Search Results (180)

Objectives: This study aims to evaluate the efficacy of hydroxyapatite-tricalcium phosphate (HAP-TCP) as a bone substitute in subantral augmentation for dental implants. Specifically, it investigates the effects of HAP-TCP on bone quality, density, and integration with implants over time. Methods: A prospective controlled longitudinal study was conducted on 22 patients (39–75 years of age) undergoing subantral augmentation and dental implantation. A total of 52 sites of augmented bone and 67 sites of native bone were analyzed using computed tomography (CT) to assess bone density in Hounsfield Units (HU), insertion torque measurements, and the Misch classification for bone quality. Augmented and native bone measurements were compared within each patient. Results: The augmented bone exhibited an average density of 1132.6 ± 334.9 HU, which is significantly higher (45.9%) than the average density of native bone at 519.3 ± 395.0 HU. Insertion torque values in the HAP-TCP augmented sites averaged 35 N·cm, showing a 71.4% increase compared to adjacent native bone sites (25 N·cm). The study found notable improvements in bone homogeneity and vascularization within the augmented zones. Conclusion: HAP-TCP demonstrates significant potential as a reliable and effective synthetic bone substitute for subantral augmentation in dental implants. It yields higher radiodensity and insertion torque than adjacent native bone, while mitigating complications associated with autogenous grafts. These observational findings support the potential clinical use of HAP-TCP for sinus augmentation. Full article

Background and Objectives: Odontogenic sinusitis (ODS) is a particular type of sinus infection induced by dental infections or iatrogenic causes. Although not rare, it is often underrated and sometimes confused with other forms of chronic rhinosinusitis. The aim of this review was to summarize the main diagnostic aspects, microbiological profile, and current options in the therapeutic management of ODS. Materials and Methods: Recent studies and consensus statements from both dental and ENT fields were reviewed. The focus was on the ODS diagnostic criteria, the types and the timing of dental and endoscopic treatment approaches, and treatment combinations inducing the best outcomes in ODS. Results: ODS usually involves anaerobic bacteria such as Fusobacterium and Peptostreptococcus. Empirical antibiotics like amoxicillin or amoxicillin–clavulanate are most often used, but antibiotic therapy alone rarely cures the disease. Dental treatment is essential in ODS cases with oroantral fistulas, infected maxillary sinus bone grafts, or implants. However, in these clinical situations, concurrent one-stage dental and endoscopic sinus surgery (ESS) treatment seems to offer the highest success rate, close to 97%. Combined surgery significantly improved ODS treatment outcomes in terms of reduced reintervention rates and recurrence. There is still debate on how wide ESS should be in uncomplicated ODS, but many reports show that maxillary antrostomy alone can be sufficient. In apical periodontitis-related ODS, recurrence after primary ESS is uncommon in the short term. Conclusions: ODS management needs cooperation between ENT and dental specialists. Treating the dental underlying infection remains critical to prevent oral or systemic complications. Future research should better define diagnostic criteria, antibiotic use guidelines, and the best timing for combined surgery. New studies on microbiology, immunity, and artificial intelligence could help improve diagnosis and medical care of ODS patients. Full article

Background: Maxillary sinus floor augmentation is widely used to enable implant placement in the atrophic posterior maxilla, yet comparative data for porcine-derived xenografts remain limited. Objective: To evaluate long-term bone regeneration and implant outcomes following sinus augmentation using a collagenated porcine xenograft. Methods: This paper reports a retrospective case series of three partially edentulous patients (aged 46–56 years) who underwent lateral sinus augmentation with a small-particle collagenated porcine xenograft (THE Graft™, Purgo Biologics, Gyeonggi-do, Republic of Korea) and staged implant placement. In one case, a controlled perforation of the Schneiderian membrane was performed to access and remove a sinus mucocele, followed by repair using a resorbable collagen membrane. Core biopsies were harvested at implant placement for histology (hematoxylin-eosin, Masson–Goldner) and tartrate-resistant acid phosphatase (TRAP) staining. Clinical outcomes included surgical events, vertical bone gain, marginal bone levels, and implant survival at long-term follow-up. Results: Healing was uneventful in all cases. Mean vertical bone gain was 12.0 mm (baseline 1.33 mm to 13.33 mm final). At a mean 46.8-month follow-up (range 38.3–52.2 months), 100% of implants were functional without failure; marginal bone loss remained < 1 mm during the first year and was stable thereafter. Histology at 3.7, 4.7, and 7.5 months showed vascularized new trabecular bone intimately contacting residual xenograft particles (new bone 20–30%, residual biomaterial 30–40%, connective tissue 30–50%). TRAP-positive multinucleated giant cells at 7.5 months indicated ongoing biomaterial degradation without severe inflammatory reactions. Conclusions: Within the limits of a small case series, collagenated porcine xenograft supported predictable bone regeneration and stable long-term implant function after sinus floor elevation, with favorable histologic integration and gradual resorption. Full article

