Publications by authors named "Luca Cordaro"

39 Publications

Influence of Bone Anatomy on Implant Placement Procedures in Edentulous Arches of Elderly Individuals: A Cross-Sectional Study on Computed Tomography Images.

Int J Oral Maxillofac Implants 2020 Sep/Oct;35(5):995-1004

Purpose: To describe the prevalence of alveolar bone atrophy in edentulous arches of elderly individuals in relation to insertion of dental implants and the eventual need for bone grafting procedures.

Materials And Methods: Computed tomography scan files of 228 edentulous arches of elderly patients (ages 65 to 100 years) were evaluated in relation to implant placement. Six measurements per arch were taken on cross-sectional reconstructions. Bone atrophy categories were described, in relation to implant placement, for the anterior and posterior sections of the arches. Six bone sections per arch were evaluated and allocated to the predetermined categories. Prevalence of each type of atrophy was calculated.

Results: In the maxilla, only 5.0% of the patients showed a bone anatomy capable of receiving implants without any augmentation both in the posterior and anterior regions; 64.4% showed the need for major reconstruction in both areas. In the mandible, 17.3% of the patients did not require any augmentation in both regions; 9.4% were in need of major reconstruction in both areas. The anterior part of the arches could eventually be treated without any bone augmentation in 10.9% of the maxillae and 72.4% of the mandibles, while minor augmentation was needed in 16.8% of maxillae and 15.8% of mandibles.

Conclusion: Most edentulous elderly patients show some degree of alveolar bone atrophy. It is often feasible to insert implants in the anterior mandible to support a restoration. In most maxillary cases, alveolar atrophy calls for augmentation procedures in both the anterior and posterior areas. In elderly individuals, the anterior maxilla often shows bone deficiency interfering with simple implant placement procedures, thus also limiting the use of tilted implants.
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http://dx.doi.org/10.11607/jomi.8297DOI Listing
October 2020

Comparison of a polyethylene glycol membrane and a collagen membrane for the treatment of bone dehiscence defects at bone level implants-A prospective, randomized, controlled, multicenter clinical trial.

Clin Oral Implants Res 2020 Nov 21;31(11):1105-1115. Epub 2020 Sep 21.

Clinic of Reconstructive Dentistry, University of Zurich, Zurich, Switzerland.

Objectives: The aim of the present randomized, controlled clinical multicenter trial was to compare a polyethylene glycol (PEG) and a native collagen membrane (BG) for simultaneous guided bone regeneration at bony dehiscence-type defects around bone level titanium implants.

Material And Methods: The study enrolled 117 patients requiring implant treatment in the posterior maxilla or mandible with expected buccal bony dehiscence-type defects at the placed titanium implants. According to a parallel groups design, defects were filled with a synthetic bone filler and randomly assigned to either PEG or BG membrane. As primary parameter, the relative vertical bone fill was assessed at baseline and at re-entry after 6 months of healing. As secondary parameters, the marginal bone level (MBL) was assessed radiographically and soft tissue conditions were recorded up to 18 months postloading.

Results: Both groups showed comparable vertical bone fill revealing a relative change in defect height of 59.7% (PEG) and 64.4% (BG). The absolute mean reduction in defect size was 2.5 mm in the PEG group and 3.2 mm in the BG group. Although both groups revealed a statistically significant mean defect reduction (p < .001), a comparison between the two groups did not show statistical significances. The non-inferiority test with inferiority limit of -5% could not be rejected, based on the 90% confidence interval of the differences of the two means with lower limit -15.4%. After 18 months, an MBL increase of 0.45 ± 0.43 mm in the PEG group and 0.41 ± 0.81 mm in the BG group was detected (p < .001). Soft tissue complications were observed in both groups without showing statistical significance.

Conclusions: Both membranes supported bone regeneration at dehiscence-type defects and obtained vertical bone fill with a relative change in defect height of 59.7% (PEG) and 64.4% (BG); however, the non-inferiority of PEG could not be shown.
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http://dx.doi.org/10.1111/clr.13657DOI Listing
November 2020

Discrepancy between patient satisfaction and biologic complication rate in patients rehabilitated with overdentures and not participating in a structured maintenance program after 7 to 12 years of loading.

Int J Oral Maxillofac Implants 2019 September/October;34(5):1143–1151. Epub 2019 Jun 1.

Purpose: There is a lack of studies reporting long-term prevalence of peri-implant diseases in patients rehabilitated with overdentures and not receiving maintenance, which is a common situation. The aim of this cross-sectional study was to evaluate the patient satisfaction and rate of biologic complications in patients rehabilitated at least 7 years before with mandibular/maxillary overdentures, who for personal or economic reasons decided not to participate in a structured supportive maintenance program.

Materials And Methods: Each of the patients filled out a health and dental history and a visual analog scale (VAS)-based satisfaction questionnaire; additionally, the patients received a clinical examination and a panoramic radiograph. The prevalence of periimplant diseases and the patient satisfaction were reported. Moreover, presumed risk indicators of peri-implant diseases and implant loss were tested through univariate analyses and multivariate, time-adjusted, logistic regressions.

Results: A total of 52 patients who received 63 overdentures on 252 implants were included. The included patients showed a high degree of satisfaction (mean VAS = 6.3; SD: 2.1) and very low discomfort rates and would repeat the type of rehabilitation (mean VAS = 6.99; SD: 2.6). The prevalence of peri-implantitis was 30.8% at patient level and 19.4% at implant level, while 23.1% of patients experienced implant loss at any time. A clear tendency toward increased prevalence of biologic complications after the eighth year of loading was noted. In loading time-adjusted regression analyses, bone-level implants were associated with a higher prevalence of recession with no/minimal inflammation (OR = 3.37; 95% CI: 1.16 to 9.77; P = .025), while the maxillary arch was associated with both severe peri-implantitis (OR = 4.18; 95% CI: 1.03 to 16.97; P = .046) and implant loss (OR = 9.27; 95% CI: 3.41 to 25.14; P = .000).

Conclusion: Despite high levels of satisfaction, patients rehabilitated with overdentures not participating in a structured supportive schedule show high rates of biologic complications. For this reason, they should be strongly motivated, at the time of prosthesis delivery, to participate in a structured maintenance program.
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http://dx.doi.org/10.11607/jomi.7465DOI Listing
December 2019

Regeneration of alveolar ridge defects. Consensus report of group 4 of the 15th European Workshop on Periodontology on Bone Regeneration.

