Romanos, Georgios E.

Vertical ridge augmentation has less long-term predictability than horizontal ridge augmentation due to common complications with vertical Guided Bone Regeneration (GBR), including early exposure of the barrier membrane and decreased bone stability. Objective: The purpose of this study was to evaluate the primary stability of short implants versus conventional implants, in vitro. Methods: Two groups of implants with reverse concave neck and neck micro threads (ULT, Ditron Dental, CA) were studied; short implants (Ø 6.0mm x 7mm) and conventional implant (Ø 3.75mm x 10mm). A total of 80 implants were placed by the same calibrated clinician at 800RPM, 40 short implants and 40 conventional implants. Each implant was placed in dense (type II) and soft (type IV) bone. Implant primary stability was recorded using insertion torque (IT), Resonance Frequency Analysis (RFA), and Periotest values. Statistical comparison with Analysis of Variance were completed to compare differences between groups. Results: The comparison of IT, RFA and Periotest of the two groups of implants showed statistical significance (P<0.0001) favoring the short implants (Ø 6.0mm x 7mm) in both the soft and dense bone qualities. Conclusion: Within the limitations of this study, short implants with wide diameter seem to have a higher level of implant stability compared to narrow implants with conventional length. Parole chiave: implant stability; reverse concave neck; short implants

Purpose: Short dental implants are usually placed to avoid vertical augmentations. However, surgical experience appears to be fundamental, especially in compromised bone qualities. This study aimed to evaluate the importance of clinical expertise on implant stability (IS) of 6mm implants placed in vitro. Materials and Methods: 480 implants (BioHorizons®-Tapered, 6mm with diameters 4.6mm and 5.8mm) were utilized. All implants were placed by three clinicians with different surgical experience levels. One master clinician (A); one third-year resident with experience near 100 implants (B); and one resident without implant surgical experience (C). Each surgeon prepared 40 osteotomies for each implant diameter in type I bone and 40 osteotomies in type IV-bone quality (Sawbones®), respectively. In each group, 20 implants were placed at crestal bone level, the other 20 implants 1mm supracrestal. The IS was evaluated using an Osstell®-device. Comparison of IS between the A, B, and C for all implant groups was performed using ANOVA and Bonferroni correction for multiple comparisons for significance level as p<0.05. Results: Implants placed supracrestally showed differences between the experienced clinicians vs. the inexperienced, but not between the master clinician and 3rd-year resident. A similar trend can be observed with implants placed at crestal levels. In type I-bone, greater stability was achieved for the experienced clinicians when compared to the inexperienced (p<0.0001); however, in type IV bone, the comparison of stability showed p <0.0001 for all groups, with greater IS values for master clinician over both residents. Conclusions: Overall, both master and moderate experienced surgeons presented increased stability on 6mm implants compared to the inexperienced resident. Parole chiave: implant stability, short implants, subcrestal implant placement

Objectives: This study investigated the remodeling process of hard tissue components in fresh extraction sockets that underwent natural healing, followed by localized alveolar split-crest surgery for implant placement. Methods: Subjects with bone defects in the aesthetic maxillary region, characterized by decreased mineral density around the affected tooth, were treated through socket healing without bone substitutes, delayed alveolar splitting, and subsequent implant placement. Preoperative (baseline, before the first and second surgeries) and postoperative cone-beam computerized tomographic (CBCT) scans were analyzed to assess changes in bone volume and crestal width. Statistical analysis was performed using non-parametric tests, with a significance level set at p < 0.01. Results: Thirteen incisors were retrospectively evaluated. No major postoperative adverse events were recorded. After two years, the implants achieved a 100% survival rate. No episodes of peri-implant mucositis or peri-implantitis were reported. Radiographs taken three months after tooth extraction revealed bone mineralization without the use of bone substitutes; however, the volume was insufficient for immediate implant placement. Following tooth extraction, the split procedure and implant placement (first and second surgeries), total bone volume showed a significant increase (p = 0.0105) from baseline (919 ± 179 mm3) to the 2-year follow-up (955 ± 176 mm3). Similarly, crestal width demonstrated a significant augmentation (p = 0.0012), increasing from 6.1 ± 2.7 mm at baseline to 7.5 ± 2.0 mm at 2 years, with a mean gain of +1.4 ± 1.0 mm due to the split-crest procedure. Conclusions: After two years, the results indicated that natural healing of the extraction socket, without the use of bone substitutes, followed by delayed localized alveolar splitting, led to a significant increase in bone volume and preservation of the outermost alveolar bone layer. The observed post-extraction site augmentation was concentrated in the frontal area. Parole chiave: Alveolar ridge split technique; alveolar remodeling; delayed implant; imaging superimposition; computerized tomography

