Tooth autotransplantation is a reliable procedure with high long-term success and survival rates and shows many advantages over dental implants, particularly for young patients in craniofacial devel-opment. Nonetheless, insufficient bone availability at the recipient site is a key limitation. This study aimed to establish the feasibility of tooth autotransplantation combined with staged or simultaneous bone regeneration to address complex cases. Two young patients with missing teeth due to hypodon-tia or trauma and who were deemed unsuitable for implants were treated. Both complex cases were addressed through autologous tooth autotransplantation, either in conjunction with simultaneous guided bone regeneration or into a previously regenerated crest. The 5-year follow-up for the auto-transplanted canine and more than 20-year follow-up for the autotransplanted premolar revealed satisfactory results. These teeth played pivotal roles in restoring both function and esthetics in young patients. Additionally, tooth vitality was preserved throughout the follow-up period, with no compli-cations noted. Tooth autotransplantation in combination with previous or simultaneous guided bone regeneration proved to be effective in restoring function and esthetics in complex situations in young patients.

Purpose: To compare the clinical effectiveness of three different devices used in guided bone regeneration procedures for partially atrophic arches. Materials and methods: A randomised controlled trial with three parallel arms was conducted. The study evaluated titanium-reinforced polytetrafluoroethylene membrane (PTFE group), semi- occlusive CAD/CAM titanium mesh (mesh group) and occlusive CAD/CAM titanium foil (foil group) in terms of surgical outcomes and complications as well as surgical times and surgeon satisfaction in 27 guided bone regeneration procedures, presenting results from 1 year post-implant placement. Results: Complications occurred in seven patients. No significant difference was found between the groups in terms of the occurrence of complications (P = 0.51), device exposure (P = 0.12) and implant failure (P = 0.650). Surgeon satisfaction varied significantly, with the PTFE group differing from the mesh (P = 0.003) and foil groups (P < 0.001), but not between meshes and foils (P = 0.172). Surgical times also differed significantly, with longer times for PTFE membranes compared to meshes (P < 0.001) and foils (P = 0.006), but with no difference between meshes and foils (P = 0.308). The mean reconstructed bone volume was 1269.55 +/- 561.08 mm3, with no significant difference observed between the three groups (P = 0.815). There was also no significant difference for mean maximum height (6.72 mm, P = 0.867) and width (7.69 mm, P = 0.998). The mean marginal bone loss at 1 year after implant placement was 0.59 +/- 0.27 mm. Conclusions: Although this study provides valuable insights into the potential benefits of using different types of CAD/CAM devices, further research with larger sample sizes and longer follow-up periods is warranted to validate these findings.

PURPOSE:To establish consensus-driven guidelines that could support the clinical decision-making process for implant-supported rehabilitation of the posterior atrophic maxilla and ultimately improve long-term treatment outcomes and patient satisfaction.MATERIALS AND METHODS:A total of 33 participants were enrolled (18 active members of the Italian Academy of Osseointegration and 15 international experts). Based on the available evidence, the development group discussed and proposed an initial list of 20 statements, which were later evalu-ated by all participants. After the forms were completed, the responses were sent for blinded ana-lysis. In most cases, when a consensus was not reached, the statements were rephrased and sent to the participants for another round of evaluation. Three rounds were planned.RESULTS:After the first round of voting, participants came close to reaching a consensus on six statements, but no consensus was achieved for the other fourteen. Following this, nineteen statements were rephrased and sent to participants again for the second round of voting, after which a consensus was reached for six statements and almost reached for three statements, but no consensus was achieved for the other ten. All 13 statements upon which no consensus was reached were rephrased and included in the third round. After this round, a consensus was achieved for an additional nine statements and almost achieved for three statements, but no consensus was reached for the remaining statement.CONCLUSION:This Delphi consensus highlights the importance of accurate preoperative planning, taking into consideration the maxillomandibular relationship to meet the functional and aesthetic requirements of the final restoration. Emphasis is placed on the role played by the sinus bony walls and floor in providing essential elements for bone formation, and on evaluation of bucco-palatal sinus width for choosing between lateral and transcrestal sinus floor elevation. Tilted and trans-sinus implants are considered viable options, whereas caution is advised when placing pterygoid implants. Zygomatic implants are seen as a potential option in specific cases, such as for completely edentulous elderly or oncological patients, for whom conventional alternatives are unsuitable.