Background: Maxillary sinus floor augmentation (MSFA) is frequently required for implant placement in the atrophic posterior maxilla. However, limited bone quality and volume can compromise long-term success. Strontium ranelate (SrR), a dual-acting bone agent, stimulates osteoblasts while inhibiting osteoclasts, potentially improving bone density and osseointegration in grafted sites. Objective: This 10-year preliminary split-mouth study evaluated the long-term effects of SrR on bone density, volume, and implant success following MSFA. Methods: Six patients underwent bilateral MSFA using a lateral window approach. One side received systemic SrR (2 g/day for 6 months) after grafting, while the contralateral side served as a control. CBCT and DEXA analyses were performed to assess bone density and volume. Bone biopsies were examined histologically and by microindentation. Data were analyzed using paired t-tests or Wilcoxon signed-rank tests, depending on distribution, with significance at p < 0.05. Results: After 10 years, SrR-treated sites demonstrated a mean 22.9% increase in bone density versus 12.5% in untreated controls. Although both groups experienced minor reductions in bone volume (SrR: −13.3%; control: −12.8%), SrR samples exhibited greater mineralization, hardness, and lamellar bone maturity. Conclusions: SrR improved bone density and mechanical properties but not long-term volume preservation. Given the small sample size (n = 6) and absence of implant stability and patient-reported outcomes, these results should be interpreted with caution. Future large-scale clinical trials incorporating survival, ISQ, and quality-of-life data are warranted. Full article

Background: To compare the histological and histomorphometrical outcomes after sinus floor elevation using an anorganic bovine bone biomaterial or a biphasic calcium phosphate biomaterial. Material and Methods: Patients who needed maxillary sinus elevation were included in this study. A total of 68 implant sites were evaluated from a total of 42 patients. Twenty patients were treated with anorganic bovine bone, while 22 were treated with biphasic calcium phosphate biomaterial. Morphological and morphometrical studies were performed on the bone samples collected during implant placement. Results: Both biomaterials induced similar relative areas of mineralized tissue overall, particularly if only the area of grafted bone was considered. In turn, a higher proportion of non-mineralized tissue was observed in cases of biphasic calcium phosphate biomaterial with less area of remnant biomaterial particles. None of the implants failed at one year of follow-up. Conclusions: Although both biomaterials induce a similar amount of bone formation, the histopathological characteristics of the grafts are different, with a greater proportion of scar connective tissue with the biphasic calcium phosphate biomaterial. Full article

Platelet-rich plasma (PRP) is an autologous blood-derived concentrate increasingly utilized in regenerative medicine for its ability to accelerate healing and tissue repair. PRP is broadly classified by leukocyte content, fibrin architecture, and platelet concentration, with classification systems developed to standardize characterization. Preparation methods, including single- or double-spin centrifugation and buffy coat techniques, influence the final composition of PRP, determining the relative proportions of platelets, leukocytes, plasma proteins, and extracellular vesicles. These components act synergistically, with platelets releasing growth factors (e.g., VEGF, PDGF, TGF-β) that stimulate angiogenesis and matrix synthesis, leukocytes providing immunomodulation, plasma proteins facilitating scaffolding, and exosomes regulating intercellular signaling. Mechanistically, PRP enhances tissue repair through four key pathways: platelet adhesion molecules promote hemostasis and cell recruitment; immunomodulation reduces pro-inflammatory cytokines and favors M2 macrophage polarization; angiogenesis supports vascular remodeling and nutrient delivery; and serotonin-mediated pathways contribute to analgesia. These processes establish a regenerative microenvironment that supports both structural repair and functional recovery. Clinically, PRP has been applied across multiple specialties. In orthopedics, it promotes tendon, cartilage, and bone healing in conditions such as tendinopathy and osteoarthritis. In dermatology, PRP enhances skin rejuvenation, scar remodeling, and hair restoration. Gynecology has adopted PRP for ovarian rejuvenation, endometrial repair, and vulvovaginal atrophy. In dentistry and oral surgery, PRP accelerates wound closure and osseointegration, while chronic wound care benefits from its angiogenic and anti-inflammatory effects. PRP has also favored gingival recession coverage, regeneration of intrabony periodontal defects, and sinus grafting. Although preparation heterogeneity remains a challenge, PRP offers a versatile, biologically active therapy with expanding clinical utility. Full article