J Clin Periodontol 2019 06;46 Suppl 21:277-286

Graduate Implant Dentistry, Loma Linda University, Loma Linda, California.

Background And Aims: Bone 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 Methods: The 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.

Results: A 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.

Conclusions: The 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.
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http://dx.doi.org/10.1111/jcpe.13121DOI Listing
June 2019

European Association for Osseointegration Delphi study on the trends in Implant Dentistry in Europe for the year 2030.

Clin Oral Implants Res 2019 May 29;30(5):476-486. Epub 2019 Apr 29.

University of Lisbon School of Dental Medicine, Lisbon, Portugal.

Objectives: To assess the potential trends for the year 2030 in dental implant dentistry in Europe using the Delphi methodology.

Material And Methods: A steering committee and a management team of experts in implant dentistry were created and validated a questionnaire including 60 questions, divided in eight topics. The survey was conducted in two rounds using an anonymous questionnaire, which provided the participants in the second round with the results of the first. Each question had three possible answers, and the results were expressed as percentages.

Results: A total of 138 experts were invited to participate in the survey. From all the invited experts, 52 answered in both the first and second rounds. Three different consensus categories were established based on the percentage of agreement: no consensus (<65%); moderate consensus (65%-85%); and high consensus (≥86%). Within the topic categories, a consensus was reached (mainly moderate consensus) for the majority of questions discussed among experts during a face to face consensus meeting. However, consensus was not reached for a small number of questions/topics.

Conclusions: About 82% of the questions reached consensus. The consensus points towards a lower number of implants to replace chewing units, with implants surfaces made of bioactive materials with reduced micro-roughness using mainly customized abutments with polished surfaces and an internal implant-abutment connection (85%). CBCT-3D technologies will be the main tool for pre-surgical implant placement diagnosis together with direct digital restorative workflows. There will be an increase in the incidence of peri-implantitis, although there will be more efficient interventions its treatment and prevention.
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http://dx.doi.org/10.1111/clr.13431DOI Listing
May 2019

Group 3 ITI Consensus Report: Patient-reported outcome measures associated with implant dentistry.

Clin Oral Implants Res 2018 Oct;29 Suppl 16:270-275

Universidad Inter Continental, Mexico City, Mexico.

Objectives: The aim of Working Group 3 was to focus on three topics that were assessed using patient-reported outcome measures (PROMs). These topics included the following: (a) the aesthetics of tooth and implant-supported fixed dental prostheses focusing on partially edentulous patients, (b) a comparison of fixed and removable implant-retained prostheses for edentulous populations, and (c) immediate versus early/conventional loading of immediately placed implants in partially edentate patients. PROMs include ratings of satisfaction and oral health-related quality of life (QHRQoL), as well as other indicators, that is, pain, general health-related quality of life (e.g., SF-36).

Materials And Methods: The Consensus Conference Group 3 participants discussed the findings of the three systematic review manuscripts. Following comprehensive discussions, participants developed consensus statements and recommendations that were then discussed in larger plenary sessions. Following this, any necessary modifications were made and approved.

Results: Patients were very satisfied with the aesthetics of implant-supported fixed dental prostheses and the surrounding mucosa. Implant neck design, restorative material, or use of a provisional restoration did not influence patients' ratings. Edentulous patients highly rate both removable and fixed implant-supported prostheses. However, they rate their ability to maintain their oral hygiene significantly higher with the removable prosthesis. Both immediate provisionalization and conventional loading receive positive patient-reported outcomes.

Conclusions: Patient-reported outcome measures should be gathered in every clinical study in which the outcomes of oral rehabilitation with dental implants are investigated. PROMs, such as patients' satisfaction and QHRQoL, should supplement other clinical parameters in our clinical definition of success.
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http://dx.doi.org/10.1111/clr.13299DOI Listing
October 2018

Biomechanical aspects: Summary and consensus statements of group 4. The 5 EAO Consensus Conference 2018.

Clin Oral Implants Res 2018 Oct;29 Suppl 18:326-331

Implaneo Dental Center, Munich, Germany.

Objectives: The aim of the present publication was to report on the EAO Workshop group-4 discussions and consensus statements on the five reviews previously prepared. These reviews provided the scientific evidence on the effect of crown-to-implant ratio, on reconstructions with cantilevers in fully and partially edentulous patients, on biological and technical complications of tilted in comparison with straight implants, and on the effects of osseointegrated implants functioning in a residual dentition.

Material And Methods: The group discussed, evaluated, corrected where deemed appropriate, and made recommendations to the authors regarding the following five reviews submitted: (a) Is there an effect of crown-to-implant ratio on implant treatment outcomes?; (b) Implant-supported cantilevered fixed dental rehabilitations in fully edentulous patients; (c) and in partially edentulous patients; (d) Biological and technical complications of tilted implants in comparison with straight implants supporting fixed dental prostheses; (e) What are the adverse effects of osseointegrated implants functioning among natural teeth of a residual dentition? Based on the five manuscripts and the discussion among the group as well as the plenum members, the major findings were summarized, consensus statements were formulated, clinical recommendations were proposed, and areas of future research were identified.

Results: Crown-to-implant ratios ranging from 0.9 to 2.2 did not influence the occurrence of biological or technical complications also in single-tooth restorations. Reconstructions with cantilevers for the rehabilitation of fully and partially edentulous jaws showed high implant and reconstruction survival rates. In contrast, the rate of complications-in particular associated with veneering material-was high during the observation period of 5-10 years. The data reported were primarily derived from studies with high risk of bias. The data for single-implant reconstructions were small. There was no evidence that distally tilted implants were associated with higher failure rates and increased amounts of marginal bone loss. The data supporting these findings, however, were at high risk of bias and frequently incompletely reported. Frequent positional changes occurred between the natural teeth and the implant-supported restorations. These changes were more pronounced in younger individuals, and even though they were reduced with age, they still occurred in adult patients. Even though these changes were frequent, potential implications for the patient are unclear.

Conclusions: The use of single-tooth restorations with crown-to-implant ratio in between 0.9 and 2.2 may be considered a viable treatment option. Multiunit reconstructions with cantilevers are a viable treatment option in fully and partially edentulous patients. Clinicians and patients should be aware, however, that complications are frequent and primarily related to resin material used for veneering. There is some evidence that tilting an implant does affect stability of the implant and the surrounding bone. Treatment options to tilted implants should carefully be considered, as the effect on soft tissues and on prosthesis behavior is poorly reported for tilted implants. Positional changes in the dentition in relation to implant-supported restorations occur frequently. The patient should be informed about the possible need for a treatment related to these changes in the long term.
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http://dx.doi.org/10.1111/clr.13284DOI Listing
October 2018

Accuracy comparison of guided surgery for dental implants according to the tissue of support: a systematic review and meta-analysis.