PURPOSE Guided bone regeneration is a widely used technique for the treatment of atrophic arches. A broad range of devices have been employed to achieve bone regeneration. The present study aimed to investigate the clinical and histological findings for a new titanium CAD/CAM device for guided bone regeneration, namely semi-occlusive titanium mesh. MATERIALS AND METHODS Nine partially edentulous patients with vertical and/or horizontal bone defects underwent a guided bone regeneration procedure to enable implant placement. The device used as a barrier was a semi-occlusive CAD/CAM titanium mesh with a laser sintered microperforated scaffold with a pore size of 0.3 mm, grafted with autogenous and xenogeneic bone in a ratio of 80:20. Eight months after guided bone regeneration, surgical and healing complications were evaluated and histological analyses of the regenerated bone were performed. RESULTS A total of 9 patients with 11 treated sites were enrolled. Two healing complications were recorded: one late exposure of the device and one early infection (18.18%). At 8 months, well-structured new regenerated trabecular bone with marrow spaces was mostly present. The percentage of newly formed bone was 30.37% ± 4.64%, that of marrow spaces was 56.43% ± 4.62%, that of residual xenogeneic material was 12.16% ± 0.49% and that of residual autogenous bone chips was 1.02% ± 0.14%. CONCLUSION Within the limitations of the present study, the results show that semi-occlusive titanium mesh could be used for vertical and horizontal ridge augmentation. Nevertheless, further follow-ups and clinical and histological studies are required.

The aim of the present study was to generate an international and multidisciplinary consensus on the clinical management of implant protrusion into the maxillary sinuses and nasal fossae. A total of 31 experts participated, 23 of whom were experts in implantology (periodontologists, maxillofacial surgeons and implantologists), 6 were otolaryngologists and 2 were radiologists. All the participants were informed of the current scientific knowledge on the topic based on a systematic search of the literature. A list of statements was created and divided into three surveys: one for all participants, one for implant providers and radiologists and one for otolaryngologists and radiologists. A consensus was reached on 15 out of 17 statements. According to the participants, osseointegrated implants protruding radiographically into the maxillary sinus or nasal fossae require as much monitoring and maintenance as implants fully covered by bone. In the event of symptoms of sinusitis, collaboration between implant providers and otolaryngologists is required. Implant removal should be considered only after pharmacological and surgical management of sinusitis have failed.

Background: Treating extended alveolar defects is challenging for their irregular shape and lack of hard and soft tissues. Virtual planned guided bone regeneration (GBR) with customized meshes aims to optimize the treatment by reducing the risk of dehiscence. The mucosa characteristics are crucial in preserving the bone graft covering and vitality. Methods: Two three-dimensional and extended defects, a mandibular posterior and anterior maxillary atrophy were reconstructed with a particulate graft and a digitally customized scaffold. The workflow entailed merging the pre-operatory clinical related data from intra-oral scanning with the radiologic ones from cone beam-CT. A final ideal prediction of the soft tissue relationship with the implant-borne prosthesis was virtually elaborated, conditioning the design of the titanium membrane fitting the bone defects. Results: A good matching between the scaffold and the bone surface was intra-operatory noted; no complications were registered in the first months of healing with complete integrity of the soft tissues above the graft. Conclusions: A careful evaluation of the soft tissues and a forecast of their final relationship with the implant and prosthesis can improve digital mesh/membrane manufacturing with a suitable healing process up to implant placement and loading, favoring peri-implant tissue stability over time.

