International journal of oral implantology (Berlin, Germany)最新文献

Background: Clinicians are often faced with changes in socket anatomy after tooth extraction. Extraction socket management can be challenging, particularly in the aesthetic zone. Before an implant-based treatment can be proposed, a detailed diagnosis of the defect type must be made and a treatment plan developed accordingly to ensure the long-term stability of peri-implant tissues.

Materials and methods: The present authors developed a new extraction socket classification and associated recommendations for planning and execution of immediate dentoalveolar restoration.

Results: The classification is based on six criteria: the bony anatomy of the 360-degree socket, socket health, facial gingival recession, periodontal biotype, bone density and apical height of the remaining bone. These criteria guide immediate dentoalveolar restoration planning so an optimal peri-implant tissue structure and aesthetic outcome can be achieved, and enabled long-term resolution in a complex clinical case.

Conclusions: When planning post-extraction treatment that is effective and predictable in the long term, 360-degree anatomical classification of the extraction socket must be performed to ensure that the treatment is proportional to the socket and surrounding soft tissue damage.

Conflict-of-interest statement: The authors declare there are no conflicts of interest relating to this study.

The following amendments are made to the published article: Int J Oral Implantol (Berl) 2021;14(2):213-222; First published 12 May 2021.

Purpose: To review and compare the available literature on bone regeneration using titanium mesh and map the current evidence on bone gain outcomes and complications while comparing this scaffold with collagen membranes.

Materials and methods: A comprehensive electronic and manual search was performed to identify randomised and non-randomised prospective controlled clinical trials that involved the use of titanium mesh in at least one arm, with outcomes including complications and vertical and/or horizontal bone gain. The focused questions were defined as follows: What are the outcomes of using titanium mesh in ridge augmentation compared to other types of barrier membrane, and what is the complication rate (membrane exposure and infection) when titanium mesh is used in these procedures?

Results: A total of 22 articles were included in the qualitative analysis. Overall, the studies that measured bone gain resulted in 3.36 mm vertical (196 subjects; 95% confidence interval 2.44 to 4.64 mm, range 1.4 to 5.7 mm) and 3.26 mm horizontal augmentation (81 subjects; 95% confidence interval 2.93 to 3.63 mm, range 2.6 to 3.7 mm), with variability among studies. The most commonly noted complication was mesh exposure, regardless of the type of mesh used, and the second most common was graft failure. The overall pooled complications rate reported in clinical trials was 10.8%. The meta-analysis comparing titanium mesh and collagen membranes, controlling for the type of bone regeneration (staged or simultaneous with implant placement), failed to show a significant difference in horizontal bone gain between the two techniques.

Conclusions: Within the limitations of the present study and acknowledging the heterogeneity among the articles included, titanium mesh can serve as a feasible protective scaffold for bone regeneration with a relatively acceptable complication rate and in defects requiring around 4 mm 3D reconstruction. Data on patient-reported outcomes were scarce.

Conflict-of-interest statement: None of the authors have any financial interests, either directly or indirectly, in the products or information mentioned in the present article.

Purpose: Accurate extraction socket evaluation is crucial for aesthetic success with immediate implant placement. The present authors propose a socket classification system to assist selection of the approach most likely to offer an optimal aesthetic outcome. The objectives of this study were to describe this novel system and evaluate the inter-rater agreement.

Materials and methods: Socket type identification was based on three parameters: the position of the gingival margin in relation to the homologous tooth, the morphology of the buccal bone plate, and the interproximal attachment level (the latter two were evaluated through gingival probing). These data were used to identify four socket types, including three from a widely applied classification system, which were subdivided into two subtypes to give types 1A, 1B, 2A, 2B, 3A, 3B, 4A and 4B. After establishing a 'gold standard' classification, a questionnaire was sent to 50 postgraduate students and 45 experienced dental practitioners.

Results: A simple system was used to classify single extraction sockets from observations of marginal and interproximal tissues. In a sample of 95 examiners, the percentage agreement with gold standard classifications was 78.7% ± 0.023% [0.56% to 0.98%] and was not significantly influenced by the examiner's level of clinical experience (P > 0.05). Treatment recommendations were proposed for each socket type.