Clin Oral Implants Res 2017 May 8;28(5):602-612. Epub 2016 Apr 8.

Eastman Dental Hospital, Rome, Italy.

Aim: To systematically assess the current dental literature comparing the accuracy of computer-aided implant surgery when using different supporting tissues (tooth, mucosa, or bone).

Material And Methods: Two reviewers searched PubMed (1972 to January 2015) and the Cochrane Central Register of Controlled Trials (Central) (2002 to January 2015). For the assessment of accuracy, studies were included with the following outcome measures: (i) angle deviation, (ii) deviation at the entry point, and (iii) deviation at the apex.

Results: Eight clinical studies from the 1602 articles initially identified met the inclusion criteria for the qualitative analysis. Four studies (n = 599 implants) were evaluated using meta-analysis. The bone-supported guides showed a statistically significant greater deviation in angle (P < 0.001), entry point (P = 0.01), and the apex (P = 0.001) when compared to the tooth-supported guides. Conversely, when only retrospective studies were analyzed, not significant differences are revealed in the deviation of the entry point and apex. The mucosa-supported guides indicated a statistically significant greater reduction in angle deviation (P = 0.02), deviation at the entry point (P = 0.002), and deviation at the apex (P = 0.04) when compared to the bone-supported guides. Between the mucosa- and tooth-supported guides, there were no statistically significant differences for any of the outcome measures.

Conclusions: It can be concluded that the tissue of the guide support influences the accuracy of computer-aided implant surgery.
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http://dx.doi.org/10.1111/clr.12841DOI Listing
May 2017

Digital technologies to support planning, treatment, and fabrication processes and outcome assessments in implant dentistry. Summary and consensus statements. The 4th EAO consensus conference 2015.

Clin Oral Implants Res 2015 Sep;26 Suppl 11:97-101

Section of Oral Implantology and Fixed Prosthetics, Department of Oral Function, Academic Centre of Dentistry Amsterdam, Amsterdam, The Netherlands.

Objective: The task of this working group was to assess the existing knowledge in computer-assisted implant planning and placement, fabrication of reconstructions applying computers compared to traditional fabrication, and assessments of treatment outcomes using novel imaging techniques.

Material And Methods: Three reviews were available for assessing the current literature and provided the basis for the discussions and the consensus report. One review dealt with the use of computers to plan implant therapy and to place implants in partially and fully edentulous patients. A second one focused on novel techniques and methods to assess treatment outcomes and the third compared CAD/CAM-fabricated reconstructions to conventionally fabricated ones.

Results: The consensus statements, the clinical recommendations, and the implications for research, all of them after approval by the plenum of the consensus conference, are described in this article. The three articles by Vercruyssen et al., Patzelt & Kohal, and Benic et al. are presented separately as part of the supplement of this consensus conference.
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http://dx.doi.org/10.1111/clr.12648DOI Listing
September 2015

The BARI technique: a new approach to immediate loading.

Int J Esthet Dent 2015 ;10(3):428-43

When dealing with full-arch rehabilitation, the provisional phase is important in order to define the correct occlusal, intermaxillary, and esthetic relationships for each individual patient. In these cases, it is difficult to transfer this information to the final restorations. Several techniques have been developed to transfer the information from tooth- or implant-supported fixed provisionals to the definitive rehabilitations. The present article describes a technique proposed by the authors to transfer the information from a removable prosthesis to an implant-supported restoration.
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December 2015

Computer-assisted flapless implant surgery in edentulous elderly patients: a 2-year follow up.

Quintessence Int 2014 May;45(5):419-29

Objective: The rehabilitation of edentulous mandibles with implant-supported overdentures is a state-of-the-art contemporary implant treatment. Computer-assisted flapless surgery is associated with decreased chairside treatment time, as well as significant reduction in patient postoperative morbidity and discomfort. The aim of this study was to evaluate the protocol of computer-guided surgery in the treatment of edentulous mandibles with overdentures supported by four intraforaminal implants and retained by Locator® attachments in elderly patients, both from a clinician's and a patient's perspective, as well as to assess the stability of the results in a 2-year period.

Method And Materials: 15 patients presenting edentulous mandibles and discomfort while wearing conventional overdentures were enrolled in the study. Careful presurgical and computer-assisted 3D treatment planning was performed. Patients were treated with four intraforaminal implants using a computer-assisted flapless approach. All patients were prosthetically rehabilitated with overdentures. Clinical parameters such as peri-implant probing depth (PPD), Plaque Index (PI), and bleeding on probing (BOP) were evaluated. Patients' perceptions regarding the outcome were assessed on visual analog scales (VAS).

Results: Out of 15 patients consecutively included in the study, only 10 patients could be treated with the designed protocol. A total of 40 Camlog implants were placed. No implant was lost over a 2-year period. BOP was negative in 82% of sites; mean PPD was 2.34 mm; 8 of the 40 implants showed the absence of keratinized tissue on the lingual or the vestibular aspect. The VAS score of 9.9 demonstrated the satisfaction of the patients.

Conclusions: Within the limitations of this study, the data demonstrate that in a significant number of cases this protocol could not be used for anatomical or technical reasons. In the cases where it could be used, the computer-assisted protocol appeared suitable for treating elderly patients with mandibular edentulism and restoring them with an overdenture in a minimally invasive way. The possibility of placing implants outside the borders of the keratinized tissue is relevant.
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http://dx.doi.org/10.3290/j.qi.a31534DOI Listing
May 2014

Clinical and radiologic outcomes after submerged and transmucosal implant placement with two-piece implants in the anterior maxilla and mandible: 3-year results of a randomized controlled clinical trial.

Clin Implant Dent Relat Res 2015 Apr 9;17(2):234-46. Epub 2013 Jul 9.

Faculty of Odontology, Universidad Complutense of Madrid, Madrid, Spain.

Purpose: The aim of this investigation was to evaluate the 3-year outcomes regarding crestal bone level, clinical parameters, and patient satisfaction, following submerged and transmucosal implant placement for two-piece implants in the anterior maxilla and mandible.