This retrospective study evaluates the clinical and radiographic outcomes of simultaneous guided bone regeneration (GBR) and implant placement procedures in the rehabilitation of partially edentulous and horizontally atrophic dental arches using resorbable membranes. A total of 49 patients were included, and 97 implants were placed. Patients were followed up for 3 to 7 years after loading. The data indicate that GBR with simultaneous implant placement and resorbable membranes can be a good clinical choice, and the data suggest that it could be better to horizontally reconstruct no more than 3 mm of bone in order to reduce the number of complications and to obtain stable results. However, this technique remains difficult and requires expert surgeons.

Background: Peri-implantitis is a multi -factorial disease that affects dental implants surrounding tissues. The identification of risk factors and risk indicators could contribute to explain the heterogeneity of the disease onset and progression. The aim of the present study is to investigate the influence of implant surface roughness and other initial conditions on the future development of peri-implantitis disease by means of a pooled individual data. Methods: A total of 203 patients from four previous cohort studies were included. The patient included received a total of 630 dental implants between 1985 and 2013, with a mean follow-up time of 13 years. Results: The multilevel regression analysis demonstrated that the smoking habit [odds ratio (OR) 2.939 with a 95% confidence interval (CI): 1.236-6.988], the presence of a rough surface implant (OR 4.877 with a 95% CI: 1.701-13.980) and the implant position in the mouth (anterior mandible OR 3.842 with a 95% CI: 1.080-13.671; posterior mandible OR 6.618 with a 95% CI: 2.437-17.975) were statistically associated with onset of peri-implantitis. Conclusions: Within the limitation of the retrospective nature of this pooled analysis, it can be concluded that the peri-implantitis disease is correlated with many factors other than biofilm accumulation. The role of initial marginal bone loss (MBL) on the occurrence of peri-implantitis is uncertain.

The role of antibiotics as adjunctive therapy in the non-surgical treatment of peri-implantitis is uncertain. The aim of this systematic review of randomized controlled trials was to assess the efficacy of antibiotic therapy, local or systemic, as an adjunctive to the non-surgical therapy of peri-implantitis. Primary outcomes were: implant success rate and complications, changes in radiographic bone level, probing pocket depth (PPD), probing attachment level (PAL), bleeding on probing (BOP) and peri-implantitis resolution. Six studies were included: two using topical and four systemic antibiotics. Adjunctive local antibiotics improved PPD (mean difference (MD) = 0.6 mm; 95% CI 0.42–0.78), BOP (MD = 0.15% (95% CI 0.10, 0.19)) and the success rate (risk ratio = 9.89; 95% CI 2.39–40.84). No significant difference in bone level and success rate were found with the use of systemic antibiotics, although they appeared to improve PPD (MD = 1.15 mm; 95% CI 0.31–1.99) and PAL (MD = 1.10 mm; 95% CI 0.13–2.08). Within the limitations of this review, the adjunctive local antibiotics showed improved outcomes in terms of success rate, PPD and BOP, while adjunctive systemic antibiotics improved PPD and PAL only. Peri-implantitis resolution was about 20–30% using adjunctive local antibiotics, whilst it ranged from 2% to 65% with adjunctive systemic antibiotics. Findings are still controversial, since they are based on few studies with high heterogeneity, at the uncertain or high risk of bias and involve few patients. Non-surgical debridement and maintenance periodontal support therapy remain pivotal and the adjunctive use of antibiotics for peri-implantitis cannot be routinely recommended, even considering the increasing concern on antibiotic resistance.

