Search Results (79)

Background/Objective: To outline strategies for the safe clinical use of orthodontic temporary anchorage devices (TADs) by analyzing papers that examine associated risks, complications, and approaches for their prevention and resolution. Methods: The research protocol used PubMed, Medline, and Scopus up to May 2024, focusing on controlled and randomized clinical trials aligned with the review objective. Fourteen studies were included; bias risk was assessed, key data extracted, and a descriptive analysis performed. Study quality and evidence strength were also evaluated. Results: TADs optimize anchorage control without relying on patient compliance. However, they carry risks and complications. TAD contact with the periodontal ligament or root without pulp involvement requires removal for spontaneous healing. If pulp is involved, the TAD should be removed and endodontic therapy performed. If anatomical structures are violated, TAD should be removed. If transient, spontaneous recovery occurs, but sometimes pharmacological treatment may be needed. A 2 mm gap between the TAD and surrounding structures can prevent damage. In the maxillary sinus, a less than 2 mm perforation of the Schneiderian membrane recovers spontaneously; wider perforations require TAD removal. Good oral hygiene and TAD abutments prevent soft tissue inflammation, which resolves with 0.2% chlorhexidine for 14 days. Unwanted forces can cause TAD fractures, requiring removal. Minor TAD mobility due to loss of primary stability can be maintained; significant instability requires repositioning. Conclusions: The use of TADs requires meticulous planning, radiological guidance, and monitoring to minimize risks and manage complications. With proper care, TADs improve orthodontic outcomes and patient satisfaction. Full article

Introduction: This study highlights the importance of maintaining dental implants, particularly in the context of peri-implantitis. It emphasizes the need for dental hygienists to choose appropriate instruments that will not damage implant surfaces while effectively cleaning them. Materials and Methods: The research involved in vitro tests using 4 ultrasonic inserts for peri-implant mechanical instrumentation on one machined and one etched healing abutment, with a focus on how these instruments affect surface roughness. For each insert, four surface roughness measurements were recorded on each abutment. The data were then analyzed in two separate designs, one for the machined abutments and one for the etched abutments. The significance of the factors was determined by analyzing them using an ANOVA test. Results: The study found significant effects of surface treatment and instrument type on surface roughness parameters. Instrumentation tended to alter the roughness of machined surfaces more than etched ones, with notable differences in performance among the various inserts. Discussion: The results suggest that surface treatment has a more substantial impact on roughness than the choice of instrument. Future studies are encouraged to explore other parameters related to bacterial biofilm retention and the potential release of material from non-metallic inserts. Conclusions: Key findings include that surface treatment significantly influences surface roughness and that specific instruments can either increase or decrease roughness based on the type of surface. Full article

Background/Objectives: Immediate implant placement in the esthetic zone can shorten treatment time but maintaining peri-implant soft tissue stability is challenging. Conventional multi-stage workflows require multiple visits and may disturb peri-implant tissues. Placing a definitive one-time abutment at surgery can preserve soft tissue contours by avoiding multiple abutment changes. This case report introduces a digital one-stage approach delivering a definitive zirconia crown with delayed occlusal veneering at surgery to streamline treatment and preserve tissue stability. Methods: A 60-year-old male with a failing maxillary canine underwent immediate implant placement using guided surgery. A customized healing abutment preserved the emergence profile for the definitive restoration. A zirconia crown with an occlusal cut-back was fabricated and delivered at surgery on the one-time abutment without occlusal contact. After 12 weeks, a ceramic overlay was bonded extraorally to the crown to restore the occlusal surface. Results: At 2-year follow-up, the implant exhibited stable bone and healthy peri-implant soft tissues, with no complications. The one-time approach preserved tissue contours by eliminating provisional stages, and delayed occlusal veneering provided excellent esthetic integration. The patient was satisfied with the immediate result and fewer visits. This one-stage approach required fewer interventions than conventional provisional workflows. Conclusions: Immediate implant placement with a one-time abutment and delayed occlusal loading preserved peri-implant tissue architecture and achieved excellent functional and esthetic outcomes at 2 years. This one-stage workflow is a tissue-preserving alternative to multi-stage protocols; further studies are needed to confirm its long-term efficacy. Full article

