Immediate implant placement and restoration shorten treatment time and help preserve alveolar structures, but achieving stable peri-implant tissues remains challenging. Titanium–zirconia hybrid tissue-level implants are designed to combine the osseointegration properties of titanium with the soft tissue advantages of zirconia. This prospective study evaluated survival, peri-implant bone stability, esthetic outcomes, and patient satisfaction of zirconia-collar implants placed immediately into extraction sockets and, when feasible, immediately restored. Twenty-seven patients received 58 implants immediately after extraction; 37

Implant retreatment following implant failure represents a biologically and technically demanding scenario, particularly in the esthetic zone. Sites of previous implant failure are frequently characterized by residual inflammation, altered bone physiology, and reduced regenerative potential, which may negatively affect the prognosis of replacement implants. A staged, biologically driven approach is therefore recommended to restore hard and soft tissues prior to implant replacement. This clinical case report describes the management of a compromised anterior maxillary site following implant failure using the Khoury technique with exclusive autogenous bone. A young female patient presented with significant esthetic impairment caused by improper implant placement performed earlier, resulting in excessive gingival display and inadequate prosthetic conditions. After atraumatic implant removal and site debridement, three-dimensional bone reconstruction was performed using thin cortical bone plates harvested from the mandibular retromolar area to stabilize autogenous particulate bone, without the use of biomaterials or barrier membranes. Implant placement was performed four months after augmentation in regenerated vital bone, allowing correct three-dimensional prosthetic positioning. Soft tissue optimization was achieved using a connective tissue graft. The patient was followed clinically and radiographically for up to seven years after implant placement. The long-term outcomes demonstrated stable peri-implant hard and soft tissues, satisfactory esthetic integration, and maintenance of regenerated bone volume over time. Within the limitations of a single case report, this clinical presentation supports the use of a staged autogenous bone-based regenerative approach for the management of extensive bone defects following implant failure in sites with compromised local biology.

Improving soft tissue quality and quantity around dental implants is crucial for successful outcomes. Platelet-Rich Fibrin (PRF) is showing promise in enhancing wound healing and implant stability. This systematic review aims to evaluate the clinical benefits of PRF in soft tissue regeneration around dental implants compared to standard methods. This systematic review adhered to the PRISMA guidelines and utilizing the PICO methodology, investigated the use of Platelet-Rich Fibrin (PRF) in soft tissue augmentation during implant therapy. The primary outcomes assessed include the width of keratinized mucosa and soft tissue thickness, comparing PRF interventions to standard techniques.The study included randomized controlled trials (RCTs) and comparative studies, focusing on human patients needing implant therapy with or without PRF. An extensive search of databases and manual references was conducted; data extraction involved assessing study quality and risk of bias, but due to high heterogeneity among studies, a meta-analysis was not feasible, leading to a systematic review of the available literature. A total of 766 references were initially identified, with 29 being eligible after screening. Nine studies were included for detailed review. The findings revealed that PRF is effective in increasing the width of keratinized mucosa (KT) and soft tissue thickness (STT) around implants. Even if free gingival grafts (FGG) sometimes performed better. However, the differences between PRF and FGG were not clinically significant, and PRF offers lower cost, ease of use, and reduced morbidity. There was limited information on the esthetic outcomes of PRF, with only two studies addressing this aspect, showing mixed results. Overall, PRF demonstrated positive effects on KT width and STT, but further research with rigorous methodology and larger sample sizes is needed to better understand its impact on implants health and esthetics.

Aims: Tooth extraction in the frontal area is associated with significant bone resorption, especially at sockets presenting with a thin buccal wall, such as most of the maxillary incisors. In the case of favorable residual hard and soft tissue anatomy, immediate implant placement in the esthetic area might be an opportunity to drive the alveolus healing course in the desired direction. Case presentation: In this clinical case, a fractured upper central incisor was replaced by an immediate two-piece implant covered with a healing screw. After 3 months, the implant was restored. The facial and interdental soft tissue was maintained with appreciable success at the 3-year follow-up visit. Conclusion: When immediate loading of the implant is not an option and the fresh extraction socket presents with fair soft tissue quality, the use of an interim healing screw might help sustain and prevent the shrinkage of peri-implant tissues. This simple technique might be a valuable option when there is no indication for adjunctive hard or soft tissue grafting or immediate loading feasibility conditions.

