C Arcuri

Graded porous polyurethane foam: A potential scaffold for oro-maxillary bone regeneration

Bone tissue engineering applications demand for biomaterials offering a substrate for cell adhesion, migration, and proliferation, while inferring suitable mechanical properties to the construct. In the present study, polyurethane (PU) foams were synthesized to develop a graded porous material-characterized by a dense shell and a porous core-for the treatment of oro-maxillary bone defects. Foam was synthesized via a one-pot reaction starting from a polyisocyanate and a biocompatible polyester diol, using water as a foaming agent. Different foaming conditions were examined, with the aim of creating a dense/porous functional graded material that would perform at the same time as an osteoconductive scaffold for bone defect regeneration and as a membrane-barrier to gingival tissue ingrowth. The obtained PU was characterized in terms of morphological and mechanical properties. Biocompatibility assessment was performed in combination with bone-marrow-derived human mesenchymal stromal cells (hBMSCs). Our findings confirm that the material is potentially suitable for guided bone regeneration applications.

Bone level changes around platform switching and platform matching implants: a systematic review with meta-analysis.

The amount of marginal bone loss is considered an important criterion to evaluate the implant therapy outcome and to predict the prognosis of the implant rehabilitation. The purpose of this systematic review was to examine the available literature comparing clinical and radiological outcomes like the implant failure rates and marginal bone loss around platform switching dental implants versus platform matching ones. English randomized controlled human clinical trials, comparing one or more PS groups with one or more PM groups, with at least 12 months of follow-up after loading and 10 implants, providing carefully the number of PS- and PM- implants used as well as implant survival and data concerning bone level changes or marginal bone loss around implants, were included. Fifteen publications, involving a total of 1439 implants and 642 patients, were eligible. More studies showed less mean marginal bone loss around PS implants and none of them showed differences in terms of implant failure rates. This review confirmed a great effectiveness of platform switching technique to prevent marginal bone resorption. Nevertheless, this result should be interpreted cautiously because of the heterogeneity of the included studies.

The flap recovery on the impacted lower third molar surgery comparing 3 different flap designs: A clinical study

Aim The purpose of the study was to analyze the healing of the deep and superficial lower first and second molars periodontium, after the surgical extraction of the contiguous impacted third molar, comparing 3 mucoperiosteal flap designs. Materials and methods 150 patients which had to undergo a impacted lower third molar surgery were enrolled in this study. They were checked from day 0 to day 90, in order to focus on the recovery quality of the soft tissues around the lower second molar, comparing 3 different flap designs. Results No intraoperatory incident happened. The complete recovery of the periodontium around the second molar has been shown in each patient after 90 days from surgery and each adverse reaction happened within the sixth week after surgery. Only 2 slight gengival recessions 0,5 mm have been find out. Conclusions The impacted third molar surgery is an operation that, if rightly programmed and performed, is relatively safe. Besides, the correct handling and management of periodontium around the second molar and the choice of the flap type to be used support a correct recovery on the second molar periodontium, avoiding any long-term damage. Clinical significance This study wanted to analyze the healing of the deep and superficial lower second molar periodontium, after the impacted lower third molar surgery. In order to improve the surgical technique used for lower third molar germectomies, we wanted to compare 3 different kind of flap designs.

Endoscopic retrieval of a dental Implant into the maxillary sinus: a case report.

PURPOSE In this article the Authors show a safe and predictable technique to remove displaced implants from the maxillary sinus. MATERIALS AND METHODS A 49-year-old female was referred, to this centre by a general dentist, for the retrieval of the ectopic dental implant. After a preliminary clinical and radiological evaluation of the case the surgical procedure was performed. A loco-regional anesthesia was carried out and then the Maxillary Sinus Retrieval Device (MSRD), proposed in this study, was inserted in the canine fossa, via a circular antrostomy 5,5mm wide, previous execution of a mucoperiosteal flap. The MSRD is a trocar, modified with a funnel-shaped cannula in order to allow the easy access of both an endoscope and a suction cannula or, in alternative, a straight forceps. The implant was easily found end retrieved thanks to the endoscopic control. The postoperative was uneventful and no nasal bleeding was reported by the patient. CONCLUSION The Authors recommend the use of the MSRD in order to minimize the biological sacrifice consequent to the implant retrieval in the maxillary sinus.