Introduction: Odontogenic keratocyst (OKC) is a locally aggressive cystic lesion derived from remnants of the dental lamina. It is most commonly located in the posterior mandible, while maxillary involvement is rare and poses diagnostic and surgical challenges due to its proximity to critical anatomical structures. This case report describes the surgical management of a maxillary OKC with an uncommon localisation. Methods: A 50-year-old male presented with an asymptomatic swelling in the posterior maxilla. Cone beam computed tomography (CBCT) revealed a well-defined unilocular radiolucency extending toward the maxillary sinus floor. Surgical management included complete enucleation and peripheral curettage, followed by histopathological confirmation. The defect was left to heal naturally through bone regeneration without the need for grafting. Results: Intraoperatively, a thin pearly white cystic capsule and buccal cortical thinning were observed, consistent with OKC. The lesion was enucleated intact, without rupture or sinus perforation. Histology confirmed the diagnosis. Postoperative healing was uneventful, with radiographic follow-up at one month showing favourable healing changes. Conclusions: Careful surgical planning combined with advanced imaging facilitates safe and effective management of OKCs in uncommon maxillary sites. Enucleation with peripheral curettage provided satisfactory short-term outcomes. Long-term follow-up remains essential due to the risk of recurrence. Full article

Background: During maxillary sinus floor augmentation, the elevated sinus mucosa may come into close contact with the pristine mucosa. The presence of xenograft granules can lead to unintended mechanical and biological interactions between the two layers, and the resulting tissue damage remains poorly understood. The aim of this study was to perform a focused histological evaluation of graft-mediated interactions between the elevated and pristine sinus mucosae. Methods: Histological slides from five previously published rabbit sinus augmentation studies using grafts with different resorption rates were retrospectively analyzed. The following main patterns of tissue alteration were identified: (1) Proximity stage, characterized by epithelial thickening, goblet cell hyperactivity, and ciliary shortening; (2) Fusion stage, with epithelial interpenetration and loss of distinct mucosal boundaries; (3) Synechiae stage, featuring connective tissue bridges linking the two mucosae; and (4) Pristine mucosa lesions, caused by direct contact between residual graft particles and the pristine sinus mucosa. Results: A total of 192 sinuses were evaluated. Sinuses augmented with slowly resorbable grafts showed proximity stage in 22.3% of cases, fusion in 7.7%, direct lesions in 9.6%, and only one instance of synechia. In contrast, the faster resorbable xenograft presented only 11.1% of proximity stage, without further alterations. Conclusions: In this rabbit model, xenografts were associated with histological alterations of the sinus mucosa, while synechiae formation was rare. These preclinical findings should not be directly extrapolated to humans but may provide a basis for future investigations. Full article