Conclusion: The single extraction socket classification for aesthetic outcomes simplifies the prediction of aesthetic outcomes and provides a rational basis for the approach to each socket type.

An advantage of treated implant surfaces is their increased degree of hydrophilicity and wettability compared with untreated, machined, smooth surfaces that are hydrophobic. The present preclinical in vivo study aimed to compare the two implant surface types, namely SLActive (Straumann, Basel, Switzerland) and nanohydroxyapatite (Hiossen, Englewood Cliffs, NJ, USA), in achieving early osseointegration. The authors hypothesised that the nanohydroxyapatite surface is comparable to SLActive for early bone-implant contact. Six male mixed foxhounds underwent mandibular premolar and first molar extraction, and the sockets healed for 42 days. The mandibles were randomised to receive implants with either SLActive (control group) or nanohydroxyapatite surfaces (test group). A total of 36 implants were placed in 6 animals, and they were sacrificed at 2 weeks (2 animals), 4 weeks (2 animals) and 6 weeks (2 animals) after implant surgery. When radiographic analysis was performed, the difference in bone level between the two groups was statistically significant at 4 weeks (P = 0.024) and 6 weeks (P = 0.008), indicating that the crestal bone level was better maintained for the test group versus the control group. The bone-implant contact was also higher for the test group at 2 (P = 0.012) and 4 weeks (P = 0.011), indicating early osseointegration. In conclusion, this study underscored the potential of implants with nanohydroxyapatite surfaces to achieve early osseointegration.

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.

Conflict-of-interest statement: The authors declare there are no conflicts of interest relating to this study.

Dental implants are a reliable treatment option for restoring missing teeth, but adequate bone quantity and quality are crucial for success. This case series presents four cases treated by different clinicians, all following very similar concepts for combined periodontal and vertical ridge augmentation using recombinant human platelet-derived growth factor-BB. All cases involved a severe periodontal defect requiring either extraction of the adjacent tooth or periodontal regeneration. Different bone grafts and membrane types were utilised. Although true periodontal regeneration cannot be said categorically to have occurred due to a lack of histological evidence, the clinical and radiographic findings suggest almost complete bone fill in all cases. This case series demonstrates that combined periodontal and vertical ridge augmentation using recombinant human platelet-derived growth factor-BB could be successful, but proper case selection and patient preparation for the possibility of multiple surgical procedures are recommended. Conflict-of-interest statement: At the time of preparing this manuscript, Dr Saleh was a clinical advisor for Lynch Biologics, Franklin, TN, USA. The other authors declare that they have no conflicts of interest relating to this study.

The following amendments are made to the published article: Int J Oral Implantol (Berl) 2024;17(1):105-117; First published 19 March 2024.

Purpose: Complex bone defects with a horizontal and vertical combined deficiency pose a clinical challenge in implant dentistry. This study reports the case of a young female patient who presented with a perforating bone defect in the aesthetic zone.

Materials and methods: Based on prosthetically guided bone regeneration, virtual 3D bone augmentation was planned. A 3D printed customised titanium mesh and the autogenous bone ring technique were then utilised simultaneously to achieve a customised bone contour. After 6 months, the titanium mesh was removed and connective tissue grafting was performed. Finally, implants were placed and the provisional and definitive prostheses were delivered following a digital approach. Vertical and horizontal bone gain, new bone density, pseudo-periosteum type and marginal bone loss were measured. Planned bone volume, regenerated bone volume and regeneration rate were analysed.

Results: Staged tooth shortening led to a coronal increase in keratinised mucosa. The customised titanium mesh and bone ring technique yielded 14.27 mm vertical bone gain and 12.9 mm horizontal bone gain in the perforating area. When the titanium mesh was removed, the reopening surgery showed a Type 1 pseudo-periosteum (none or < 1 mm), and CBCT scans revealed a new bone density of ~550 HU. With a planned bone volume of 1063.55 mm3, the regenerated bone volume was 969.29 mm3, indicating a regeneration rate of 91.14%. The 1-year follow-up after definitive restoration revealed no complications except for 0.55 to 0.60 mm marginal bone loss.

Conclusion: Combined application of customised titanium mesh and an autogenous bone ring block shows promising potential to achieve prosthetically guided bone regeneration for complex bone defects in the aesthetic zone.