Preservation of extraction socket in immediate implant placement: A clinical study

AIM The objective of this study was to compare different approaches temporary restoration in an immediate implant placement. To determine the respective influence of each parameter, two treatment groups were formed; a strict and standardized study protocol was applied to minimize the influence of bias and confounding factors. The Pink Esthetic Score (PES) - the esthetic out-come of soft tissue appearance was evaluated. MATERIAL AND METHODS Sixteen patients with a single failing tooth in the maxilla and a natural contralateral site were randomly distributed into two groups. Treatment variations affected the provisional restorative in detail, group 1 with immediate implant placement and immediate temporary restoration with the simulation of the first three mm of the root and the seal of the socket, group 2 with immediate implant placement and immediate temporary restoration without the seal of the socket. All patients received the final prosthetic restoration 10-12 weeks after implant placement. Standardized photographs were taken eight months after tooth extraction. Five competent observers analyzed the esthetic outcome according to the PES. RESULTS The overall scores of the four treatment groups revealed PES values of 8.47 (SD 2.08, group 1), 6.62 (SD 3.24, group 2). The differences between groups 1 and 2 and were statistically significant (P=0.015 and P=0.047). The single parameter analysis displayed a certain range of fluctuation and heterogeneity. CONCLUSIONS Immediate implant placement and restoration appear to be a suitable alternative to early implant placement if an experienced surgeon is entrusted with the implantation procedure.

Transcrestal guided sinus lift without grafting materials: A 36 months clinical prospective study

PURPOSE This study describes the ability to perform a technique for bone regeneration in maxillary posterior deficit (TGSL) without the use of bone grafting materials using a highly minimally invasive protocol. MATERIALS AND METHODS Sixty six implants have been inserted in the sinus floor of a total of 39 patients through the transcrestal guided sinus lift technique (TGSL). All patients have been followed for at least three years in function. The drilling protocol was adapted on the basis of bone density of each implant site to achieve a torque between 45 and 55 Ncm. Healing titanium abutments tightened to 35 Ncm have been used. A CAD/CAM metal ceramics final prosthetic restoration has been generated a six months after the tissues healing and the provisional functionalization of the occlusion. Survival rate of implants and prostheses, biological and biomechanical complications, changes in marginal bone levels, and total height of alveolar crest bone before and after surgery have been evaluate and measured by the results obtained in this prospective study. It was also measured the periodontal parameters as well as levels of perception of pain by the patient during the entire recovery period. RESULTS The result of the data of follow-up was 41.96 (24 to 36) months. Cumulative implant survival was 98.53% at 3 years. There were no biological and mechanical complications and there were no prosthetic failures during the whole period of follow-up. The Marginal Bone Loss (MBL) average during the first year of operation was from 0.33 to 0.36 mm, while the 3-year follow-up, the MBL average was 0.51 to 0.29 mm. The average of residual bone height of alveolar ridge before treatment was 6.7 to 1.6 mm (range 5.1 to 9.2 mm), while the average bone height was gained 6,4 - 1.6 mm (range 3.2 to 8.1 mm). All patients reported lower pain levels and found to have normal periodontal parameters. CONCLUSIONS This study suggests that the use of guided surgery to perform transcrestal maxillary sinus lift to increase the sub-antral crestal height is a minimally invasive technique of success for the short and medium-term of follow-up, thus avoiding the extended treatment time and reducing the morbidity associated with the lifting of the floor of the maxillary sinus with traditional technique using bone grafting materials. Furthermore, this protocol without the use of graft materials does not vary the final outcome that have demonstrated the presence of newly formed bone around implants offering always predictable results, and giving a further reduction in the costs of the procedure rehabilitation.