Search Results (108)

Titanium–aluminum–vanadium (Ti6Al4V) is a material chosen for spine, orthopedic, and dental implants due to its combination of desirable mechanical and biological properties. Lasers have been used to modify metal surfaces, enabling the generation of a surface on Ti6Al4V with distinct micro- and nano-scale structures. Studies indicate that topography with micro/nano features of osteoclast resorption pits causes bone marrow stromal cells (MSCs) and osteoprogenitor cells to favor differentiation into an osteoblastic phenotype. This study examined whether the biological response of human MSCs to Ti6Al4V surfaces is sensitive to laser treatment-controlled micro/nano-topography. First, 15 mm diameter Ti6Al4V discs (Spine Wave Inc., Shelton, CT, USA) were either machined (M) or additively manufactured (AM). Surface treatments included no laser treatment (NT), nanosecond laser (Ns), femtosecond laser (Fs), or nanosecond followed by femtosecond laser (Ns+Fs). Surface wettability, roughness, and surface chemistry were determined using sessile drop contact angle, laser confocal microscopy, X-ray photoelectron spectroscopy (XPS), and scanning electron microscopy (SEM). Human MSCs were cultured in growth media on tissue culture polystyrene (TCPS) or test surfaces. On day 7, the levels of osteocalcin (OCN), osteopontin (OPN), osteoprotegerin (OPG), and vascular endothelial growth factor 165 (VEGF) in the conditioned media were measured. M NT, Fs, and Ns+Fs surfaces were hydrophilic; Ns was hydrophobic. AM NT and Fs surfaces were hydrophilic; AM Ns and Ns+Fs were hydrophobic. Roughness (Sa and Sz) increased after Ns and Ns+Fs treatment for both M and AM disks. All surfaces primarily consisted of oxygen, titanium, and carbon; Fs had increased levels of aluminum for both M and AM. SEM images showed that M NT discs had a smooth surface, whereas AM surfaces appeared rough at a higher magnification. Fs surfaces had a similar morphology to their respective NT disc at low magnification, but higher magnification revealed nano-scale bumps not seen on NT surfaces. AM Fs surfaces also had regular interval ridges that were not seen on non-femto laser-ablated surfaces. Surface roughness was increased on M and AM Ns and Ns+Fs disks compared to NT and Fs disks. OCN was enhanced, and DNA was reduced on Ns and Ns+Fs, with no difference between them. OPN, OPG, and VEGF levels for laser-treated M surfaces were unchanged compared to NT, apart from an increase in OPG on Fs. MSCs grown on AM Ns and Ns+Fs surfaces had increased levels of OCN per DNA. These results indicate that MSCs cultured on AM Ns and AM Ns+Fs surfaces, which exhibited unique roughness at the microscale and nanoscale, had enhanced differentiation to an osteoblastic phenotype. The laser treatments of the surface mediated this enhancement of MSC differentiation and warrant further clinical investigation. 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

Two-dimensional imaging is still commonly used in dentistry, but does not provide the three-dimensional information often required for the accurate assessment of dental structures. Photon-counting computed tomography (PCCT), a new three-dimensional modality mainly used in general medicine, has shown promising potential for dental applications. With growing digitalization and cross-disciplinary integration, using PCCT data from other medical fields is becoming increasingly relevant. Conventional CT scans, such as those of the cervical spine, have so far lacked the resolution to reliably evaluate dental structures or implants. This study evaluates the diagnostic utility of PCCT for visualizing peri-implant structures in routine clinical photon-counting CT acquisitions and assesses the influence of metal artifact reduction (MAR) algorithms on image quality. Ten dental implants were retrospectively included in this IRB-approved study. Standard PCCT scans were reconstructed at multiple keV levels with and without MAR. Quantitative image analysis was performed with respect to contrast and image noise. Qualitative evaluation of peri-implant tissues, implant shoulder, and apex was performed independently by two experienced dental professionals using a five-point Likert scale. Inter-reader agreement was measured using intraclass correlation coefficients (ICCs). PCCT enabled high-resolution imaging of all peri-implant regions with excellent inter-reader agreement (ICC > 0.75 for all structures). Non-MAR reconstructions consistently outperformed MAR reconstructions across all evaluated regions. MAR led to reduced clarity, particularly in immediate peri-implant areas, without significant benefit from energy level adjustments. All imaging protocols were deemed diagnostically acceptable. This is the first in vivo study demonstrating the feasibility of opportunistic dental diagnostics using PCCT in a clinical setting. While MAR reduces peripheral artifacts, it adversely affects image clarity near implants. PCCT offers excellent image quality for peri-implant assessments and enables incidental detection of dental pathologies without additional radiation exposure. PCCT opens new possibilities for opportunistic, three-dimensional dental diagnostics during non-dental CT scans, potentially enabling earlier detection of clinically significant pathologies. Full article