Background: Single implants yield predictable survival and success using various treatment protocols. Innovations in design and surface texture improved survival and ensured crestal bone stability, crucial to avoiding biological complications. This study focuses on survival and peri-implant crestal bone remodeling during healing and function of single hybrid-surface implants (Machine Surface Coronal, MSc, Southern Implants Pty Ltd., Irene, South Africa), featuring a minimally rough coronal region and moderately rough body. The specific aims were firstly to compare the clinical outcome between 3 surgical protocols and secondly to assess whether the outcome is affected by macroscopic implant design. Methods: Clinical records of 120 consecutively placed single MSc-implants in private practice were scrutinized after 12–62 months in function. Implants were placed using one of three surgical protocols as selected by the surgeon based on clinical judgment and treatment indication: flap-healed surgery with healing abutment (HA), flapless surgery with HA, or immediate implant placement (IIP) with HA. Six different implant types, albeit with the same MSc-surface feature, were utilized, based on individual clinical indications. Radiographical crestal bone level changes over time were analyzed and effect of implant design, gender, smoking status and surgical protocol was explored. Results: 101 implants was available for analysis. Six implants failed prior to loading (5%); 30% in smokers versus 3.3% in non-smokers. Initial bone remodeling, due to biologic width formation, was 0.762 mm (SD 0.940) at time of loading and 0.933 mm (SD 1.057) after 2 years (p = 0.07). Steady state bone levels at final recall (12–62 months; mean 24) were irrespective of implant type (p = 0.51), surgical protocol (p = 0.10), gender (p = 0.557) or smoking habit (p = 0.27). 54% of the implants showed bone gain between loading and final, whereas only 3% had bone loss above 3 mm. Conclusions: Under daily clinical conditions, MSc-hybrid implants yield predictable clinical outcomes in line with contemporary implant systems, irrespective of implant length and diameter. A 5.9% early failure rate was found irrespective of smoking status, with no late failures. Failure rate dropped to 3.3% when smokers were excluded. Crestal bone remodeling at the time of loading, mimicking biologic width formation, as well as bone level changes over time, is indicative of a healthy peri-implant steady state irrespective of the surgical protocol. Full article

Background: Dental implants are widely used to replace missing teeth, particularly in aesthetically sensitive areas. The implant’s macrogeometry is crucial for ensuring primary stability and successful osseointegration. Internal conical connections and reactive surfaces on implants have shown positive outcomes in tissue and bone stability. In response, a hybrid conical dental implant was designed to address a variety of clinical scenarios. Materials and Methods: This pilot study evaluated the performance of the hybrid conical implant using histological and micro-CT analysis in a preclinical model with immediate loading. Five implants were placed in a mongrel dog, and histomorphometric and micro-CT assessments were performed after 60 days of healing. Results: Analysis showed a high degree of osseointegration, with BIC at 61.56% and BT/TV at 77%. Micro-CT confirmed these findings, with nBIC at 82.20%. Vertical measurements indicated stable crestal bone. Peri-implant tissue displayed organized supracrestal connective tissue, without signs of inflammation or bone saucerization. Polarized light microscopy revealed collagen fibers in perpendicular and oblique orientations around the abutment, suggesting mechanical integration and biological sealing despite the absence of a prosthetic crown. Conclusions: Within the limitations of this exploratory study with one animal study, the hybrid conical implant showed favorable biological and structural responses under immediate loading. These preliminary findings provide useful insights for the refinement of implant design, although further investigations in larger preclinical and clinical studies are required before clinical applicability can be confirmed. Full article