Background: Traditional parameters such as bone-to-implant contact percentage (BIC%) provide only static insights into implant integration and do not reflect the temporal dynamics of bone regeneration. The concept of Dynamic Regenerative Balance (DRB) was introduced to represent the biological equilibrium between bone formation and graft resorption. The break-even point serves as a measurable approximation of this equilibrium. This study aimed to illustrate the usefulness of the break-even point in expressing the balance between graft resorption and new bone formation, rather than to define definitive values for specific biomaterials. Methods: Four preclinical studies on sinus floor elevation in rabbits were selected. Each reported histomorphometric data on new bone formation and graft resorption at two or more time points. Six biomaterials were analyzed: autogenous bone, Bio-Oss^®, Bio-Oss Collagen^®, Gen-Os^®, Maxresorb^®, and Maxresorb^® Inject. The break-even point was calculated by linear extrapolation as the time at which new bone equals residual graft percentage. Results: The break-even point varied significantly among biomaterials (expressed in days/area %): autogenous bone reached equilibrium fastest (18.4 days/13.5%), followed by Gen-Os^® (40.4 d/19.1%). Bio-Oss Collagen^® (62.3 d/28.3%), Maxresorb^® (73.9 d/36.4%), and Maxresorb^® Inject (96.1 d/34.1%). For Bio-Oss^®, it occurred at 81.8 days (33.6%) in one study, while in another, it was not reached within 6 months. These differences reflect distinct regenerative kinetics and resorption profiles among materials. Conclusions: The break-even point offers a simple and informative parameter to describe the balance between graft resorption and new bone formation, providing a useful complement to conventional histomorphometric measures and a framework for future studies. Full article

For decades, regeneration of alveolar bone defects has depended on traditional grafting options, such as autogenous/allogenic grafts or allografts. Recently, extracted teeth was introduced as an alternative graft source. Tooth autografts are being used and have gained significant attention due to their biocompatibility, osteoconductivity, osteoinductivity, and osteogenic properties. Furthermore, tooth allografts have potential to act as natural biocomposites for oral regeneration procedures and might be advantageous options in near future. Recent advances in tooth banking, including cryopreservation, can serve to maintain bioactivity and to improve the safety, viability, and regenerative potential of teeth. They might be revolutionary in oral surgery, offering a more sustainable solution to the growing demand for bone regeneration procedures. Nevertheless, challenges such as immunogenic responses, ethical issues, and regulatory constraints persist. Ongoing research and technological innovation continue to address these problems. To date, the success rates of tooth autografts are promising, and they are regarded as a reliable option in clinical practice, with predictable outcomes in alveolar ridge preservation, sinus augmentation, periodontal regeneration, guided bone regeneration (GBR), and endodontic surgery by providing natural scaffolds for cell integration and bone remodeling. However, the scientific literature on tooth allografts is lacking. Therefore, this review aimed to comprehensively evaluate the scientific literature for comparing the properties of tooth grafts with other grafting options, in terms of processing techniques, and various clinical applications, positioning them as versatile biocomposites for the future, bridging material science and regenerative dentistry. Furthermore, possible applications of allogenic tooth grafts and overcoming current limitations are also discussed. Full article

Aim: This retrospective observational clinical cohort study evaluated 84-month clinical and radiographic outcomes of a regenerative protocol combining autologous dentin grafts processed with the Tooth Transformer^® device and Concentrated Growth Factors (CGFs) in patients with severe maxillary atrophy undergoing sinus augmentation with simultaneous implant placement. Materials and Methods: Thirty-one patients (30–75 years) with residual crestal bone height ≥ 5 mm and requiring extraction of ≥2 molars were included. Extracted teeth were processed with the Tooth Transformer^® to obtain demineralized dentin granules (500–1000 µm), which were combined with CGFs prepared using the Medifuge MF200^® to form “sticky bone.” All patients underwent sinus lift via a lateral window approach (Hilt Tatum technique) with simultaneous placement of 98 implants (12–14 mm), which were loaded after six months. Results: At the 84-month follow-up, no implant failures or peri-implantitis were recorded. CBCT and clinical evaluations showed stable regenerated bone volume and absence of peri-implant bone resorption. All patients received fixed prostheses within six months without complications. Conclusions: The combined use of processed autologous dentin and CGFs proved to be a safe, predictable, and effective regenerative technique in cases of severe maxillary atrophy, with a 100% implant survival rate at five years. 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