Background/Objectives: Dental implants represent a viable solution for replacing missing teeth; however, multiple disconnections and reconnections of intermediate abutments contribute to the apical displacement of the peri-implant connective tissue barrier, resulting in additional marginal bone loss. To the best of our knowledge, no definitive customized abutments currently exist that are specifically designed according to the morphology of the tooth to be replaced and its position within the dental arch, allowing for digital planning within the prosthetic implant design and insertion during the surgical procedure without subsequent disconnection. Methods: The First Biological Respect (FR) technique, described in this case report, enables the digital planning not only of the implant but also of the patented FR customized-shaped, definitive abutment and associated FR prosthetic components. The FR technique was applied to a case involving an immediate post-extraction implant in position 12. Results: With the limitations of a case report, the application of the FR protocol demonstrated stable crestal bone levels at the 1-year follow-up. Additionally, soft tissue volume was maintained at 6 months, reflecting the accuracy of the customized prosthetic components in supporting, guiding, and protecting peri-implant soft tissues. At the 1-year follow-up, an increase in soft tissue volume was observed, likely attributable to tissue maturation and the further customization of the definitive prosthetic elements. Conclusions: The FR technique represents a viable therapeutic alternative that, through its patented, fully customized components, allows for the digital planning of the implant, as well as the customized definitive abutment, coping, provisional, and final prosthetic framework. This facilitates a single-stage surgical and prosthetic approach. By eliminating the need for repeated abutment disconnections, this method supports the long-term stability of both hard and soft peri-implant tissues while also reducing overall treatment time for both clinician and patient. Further studies involving larger patient cohorts are necessary to validate this protocol. Full article

Background and Clinical Significance: Dental implants are widely used; however, tooth extraction often results in alveolar bone loss and gingival recession, necessitating bone and connective tissue reconstruction, especially in the esthetic anterior regions. To address these issues, implants are occasionally connected to adjacent teeth, but this remains controversial, as complications (e.g., intrusion of natural teeth) have been observed. This report demonstrates the long-term success of implants replaced after removing maxillary bilateral central incisors and connecting them to lateral incisors with reduced supportive bone due to periodontitis. Case Presentation: A 57-year-old woman with root fractures in maxillary bilateral central incisors, periodontitis, and malocclusion was treated with connecting implants and natural teeth. Bone levels surrounding maxillary bilateral lateral incisors were diminished due to root fractures in adjacent central incisors and periodontitis. After initial periodontal therapy, hopeless maxillary central incisors were extracted, replaced with implants using a digitally simulated surgical guide, and guided bone regeneration and connective tissue grafting were performed. Implants were connected to lateral incisors with provisional restorations, and orthodontic treatment was initiated following digital set-ups incorporating implants into the overall strategy. Final porcelain-fused-to-zirconia restorations were placed after orthodontic treatment. At the 5-year follow-up, gingival morphology, coloration, and position of lateral incisors remained stable. Conclusions: This case demonstrates that connecting implants to natural teeth in the anterior region can effectively maintain periodontal tissues around natural teeth and allow for minimally invasive, short-term, and esthetic treatment. However, careful long-term observation through maintenance is necessary due to limited evidence for this approach in the anterior region. Full article