Background: The implant–abutment interface has been thoroughly examined due to its impact on the success of implant healing and longevity. Removing the abutment is advantageous, but it changes the biomechanics of the implant fixture and restoration. This in vitro three-dimensional finite element analytical (FEA) study aims to evaluate the distribution of von Mises stress (VMS) in abutment-free and three additional implant abutment connections composed of various titanium alloys. Materials and methods: A three-dimensional implant-supported single-crown prosthesis model was digitally generated on the mandibular section using a combination of microcomputed tomography imaging (microCT), a computer-assisted designing (CAD) program (SolidWorks), Analysis of Systems (ANSYS), and a 3D digital scan (Visual Computing Lab). Four digital models [A (BioHorizons), B (Straumann AG), C abutment-free (Matrix), and D (TRI)] representing three different functional biomaterials [wrought Ti-6Al-4Va ELI, Roxolid (85% Ti, 15% Zr), and Ti-6Al-4V ELI] were subjected to simulated static/cyclic static loading in axial/oblique directions after being restored with highly translucent monolithic zirconia restoration. The stresses generated on the implant fixture, abutment, crown, screw, cortical, and cancellous bones were measured. Results: The highest VMSs were generated by the abutment-free (Model C, Matrix) implant system on the implant fixture [static (32.36 Mpa), cyclic static (83.34 Mpa)], screw [static (16.85 Mpa), cyclic static (30.33 Mpa), oblique (57.46 Mpa)], and cortical bone [static (26.55), cyclic static (108.99 Mpa), oblique (47.8 Mpa)]. The lowest VMSs in the implant fixture, abutment, screw, and crown were associated with the binary alloy Roxolid [83–87% Ti and 13–17% Zr]. Conclusions: Abutment-free implant systems generate twice the stress on cortical bone than other abutment implant systems while producing the highest stresses on the fixture and screw, therefore demanding further clinical investigations. Roxolid, a binary alloy of titanium and zirconia, showed the least overall stresses in different loadings and directions. Full article

Background/Objectives: The aim of the study was to investigate the risk factors related to early implant failures in patients treated in a private implant clinic. Methods: The study was retrospectively conducted on 392 patients (mean age = 51.2 ± 15.4 years, 48.9% female and 51.1% male) who received 930 dental implants within the period from 2000 to 2020. Included patients had received at least one implant. Patients were excluded in case of incomplete dental records that did not contain the necessary information, including personal information (patient’s name, age, gender, history and current condition of systemic diseases) and treatment protocol record. No patients were excluded on the basis of systemic disease if it did not contraindicate dental implant surgery. Patient-related variables (age, gender, smoking, history of periodontitis, accompanying disease), surgical-related variables (surgical technique, bone augmentation, lateral sinus lift, internal sinus lift, immediate implant placement after tooth extraction, immediate mucosal grafting, insertion torque,) and implant-related variables (implant design, implant level, implant surface, site of implant placement, implants diameter, length and implants brand name) were recorded. Results: GEE analysis results showed that the implant-based failure rate before or at the abutment connection stage was 5.8%. Seven factors were identified associated with early implant failures: male gender, smoking, history of radiotherapy and chemotherapy, maxilla implant placement, non-submerged healing method, implant design and implant brand. Conclusions: In light of the results obtained, both patient-related variables (gender, smoking, history of radiotherapy and chemotherapy) and variables related to the type of implant, its position and the surgical technique used (maxilla implant placement, non-submerged healing method, implant design and implant brands) were found to be statistically correlated with early failures in this study. Full article