Background: Periodontitis is a chronic inflammatory condition associated with dysbiosis of the oral microbiota. The aim of the present clinical study was to explore the adjunctive effect of ozonized water irrigation in the circuits of ultrasonic scalers for the full-mouth decontamination of patients with periodontitis Stage I or II.Methods: The study was a randomized, single-blinded, parallel-group clinical trial. The test group (n=25) was treated with ultrasonic scalers irrigated with ozonized water, whereas the control group (n=25) received normal tap water irrigation within the ultrasonic scalers used during the professional mechanical debridement. Full mouth plaque score, bleeding score, probing pocket depth, and the gingival index were evaluated at baseline, two, and 4 weeks after treatment. The pain perceived and dental anxiety were also assessed after treatment by means of the visual analog scale (VAS). Results: All periodontal parameters resulted in significant improvement for both study groups. The effect of the treatment group on the gingival index was significant, in particular, patients in the test group experienced a greater reduction in this score. No significant differences could be observed with regards to the average probing depth, full mouth plaque index and bleeding score. Patients treated with ozonized water running in the circuits of ultrasonic scalers displayed also lower scores for pain and dental anxiety. Conclusion: The present study showed a significant clinical effect on gingival inflammation attributable to adjunctive ozone irrigation during nonsurgical periodontal therapy. Further studies, including patients with severe periodontitis and greater sample sizes, are recommended to test the clinical effect of ozonized water in the circuits of ultrasonic scalers.

The placement of immediate implants in compromised sockets often requires adjunctive reconstructive measures. In particular, the loss of integrity of the buccal wall may preclude implant placement or, at least, it requires contextual, guided bone regeneration. There is no uniform consensus regarding the best biomaterial or strategy to reconstruct buccal bone defects.

PURPOSE:To examine the remodeling process of both the soft and hard tissue components of the postextraction socket around immediately loaded dental implants after tooth extraction in maxillary esthetic areas.MATERIALS AND METHODS:Subjects underwent immediate placement of single implants in postextraction sockets without bone grafting, and their immediate provisionalization with custom tooth-like interim crowns were fabricated using digital diagnostic impressions and a dental milling machine. Intraoperative and 1-year follow-up layered scans of the postextraction sockets after implantation were acquired using a 3D optical system. In the short term, subjects underwent computed tomographic scans. Digital impressions for gingival contours, originally stored as STL (standard tessellation language) files, were converted to DICOM (Digital Imaging and Communications in Medicine) files with the implant shoulder working as a referral point, which were then superimposed to 3D radiologic images. The observed volumetric and linear outcomes were measured using a program known as DentaScan. The width of the alveolar crest at the level of the implant shoulder and marginal bone levels were acquired. Nonparametric tests were applied with a level of significance set at P < .01.RESULTS:No failure was reported after a follow-up of 1 year. Little or no inflammation of the treated areas was registered, and there were practically no signs of suppuration. The areas showed a significant reduction in the overall volumes for both soft and bone tissue, with a P value < .0001 from the baseline (0.983 ± 0.172 cm3) to the 1-year survey (0.865 ± 0.156 cm3). If the soft and bone tissue changes were separately evaluated, a significant loss (with a P value < .0001) was registered for only the bone tissues (from 0.434 ± 0.075 to 0.355 ± 0.061 cm3). Moreover, changes in gingival tissue from baseline to the 1-year survey (-0.040 ± 0.067) appeared to be significantly different from the overall volume loss (-0.118 ± 0.083 cm3). A shrinkage in width (-0.5 ± 0.7 mm) was found from baseline (12.6 ± 0.6 mm) to the 1-year follow-up (12.1 ± 0.9 mm). Marginal bone levels were 0.97 ± 0.70 mm and 0.39 ± 0.78 mm, respectively, at the mesial and distal aspects of the implants.CONCLUSIONS:The present analysis suggested that immediately customized provisionalization was effective enough to prevent both volume loss and linear shrinkage at the layers of the treated areas. Moreover, the buccal aspects seemed to be the areas most affected by the loss of volume. The mean loss in width, which amounted to roughly 0.5 mm, appeared to be negligible when compared to the overall width measured before surgery.