The prosthetic emergence profile is a factor potentially affecting marginal bone level around dental implants. The aim of this review is to provide a comprehensive analysis of the influence of the prosthetic emergence profile on peri-implant marginal bone-level stability. The marginal bone level is an important parameter in implant dentistry, reflecting the stability of dental implants, and it is a critical indicator of long-term implant success. Minimizing marginal bone loss around dental implants is a key factor for maintaining implant function, supporting peri-implant soft tissues, and achieving predictable aesthetic outcomes. The scientific literature presents various examples of evidence on the influence of emergence angle and prosthetic designs on marginal bone loss. Several studies suggest that emergence angles exceeding 30° and convex prosthetic designs may increase the risk of peri-implantitis and bone resorption, while others find no significant correlation. Moreover, several studies demonstrated the positive influence of taper joint connections on marginal bone stability. Although the current literature remains diverse, it is essential to prioritize cleanability and minimize plaque accumulation for a successful implant-prosthetic restoration. Proper maintenance and a continuous follow-up to monitor marginal bone loss are beneficial for obtaining stable and optimal long-term results. Full article

Background: One of the parameters of maximum interest regarding the quality of the intraoral hard tissues is represented by the bone density, with direct clinical implications. The evaluation of this extremely important clinical parameter can be achieved by several imaging methods, of which the most known in dentistry is represented by the cone beam computed tomography (CBCT). Objectives: The purpose of the study is to obtain a quantitative analysis of bone mineral density changes in patients who underwent treatments of photobiomodulation (PBM), as complementary to a surgical approach in oral surgery and implantology. Methods: The study included the retrospective analysis of maxillary cone beam computed tomography of 28 patients without pathology or medication known to affect bone metabolism or its qualitative and quantitative properties. All patients from the study group followed the same laser PBM treatment protocol after placing dental implants; the PBM protocol implied the intraoral use of a gallium aluminum arsenide laser (GaAlAs) of 808 nm, 450 mW, in pulsed mode, administering an energy of 6 J in 3 points corresponding to each inserted dental implant—mesial, distal, and apical—totaling 18 J/implant. Treatment sessions were performed immediately postoperatively and at a subsequent distance of 48 h for 2 weeks (a total of eight sessions). For every patient, bone density was analyzed before and after PBM treatment, in the same areas of interest, within the same anatomical landmarks. A comparison was also made between the results obtained for the anterior maxilla and the posterior maxilla. All the measurements made were analyzed statistically, the results being presented in the dedicated section. Results: Based on the data analysis, the comparison between the lasered and non-lasered groups reveals that patients who underwent PBM showed a statistically significant improvement in bone mineral density, with the mean increasing from 530.91 HU before treatment to 842.55 HU after treatment (t-test: p < 0.001). In contrast, the non-lasered group showed no significant improvement, with a slight decrease in bone mineral density, as the mean dropped from 495.19 HU before treatment to 462.16 HU after treatment (t-test: p = 0.47). Conclusions: The study demonstrated results with statistical significance regarding the mineral bone density improvement of patients who underwent laser PBM treatment. This positive effect of laser therapy has been shown, both at the level of the vestibular cortical bone and at level of the trabecular bone, independent of the patient’s sex, for the anterior maxilla and at the lateral areas also. Full article