The release of titanium nanoparticles during implant placement in dense bone is a significant concern, as it can potentially have adverse effects on the peri-implant tissues and an impact on the etiology of peri-implant diseases. The objective of this study was to examine the presence of titanium nanoparticles at the bone-implant interface during implant placement utilizing the bone condensation technique in vitro. Artificial Type IV bone slices (4mm thick) were securely held in place with a vice. Two groups of implants were placed. One group (test group) was placed under the condensation technique using cylindrical osteotomes. The other group (control group) was placed following the traditional surgical protocol. Implants were placed in parallel between bone slices held in a vice. Three groups of implant designs (6 implants in each group) were inserted into the bone. Two implant designs consisted of implants made of pure titanium (grade 4), while the third implant design group was constructed of titanium alloy (Ti6Al4V). Subsequently, the blocks were separated, and the peri-implant bone interface was qualitatively evaluated for titanium presence using X-ray-fluorescence spectrometry (XFS) at the coronal, middle, and apical thirds of osteotomies (n=12/ implant system). Descriptive statistical analysis showing the mean values (+/-SD) of titanium nanoparticles was performed. No detectable titanium levels were identified in the control group of titanium alloy-implants compared to pure titanium-implants. In contrast, the test group of all implant systems showed presence of titanium nanoparticles in coronal, middle, and apical thirds. Our results indicate that bone condensation technique is associated with titanium release during implant placement in vitro. These findings were shown for both pure titanium- and titanium alloy-dental implants. Parole chiave: condensation, interface, primary stability, titanium nanoparticles

Purpose: To investigate whether the wettability of two zirconia (Zr) implant disk surfaces is affected by glycine and erythritol air polishing using the following wetting solutions as test mediums: saline, bovine serum albumin (BSA), bovine thrombin, and bovine artificial blood. Materials and Methods: The two types of Zr disks used were SDS (Swiss Dental Solutions; n = 6) and Patent (Zircon Medical AG; n = 6). Surface parameters (Sa, Sz, Sdr, Ssk, Sku, and Spd) were measured to determine their initial surface roughness. Air polishing was completed using glycine or erythritol powders using the AIRFLOW PERIO device (EMS Dental). The wettability of the disk surfaces was evaluated by the contact angle analysis applied to the treated and untreated disks using four wetting solutions, including saline, BSA, bovine thrombin, and bovine artificial blood. In total, 720 contact angle measurements were completed with n = 30 per group. Statistical analysis was performed using one-way ANOVA and the post-hoc Tukey HSD test. Results: The results indicate that SDS has a greater wettability than Patent before and after air polishing. The wettability of surfaces treated with glycine was hydrophobic in some cases. Erythritol increased the surface wettability of Zr disks more than glycine. BSA and bovine artificial blood had lower contact angles than saline and bovine thrombin for both types of untreated disks. Conclusions: The initial wettability of Zr disks differs between manufacturers, and air polishing with erythritol powder increases the wettability of Zr implant disks for saline, bovine serum, bovine thrombin, and bovine artificial blood. Parole chiave: contact angle, erythritol, glycine, wettability, zirconia

This paper is based on lean principles and how they can apply to dental offices for general dental practitioners and specialists. In addition, this paper highlights how to identify and eliminate waste. This information provides value to the process in a dental office, establishing a platform and roadmap for lean thinking and how these principles can be utilized further in health care for reliable, efficient, and sustainable clinical outcomes. Parole chiave: kaizen, lean, practice management

Summary: Most available antiseptic solutions have strong antibacterial effects, but many also possess major cytotoxic effects on gingival fibroblasts, osteoblasts, osteoprogenitor cells, and/or epithelial cells. A novel VEGA Oral Care Recovery Kit (StellaLife) consisting of 16 active ingredients that are monographed in the Homeopathic Pharmacopeia of the United States (HPUS) has gained tremendous momentum as a replacement for more cytotoxic oral rinses such as chlorhexidine. While accumulating evidence has thus far supported its use, little of the gathered data have fully described the properties of the oral formulation. Therefore, the aim of the present review article was 3-fold. First, a biological characterization regarding the active ingredients found in StellaLife Recovery Kit including their biological properties was assessed in 4 predominant categories; 1) antimicrobial resistance, 2) accelerated wound healing, 3) pain management control, and 4) anti-cancer properties. The second aim of this review article was to assess both fundamental and clinical research to date comparing VEGA oral rinse (StellaLife) to the more commonly utilized CHX for differences regarding their effect on decreasing bacterial loads as well as cell viability, survival, proliferation, and expression of both regenerative cytokines and inflammatory markers. Lastly, clinical case examples are presented describing the use of StellaLife remedies in a variety of clinical situations. These include but are not limited to wisdom-tooth extraction, extraction site management, dental implants and ridge augmentation, soft-tissue grafting procedures, frenectomies, and also temporary relief of dry sockets, dry mouth, aphthous ulcers, mucositis, lichen planus, among others. In summary, findings from the present review article provide evidence from basic laboratory experiments that validate clinical studies supporting the use of the StellaLife oral rinse regarding its superior biocompatibility and wound healing properties when compared to common antiseptic solutions such as CHX. Parole chiave: antiseptic solution, cell viability, chlorhexidine, oral rinses, periodontal disease, StellaLife, wound healing