Materials And Methods: Patients requiring dental implants for single-tooth replacement in the anterior maxilla or mandible were enrolled in a randomized, controlled, multicenter clinical trial. The implants were randomized at placement to either submerged or transmucosal healing, with final restorations placed after 6 months. Radiographic and clinical parameters were recorded after 1, 2, and 3 years; a questionnaire was also used to assess patient satisfaction. A two-sided, unpaired T-test (significance level p ≤ .05) was used to statistically evaluate the differences between the two groups.

Results: A total of 106 patients were included in the 3-year analysis. The mean change in crestal bone level from implant placement to 3 years was 0.68 ± 0.98 mm (p < .001) and 0.58 ± 0.77 mm (p < .001) in the submerged and transmucosal groups, respectively; the differences between the groups were not significant. Clinical parameters remained stable throughout the study, with no significant differences between the groups, and patient satisfaction was good or excellent for over 90% of subjects in both groups.

Conclusions: The results demonstrate excellent clinical and radiographic conditions after 3 years for implants supporting single-tooth restorations, regardless of whether a submerged or transmucosal surgical technique was used.
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http://dx.doi.org/10.1111/cid.12107DOI Listing
April 2015

Rehabilitation of an edentulous atrophic maxilla with four unsplinted narrow diameter titanium-zirconium implants supporting an overdenture.

Quintessence Int 2013 Jan;44(1):37-43

Department of Periodontology and Prosthodontics, Eastman Dental Hospital, Rome, Italy.

The edentulous maxilla is often affected by bone resorption, sometimes making it difficult to place standard diameter implants. Narrow diameter implants made of titanium-zirconium (Ti-Zr) alloy, which has superior mechanical properties compared with titanium, have been proposed for these difficult situations. This retrospective clinical observation reports the outcome of the use of reduced diameter implants made of Ti-Zr alloy supporting maxillary overdentures retained with locator abutments. The charts of all patients who received maxillary overdentures supported by four unsplinted implants from January 2009 to June 2010 at the Department of Periodontology and Prosthodontics, Eastman Dental Hospital, Rome, Italy, were reviewed. All patients treated with four narrow diameter Ti-Zr implants were selected for the present case series. Ten patients were found, six of whom received augmentation procedures. After 12 to 16 months of follow-up, no implants were lost, and only one implant showed bone resorption greater than 1.5 mm. Implants showed a success rate of 97.5% and a survival rate of 100%. All prostheses were successfully in function. The present case series showed promising results regarding the use of narrow diameter implants made of Ti-Zr supporting maxillary overdentures retained with locator abutments.
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http://dx.doi.org/10.3290/j.qi.a28745DOI Listing
January 2013

[Alveolar reconstruction for implant placement: different techniques for different defects].

Authors:
Luca Cordaro

Zhonghua Kou Qiang Yi Xue Za Zhi 2012 Oct;47(10):580-3

Department of Periodontology and Prosthodontics, Eastman Dental Hospital, Roma, Italy.

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http://dx.doi.org/10.3760/cma.j.issn.1002-0098.2012.10.002DOI Listing
October 2012

Reconstruction of the moderately atrophic edentulous maxilla with mandibular bone grafts.

Clin Oral Implants Res 2013 Nov 13;24(11):1214-21. Epub 2012 Jul 13.

Department of Periodontology and Prosthodontics, Eastman Dental Hospital, Roma, Italy.

Background: Mandibular bone grafts are used for alveolar reconstruction in partially edentulous patients. Few reports describe the use of mandibular bone for total maxillary reconstruction.

Aim: To describe indications to the use of extensive mandibular bone grafts for maxillary reconstructions in edentulous patients.

Methods: A retrospective evaluation of a group of patients with edentulous resorbed maxillae reconstructed with mandibular bone grafts in preparation for implant placement was performed. The studied cohort consisted of 15 patients who were treated with mandibular onlay blocks and sinus augmentation with mandibular bone in an outpatient setting under local anesthesia (MG). This approach was chosen when residual bone height in the anterior maxilla was at least 8 mm combined with posterior vertical deficiency and anterior horizontal defects. Success and survival rates of the implants and prostheses together with the achievement of the planned prosthetic plan were recorded. Patients also performed an evaluation of the outcome with the aid of Visual Analog Scales. Mean follow-up time was 19 months after prosthesis delivery.

Results: No major surgical complications occurred at recipient or donor sites. A total of 81 implants were inserted, and survival and success rates were 97.6% and 93%, respectively. Planned prostheses could be delivered to all patients (eight overdentures and seven fixed dental prostheses).

Conclusions: With the limitations of the present clinical study, it can be stated that edentulous maxillae with a moderate atrophy may be successfully augmented with mandibular bone grafts in an outpatient setting under local anesthesia and e.v. sedation. This is the case when posterior maxillary deficiency is combined with horizontal defects, but with a residual height of 8 mm or more in the anterior maxilla. When the residual anterior bone height is less than 8 mm, or when the inter-arch discrepancy needs to be corrected with an osteotomy, extraoral bone harvesting needs to be considered.
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http://dx.doi.org/10.1111/j.1600-0501.2012.02532.xDOI Listing
November 2013

Implant-supported single tooth restoration in the aesthetic zone: transmucosal and submerged healing provide similar outcome when simultaneous bone augmentation is needed.

Clin Oral Implants Res 2013 Oct 15;24(10):1130-6. Epub 2012 Jun 15.

Department of Periodontology and Prosthodontics, Eastman Dental Hospital, Roma, Italy.

Aim: The aim of this study was to compare the clinical outcomes after 2 years with bone level implants placed to restore a single missing teeth that needed simultaneous augmentation and were treated with a transmucosal or submerged approach.

Methods: This study analyzed a subset of patients included in an ongoing prospective multicenter randomized clinical trial (RCT) involving12 centers where patients were to be followed-up to 5 years after loading. Of the 120 implants that were placed in the original study, and randomly assigned to submerged or non-submerged healing, 52 needed simultaneous augmentation (28 women patients and 24 men patients, between 23 and 78 years of age). Twenty-seven of them received implants with submerged healing (AuS), while in 25 patients the implants were inserted with a non-submerged protocol (AuNS). At the 2-year follow-up visit, radiographic crestal bone level changes were recorded as well as soft tissue parameters included Pocket probing depth (PPD), bleeding on probing (BoP) and clinical attachment level (CAL) at teeth adjacent to the implant site.

Results: After 2 years a small amount of bone resorption was found in both groups (0.37 ± 0.49 mm in the AuS group and 0.54 ± 0.76 in the AuNS group; P < 0.001). There was no statistically significant difference between AuS Group and AuNS group for PPD (2.5 vs. 2.4 mm), BOP (BOP + sites: 8.8% vs. 11.5%) and CAL (2.8 vs. 2.4 mm) at the 2-year follow-up visit.