OBJECTIVES To compare the one-year aesthetic results of flapless single implants, placed in fresh extraction sockets with bone replacement and immediate provisional restoration with or without a connective tissue graft (CGT). MATERIAL AND METHODS The present study proposes a partially blinded multicenter parallel randomized controlled trial, where computer-generated tables were used for central randomization to allocate treatments. 59 out of the 60 patients screened by eight private practices in Northern Italy fulfilled the inclusion criteria. Immediate implants was placed in a fresh extraction socket with a non-functional immediate provisional restoration with (Test group) or without (Control group) a CGT. The primary outcome variable was the implant Crown Aesthetic Index (ICAI) at the 1-year follow-up. RESULTS ICAI for the 59 randomized patients (Test group = 31, Control group = 28) at the 1-year follow-up was 4.69 (95% CI = 3.16 - 6.22) for the Test group and 3.45 (95%CI = 1.83-5.08) for the Control group, without statistically significant difference between the two groups (p=0.086). One implant failure was recorded in each group, resulting in an implant survival rate of 96.8% [95%CI = 83.3 - 99.9] for the Test group and 96.4% [95%CI = 81.7 -99.9] for the Control group. Other secondary outcome variables and complication rates were comparable across the two groups. CONCLUSIONS Within the limitations of the present clinical trial, the results suggested that the adjunct use of CTG is not mandatory to achieve successful aesthetic outcomes for a well-planned immediate implant placement with immediate non-functional provisional restoration in a fresh extraction socket.

AIM AND OBJECTIVE The aim of the present split-mouth prospective study was to evaluate clinically and histologically the bone regeneration obtained following preprosthetic vertical bone augmentation performed with titanium-reinforced dense polytetrafluoroethylene membrane (d-PM) compared to titanium mesh (TM). MATERIALS AND METHODS Healthy adult patients presenting with bilateral partial edentulism in the posterior mandible requiring vertical ridge augmentation for implant placement purposes were consecutively included. One side of the mandible was randomly assigned to the use of d-PM, the other to TM. The graft consisted in a mixture of autogenous bone harvested nearby the surgical site and deproteinized bovine bone mineral particles in a 1:1 ratio. On each side during bone augmentation surgery, a 2-mm diameter mini-implant was inserted for clinical and histological analyses. After a healing period of 8 months, the second surgical phase was carried out to remove the nonresorbable barriers, to evaluate clinically the vertical bone gain, and to collect a bone biopsy that included the mini-implant. During the same surgical session, dental implants were inserted in a prosthetically guided position. RESULTS A total of five patients were enrolled. Eight out of 10 sites healed uneventfully. In the remaining two sites, premature exposure of the TM was observed. Mean vertical bone gain of 4.2 and 1.5 mm was achieved in d-PM and TM groups, respectively (p = 0.06). A mean mineralized tissue of 48.28 and 35.54% was observed in d-PM and TM groups, respectively (p = 0.51). CONCLUSION The vertical bone gain, although not significantly, was higher in the d-PM group. Similar histological outcomes were noticed if exposure did not occur. In case of wound dehiscence, major resorption was observed. CLINICAL SIGNIFICANCE Both d-PM and TM can be used to augment atrophic localized ridges vertically. The outcome of bone regeneration seems to be impaired by exposure of the device. How to cite this article: Maiorana C, Fontana F, Rasia dal Polo M, et al. Dense Polytetrafluoroethylene Membrane versus Titanium Mesh in Vertical Ridge Augmentation: Clinical and Histological Results of a Split-mouth Prospective Study. J Contemp Dent Pract 2021;22(5):465-472.

In everyday practice, surgeons have to deal with bone atrophy. These rehabilitations are even more complex in the posterior mandible, and it is still unclear in the literature which fixed rehabilitation option is best. The purpose of this article was to help oral surgeons to choose the proper and updated treatment for their atrophic patients. Posterior mandible bone atrophies were divided into four main groups depending on the bone height measured above the inferior alveolar nerve: (1) ≤ 4 mm; (2) > 4 mm ≤ 5 mm; (3) > 5 mm ≤ 6 mm; (4) > 6 mm < 7 mm. Different approaches were proposed for each group, considering patient expectations. If ≤ 4 mm of bone height was available, guided bone regeneration was used as the adequate approach. For bone heights > 4 mm and ≤ 6 mm, the "sandwich" technique and/or short implants were used, depending on esthetics. In cases with > 6 mm and < 7 mm above the mandibular canal, short implants might be the proper option. The authors' clinical experience and the literature were considered in order to suggest a possible correct treatment decision based on the residual bone height in the posterior mandible.