Objectives: The presence of gingival buccal recession is a frequent problem especially in the canine area. The cortical buccal bone may be absent in presence of health normal lingual/palatal bone and of other periodontal pockets. The present case report describes a minimally invasive approach in a 76-year-old patient with previously endodontically treated lower canine affected by root fracture and by a serious chronic buccal recession. Methods: The tooth was characterized by a deep vestibular bone defect, lack of buccal bone and acute periapical lesion. After extraction, Maryland bridge was positioned on the edentulous area. A two-piece convergent neck transmucosal implant was inserted with a flapless approach after 6 months. Maryland bridge was left in place for additional 3 months. After this time, digital impressions were taken, and a customized abutment was positioned. A provisional crown was designed according to Biologically Oriented Preparation Technique (BOPT) concept and maintained for 6 months. A zirconia definitive crown was digitally designed and cemented with a polycarboxylate-based cement. The Pink Esthetic Score (PES) was used as an index to assess peri-implant soft tissue stability over time (preoperatively, at 9 months, at 12 months and 72 months). Results: The patient was followed for 6 years under a conventional hygienic recall program. No complications occurred, and the PES improved from 4 preoperatively to 8 at 9 months, 10 at 12 months and 13 at 72 months. Conclusions: The use of Maryland bridge prevented occlusal trauma on healing tissues and appeared to support bone and soft tissue healing for transmucosal implant placement. A stable aesthetic rehabilitation was achieved up to 6 years. Full article

Background/Objectives: The aim of the present study is to evaluate the influence of the healing abutment height on secondary implant stability measured by resonance frequency analysis. In this prospective observational clinical study of 30 implants, the secondary stability of the implant was measured via resonance frequency analysis of the abutment during the osseointegration process. Methods: Two groups were compared: a <4 group (n = 15), with a space between the healing abutment and the antagonist of <4 mm, and a ≥4 group (n = 15), with a space of ≥4 mm. Results: Statistically significant differences (p < 0.05) in the implant stability values obtained at surgery (T0) and at the eighth week of osseointegration (T8) were observed between the two groups, with higher values for the <4 group. Pearson’s correlation analysis revealed a trend towards a significant relationship with the mean force (−0.6546) and a linear inverse relationship, so that by decreasing the distance between the abutment and the contact with the antagonist, the secondary implant stability values increased. A comparison of the mesial and distal peri-implant marginal bone levels at T0 and T8 did not reveal statistically significant differences (p > 0.05). A greater healing abutment height, placing it closer to the antagonist, increases and accelerates secondary stability, as measured by resonance frequency analysis. Conclusions: The results of the study support the recommendation of using high healing abutments, placing the abutment close to the opposing occlusal plane, according to biomechanical criteria. Full article

Objectives: This study aimed to evaluate the effects of different titanium (Ti) anodized surfaces on soft tissue healing around dental implant abutments. Methods: Discs of machined (MC), pink anodized (PA) and yellow anodized (YA) surfaces were morphologically characterized and evaluated in vitro. Cell adhesion and collagen synthesis by human gingival fibroblasts (hGFs) were assessed to evaluate the regenerative potential of the surfaces under study. Their inflammatory potential was evaluated in THP-1 cell cultures by measuring cytokine secretion, and their proteomic adsorption patterns were characterized using nano-liquid chromatography mass spectrometry (nLC-MS/MS). Statistical significance was considered at 5%. In relation to proteomics, statistical differences were evaluated using the Student t-test with the Perseus application. Results: The anodization process resulted in a reduction in the surface roughness parameter (Ra) relative to the machined titanium (p < 0.05). No differences in hGF adhesion were found between the surfaces after one day. PA induced increased hGF collagen synthesis after 7 days (p < 0.05). The secretion of TNF-α was lower for anodized surfaces than for MC, and its concentration was lower for PA than for YA (p < 0.05). In turn, TGF-β was higher for PA and YA versus MC after one and three days of culture. A total of 176 distinct proteins were identified and 26 showed differences in adhesion between the anodized surfaces and MC. These differential proteins were related to coagulation, lipid metabolism, transport activity, plasminogen activation and a reduction in the immune response. Conclusions: Anodized Ti surfaces showed promising anti-inflammatory and regenerative potential for use in dental implant abutments. Anodization reduced surface roughness, increased collagen synthesis and lowered TNF-α secretion while increasing TGF-β levels compared to machined surfaces. Identified proteins related to coagulation and lipid metabolism supported these findings. Clinical relevance: Anodized surfaces could offer improved short-term peri-implant soft tissue healing over machined surfaces. The analysis of abutment surface, instead of implant surface, is a new approach that can provide valuable information. Full article