Background: Aphthous stomatitis is a common disease of the oral mucosa and its pathogenesis is associated with several risk factors. Frequently, minor ulcers are idiopathic in nature and often resolve naturally. However, those ulcers are painful and sensibly compromise patients’ eating. There are different treatment strategies for the clinical management of oral aphthae. Methods: The present study assessed the efficacy of a film-forming cream in accelerating the healing and diminishing the pain associated with minor aphthae in a randomized fashion design. The test product (AphtoFixⓇ) was compared with placebo cream in a cohort of patients with a diagnosis of minor recurrent stomatitis. Patients were randomly distributed into two groups and were followed for 10 days. The primary outcomes included the number of days until symptoms were relieved and the number of days to complete healing. Results: Thirty-six patients completed the follow-up, eighteen per group. All lesions eventually healed within day 10. However, patients in the test group experienced significantly less pain, already from day 1. Patients in the test group also showed a faster healing rate of the lesion with an average of 7 days against the 9 days required for patients in the control group. Conclusion: The present study supported the utility of a film-forming in cream in relieving the patient from symptoms associated with aphthous stomatitis already at day 1 of product use. Patients also displayed faster healing of the lesions when compared to the control group. Further studies with greater sample size and patient stratification according to age and risk factors are recommended to support the present findings.

Aim: Bacterial plaque is associated with periodontal inflammation. The aim of this study was to prospectively assess the clinical effectiveness of two different agents in a staged approach for nonsurgical periodontal treatment in terms of clinical and patients related outcomes in a cohort of patients with periodontitis: NitrAdine (R)-based disinfectant formula (PerioTabs (R)) vs. Chlorhexidine (CHX) 0.12% toothpaste and mouthwash 0.20%. Materials and Methods: In the current randomized investigation, patients diagnosed with periodontal disease (stages I-III) scheduled for nonsurgical periodontal therapy were assigned at random to utilize PerioTabs (R), a NitrAdine (R) brushing solution, or a CHX mouthwash at home. After 10-15 days of product use, active decontamination using sonic scalers and powders was carried out. The study's outcomes were tracked at the beginning, throughout the professional intervention, and 30 and 90 days later. Assessments were made of clinical and patient-related factors. For the purposes of descriptive and inferential statistics, the chosen variables were entered into a virtual environment. Results: Forty patients were included in the final analysis. All patients showed major clinical and patient-related outcomes improvement after therapy at each time point. In the PerioTabs (R) group, the decrease in the bleeding score observed after the initial 10-day preparatory period (before active decontamination) was greater than in the CHX group, respectively, -45.17 +/- 4.69% and -21.51 +/- 2.07%. Conclusion: This study reported that the staged approach improved the clinical effectiveness of periodontal treatment in patients with periodontal disease and further suggests that PerioTabs (R) can be used as an efficient alternative to CHX as an adjunctive antimicrobial intervention prior to active decontamination.

The present report describes the rehabilitation of partial edentulism (Kennedy's class II) in an elderly woman presenting with severe atrophy of the posterior maxilla, preventing standard implant placement. The woman had a positive history for osteoporosis and ongoing oral bisphosphonates therapy, thus, bone regeneration procedures, such as sinus lifting, were ruled out from the available options for her. Plus, the woman desired immediate fixed rehabilitation, thus, a 3D-printed custom subperiosteal implant was planned. The entire process, from impression acquisition to implant production was implemented in a digital setting and completed in three weeks. The surgeon was in charge of designing general implant features and the number, size, and position of future abutments. At surgery, the implant showed excellent fit and stability. One year after loading, the implant showed perfect integration and no complication could be recorded. Custom subperiosteal implants might represent a valid alternative for the rehabilitation of severely resorbed maxilla in elderly patients who cannot or do not want to undergo bone regeneration procedures. Further studies with large sample size and longer follow-up are recommended.

The design of the implant prosthesis–abutment complex appears crucial for shaping healthy and stable peri-implant soft tissues. The aim of the present animal study was to compare two implants with different healing abutment geometries: a concave design (TEST) and a straight one (CTRL). Transmission electron microscopy (TEM) was used to quantify the three-dimensional topography and morphological properties of collagen at nanoscale resolution. 2 swine were included in the experiment and 6 implants per animal were randomly placed in the left or right hemimandible in either the physiologically mature bone present between the lower canine and first premolar or in the mandibular premolar area, within tooth extraction sites. Each CTRL implant was positioned across from its respective TEST implant on the other side of the jaw. After 12 weeks of healing, 8 specimens (4 CTRL and 4 TEST) were retrieved and prepared for histological and TEM analysis. The results showed a significantly higher percentage of area covered by collagen bundles and average bundle size in TEST implants, as well as a significant decrease in the number of longitudinally oriented bundles with respect to CTRL implants, which is potentially due to the larger size of TEST bundles. These data suggest that a concave transmucosal abutment design serves as a scaffold, favoring the deposition and growth of a well-organized peri-implant collagen structure over the implant platform in the early healing phase, also promoting the convergence of collagen fibers toward the abutment collar.