Background: Dental implantology is the greatest popular choice for the treatment of partial or total edentulism. However, despite its apparent simplicity, it represents a technique that necessitates adequate surgical knowledge and significant technical skills. There are several potential complications related to dental implant surgery and some of these can be particularly dangerous. The aim of the present study is to make a comprehensive review of head and neck abscess as a complication of dental implant infections and the consequent medical and therapeutic approach. Case report: A case of submental abscess related to peri-implantitis is presented from the hospital access to the emergence surgical treatment and medical therapy. The patient presented with painful swelling in the right submental and submandibular region. The surgical procedure included both an extraoral and intraoral approach. Extraorally, a right paramedian submental incision was performed. Intraorally, after removal of the fixed prosthesis screwed to a single implant, a muco-periosteal flap was elevated in correspondence of the third and fourth quadrants to allow implant exposure. All implant sites of infection and possible complications were removed. Then, Penrose-type drains were positioned intraorally and extraorally. Results: The patient remained hospitalized for ten days for clinical conditions assessment, the wounds were treated, and the drains replaced. Laboratory tests showed that neutrophils and PCR returned to normal values, indicating an interruption of the inflammatory process. The patient was discharged in good general and local clinical conditions with dedicated therapy. Conclusions: At 5-month follow-up the swelling had vanished and tissues appeared normotrophic and healthy. However, a computed tomography (CT) scan of the lower arch showed significant generalized bone loss at the mandibular level compatible with a state of advanced bone atrophy. The early diagnosis and treatment of these complications is fundamental for the patient prognosis. Full article

Purpose: To conduct a comprehensive systematic review and meta-analysis on marginal bone loss (MBL) in dental implants, enhancing the understanding and management of both bone-level and tissue-level implants. Methods: MEDLINE-PubMed and Scopus databases were searched for relevant English articles (up to April 2024), assessing the MBL as the primary outcome. The relevant data were extracted, and a meta-analysis was performed to evaluate the effect of implant neck design. Results: A total of 17 studies were included for qualitative analysis. Out of the 21 articles included, 15 studies established a statistically significant difference in MBL between the study groups; however, the differences were not found to be clinically relevant. Bone-level implants with platform-switched abutments in most of the cases showed better marginal bone stability compared to tissue-level implants or bone-level implants with matching abutments. Seven RCT studies were evaluated for the MBL between bone-level and tissue-level implants. The difference in MBL between bone-level implants and tissue-level implants was statistically significant, with a greater loss of bone in bone-level implants (Mean Difference: 0.11, 95% CI:0.02 to 0.19, p = 0.01 and I² heterogeneity: 81%, p < 0.0001). Conclusions: This review underscores the need for standardized measurement techniques, consideration of patient-specific factors in clinical decision-making, and further long-term studies to optimize dental implant success and patient outcomes. Full article

Background: Immediate post-extraction dental implants are increasingly popular, but ensuring primary stability and managing peri-implant tissues remain challenging. Implant macro-design significantly impacts stability and osseointegration. This study used Cone-beam Computed Tomography (CBCT) to evaluate changes in alveolar bone following immediate placement of two implant designs, System 2P and Dura-Vit 3P, which feature semi-conical microgeometry and apical self-tapping portions for improved stability and bone regeneration. Methods: With a 1:1 allocation ratio, the current investigation was a two-arm parallel group randomized clinical trial. Patients qualified if they required immediate dental replacements with adequate buccal bone support. Two types of implants were placed: System 2P (cylindrical shape) and Dura-Vit 3P (more conical shape, with a particular architecture of threads). Following the intervention, CBCT was performed both immediately (T1) and six months later (T2). Measurements of CBCT horizontal bone level at apical, medial, and bevel height on the palatal/lingual and vestibular sides as well as the buccal vertical gap were the primary results. Complications, implant stability quotient (ISQ), and torque insertion were evaluated. The Mann–Whitney test was used to determine time-based differences within each group, while the Wilcoxon test was used to estimate differences between groups. The impact of baseline marginal gap dimension and gingival biotype was estimated using multiple regressions. Results: Thirty patients were recruited and randomized to treatments, with two lost to follow-up. One System 2P implant failed and two patients of the Dura-Vit 3P group dropped out. At T1, the Dura-Vit 3P group exhibited a lower mean insertion torque and a higher ISQ than the System 2P group. Furthermore, the Dura-Vit 3P group showed lower bone reduction compared to System 2P at horizontal and vertical measurements with significant differences for the vestibular and palatal base and medial level (p-values < 0.05). Regression models indicated a positive effect of thick biotypes on gap filling and dimensional bone reduction. No complications were observed in both groups. Conclusions: The Dura-Vit 3P implant exhibits high primary stability when inserted in post-extraction sites. Furthermore, this kind of implant stimulates higher bone stability on both the palatal and buccal side when compared to the System 2P implant. The present findings support the evidence that the macro-design of the Dura-Vit 3P implant promotes increased primary stability and reduces bone loss. Full article