Conclusions: When a single implant is placed in the aesthetic zone in conjunction with bone augmentation for a moderate peri-implant defect, submerged and transmucosal healing determine similar outcome, hence there is no need to submerge an implant in this given clinical situation.
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http://dx.doi.org/10.1111/j.1600-0501.2012.02521.xDOI Listing
October 2013

Single unit attachments improve peri-implant soft tissue conditions in mandibular overdentures supported by four implants.

Clin Oral Implants Res 2013 May 10;24(5):536-42. Epub 2012 Feb 10.

Department of Periodontics and Prosthodontics, Eastman Dental Hospital, Roma, Italy.

Aim: To evaluate the clinical performance as well as patients' and clinicians' satisfaction on two different prosthodontic retention systems for implant-overdentures in the mandible.

Methods: In this retrospective study, patients provided with four intraforaminal implants with at least 12 months of follow-up since overdenture delivery were evaluated. A total of 39 patients were treated either with Locator(®) attachment or with cad-cam milled bar. Clinical parameters such as Peri-implant Probing Depth (PPD), Plaque Index (PI), and Bleeding on Probing (BOP) were evaluated. Patients' and clinicians' perceptions regarding the outcome were assessed on visual analog scales (VAS).

Results: The mean follow-up was 13 months in the Locator(®) group and 18 months in the Bar group and no implants were lost. The Locator group showed better results for PPD, PI, and BOP values. Patients' satisfaction was high in both groups, whereas the clinicians found better hygienic conditions and soft tissue health in the Locator group.

Conclusions: Although the patients' satisfaction was similar in both groups the Locator(®) system demonstrated better soft tissues scores because hygienic maintenance was more complicated around bars. This may increase the frequency of chronic inflammations around the implants.
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http://dx.doi.org/10.1111/j.1600-0501.2012.02426.xDOI Listing
May 2013

Split-mouth comparison of a coronally advanced flap with or without enamel matrix derivative for coverage of multiple gingival recession defects: 6- and 24-month follow-up.

Int J Periodontics Restorative Dent 2012 Feb;32(1):e10-20

Department of Periodontology and Implant Dentistry, George Eastman Hospital, Rome, Italy.

The aim of this study was to evaluate whether the use of enamel matrix derivative (EMD) improves clinical results of the coronally advanced flap (CAF) procedure in the treatment of multiple gingival recession defects. Ten patients presenting at least two adjacent buccal gingival recession defects affecting symmetric teeth on both sides of the maxilla were included in this study. Each set of multiple recession defects was assigned randomly to the test or control group. A bilateral simultaneous CAF procedure with vertical releasing incisions, with the adjunct of EMD for test sites, was performed. Clinical measurements (recession length, keratinized tissue, probing depth, and clinical attachment level) were assessed at baseline and 6 and 24 months after surgery by a blinded examiner. At the 6-month evaluation, both treatment procedures displayed good results with significant root coverage gain (CAF, 80.7% ± 20%; CAF + EMD, 82.8% ± 14%). A similar amount of relapse was noted at the 24-month evaluation when compared with the 6-month results (CAF, 71.0% ± 22%; CAF + EMD, 74.8% ± 16%). The use of EMD does not seem to significantly improve the results of the CAF procedure for root coverage in treatment of multiple recessions.
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February 2012

Marginal discrepancies of Ni/Cr crowns for a soft tissue-level, trans-mucosal implant system.

Clin Oral Implants Res 2013 Aug 24;24 Suppl A100:82-7. Epub 2011 Nov 24.

Objective: To examine the marginal fit of frameworks for implant-supported single crowns built with or without the use of prefabricated plastic copings.

Methods: Sixty premolar sized metal crown frameworks for cemented implant restorations were prepared by two separate dental laboratories. Twenty were prepared with the use of original plastic copings for burn-out (OPC), twenty without any prefabricated plastic coping (WPC), and finally twenty with modified plastic copings (MPC). Specimens were inspected at 100× magnification. Marginal discrepancies can emerge at the vertical level as marginal gaps (MG) or horizontal differences in the circumferential precision of the restorations (HEX). HEX and MG were recorded at 10 different points in each metal crown. The ANOVA test was performed to estimate if there were statistically significant differences between the two dental laboratories. ANOVA Test was also used between Groups OPC, WPC, and MPC to evaluate differences in the mean MG and HEX values. The Tukey's post hoc test was also performed to determine whether couples of data sets were different or not.

Results: No statistically significant differences regarding HEX and MG were found among the two dental laboratories. Significant differences were found among OPC, WPC, and MPC groups both for MG and HEX (P < 0.05). Tukey post hoc tests revealed that there were statistically significant differences (P-value < 0.05) in all pairs of groups and for both dimensions measured. The OPC group showed horizontal and vertical over-extension. The WPC group margins appeared vertically under-extended but horizontally over-extended. The WPC groups showed unpredictability of results in the vertical dimension. The MPC group margins demonstrated horizontal over-extension and appeared vertically slightly under-extended. The frameworks belonging to this group appeared the most precise in the vertical dimension.

Conclusions: Casting Ni/Cr alloys without the use of prefabricated plastic components leads to unpredictable precision in the vertical marginal discrepancies. The use of plastic copings results in more predictable but horizontally and vertical over-extended margins when the snap-on mechanism is not removed properly after the casting due to the hardness of the Ni/Cr alloys. The removal of the snap-on mechanism after the wax-up and before casting (MPC group) results in more uniform and smaller vertical marginal discrepancies.
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http://dx.doi.org/10.1111/j.1600-0501.2011.02379.xDOI Listing
August 2013

Submerged and transmucosal healing yield the same clinical outcomes with two-piece implants in the anterior maxilla and mandible: interim 1-year results of a randomized, controlled clinical trial.

Clin Oral Implants Res 2012 Feb 4;23(2):211-219. Epub 2011 Jul 4.

Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, SwitzerlandDepartment of Periodontology, Universidad Complutense de Madrid, Madrid, SpainBalwyn Periodontic Centre, School of Dental Science, University of Melbourne, Melbourne, AustraliaDepartment of Prosthodontics, College of Dentistry, University of Florida, Gainesville, FL, USADepartment of Oral Surgery and Dental Emergency Care, Faculty of Health, University Witten/Herdecke, Witten, GermanyDepartment of Oral and Maxillofacial Surgery, SU/Mölndal Hospital, Mölndal and the Sahlgrenska Academy, Göteborg University, Mölndal, SwedenDepartment of Periodontology and Prosthodontics, Eastman Dental Hospital, Rome, ItalyFlorida Institute for Periodontics and Dental Implants, Boca Raton, FL, USADepartment of Oral, Maxillo and Facial Plastic Surgery, Center for Implant Dentistry, Klinikum Stuttgart, GermanyDepartment of Oral and Maxillofacial Surgery, University of Schleswig-Holstein, Kiel, GermanyPrivate Dental Clinic, Munich, Germany.

Objectives: To test whether or not transmucosal healing at two-piece implants is as successful as submerged placement regarding crestal bone levels and patient satisfaction.

Material And Methods: Adults requiring implants in the anterior maxilla or mandible in regions 21-25, 11-15, 31-35 or 41-45 (WHO) were recruited for this randomized, controlled multi-center clinical trial of a 5-year duration. Randomization was performed at implantation allowing for either submerged or transmucosal healing. Final reconstructions were seated 6 months after implantation. Radiographic interproximal crestal bone levels and peri-implant soft tissue parameters were measured at implant placement (IP) (baseline), 6 and 12 months. Patient satisfaction was assessed by a questionnaire. A two-sided t-test (80% power, significance level α=0.05) was performed on bone-level changes at 6 and 12 months.

Results: One hundred and twenty-seven subjects were included in the 12-month analysis (submerged [S]: 52.5%, transmucosal [TM]: 47.2%). From IP to 6 months, the change in the crestal bone level was -0.32 mm (P<0.001) for the S group and -0.29 mm (P<0.001) for the TM group. From IP to 12 months, bone-level changes were statistically significant in both groups (S -0.47 mm, P<0.001; TM -0.48 mm, P<0.001). The mean differences of change in the bone levels between the two groups were not statistically significant at either time point, indicating the equivalence of both procedures. For both groups, very good results were obtained for soft tissue parameters and for patient satisfaction.

Conclusions: Transmucosal healing of two-piece implants is as successful as the submerged healing mode with respect to tissue integration and patient satisfaction within the first 12 months after IP.
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http://dx.doi.org/10.1111/j.1600-0501.2011.02210.xDOI Listing
February 2012

Mandibular bone harvesting for alveolar reconstruction and implant placement: subjective and objective cross-sectional evaluation of donor and recipient site up to 4 years.

Clin Oral Implants Res 2011 Nov 28;22(11):1320-6. Epub 2011 Mar 28.

Department of Periodontics and Prosthodontics, Eastman Dental Hospital, Roma, Italy.

Aim: To evaluate the long-term morbidity of intraoral bone harvesting from two different donor sites (mandibular symphysis or ramus) for bone augmentation procedures before or at the time of implant placement and to evaluate the success and the survival rates of implants placed in sites augmented with mandibular bone.

Methods: Seventy-eight patients who received mandibular bone grafts were recalled after 18-42 months follow-up (mean 29 months). The group consisted of 36 men and 42 women aged between 18 and 68 years old at the moment of augmentation surgery. Vitality of teeth adjacent to the harvesting sites was investigated. Soft tissue superficial sensory function was assessed by the Pointed-Blunt Test and the Two-Point-Discrimination Test. Implant health status was assessed measuring peri-implant probing depth and bleeding on probing. Implant survival and success rates were also calculated. In order to evaluate patients' perception of the morbidity of the procedures, the patients were asked to answer several questions by means of visual analogue scales (VAS).

Results: Only two teeth (out of 282) in the chin harvesting group needed root canal treatment after surgery. A higher frequency of minor temporary and permanent sensorial disturbances was found in the group of patients who received chin harvesting procedures (2.3% vs. 13%P=0.03), while pain during chewing and bleeding were more frequently recorded after ramus harvesting (9.8% vs. 0%P=0.03). No permanent anesthesia of any region of the skin was reported. Implants' survival and success rate were comparable to implants placed in bone reconstructed with other techniques and were not influenced by the choice of the donor site. Patient's perception regarding the morbidity of the procedures was very low and did not differ between ramus and chin harvesting groups (mean VAS scores <4).

Conclusion: The present cross-sectional retrospective study demonstrated the safety of mandibular grafts that reported excellent results in terms of implant success and survival rates with minor complications regarding the donor site area. When the chin was chosen as donor site, minor sensorial disturbances of mucosa and teeth were recorded. The majority of these disturbances were temporary; only few of them were permanent but still had no impact on patient's life.
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http://dx.doi.org/10.1111/j.1600-0501.2010.02115.xDOI Listing
November 2011

Effect of bovine bone and collagen membranes on healing of mandibular bone blocks: a prospective randomized controlled study.

Clin Oral Implants Res 2011 Oct 11;22(10):1145-1150. Epub 2011 Feb 11.

Department of Periodontics and Prosthodontics, Eastman Dental Hospital, Roma, Italy.

Aim: The aim of the present study was to evaluate if the use of deprotenized bovine bone mineral (DBBM) and collagen barrier membranes (CM) in combination with mandibular bone block grafts could reduce bone block graft resorption during healing.

Methods: A prospective randomized controlled study has been designed. Twenty-two ridges presenting horizontal alveolar deficiency (crest width <4 mm) and at least two adjacent missing teeth were included in the study. In the control group, one or multiple mandibular blocks were used to gain horizontal augmentation of the ridge. In the test group, DBBM granules were added at the periphery and over the graft. The reconstructions were covered by two layers of CM. Implants were placed 4 months after grafting. Direct measurements of crest width were performed before and immediately after bone augmentation, and immediately before implant placement.

Results: Statistical analysis showed no significant differences in crest width between test and control groups at baseline and immediately after grafting. Mean augmentation at first surgery in the test group was 4.18 vs. 4.57 mm in the control group. Final gain obtained at the time of implant placement was 3.93 mm in the test and 3.67 mm in the control groups. The difference in mean graft resorption between test and control sites was statistically significant (0.25 mm in the test group vs. 0.89 mm in the control group, P=0.03). Complications seem to occur more often in the test group (complications recorded in three cases in the test group vs. one complication recorded in the control group). In all cases, implants could be placed in the planned sites and a total of 55 implants were placed (28 in the test group and 27 in the control group). All implants could be considered successfully integrated at the 24-month follow-up visit.