Objective: The present systematic review aimed to assess the efficacy of photobiomodulation (PBM) therapy on neurosensory recovery of patients with inferior alveolar nerve injury following third molar surgery or dental implant placement. Method and materials: An electronic search was carried out in Scopus, Embase, Medline, PubMed, Web of Science, Cochrane Library, and Google Scholar databases. Among 1,122 identified papers, seven articles (three RCTs, one observational study, and three case series) met the inclusion criteria. Results: Time lapse from nerve injury to the onset of PBM therapy varied widely from 2 days to 4 years. The number of patients in each study ranged between 4 and 74. In the majority of the studies, PBM was done using a diode laser at wavelengths ?in the range of 808 to 830 nm with power of 5 to 500 mW and radiation dose of 3 to 244 J/cm2. Two out of three RCTs found significant neurosensory recovery in the patients who received PBM therapy compared to the controls. The observational study and all case series reported significant improvement in the neurosensory status following PBM therapy. The degree of neurosensory recovery was found to be greater in younger patients and those who received the treatment within 6 months following the injury. Conclusions: Due to the limited number of well-designed RCTs and small number of patients in each study, it is not possible to make a clear conclusion about the efficacy of PBM therapy on neurosensory recovery in patients with inferior alveolar nerve injury following third molar or implant procedures. Considering the possibility of spontaneous inferior alveolar nerve recovery during this period, the conclusion based on the studies with no control group should be interpreted with caution. (Quintessence Int 2021;52:140–153; doi: 10.3290/j.qi.a45430) Parole chiave: dental implants, inferior alveolar nerve, low-level light therapy, nerve regeneration, oral surgical procedures, photobiomodulation therapy

Bone regeneration and remodeling are crucial to healing after surgical interventions. Local and systemic factors impact healing. Some well-known medications actively alter bone remodeling. The objective of this report was to increase awareness of less commonly recognized medications that may delay the integration of bone grafts. This case report presents the delayed integration of a bone graft after tooth removal, socket preservation, and ridge augmentation procedures in a patient taking various medications that may have affected bone remodeling. The literature review enables the discussion of evidence regarding delayed bone remodeling associated with selective serotonin reuptake inhibitors (SSRIs), sodium-glucose cotransporter 2 (SGLT2) inhibitors, metformin, and nonsteroidal anti-inflammatory drugs (NSAIDs), and the clinical implications for patients taking these medications. Parole chiave: bone grafting, bone remodeling, delayed osseointegration, dental implant, medication

Die Sofortbelastung von dentalen enossalen Implantaten entwickelte sich innerhalb der letzten 30 Jahre kontinuierlich weiter. Verschiedene Sofortbelastungskonzepte, welche zur Versorgung teilbezahnter sowie zahnloser Patienten sowohl festsitzend als auch herausnehmbar gestaltet wurden, zeigten sich statistisch erwiesen als überzeugende Versorgungsalternative. Eine prothetische Versorgung jenseits von individuell gefertigten Suprakonstruktionen, wie dem Steg, stellt die Versorgung mittels präfabrizierter teleskopierender Pfosten dar. In der vorliegenden Arbeit wird anhand von zwei retrospektiven Studien dieses Sofortbelastungskonzept für den zahnlosen Unterkiefer präsentiert. Die Auswertung mit der Bestimmung der Erfolgsrate nach den Albrektsson-Kriterien ergab bei Spätimplantation einen Wert von 95,16 % und bei Sofortimplantation und Belastung von 89,86 %. Nach Analyse der gesammelten Daten und der Diskussion ermittelter Werte mit bisher in der Literatur beschriebenen Sofortbelastungsstudien kann ein positives Fazit für das untersuchte Konzept erstellt werden. Vorteile sind die Konusverbindung, die Funktion der Prothese als Wundverband, eine Reduktion der Prothesenbasis, die unmittelbare Wiederherstellung von Kaufunktion sowie Ästhetik, der verkürzte Behandlungszeitraum, die optimale Hygienefähigkeit und Wirtschaftlichkeit sowie der hohe Patientenkomfort gerade bei älteren Patienten. Zusammenfassend lässt sich konstatieren, dass die Sofortbelastung dentaler enossaler Implantate mit präfabrizierten teleskopierenden Pfosten als ein erfolgreiches Behandlungskonzept mit hohen Erfolgsraten für den zahnlosen Unterkiefer angesehen werden kann. Manuskripteingang: 25.10.2020, Annahme: 16.12.2020 Parole chiave: Sofortbelastung, Unterkiefer, zahnlos