Background/Objectives: The long-term success of dental implants can be influenced by the material properties of abutments and their interaction with peri-implant tissues. This study investigates the impact of three abutment materials—titanium (Ti), zirconium oxide (Zr), and polymethylmethacrylate (PMMA)—on the inflammatory response in peri-implant sulcular fluid (PISF), using active-matrix metalloproteinase-8 (aMMP-8) as a biomarker. Methods: In this prospective, randomized clinical trial, 30 patients were assigned to Ti, Zr, or PMMA abutment groups. PISF samples were collected at predefined intervals over 12 months and analyzed for aMMP-8 levels using enzyme-linked immunosorbent assays (ELISA). Clinical parameters (probing depth, bleeding on probing, and plaque index) and radiographic assessments of bone resorption were also evaluated. Results: Two weeks after implant uncovering, baseline aMMP-8 levels varied significantly among materials, with Zr demonstrating the highest levels. Over time (2, 3, 6 and 12 months after implant uncovering), aMMP-8 levels decreased across all groups, with no significant differences observed at 12 months. Radiographic assessments indicated no statistically significant differences in bone resorption, with clinical parameters remaining comparable across all groups. Conclusions: Initial inflammatory responses to abutment materials may vary; however, all tested materials—Ti, Zr, and PMMA—showed long-term biocompatibility and supported healthy peri-implant tissue integration. These findings indicate that selecting any of the tested abutment materials does not significantly affect long-term peri-implant health. Full article

Background: Sterilization is required for any biomedical device intended to be used in contact with the human body. Several studies have reported alterations in the bulk and surface properties of such devices after repeated sterilization cycles. These surface modifications may influence other clinical parameters. Therefore, the aim of this study was to investigate the surface and chemical properties of implant scan bodies (SBs) after consecutive autoclave sterilization procedures. Methods: The objective was to analyze the scan bodies using Fourier transform infrared spectroscopy (FTIR) and X-ray photoelectron spectroscopy (XPS) for chemical analysis and an optical profilometer to analyze the surface roughness. Results: FTIR spectra depicted the appearance of peak at 1741 and 1100 cm⁻¹ due to the diphenyl ether band disappearance. The XPS spectra showed alterations in the elemental composition after autoclaving and roughness were significantly reduced in PEEK BL and TL SBs. Conclusions: These results indicated that some surface modifications were induced by repeated sterilization cycles. Full article

Background/Objectives: Photobiomodulation therapy (PBM) creates a biostimulatory or modulatory effect, promoting tissue regeneration and improving patients’ health-related quality of life (HRQoL). PBM has shown promise as an effective treatment and management strategy for peripheral nerve injuries, including inferior alveolar nerve (IAN) damage. This study aims to assess the impact of PBM on HRQoL in patients with iatrogenic IAN injuries. Methods: A prospective study was implemented to investigate the research question. PBM treatments were administered weekly, with patient discharge contingent upon either complete recovery or stabilization of associated signs and symptoms. HRQoL was assessed using the EQ-5D-5L questionnaire at the initial and final appointments. Results: The study included 71 participants, divided into 3 groups based on etiology: inferior third molar surgery, mandibular orthognathic surgery, and dental implant surgery. The results showed a widespread reduction of symptoms along with a statistically significant improvement (p < 0.001) across four of the five dimensions of the EQ-5D-5L questionnaire, as well as in patients’ perceived health levels in both Groups I and II. Group III patients also demonstrated a notable improvement; however, due to the small sample size, statistical analysis was not conducted for this group. Conclusions: PBM demonstrated a comparable ability to enhance HRQoL and alleviate symptoms in patients with IAN injuries within different etiologies. These findings underscore the effectiveness of the protocol used in this study and highlight potential avenues for expanding research in this field. Full article