Conclusion: The results from this study showed that the addition of bovine bone mineral and a CM around and over a mandibular bone block graft could minimize graft resorption during healing. On the other hand, the use of bone substitutes and barrier membranes in combination with block grafts increased the frequency of complications and the difficulty of their management.
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http://dx.doi.org/10.1111/j.1600-0501.2010.02093.xDOI Listing
October 2011

Transition from a failing dentition to a removable implant-supported prosthesis: a staged approach.

Quintessence Int 2010 May;41(5):371-8

Department of Periodontics and Implant Dentistry, Eastman Dental Hospital, Roma, Italy.

Patients with hopeless dentition often present difficulties in the management of the transitional phase to the final restoration. This article describes a staged approach to achieve a full-arch, implant-supported, removable prosthesis in patients with a hopeless dentition. The approach described allows the clinician to proceed in a staged manner and facilitate prosthetic steps by keeping fixed references for vertical dimension. This technique includes initial conservative periodontal care and, afterward, extraction of some strategic teeth, while others are temporarily maintained. At this point, the implants are positioned, and during the healing period, the remaining natural abutments are used for occlusal reference and to stabilize the removable provisional prosthesis. After osseointegration of the implants, the residual teeth are extracted and the final prosthesis is delivered. The main advantages of the technique include maintenance of function during treatment, stabilization of the removable provisional (especially in the mandibular arch), prosthetic-guided insertion of implants, and easier retrieval of prosthetic references. The main drawbacks are longer treatment time and the need for two surgical steps.
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May 2010

Consensus statements and recommended clinical procedures regarding loading protocols.

Int J Oral Maxillofac Implants 2009 ;24 Suppl:180-3

Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, 188 Longwood Avenue, Boston, MA 02115, USA.

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February 2010

Implant loading protocols for the partially edentulous posterior mandible.

Int J Oral Maxillofac Implants 2009 ;24 Suppl:158-68

Department of Periodontics and Prosthodontics, Eastman Dental Hospital, Rome, Italy.

Purpose: To evaluate the predictability of early and immediate loading protocols of implants in the posterior mandible and to investigate whether there is a difference in success rates, survival rates, and peri-implant parameters, including marginal bone level changes, between loading protocols.

Materials And Methods: A comprehensive systematic review of the literature was conducted. The selection of publications reporting on human clinical studies was based on predetermined inclusion criteria and was agreed upon by two reviewers.

Results: A total of 19 papers were selected: 8 on early loading, 9 addressing immediate loading, and 2 comparing immediate and early loading. Of the 19 studies, 5 were randomized clinical trials and 14 were prospective studies.

Conclusions: Existing literature supports the early loading of microroughened dental implants in the partially edentulous posterior mandible at 6 to 8 weeks in the absence of modifying factors. Therefore, loading within this time frame can be considered routine for the majority of clinical situations in the posterior mandible, either with single crowns or fixed dental prostheses. Immediate loading of microroughened dental implants in the partially edentulous posterior mandible proved to be a viable treatment alternative. Caution is necessary when interpreting published outcomes for immediate loading, as the inclusion exclusion criteria are inconsistent and many subjective confounding factors are evident. Additional studies with longer follow-ups, specifically randomized clinical trials, are needed to consolidate the data for immediate loading. Priority should be given to trials testing immediate loading.
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February 2010

Implant loading protocols for partially edentulous maxillary posterior sites.

Int J Oral Maxillofac Implants 2009 ;24 Suppl:147-57

Department of Oral and Maxillofacial Surgery, University of Torino, Torino, Italy.

Purpose: To evaluate early and immediate loading of implants in the posterior maxilla and to investigate whether there is a difference in success rates, survival rates, and peri-implant parameters, including marginal bone level changes.

Materials And Methods: A comprehensive systematic review of the literature was conducted. The selection of publications reporting on human clinical studies was based on predetermined inclusion criteria and was agreed upon by two reviewers.

Results: Twelve papers were identified on early loading (two randomized controlled clinical trials [RCTs] and 10 prospective case series studies). Six papers were found on immediate loading (one RCT, four prospective case series, and one retrospective study).

Conclusions: Under certain circumstances it is possible to successfully load dental implants in the posterior maxilla early or immediately after their placement in selected patients. The success rate appears to be technique sensitive, although no study has directly assessed this. A high degree of primary implant stability (high value of insertion torque) and implant surface characteristics play an important role. It is not possible to draw evidence-based conclusions concerning contraindications, threshold values for implant stability, bone quality and quantity needed, or impact of occlusal loading forces. As for the impact of the surgical technique on implant outcome in different bone densities, no studies prove significant superior results with one technique over another. Well-designed RCTs with a large number of patients are necessary to make early/immediate loading protocols in posterior maxilla evidence based, but ethical and practical considerations may limit the real possibility of such studies in the near future.
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February 2010

Clinical outcome of submerged vs. non-submerged implants placed in fresh extraction sockets.

Clin Oral Implants Res 2009 Dec 30;20(12):1307-13. Epub 2009 Aug 30.

Eastman Dental Hospital, Department of Periodontics and Implant Dentistry, Rome, Italy.

Aim: The aim of this study was to compare the clinical outcome of submerged vs. non-submerged tapered implants placed into fresh extraction sockets.

Materials And Methods: A prospective, controlled, multicenter, randomized, clinical trial has been performed in two centers in Rome and Torino (Italy). Thirty healthy patients were recruited according to the following inclusion criteria: need for an immediate post extraction implant, ages between 18 and 70, horizontal defect depth <2 mm, smokers <10 cigarettes/day and absence of any circumstance or condition that could represent contraindications to implant surgery. The patients were randomly allocated to submerged or non-submerged treatment groups immediately after flap elevation and tooth extraction. Submerged implants were exposed 8 weeks after the first surgery; all implants were loaded with provisional restorations 12 weeks after the first surgery and with definitive restoration 12 weeks thereafter. Clinical and radiographic parameters were evaluated at baseline, at implant loading and at the 1-year follow-up visit.

Results: The results showed statistically significant differences between the two groups in the mean value of keratinized tissue (KT) height after surgery that was significantly reduced for submerged implants when compared with transmucosal implants (mean reduction of KT at year follow-up: T group 0.2 mm, S group 1.3 mm; P=0.007).

Conclusion: Similar outcomes were found for submerged and non-submerged implants placed in fresh extraction sockets with a horizontal peri-implant defect smaller than 2 mm, except for a reduction of KT in the submerged group. Either with a submerged or a non-submerged procedure, 1 mm of mean soft tissue recession is seen after 1 year when compared with the pre-extraction situation.
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http://dx.doi.org/10.1111/j.1600-0501.2009.01724.xDOI Listing
December 2009

Two-year prospective clinical comparison of immediate replacement vs. immediate restoration of single tooth in the esthetic zone.

