Claudio Stacchi

Changes in Implant Stability Using Different Site Preparation Techniques: Twist Drills versus Piezosurgery. A Single-Blinded, Randomized, Controlled Clinical Trial

PURPOSE The objective of the present investigation was to longitudinally monitor stability changes of implants inserted using traditional rotary instruments or piezoelectric inserts, and to follow their variations during the first 90 days of healing. MATERIALS AND METHODS A randomized, controlled trial was conducted on 20 patients. Each patient received two identical, adjacent implants in the upper premolar area: the test site was prepared with piezosurgery, and the control site was prepared using twist drills. Resonance frequency analysis measurements were taken by a blinded operator on the day of surgery and after 7, 14, 21, 28, 42, 56, and 90 days. RESULTS At 90 days, 39 out of 40 implants were osseointegrated (one failure in the control group). Both groups showed an initial decrease in mean implant stability quotient (ISQ) values: a shift in implant stability to increasing ISQ values occurred after 14 days in the test group and after 21 days in the control group. The lowest mean ISQ value was recorded at 14 days for test implants (97.3% of the primary stability) and at 21 days for the control implants (90.8% of the primary stability). ISQ variations with respect to primary stability differed significantly between the two groups during the entire period of observation: from day 14 to day 42, in particular, the differences were extremely significant (p < .0001). All 39 implants were in function successfully at the visit scheduled 1 year after insertion. CONCLUSIONS The findings from this study suggest that ultrasonic implant site preparation results in a limited decrease of ISQ values and in an earlier shifting from a decreasing to an increasing stability pattern, when compared with the traditional drilling technique. From a clinical point of view, implants inserted with the piezoelectric technique demonstrated a short-term clinical success similar to those inserted using twist drills.

Minimally invasive transcrestal sinus floor elevation with deproteinized bovine bone or β‐tricalcium phosphate: a multicenter, double‐blind, randomized, controlled clinical trial

AIMS To evaluate the outcomes of transcrestal sinus floor elevation (tSFE) performed with a minimally invasive procedure (Smart Lift technique) combined with the additional use of deproteinized bovine bone mineral (DBBM) or β-tricalcium phosphate (β-TCP). METHODS In a multicenter randomized controlled trial, 38 sites in 38 patients were treated with the Smart Lift technique in association with DBBM (n = 19) or β-TCP (n = 19). The extent of the sinus lift (SL) and the height of the graft apical to the implant apex (aGH) were assessed on periapical radiographs taken immediately after surgery and at 6 months following surgery. RESULTS (i) Substantial aGH and SL were observed immediately after surgery and at 6 months, with no significant differences between DBBM and β-TCP groups; (ii) a significant graft remodelling was observed from post-surgery to 6-months in the β-TCP group and (iii) limited incidence of complications as well as limited post-operative pain and discomfort were associated with the use of both graft materials. CONCLUSIONS The Smart Lift technique in conjunction with the additional use of either DBBM or β-TCP may provide a substantial elevation of the maxillary sinus floor along with limited post-surgical complications and post-operative pain/discomfort.

Ultrasonic Implant Site Preparation Using Piezosurgery: A Multicenter Case Series Study Analyzing 3,579 Implants with a 1- to 3-Year Follow-Up

This multicenter case series introduces an innovative ultrasonic implant site preparation (UISP) technique as an alternative to the use of traditional rotary instruments. A total of 3,579 implants were inserted in 1,885 subjects, and the sites were prepared using a specific ultrasonic device with a 1- to 3-year follow-up. No surgical complications related to the UISP protocol were reported for any of the implant sites. Seventy-eight implants (59 maxillary, 19 mandibular) failed within 5 months of insertion, for an overall osseointegration percentage of 97.82% (97.14% maxilla, 98.75% mandible). Three maxillary implants failed after 3 years of loading, with an overall implant survival rate of 97.74% (96.99% maxilla, 98.75% mandible).