This prospective longitudinal clinical trial aimed to evaluate the success of a bone-level implant with an integrated platform-switched connection by assessing peri-implant soft tissue and marginal bone level. Twenty-six patients were treated in two different centers with implants placed in healed partially edentulous ridges. Implant success rate and marginal bone level were evaluated with photographs, radiographs, and clinical measurements, with a 6-month postloading follow-up. The esthetic appearance of the photographed peri-implant soft tissue was evaluated at 6 months via the Pink Esthetic Score applied by two calibrated operators. All of the implants except for one placed in the mandible demonstrated successful osseointegration, resulting in a success rate of 97.8% at the 6-month follow-up. Compared to historical controls, no detectable differences in peri-implant marginal bone loss or esthetic outcome were seen.

Background: Guided Bone Regeneration (GBR) has become one of the treatment options to augment the bone. Nevertheless, it remains a potential challenge due to the technique complexity and because of the need for experienced operators. Results from the literature are encouraging but little data exist about the long-term stability and resorption of the augmented bone. In addition, very limited data indicate how much bone it is possible to regenerate with success and with an acceptable complication rate. Aim/Hypothesis: To evaluate clinical and radiographic outcomes of GBR procedures in the rehabilitation of partially edentulous atrophic jaws with a 3 to 7-year follow-up, with a special focus on trying to evaluate a possible threshold on maximum vertical bone gain especially in the posterior mandible. Materials and Methods: A retrospective study was conducted including patients with previously partially edentulism, bone atrophy treated with GBR performed with NO-resorbable membranes and with at least 3 years of follow-up. In 1-stage approach implants were placed after flap releasing. A 1:1 mixture of particulated autogenous bone and of bovine-derived xenograft was used. NO-resorbable membranes used were made of polytetrafluoroethylene titanium-reinforced. In 2-stage approach implants were placed after the removal of the membrane (9 months after), left submerged and exposed 4 months later. Temporary prostheses were delivered 3-4 weeks after implant exposure and definitive prostheses were delivered 6 months later. Outcomes measures were: biological complications; implant and prosthetic failures; vertical and horizontal mean bone gain; peri-implant marginal bone level changes. Data were summarized using frequencies, means and standard deviations. P < 0.05 was set as the level for statistical significance. Results: 58 GBR procedures were considered and 122 implants (In-Kone, Global D, France) were placed. The total of 58 patients had a follow-up of 3 years, 38 patients had a follow-up of 5 years, 28 patients had a follow-up of 7 years. Twelve temporary paresthesia lasting from 1 to 8 days occurred after augmentation procedure with full recovery. 4 premature exposure of the membrane (6.9%) were reported. 2 implants and, as a consequence, the prosthesis failed in the same patient (survival rate: 98.4%). A statistically significant difference was found in the number of patients with complications (14 complications in patients with bone height increase > 6 mm, P = 0.046) and paresthesia (9 vs 3, P = 0.039) when the bone height increase was > 6 mm in the posterior mandible. Mean bone width after reconstructive surgery was 8.03 ± 1.45 mm with a mean increase of 1.40 ± 1.37 from baseline. At 3, 5 and 7 years after loading implants gradually lost statistically significant marginal peri-implant bone. Conclusions and Clinical Implications: Within the limitations of the study, in order to reduce the number of complications increasing success rate and bone stability during time, vertical augmentation in posterior mandible should be limited up to 6 mm, probably due to the biology concept because the greater is the increase, the longer is the distance away from the native bone that guarantees blood supply and cells. This technique requires expert surgeons and these findings should be confirmed by RCTs with long follow-ups. Keywords: Guided bone regeneration, Edentulous jaws, Atrophic jaws, NO-resorbable membrane, vertical bone gain