After tooth extraction, bone levels in the alveoli decrease. Using a bone substitute can help minimize this bone loss. The substitute can be sourced from a human or animal donor or synthetically prepared. In this study, we aimed to address the following PICOS question: In patients needing dental alveolar preservation for implant placement, how does alveolar preservation using a bovine hydroxyapatite bone xenograft with collagen compare to a xenograft without collagen in terms of changes in alveolar height and width, bone density, and the characteristics of the bone tissue observed in biopsies taken at 6 months? We evaluated two xenograft-type bone substitutes for preserving post-extraction dental sockets using tomography and microscopy to answer that question. A total of 18 dental alveoli were studied: 11 preserved with a xenograft composed of apatite (InterOss) and 7 with a xenograft composed of apatite–collagen (InterOss Collagen). Tomographic controls were performed at 1 and 6 months, and microscopic studies were performed on 13 samples. The biopsies were examined with scanning electron microscopy (SEM) and energy-dispersive spectroscopy (EDS). A Multivariate Analysis of Variance (MANOVA) was conducted in the statistical analysis, revealing a significant increase in bone density over time (p = 0.04). Specifically, bone density increased from an average of 526.14 HU at 30 days to 721.96 HU at 60 days in collagen-free samples. However, no statistically significant differences in height or width were found between groups. The MANOVA results indicated that the overall model had a low predictive ability for height, width, and density variables (R-squared values were low), likely due to sample size limitations and the complexity of bone tissue dynamics. On the other hand, FTIR analysis revealed the presence of phosphate groups, carbonates, and amides I, II, and III, indicative of inorganic (hydroxyapatite) and organic (type I collagen) materials in the xenografts. TGA and DSC showed high thermal stability, with minimal mass loss below 150 °C. Finally, both xenografts were influential in alveolar bone regeneration after extraction without significant differences. The trend of increasing collagen density suggests an effect that requires further investigation. However, it is recommended that the sample size be increased to enhance the validity of the results. Full article

Background/Aim: The stability of peri-implant tissues is crucial for the long-term success of dental implant treatments. A new cervical implant design has been developed to address the challenges associated with peri-implant tissue stability, featuring a concave cervical portion to increase tissue volume in this area. The present study aimed to clinically evaluate the effectiveness of the new cervical implant design in maintaining peri-implant tissue stability. Materials and Methods: Five clinical cases involving completely edentulous patients were selected, in which 25 implants were installed. The marginal bone level around each implant was assessed at three different time points—T0: immediately after the prosthesis installation, T1: 6 months post installation, and T2: at the last control visit, up to 38 months later. Measurements were taken to analyze changes in marginal bone levels (MBLs) and the keratinized mucosa (KM) over time. Furthermore, the keratinized mucosa (KM) around the implants was evaluated. Results: The mean and standard deviation values of the marginal bone levels at each time point were as follows—T0: 0.59 ± 0.55 mm; T1: 1.41 ± 0.59 mm; T2: 1.76 ± 0.69 mm. Statistical analysis showed significant differences across the time points (ANOVA p < 0.0001). The overall mean KM values were 3.85 mm for T1 and T2, showing the stability of the peri-implant soft tissues at ≥1-year controls. Conclusion: Within the limitations of the present study, the results showed that the Collo implants presented measured MBL values increasing within the time range analyzed in each case but within the normal values cited in the literature for these types of rehabilitation treatments. However, the measured KM values presented, in all cases, an average above the values referenced in the literature as a minimum for maintaining the health of the peri-implant tissues. Full article