Background/Objectives: The essential trace element zinc (Zn) has a pivotal role in wound healing and can show antibacterial activity, but its application in oral implant materials is underexplored. Customized healing abutments can modulate the peri-implant tissue health when appropriate bioactive materials promoting mucosal healing are used. The present study investigated a novel Zn-containing polymer for its potential in soft-tissue engineering applications. Methods: Four traditional materials—titanium, glass ionomer, a composite, and the novel Zn-containing polymer—were tested in vitro for bacterial growth using a multispecies oral bacterial model compared to hydroxyapatite. The biocompatibility of the materials was also evaluated by evaluating the adhesion, proliferation, and cytotoxicity of human oral keratinocytes (HOK-18A) onto these materials, compared to tissue culture plastic. Results: The Zn-containing polymer exhibited a significantly lower biofilm formation compared to conventional materials as it was composed of less pathogenic bacteria. The Zn-containing material also demonstrated a superior biocompatibility towards HOK-18A, approximating the adhesion and proliferation of the keratinocytes to optimal tissue culture conditions. Moreover, these properties did not seem to degrade and were maintained over a period of 31 days. The cytotoxicity assessment revealed no significant reduction in metabolic activity for any material. Conclusions: This study highlights the potential of the novel Zn-containing polymer in soft-tissue engineering, owing to its antimicrobial and biocompatible assets. These properties, combined with the ease of chairside modeling, position the material as a promising alternative for creating customized healing abutments. Further research is needed to explore its mechanism of wound healing modulation and its clinical performance. Full article

Objectives: This study aimed to histologically evaluate, in humans, the orientation of collagen fibers around screw-less, Morse taper, hemispherical base abutments. Methods: This study was designed as an observational, case–control, clinical trial to evaluate the histological orientation of collagen fibers around implants. Biopsies of the peri-implant tissue were performed 8 (group A, control) or 16 (group B, test) weeks of implant uncovering, and histologically analyzed under optical microscope using Hematoxylin and Eosin, Masson, and Picro Sirius histochemical staining and a scanning electron microscope. Results: Eight patients were enrolled in this study and 16 biopsies were performed. All the biopsies were correctly analyzed. The histological examination of cross-sectional portions of the tissue taken 8 weeks after implant uncovering showed the almost complete absence of epithelial lining, while the connective tissue bundles in the superficial portion showed a lower circular pattern. The histochemical cross-section examination of the tissue taken 16 weeks after implant uncovering showed the partial presence of non-keratinizing epithelial lining at the implant site and the collagen bundles showed a greater organization, with a circumferential course around the abutment. At 8 weeks, the final histological analysis showed an average height of 1.01 mm for the keratinized epithelium, 0.83 mm for the non-keratinized epithelium, and 1.39 mm for the connective tissue. While, at 16 weeks, the values were 1.20 mm, 0.48 mm, and 1.11 mm, respectively. No statistically significant differences were found between the groups (p > 0.05). Conclusions: Histologically, there were not any differences in the height and profile of the gingiva between 8 and 16 weeks of healing after prosthesis delivery. Greater organization of the collagen fibers with a circumferential course around the abutment was found in the test group (16 weeks) compared with the control group (8 weeks). Full article