The aim of this retrospective study was to evaluate clinical and radiographic outcomes of guided bone regeneration (GBR) procedures in the rehabilitation of partially edentulous atrophic arches. A total of 58 patients were included with a follow-up of 3 to 7 years after loading. Data seem to indicate that GBR with nonresorbable membranes can be a good clinical choice and suggest that it could be used to vertically reconstruct no more than 6 mm of bone in the posterior mandible. However, this technique remains difficult and requires expert surgeons.

A short inflammatory phase and fast ingrowth of blood vessels and mesenchymal cells are essential for tissue integration of a biomaterial. Macrophages play a key role in this process. We investigated invasion of macrophages, blood vessels, and proliferating cells into a highly porous and volume-stable collagen matrix (VCMX) used for soft tissue augmentation around teeth and dental implants. The biomaterial was implanted in submucosal pouches in the canine maxilla, and the tissue response was analyzed at six different time points. Immunohistochemistry was done for proliferating cells (PCNA), macrophages (MAC387), multinucleated giant cells (CD86), and blood vessels (TGM2). Blood rapidly filled the VCMX pores. During the first week, MAC387+ cells populated the VCMX pores, blood vessels and PCNA+ cells invaded the VCMX, and CD86+ scattered cells were observed. At 15 days, MAC387+ cells were scanty, blood vessels had completely invaded the VCMX, the number of proliferating cells peaked, and fibroblasts appeared. At 30 days, MAC387+ were absent, the numbers of proliferating and CD86+ cells had declined, while blood vessel and fibroblast numbers were high. At 90 days, residual VCMX was well-integrated in soft connective tissue. In conclusion, the VCMX elicited a short inflammatory phase followed by rapid tissue integration.

BACKGROUND AND AIMSBone augmentation procedures to enable dental implant placement are frequently performed. The remit of this working group was to evaluate the current evidence on the efficacy of regenerative measures for the reconstruction of alveolar ridge defects.MATERIAL AND METHODSThe discussions were based on four systematic reviews focusing on lateral bone augmentation with implant placement at a later stage, vertical bone augmentation, reconstructive treatment of peri-implantitis associated defects, and long-term results of lateral window sinus augmentation procedures.RESULTSA substantial body of evidence supports lateral bone augmentation prior to implant placement as a predictable procedure in order to gain sufficient ridge width for implant placement. Also, vertical ridge augmentation procedures were in many studies shown to be effective in treating deficient alveolar ridges to allow for dental implant placement. However, for both procedures the rate of associated complications was high. The adjunctive benefit of reconstructive measures for the treatment of peri-implantitis-related bone defects has only been assessed in a few RCTs. Meta-analyses demonstrated a benefit with regard to radiographic bone gain but not for clinical outcomes. Lateral window sinus floor augmentation was shown to be a reliable procedure in the long term for the partially and fully edentulous maxilla.CONCLUSIONSThe evaluated bone augmentation procedures were proven to be effective for the reconstruction of alveolar ridge defects. However, some procedures are demanding and bear a higher risk for post-operative complications.

The aim of this study is to evaluate the long-term performance of anodized surface implants placed in native bone and followed-up for up to 17 years. Success and survival rates, prevalence of peri-implantitis, and the correlation between the presence of peri-implantitis and other clinical and demographic variables were calculated. After a mean follow-up time of 10.4 years (range: 5 to 17 years), 91.7% of 223 analyzed implants were still in function. Peri-implantitis affected 63 implants (28.3%) in 26 patients (44%). Eleven implants with peri-implantitis (4.9%) failed. Within the limits of this retrospective analysis, anodized implants appear to be prone to peri-implantitis, mainly in the posterior mandible and in patients with unsatisfactory plaque control.