Intraoperative Complications during Sinus Floor Elevation Using Two Different Ultrasonic Approaches: A Two-Center, Randomized, Controlled Clinical Trial

PURPOSE The aim of this study was to assess the prevalence of intraoperative complications during maxillary sinus elevation with lateral approach using a piezoelectric device with two different surgical techniques. MATERIALS AND METHODS Antrostomies were randomly performed by outlining a window (group A, 36 patients) or by eroding the cortical wall with a grinding insert until the membrane was visible under a thin layer of bone, before outlining the window (group B, 36 patients). Occurrence of membrane perforation, laceration of vascular branches, and surgical time was recorded. RESULTS Seventy-two patients underwent sinus floor elevation: four perforations (11.1%) were observed in group A (two occurred during elevation with hand instruments) and zero perforations in group B (p < .05). No evidence of vascular lacerations was registered in both groups. A clinically insignificant but statistically shorter surgical time was recorded in group A (9.2 ± 3.7 minutes) than in group B (13.3 ± 2.4 minutes; p < .05). CONCLUSIONS Within the limits of the present study, it may be concluded that ultrasonic erosion of the lateral wall of the sinus is a more predictable technique than piezoelectric outlining of a bone window in preventing from accidental perforations of Schneiderian membrane during sinus augmentation procedures.

Risk Factors for Peri-Implantitis: Effect of History of Periodontal Disease and Smoking Habits. A Systematic Review and Meta-Analysis

ABSTRACT Objectives The purpose of this review was to evaluate whether history of periodontitis and smoking habits could represent a risk factor for peri-implantitis and implant loss. Material and Methods This systematic review followed PRISMA guidelines and was registered at the PROSPERO database [registration numbers CRD42016034160 (effect of history of periodontitis) and CRD42016033676 (effect of smoking)]. Broad electronic (MEDLINE) and manual searches were conducted among articles published from January 1st 1990 up to December 31st 2015, resulting in 49332 records for history of periodontitis and 3199 for smoking habits. Selection criteria included prospective studies comparing two cohorts of patients, with and without the investigated risk factor, with a minimum follow-up period of three years, and reporting data on peri-implantitis and implant loss occurrence. Considering that only prospective studies were included, dichotomous data were expressed as risk ratios and 95% confidence intervals. Results Three studies evaluating history of periodontitis (on which quantitative analysis was performed) and one study on smoking effect were included. Both implant and patient-based meta-analyses revealed a significantly higher risk of developing peri-implantitis in patients with a history of periodontitis compared with periodontally healthy subjects, but not a statistically significant increased risk for implant loss. Conclusions The outcomes of this systematic review indicate history of periodontitis as a possible risk factor for peri-implantitis, while insufficient data are present in literature to evaluate the role of smoking. However, available evidence is still weak and immature, and sound epidemiological studies are needed to analyse the specific contribution of these potential risk factors.

Laurell-Gottlow suture modified by Sentineri for tight closure of a wound with a single line of sutures.

Primary wound healing requires precise approximation of he edges of the wound and their firm stabilisation during he early phases of healing.1 A line of horizontal mattress utures followed by interrupted sutures is considered reliable or the closure of flaps.2 Horizontal mattress sutures maxmise eversion of the wound, which encourages close contact etween the inner portions of the flap and keeps epithelium way from underlying structures, reduces dead space and inimises tension across the wound. However, the use of dditional interrupted sutures is necessary to approximate he edges of the wound and obtain primary healing. The Laurell and Gottlow suture3 is a modified horizontal attress suture used to avoid interrupted sutures, even if its version potential and tightness of closure are less than those f conventional mattress sutures. Our proposal is to modify he technique in a single line of sutures to close the edges of he incision completely with eversion comparable to that of orizontal mattress sutures. The Sentineri technique has five steps in common with the aurell and Gottlow suture. First, the needle is inserted from he outside of the buccal flap 3–4 mm from its margin. The nternal side of the lingual flap is then pierced 3–4 mm from he margin of the lingual flap. The outside of the lingual flap is then pierced 5 mm lateral o the second piercing, and the needle passed through the nside of the buccal flap (point A). The needle is then brought own lingually over the coronal aspect of the flap and passed hrough the loop. In the Laurell and Gottlow technique the suture is now tied o the free end. However, the Sentineri technique proceeds Fig. 1) by leaving the suture with the needle over the loop. he thread that exits from point A is pulled and tied to the free nd with a surgical knot (Fig. 2). The needle is then pulled o tighten the suture, and tied to the free end with a surgical not (Figs. 3 and 4).

Surgical relocation of a malpositioned, unserviceable implant protruding into the maxillary sinus cavity. A clinical report.

Malpositioned implants always result in significant mechanical and aesthetic restorative challenges. This case report describes the correction of position of an unserviceable osseointegrated implant also protruding into the maxillary sinus cavity. This surgical technique facilitated the relocation of an implant-bony segment into a more favorable aesthetic and biomechanical position in a single stage surgery.