Significant alveolar bone resorption follows tooth extraction. Immediate implant placement alone is not sufficient to prevent this phenomenon. The present study aims at reporting the clinical and radiologic outcome of an immediate implant with a custom healing abutment. In this clinical case, a fractured upper first premolar was replaced by an immediate implant and a customized healing abutment designed on the perimeter of the extractive alveolus. After 3 months, the implant was restored. The facial and interdental soft tissue was maintained with appreciable success after 5 years. The pre-and 5-year post-treatment computerized tomography scans showed bone regeneration of the buccal plate. Use of an interim customized healing abutment helps prevent hard- and soft-tissue collapse and promotes bone regeneration. This technique is straightforward and may represent a smart preservation strategy when there is no indication for adjunctive hard or soft tissue grafting. Given the limited nature of this case report, further studies are needed to confirm the present findings.

Background: After tooth extraction, the alveolar bone loses volume in height and width over time, meaning that reconstructive procedures may be necessary to perform implant placement. In the maxilla, to increase the bone volume, a mini-invasive surgery, such as a sinus lift using the crestal approach, could be performed. Methods: A crestal approach was used in this study to perform the sinus lift, fracturing the bone and inserting collagen (Condress®). The single dental implant was placed in the healed bone after six months. Results: The newly formed bone was histologically analyzed after healing. Histomorphological analyses confirmed the quality of the new bone formation even without graft biomaterials. This is probably due to the enlargement of the space, meaning more vascularization and stabilization of the coagulum. Conclusion: Using just collagen could be sufficient to induce proper new bone formation in particular clinical situations, with a minimally invasive surgery to perform a sinus lift.

Background: Hyaluronic acid and amino acids play an important role in the wound healing process, stimulating the development of the connective tissue and the activity and proliferation of fibroblasts. The aim of the present controlled clinical study was to evaluate the clinical efficacy of a topical gel formula containing hyaluronic acid and amino acids in terms of wound closure rate, painkiller intake, and patients’ reported pain and edema. Methods: This study included patients in need of a single tooth extraction. Patients were randomized into two groups with differing post-operative care regimens. Patients in the test group used the amino acid and hyaluronic acid-based gel, while the control group did not use any product. Each parameter was measured in both groups at different time points: immediately after surgery, and after 7, 14, 30, and 60 days. Results: A total of 40 patients (46.52 ± 9.84 years old) completed the observational period, and 40 extraction sockets were examined. After 7 days, the edema was significantly lower in the test group. The reported pain was lower in the test group without a significant difference, except for the first time point at 7 days. With the follow-up questionnaire, patients declared to have taken painkillers mainly during the first 7 days after surgery; however, the test group showed a lower need for painkillers than the control group. Conclusion: The post-operative and domiciliary use of an amino acid and hyaluronic acid-based gel for the management of soft tissue closure after tooth extraction is a valid coadjutant to reduce swelling, pain, and the need for painkillers. Additional studies are required to support the results of the present study.

INTRODUCTION:Immediate implant in the esthetic area is a challenging procedure. Chronic infection often contributes to extensive bone loss and acute infection often precludes a safe, clean surgery. However, it is quite common to come across failing teeth in the esthetic area, where the patient often demands a faster rehabilitation. CASE PRESENTATION:In this clinical case, a fractured upper central incisor was replaced by an immediate implant, and the perimetrical area was filled with heterologous bone blended with patient-derived leukocyte- and platelet-rich fibrin (L-PRF) in the form of sticky bone. A Maryland bridge was bonded to the adjacent teeth with the intent to guarantee minimum esthetic to the patient. After 5 months, the implant was connected to a definitive abutment and crown. The facial and interdental soft tissue was maintained with appreciable success after 2 years. The pre-treatment and 2-year- post-treatment computed tomography scans revealed marginal bone preservation. CONCLUSION:The use of sticky bone and L-PRF in immediate implant sites helps prevent hard and soft-tissue collapse and may favor faster and sounder healing. KEY POINTS:Why is this case new information? It provides support to the efficacy of immediate implant placement with simultaneous use of L-PRF. What are the keys to successful management of this case? Having L-PRF supporting wound healing. What are the primary limitations to success in this case? Having sufficient bone apical to the existing socket and at adjacent teeth.