Background: In atrophic posterior maxillary regions, sub-antral surgery is often used for rehabilitation with implants. In order to stimulate bone regeneration, autogenous, xenogenic, alloplastic and platelet-rich fibrin (PRF) grafts are commonly used. Aim: To assess the effectiveness of PRF alone or combination with synthetic bone substitutes on bone formation, implant stability, and survival in sub-antral surgery. Materials and Methods: A literature review was carried out from September 2024 to April 2025, according to PRISMA guidelines using the PubMed, Cochrane Library, Wiley, ScienceDirect, and Web of Science databases. From a total of 601 articles identified, 11 met the inclusion criteria and were selected for analysis. Results: PRF in combination with synthetic materials has shown potential benefits, especially in increasing biomechanical stability and bone formation. Although, most studies have not reported statistically significant differences when comparing the use of synthetic material alone against its combination with PRF. Discussion: The use of synthetic grafts in combination with PRF has become increasingly common in sub-antral implant procedures. PRF promotes angiogenesis, osteoprogenitor cell differentiation and bone regeneration, favouring the healing and remodelling process of the tissues, as well as greater stability and longevity of the implant. Conclusions: The combination of PRF with synthetic bone grafting shows promising results; however, further studies are needed to confirm the efficacy of PRF in maxillary sinus grafts in conjunction with the use of biomaterials. Full article

Background: Maxillary sinus floor augmentation (MSFA) is commonly used to increase posterior maxillary bone volume prior to implant placement. Although generally successful, late complications can impact long-term outcomes. The purpose of the study was to estimate the incidence and timing of atypical late complications following (MSFA) using bovine xenohybrid bone grafts. The study also aimed to evaluate whether preoperative bone volume is associated with the risk of complications. Methods: This retrospective cohort study was conducted at the Center of Oral and Maxillofacial Surgery, Danube Private University, Krems-Stein, Austria, and included patients who underwent MSFA with bovine xenohybrid bone grafts and either simultaneous or staged implant placement between January 2020 and December 2023. Preoperative bone volume of the posterior maxilla measured via cone beam computed tomography (CBCT) in the planned implant insertion position. The primary endpoint was the time (days) from MSFA to the occurrence of a graft-related complication (defined as atypical if occurring more than 6 months after MSFA and not related to peri-implantitis) The covariates included subjects’ age, sex, the quantity of graft used for MSFA, timing of dental implant insertion (simultaneous vs. staged) and implant dimensions. Kaplan–Meier analysis and Cox proportional hazards regression were used to evaluate time-to-event data. Only one graft site per patient was analyzed. Results: Atypical complications occurred in 9 out of 47 patients (19.1%), with an average time to onset of 645 days. In a multivariable analysis, a lower preoperative bone volume was found to be an independent predictor of an increased risk of complications (hazard ratio [HR]: 0.972; 95% confidence interval [CI]: 0.925–1.021; p = 0.252). However, the quantity of graft used for MSFA was not found to be a predictor (p = 0.46). Conclusions: Within the limitations of a retrospective study, reduced native bone volume appears to increase the risk of atypical late complications following MSFA with bovine xenohybrid grafts. This makes closer clinical and radiologic follow-up of patients over a longer period very necessary. Full article

Intraosseous hemangiomas (IH) are rare intrabony lesions that represent less than 1% of intraosseous tumors. IH are mostly seen in the axial skeleton and skull. Most commonly, the frontal bone, zygomatic, sphenoid, maxilla, ethmoid, and lacrimal bone can manifest IH. Currently, IH is classified as a developmental condition of endothelial origin. According to WHO, the five histological types of IH are cavernous, capillary, epithelioid, histiocytoid, and sclerosing. IH of the zygoma is an extremely rare condition with female predominance. A systematic review recently estimated that there were 78 cases published in the literature until 2023. The lesion is usually asymptomatic and presents with a gradually deteriorating deformity of the malar area, and the patient might be able to recall a history of trauma. Numbness due to involvement of the infraorbital nerve might also be present; however, atypical skin and bone sensations might also occur. Other symptoms include painful swelling, bone asymmetry, skin irritation, sinus pressure, paresthesia, diplopia, enophthalmos, or atypical neuralgia. A bony lesion with a trabecular pattern in a radiating formation (sunburst pattern) or a multilocal lytic lesion pattern created by the multiple cavernous spaces (honeycomb pattern) is commonly observed during radiologic evaluation. We present a rare case of IH of the zygoma in a 65-year-old generally healthy woman. A cyst-like bone tumor was revealed from the CT scan, which made preoperative biopsy of the lesion problematic. A careful radiological diagnostic differentiation of the lesion should always be conducted in such cases to outline a safe surgical plan and possible alternatives if needed. The patient underwent total tumor resection in the operating room, and the defect was reconstructed with the use of a titanium mesh and a synthetic hydroxyapatite bone graft based on a 3D surgical guide printed model. Full article