Gaetano Marenzi

Implant success, survival, and failure: the International Congress of Oral Implantologists (ICOI) Pisa Consensus Conference.

The primary function of a dental implant is to act as an abutment for a prosthetic device, similar to a natural tooth root and crown. Any success criteria, therefore, must include first and foremost support of a functional prosthesis. In addition, although clinical criteria for prosthetic success are beyond the scope of this article, patient satisfaction with the esthetic appearance of the implant restoration is necessary in clinical practice. The restoring dentist designs and fabricates a prosthesis similar to one supported by a tooth, and as such often evaluates and treats the dental implant similarly to a natural tooth. Yet, fundamental differences in the support system between these entities should be recognized. The purpose of this article is to use a few indices developed for natural teeth as an index that is specific for endosteal root-form implants. This article is also intended to update and upgrade what is purported to be implant success, implant survival, and implant failure. The Health Scale presented in this article was developed and accepted by the International Congress of Oral Implantologists Consensus Conference for Implant Success in Pisa, Italy, October 2007.

Prevention of postoperative bleeding in anticoagulated patients undergoing oral surgery: use of platelet-rich plasma gel

PURPOSE This study evaluated the effectiveness of a protocol using platelet-rich plasma (PRP) to prevent bleeding after dental extraction in patients treated with anticoagulant oral therapy. MATERIALS AND METHODS Forty patients with mechanical heart-value replacement who were treated with anticoagulant oral therapy were selected for the study. Each patient was treated with PRP gel placed into residual alveolar bone after extraction without heparin administration after suspension of oral anticoagulant drugs (36 hours). RESULTS Only 2 patients reported hemorrhagic complications (5%). Sixteen patients (40%) had mild bleeding that was easy to control with hemostatic topical agents; this mild bleeding terminated completely 1 to 3 days after the surgical procedures. The remaining 22 patients (55%) presented with adequate hemostasis. CONCLUSIONS Oral surgery in heart surgical patients under oral anticoagulant therapy may be facilitated with PRP gel. Its use is an advanced and safe procedure. This biological and therapeutical improvement can simplify systemic management and help avoid hemorrhagic and/or thromboembolic complications.

Aesthetics in oral implantology: biological, clinical, surgical, and prosthetic aspects.

Objectives:The aim of this study was to identify a correct clinical, surgical, and prosthetic management of endosseous implants replacing missing teeth in the anterior maxilla, achieving predictable aesthetic outcomes. Placement of immediate post-extraction implants without incisions or flap elevation is one of the surgical treatment options able to improve the healing and regenerative potentials of the fresh socket. Materials:Fifty-five patients (33 men, 22 women), ranging in age from 19 to 57 years (mean 29), were selected for this study. All the patients were not smokers, no bruxers, presented stable soft tissue conditions, an acceptable occlusion, and the absence of pathologies that would contraindicate bone healing. Patients were treated with implants made by 2 manufacturers: Institute Straumann, Walderburg, Switzerland and Friadent, Mannheim, Germany. A total of 87 implants were placed immediately after each failing tooth had been removed. The temporary restoration was placed 3 months after implant place-ment, and the final restoration was placed 4 months from the surgical procedure. The patients were evaluated clinically and radiographically at implant placement, and 2, 4, 18, and 24 months post-insertion. Results:At 24 months, only 3 implants were lost (2 in male patients;1 in female patient). All of these failed implants did not achieve osseointegration. The overall success rate was 96.6%, with an implant failure rate of 3.4%, all prior to restoration. Conclusions:The immediate placement in the anterior maxilla fresh extraction sockets without incisions or flaps elevation is a surgical option that can ensure ideal peri-implant tissues healing, preserving the presurgical gingival and bone aspects. For a predicable aesthetic result, the most important aspect seems to be the height and thickness of the buccal bone wall, which remain after immediate placement of the fixture.

Platelet-Rich Plasma and Resorbable Membrane for Prevention of Periodontal Defects After Deeply Impacted Lower Third Molar Extraction

