collagen matrix in the soft tissues of an animal model. Its proven safety in this model provides an optimal starting point for further research projects considering its clinical applications.

The objective of this study was to investigate the potential of xenograft (cancellous bovine bone) granules to form vital bone in non-natural boneforming areas of maxillary sinuses. Fourteen sinus augmentations were performed in 14 patients. Surgical outcomes were uneventful, and sufficient radiopaque volume was present radiographically to place dental implants in all sites. Clinical reentry at 6 months revealed bone formation at the osteotomy site. Histologic evaluation of the obtained bone cores revealed that xenograft granules were integrated and surrounded by woven bone and lamellar bone that were in close contact with the particles. The average percentage of newly formed bone at 6 months was 27.5% ± 8.9%. Vital bone formation using the xenograft granules was supported by both clinical and histologic evidence.

The goal of classifying complications in guided bone regeneration procedures with nonresorbable membranes is to provide the clinician with an instrument for easier identification of both the problem and treatment modality. A standardized terminology represents a key point for proper communication among clinicians and provides guidelines for managing these drawbacks.

This preclinical study evaluated the efficacy of purified recombinant human platelet-derived growth factor (rhPDGF-BB), combined with a novel equine hydroxyapatite and collagen (eHAC) bone block, in providing vertical bone regeneration in critical-size defects simulating localized mandibular alveolar bone atrophy. In addition, the impact of barrier membrane placement in growth factor-mediated bone regeneration was also studied. Bilateral posterior mandibular defects simulating severe localized bony atrophy were created in 12 adult foxhounds following removal of all four mandibular premolars. Three months later, the defects were grafted as follows: group A: eHAC block alone; group B: eHAC block + collagen membrane; group C: eHAC block + rhPDGF-BB; group D: eHAC block + rhPDGF-BB + membrane. The animals were sacrificed after 5 months and the grafted areas were examined histologically, radiographically, and clinically. Groups A and B (controls) exhibited little to no vertical bone regeneration. Group C demonstrated significant vertical bone regeneration, with dense, well-vascularized bone, high bone-to-implant contact, and accelerated replacement of graft particles with newly formed bone. In group D, with the imposition of a barrier membrane, robust bone regeneration was less evident when compared to group C. As in the first study in this series, the importance of the periosteum as a source of osteoprogenitor cells in growth factor-mediated regenerative procedures is examined.

The present investigation was performed to compare the biocompatibility, safety, and manageability of a newly developed bone block and a deproteinized bovine bone block (Bio-Oss) for the treatment of localized bone defects in a dog model. Two male beagle dogs were used for this study. The mandibular premolars were extracted and two saddle-type defects were created bilaterally in the edentulous area. The defects were filled according to a randomized design with Bio-Oss bone block or with an equine hydroxyapatite plus collagen bone block (eHAC). Most control and test sites developed dehiscences during healing. After 4 weeks, the animals were euthanized and each hemimandible was prepared for histologic examination. No significant difference in terms of local tolerance was observed between test and control sites, and test and control sites showed similar histologic findings. However, a significant difference was noticed between the Bio-Oss block and the new bone block in terms of manageability.

Objectives: The aim of this cohort study was to evaluate the safety and the acceptability of an electric toothbrush used on the peri-implant mucosa of implants placed in the aesthetic area. Methods: One hundred consecutive patients rehabilitated with implants positioned in the maxillary aesthetic area were recruited. Implants had to be restored at least 6 months prior to baseline. At baseline, subjects were provided with Oral-B Professional Care 7000 and received appropriate instructions to brush twice a day over a 12-month period. Papillary bleeding index, recession and probing depth were measured at baseline and at 3, 6, and 12 months. Results: Ninety-eight (98) patients completed the study. There was an overall reduction of recession (mean 0.2 mm) of borderline statistical significance. All of the changes occurred at the first followup visit (P=0.09) and persisted thereafter. The statistical analyses regarding the probing depth found a highly significant decrease over time (mean 0.3 mm). The bleeding score showed a gradual decrease over time, with a reduction at 12 months by more than half (0.65) in comparison with the baseline (1.50) and was shown to be highly significant (Wilcoxon sign-rank test: P0.001). No patient showed adverse effects such as ulcerations or desquamation. A high score of satisfaction by the patients using the electric toothbrush was reported (94% would continue to use it). Conclusion: The electric toothbrush Oral B Professional Care 7000 appears to be safe for patients with fixed prosthesis on implants in aesthetic areas. Successive randomised clinical trials are needed to compare this instrument with other therapeutic devices for mechanical plaque control. Keywords: electric toothbrush, implant, maintenance, peri-implant mucosa, powered toothbrush