Clin Oral Implants Res 2008 Nov;19(11):1148-53

Department of Prosthodontics, Division of Implant Supported Prosthodontics, George Eastman Dental Hospital, Roma, Italy.

Aim: To compare the immediate restoration of single implants in the esthetic zones performed on implants placed immediately after tooth extraction or 8 weeks later (immediate replacement vs. immediate restoration).

Methods: Sixteen patients (10 women and 6 men) with a mean age of 35 years (ranging from 21 to 49 years old) were treated from 2004 to 2005 for single-tooth replacement in the upper arch. The patients were randomly divided into two groups: in the test group patients received implants placed and restored (non-occlusal loading) at the time of tooth extraction; in the control group implants were placed 8 weeks after tooth extraction and immediately restored. All the patients received tapered effect (TE) implants from the Straumann Dental Implant System. The following parameters were evaluated at the moment of provisional restoration (within 48 h after implant placement) and at the 2 years follow-up visit: marginal bone resorption, papilla index, position of the mucosal margin. The implant stability quotient was measured at the moment of implant placement and at the moment of the delivery of the definitive restoration.

Results: No statistically significant differences were found in any of the studied parameters between the test and the control groups (P>0.05). The implant stability quotient values between the test and control groups were significant (P<0.05) at the moment of implant placement but were no more significant at the loading of the definitive restoration (P>0.05).

Conclusion: The results of the present study suggest that immediate replacement without functional loading may be considered a valuable therapeutic option for selected cases of single-tooth replacement in the esthetic area when TE implants are used. Implant stability at the moment of implant placement is slightly inferior in the immediate replacement group, but it does not affect the treatment result.
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http://dx.doi.org/10.1111/j.1600-0501.2008.01578.xDOI Listing
November 2008

Evaluation of the marginal precision of one-piece complete arch titanium frameworks fabricated using five different methods for implant-supported restorations.

Clin Oral Implants Res 2008 Aug;19(8):772-9

Department of Periodontics and Implant Dentistry, Eastman Dental Hospital, Roma, Italy.

Objective: The aim of the present work was to compare the marginal precision of titanium frameworks for a complete arch-fixed prosthesis fabricated using five different methods.

Methods: A prospective study was designed. Fifteen titanium frameworks for totally edentulous upper or lower jaws, each supported by five to nine implants, were assigned to five study groups, so as to have three frameworks in each group for each technique: (1) lost wax technique frameworks, (2) cast titanium sovrastructures laser welded to prefabricated titanium copings, (3) Procera Implant Bridge, (4) Cresco Ti System and (5) CAM StructSURE Precision Milled Bar. The microgap between the framework and the shoulders of implant analogues was measured on the master cast with a stereomicroscope at a magnification of 100 x at four different locations, yielding a total of 364 data points on 91 implants. Data were analyzed using an ANOVA and a Tukey post hoc test (P=<0.05).

Results: The mean values for the microgap were 78 microm (SD+/-48) for lost wax technique frameworks, 33 microm (SD+/-19) for cast titanium sovrastructures laser welded to titanium copyings, 21 microm (SD+/-10) for the Procera implant bridge, 18 microm (SD+/-8) for the Cresco Ti System and 27 microm (SD+/-15) for the CAM StructSURE. The differences among the mean values were statistically significant (P<0.01 or P<0.05). The comparisons among groups 3, 4, and 5 and between groups 2 and 5 were not significant (P>0.05).

Conclusion: The computer-aided procedures analyzed in the present study were able to produce a precision-fitting framework, with no significant differences among them and, at the same time, showed a greater precision compared with the traditional casting methods or with the use of prefabricated titanium copings. However, it should be noted that, even if group 2 frameworks were not as accurate as groups 3 and 4, cast titanium sovrastructures laser welded to prefabricated titanium copings showed significantly better marginal precision than the frameworks produced with the lost wax technique.
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http://dx.doi.org/10.1111/j.1600-0501.2008.01555.xDOI Listing
August 2008

Maxillary sinus grafting with Bio-Oss or Straumann Bone Ceramic: histomorphometric results from a randomized controlled multicenter clinical trial.

Clin Oral Implants Res 2008 Aug;19(8):796-803

Department of Periodontology and Implant Dentistry, Eastman Dental Hospital, Rome, Italy.

Introduction: This investigation was designed to compare the histomorphometric results from sinus floor augmentation with anorganic bovine bone (ABB) and a new biphasic calcium phosphate, Straumann Bone Ceramic (BCP).

Materials And Methods: Forty-eight maxillary sinuses were treated in 37 patients. Residual bone width was > or =6 mm and height was > or =3 mm and <8 mm. Lateral sinus augmentation was used, with grafting using either ABB (control group; 23 sinuses) or BCP (test group; 25 sinuses); sites were randomly assigned to the control or test groups. After 180-240 days of healing, implant sites were created and biopsies taken for histological and histomorphometric analyses. The parameters assessed were (1) area fraction of new bone, soft tissue, and graft substitute material in the grafted region; (2) area fraction of bone and soft tissue components in the residual alveolar ridge compartment; and (3) the percentage of surface contact between the graft substitute material and new bone.

Results: Measurable biopsies were available from 56% of the test and 81.8% of the control sites. Histology showed close contact between new bone and graft particles for both groups, with no significant differences in the amount of mineralized bone (21.6+/-10.0% for BCP vs. 19.8+/-7.9% for ABB; P=0.53) in the biopsy treatment compartment of test and control site. The bone-to-graft contact was found to be significantly greater for ABB (48.2+/-12.9% vs. 34.0+/-14.0% for BCP). Significantly less remaining percentage of graft substitute material was found in the BCP group (26.6+/-5.2% vs. 37.7+/-8.5% for ABB; P=0.001), with more soft tissue components (46.4+/-7.7% vs. 40.4+/-7.3% for ABB; P=0.07). However, the amount of soft tissue components for both groups was found not to be greater than in the residual alveolar ridge.

Discussion: Both ABB and BCP produced similar amounts of newly formed bone, with similar histologic appearance, indicating that both materials are suitable for sinus augmentation for the placement of dental implants. The potential clinical relevance of more soft tissue components and different resorption characteristics of BCP requires further investigation.
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http://dx.doi.org/10.1111/j.1600-0501.2008.01565.xDOI Listing
August 2008