Background: Mandibular reconstruction poses challenges in achieving functional and aesthetic outcomes. Effective oral rehabilitation is crucial for restoring function and improving quality of life; however, the altered neomandibular anatomy complicates oral hygiene, increasing the risk of peri-implant complications and making successful rehabilitation more difficult. This study introduces a novel approach combining vestibuloplasty with patient-specific implant-retained splints to enhance oral health and improve rehabilitation outcomes. Methods: Three patients underwent mandibular reconstruction with a free vascularized fibula flap (FFF). After 6 months of osseointegration, vestibuloplasty and soft tissue refinement were performed, with a split-thickness skin graft placed on the FFF periosteum. An implant-retained splint was secured to the abutments for two weeks to support soft tissue healing. Implant survival, bone loss, and peri-implant health were evaluated over a 2-year follow-up. Results: A total of 12 implants were placed, primarily in the neomandible (83.3%), with a 100% survival rate. Implant survival was assessed. Implant survival was assessed based on established criteria for clinical success, including stability, presence of pain, bleeding on probing (BOP), pocketdepth, bone loss and lack of peri-implant radiolucency. Functional outcomes included normal mouth opening, laterotrusion, and protrusion. Pocket depths ranged from 3 to 4 mm, except for one implant in cases 1 and 2. The mean BOP was 51.7%. Conclusions: This case series introduces a surgical technique that combines CAD/CAM and vestibuloplasty to optimize dental rehabilitation in mandibular FFF reconstructions, demonstrating safe thinning of soft tissues for improved oral hygiene and survival. Full article

Introduction: This preliminary in vitro study aims to evaluate the application of micro-CT in analyzing the microstructural coupling between dental implant fixtures and prosthetic abutments, with an emphasis on understanding the effectiveness and limitations of this technique in dental implantology. Materials and Methods: A search of PubMed, MEDLINE, and the Cochrane Library up to May 2024 identified eight relevant studies that examined different facets of dental implantology, such as osseointegration, implant stability, and the comparative accuracy of micro-CT versus other imaging techniques. A comparative micro-CT radiographic analysis was performed on five different implant fixtures with respective prosthetic and healing abutments, by using SkyScan1174 micro-CT. Results: The reviewed studies demonstrated that micro-CT is reliable for assessing bone quality, implant stability, and the microstructural integrity of dental implants. Micro-computed tomography (micro-CT) studies reveal bone–implant contact (BIC) ratios of 40–80%, bone volume per total volume (BV/TV) values of 20–60%, and detect microgaps as small as 0.3 µm, highlighting its high-resolution capability (5–10 µm) for detailed implant analysis. The comparative analysis of the implant fixtures analyzed the implant–abutment connection, highlighting the relevance of implant design for ensuring stability. Conclusions: Micro-CT analysis has proven to be a valuable tool for evaluating the intricate microstructural properties of dental implants, offering insights into implant stability, bone quality, and osseointegration. The literature reviewed highlights consistent findings that underscore micro-CT’s accuracy and reliability in capturing high-resolution data, suggesting its potential as a standard imaging modality in implant research and clinical assessment. Full article

Titanium (Ti) is considered the gold standard material for provisional implant restorations. Polyetheretherketone (PEEK), a polymeric thermoplastic material, has been progressively used in prosthetic, restorative, and implant dentistry. Recently, PEEK has been used in implant dentistry as a provisional implant restoration. Plaque accumulation and biofilm formation become the major concerns when infection and inflammation occur in the peri-implant tissue. Few reports were studied regarding the biofilm formation on the PEEK surface. This study aimed to compare plaque accumulation between the PEEK and Ti healing abutments. In an in vitro setting, the Ti healing abutment and PEEK healing abutment were subjected to biofilm formation; the result was collected after 24 h, 48 h, 72 h, and 7 days. Biofilms were studied following staining with crystal violet. The data were analyzed by Two-Way ANOVA. It was found that between Ti healing abutment and PEEK healing abutment materials, the biofilm formation on the PEEK surface is slightly higher than Ti, but no statistical difference (p > 0.05) was found. The results suggested that plaque accumulation between the Ti healing abutment and the PEEK healing abutment was not different. We concluded that the plaque accumulation on the surface PEEK healing abutment was similar to the conventional Ti healing abutment materials. Hence, both the PEEK and Ti healing abutments can be used as a healing abutment biomaterial according to the requirements of the prostheses in implant dentistry. Full article