Histologic and Histomorphometric Comparison between Sintered Nanohydroxyapatite and Anorganic Bovine Xenograft in Maxillary Sinus Grafting: A Split-Mouth Randomized Controlled Clinical Trial

The presence of vital bone after maxillary sinus augmentation is crucial to enhance the quality of bone-implant interface, ensuring predictable long-term results. The aims of this RCT with split-mouth design were the histologic and histomorphometric comparison of two different biomaterials in sinus elevation after 6 months of healing and the evaluation of the clinical outcomes of implants inserted in the augmented areas after 12 months of prosthetic loading. Twenty-eight patients (10 females, 18 males) were treated with bilateral sinus floor elevation with lateral approach. Pure sintered nanohydroxyapatite (NHA) and anorganic bovine bone (ABB) were used as test and active control, respectively. After six months, 52 bone biopsies were harvested from 26 patients, and 107 implants were inserted in the augmented areas. Histomorphometry showed that, in the two groups, vital bone percentages were 34.9 ± 15% (NHA) and 38.5 ± 17% (ABB) (p = 0.428), marrow spaces percentages were 44.5 ± 18% (NHA) and 43.5 ± 23% (ABB) (p = 0.866), and residual graft percentages were 20.6 ± 13% (NHA) and 22.3 ± 12% (ABB) (p = 0.638). After 6 months of healing, no statistically significant difference was present in histomorphometric outcomes between NHA and ABB groups. Implant survival rate in NHA group after 12 months of loading was 96.4%, showing no statistically significant differences with ABB group.

AQP1 expression in human gingiva and its correlation with periodontal and peri-implant tissue alterations

Aquaporins (AQPs) are a family of hydrophobic integral membrane proteins that function as transmembrane channels and play an important role in tissue homeostasis. Aquaporin-1 (AQP1), in particular, has been reported to be involved in several biological processes including inflammation, angiogenesis, wound healing and others. Periodontitis and peri-implantitis can be defined as inflammatory processes that affect the tissues surrounding a tooth or an osseointegrated implant, respectively. To date, there are limited data about the involvement of AQPs in these diseases. The aim of this study was to evaluate the possible link between the histomorphological alterations and the expression of AQP1 in healthy, pathological and healed periodontal and peri-implant gingival tissues. The results obtained showed that changes in organization of collagen fibers were observed in periodontitis and peri-implantitis, together with an increase in the percentage of area occupied by inflammatory cell infiltration and an increase of AQP1 immunostaining, which was located in the endothelial cells of the vessels within the lamina propria. Moreover, in healed periodontal and peri-implant mucosa a restoration of histomorphological alterations was observed together with a concomitant decrease of AQP1 immunostaining. These data suggested a possible link between the degree of inflammatory state and the presence of AQP1, where the latter could be involved in the chain of inflammatory reactions triggered at periodontal and peri-implant levels.

Intraoperative Complications During Sinus Floor Elevation with Lateral Approach: A Systematic Review

PURPOSE To analyze the occurrence of intraoperative complications during sinus floor elevation with a lateral approach and their correlations with the technique adopted by surgeons. MATERIALS AND METHODS Electronic and manual searches resulted in 4,417 records on sinus floor elevation. Twenty-one randomized clinical trials (RCTs) and 11 prospective controlled clinical trials (CCTs) reporting occurrence of intraoperative complications were included. Risk of bias was assessed according to the Cochrane tool and a modified Downs and Black quality analysis for RCTs and CCTs, respectively. RESULTS Sinus membrane perforation and hemorrhagic events following vascular lesions were the only intraoperative complications reported by the selected studies with overall occurrences of 15.7% and 0.4%, respectively. Three different surgical devices (rotary instruments, piezoelectric osteotomes, and manual bone scrapers) were used to perform the lateral antrostomy. Ultrasonic devices and bone scrapers showed a lower incidence (10.9% and 6.0%, respectively) of membrane perforation compared with that of rotary instruments (20.1%). Among the different ultrasonic procedures, erosion of the lateral antral wall showed the lowest membrane perforations (4.7% incidence). Hemorrhagic complications seemed to be extremely infrequent with any surgical technique. CONCLUSION Sinus membrane perforation was the most frequently described intraoperative complication during sinus floor elevation with a lateral approach. Thinning the lateral wall of the sinus before performing the antrostomy (either with ultrasonic devices or manual bone scrapers) seemed to be an important factor in preventing membrane perforation during sinus surgery. Further high-quality RCTs specifically investigating intraoperative complication occurrence are needed.