The healing process of the tooth extraction socket often leads to significant resorption of the alveolar bone, eventually causing clinical difficulties for future implant-supported rehabilitations. The aim of the present animal study was to evaluate alveolar bone remodeling after tooth extraction in a rabbit model, either with or without the use of a plain collagen plug inside the socket, by means of micro-computed tomography. The study included the micro-tomography analysis of 36 rabbits’ incisor extraction sockets, either left empty or filled with a collagen plug. All animals were euthanized in a staggered manner, in order to address molecular, histologic, and radiographic analyses at different time-points, up to 90 days after surgery. The three-dimensional evaluation was carried out using micro-computed tomography technology on excised bone blocks including the alveolus and the contralateral bone. Both linear and volumetric measures were recorded: the percentage of bone volume change (ΔBV) within the region of interest was considered the primary endpoint of the study. The micro-CT analysis revealed mean volumetric changes of −58.1% ± from baseline to 3 months for the control group, and almost no bone loss for the test group, −4.6%. The sockets treated with the collagen plug showed significantly less dimensional resorption, while the natural-healing group showed an evident collapse of the alveolar bone three months after extraction surgery.

Abstract Background: Diabetes is a chronic condition associated to higher levels of systemic oxidative stress. This might pose a risk of failure for implant therapies. However, there is insufficient data regarding the long-term implant survival in patients with diabetes assessing different implant designs and complementary information related to patients’ general oral health status. The aim of this cohort study was to investigate the survival and success rates of titanium-zirconia tissue-level dental implants in patients with a history of T2DM and to assess the outcome according to glycemic control and oxidative stress levels.Methods: The present cross-sectional study evaluated the implant success among a cohort of patients diagnosed with diabetes type II and rehabilitated with titanium-zirconia tissue-level implants. Blood and salivary oxidative stress has been scored at different time points with U CARR units. Results: Thirty-seven implants in twenty-eight patients have been included in the analysis. All implants were healthy, not showing pathological bone loss neither signs or symptoms of mucositis/peri-implantitis at the last follow-up visit. Local and systemic stress appeared unrelated. The blood test scored an average value of 367±71.8 U CARR which is to be expected in a diabetic cohort, with no difference on the basis of glycemic control. The average salivary test score was 2203±364 U CARR, which is within the limits of a healthy range. This test was found to be higher in diabetic patients showing poor glycemic control. Conclusion: Tissue level implants are a reliable solution in diabetic patients with varying levels of glycemic control and systemic oxidative stress, as long as the general oral health is preserved. Assessment of salivary antioxidants could be a non-invasive beneficial procedure to routing patients to the appropriate treatment plan, discouraging elective surgical procedure unless strict hygiene measures are followed.

Background: Orthopantomography (OPG) is usually used as a primary diagnostic radiological exam in the planning of third molar surgery because it is deeply available in dental clinics and has lower radiation doses compared to Cone-beam computed tomography (CBCT). The OPG provides a bi-dimensional image, but several radiological signs have been proposed to study the position of the lower third molar and to predict surgical risks. Methods: Patients were divided into two groups, the OPG with a radiolucent area (D-group) and the OPG without any sign (C-group) in correspondence of inferior wisdom tooth roots. Results: The mean distance between the inferior third molar root and the lingual cortical mandibular bone was −1.09 ± 1.5 mm. The nearness of the root that is less than 1 mm was more frequent in the D-group (84.85%) compared to the C-group (14.58%) with statistical significance (Odd ratio: 32.8) using the Chi-square test. Conclusions: When the root of the impacted inferior third molar is impacted into the lingual cortical plate, a periapical band-like radiolucent sign may appear in the OPG image. It could be useful for the prediction of root position and surgical risks.

Abstract Background The aim of this retrospective study was to document the long-term clinical efficacy of a surgical-prosthetic technique (the flat one-bridge technique) involving the immediate restoration of both postextraction and nonpostextraction implants supporting full-arch restorations. Methods Implants were placed by adapting the axis to the available bone. Flat definitive abutments were connected during surgery and never disconnected to compensate for eventual implant disparallelism. Bone grafting was performed when needed. The patients received a screw-retained provisional restoration within 48 h of surgery and a final screw-retained prosthesis within 1 year. Results Sixty-six patients received 494 implants distributed in 75 prostheses. The median follow-up was 86 months (range 82–168 months). Only three implants had failed at the last follow-up. Implant survival was 99.6%. Conclusion The flat one-bridge prosthetic protocol is a viable procedure with excellent long-term outcomes. No difference in clinical success could be observed between postextractive and nonpostextractive implants.