PURPOSE The extraction of deeply included third molars may cause multiple periodontal defects at the distal root of the second molar. Platelet-rich plasma (PRP) is a material containing autologous growth factors, which may be used in repairing and preventing periodontal complications at the distal root of the second molar adjacent to the extracted third molar. We have previously analyzed the effects of autologous PRP on periodontal tissues after extraction of the third molar in 18 young patients. In the current study, we investigated the clinical effects of a resorbable collagen membrane of porcine origin (Bio-Gide; Geistlich Biomaterials, Wolhusen, Switzerland) associated with PRP on bone regeneration after surgical avulsion of the inferior third molars in mesio-horizontal inclusion in comparison with the use of PRP alone. MATERIALS AND METHODS Inclusion criteria were the presence of a pocket distal to the mandibular second molar with a probing depth greater than or equal to 7.5 mm and a probing attachment level greater than or equal to 6 mm, and a postextraction defect presenting with the vestibular and lingual cortical bone intact. RESULTS AND CONCLUSIONS We show that although clinical results from the comparison of PRP alone versus PRP and resorbable membrane can be considered similar, from a histologic point of view, the association of PRP to Bio-Gide membrane showed earlier signs of bone maturation but not a higher grade of bone regeneration.

Sublingual ranula: a closer look to its surgical management.

Ranulas have been managed by various surgical methods, and the optimal treatment is still controversial. The aim of this study was to analyze a group of 124 surgically treated patients with intraoral ranula to assess 3 different methods: sublingual gland removal combined with the ranula excision, conventional marsupialization, and a variant of the marsupialization technique usually performed in our departments. Recurrence rate was 0% after radical treatment, 25.8% after marsupialization, and 12% after modified marsupialization. We suggest that conservative methods should always be considered as treatment of superficial oral ranulas. The modification of the conventional marsupialization by suturing the edges of the pseudocyst before unroofing of the lesion was demonstrated to be a useful technical strategy that simplifies and accelerates the surgical procedures and probably contributed to preventing recurrences.

Implant Therapy in Irradiated Patients

In this multicenter study, submerged implants were prospectively followed to evaluate their long-term prognosis in irradiated patients. In a total of 77 patients treated for oral or neck cancer, 188 implants were consecutively placed. After a healing period, the successfully integrated implants were restored with 69 removable and 38 fixed restorations. The implants cumulative survival and success rates were evaluated over a period of at least 36 months. In addition, cumulative success rates were calculated for implant subgroups divided per implant site (mandible or maxilla), radiation dosage, and the time interval between the last irradiation and implant placement. During the healing period, 20 implants did not successfully integrate, whereas 168 implants were classified as success (including both survival and success rates). The analysis of implant subgroups showed slightly more favorable cumulative success rate for mandibular implants (98.4%) compared with maxillary implants (57.1%) and clearly better success rate for a radiation dosage minor of 50-Gy doses. A time greater than 12 months as interval between last irradiation and implant placement seems not to promote better clinical results.

Influence of Leukocyte- and Platelet-Rich Fibrin (L-PRF) in the Healing of Simple Postextraction Sockets: A Split-Mouth Study

The aim of this study was to evaluate the effects of leukocyte- and platelet-rich fibrin (L-PRF) on the pain and soft tissue healing after tooth extractions. Twenty-six patients (9 males and 17 females) were treated with multiple extractions (2 to 8), with a total of 108 extractions. This was an exploratory single blinded randomized clinical trial with a split-mouth design. The pain after the surgery was assessed in each patient by the VAS scale (1 to 10) at intervals of 24-48-72-96 hours. The soft tissue healing was clinically evaluated at 3, 7, 14, and 21 days after surgery by the same examiner surgeon, using the modified Healing Index (4 to 12). The mean value of postextraction pain was 3.2 ± 0.3 in the experimental sides and 4.1 ± 0.1 in the control sides. After 7 days from the extractions, the values of modified Healing Index in the experimental and control groups were, respectively, 4.8 ± 0.6 and 5.1 ± 0.9. The use of L-PRF in postextraction sockets filling can be proposed as a useful procedure in order to manage the postoperative pain and to promote the soft tissue healing process, reducing the early adverse effects of the inflammation.

Melt-spun bioactive sutures containing nanohybrids for local delivery of anti-inflammatory drugs

In this work, a novel concept is introduced in drug-eluting fibres to ensure a good control of drug delivery features and wide applicability to different bioactive compounds. Composite bioactive sutures based on fibre grade poly(ε-caprolactone) (PCL) and loaded with the anti-inflammatory drug Diclofenac (Dic) or a Dic nanohybrid where the drug is intercalated in a synthetic hydrotalcite (Mg/Al hydroxycarbonate) (HT-Dic) were developed. Fibres were prepared by melt-spinning at different PCL/HT-Dic/Dic ratios and analysed in terms of morphology, mechanical properties and drug release features. Results emphasized that tensile properties of fibres are clearly affected by Dic or HT-Dic addition, while the presence of knots has limited influence on the mechanical behaviour of the sutures. Release of Dic strongly depends on how Dic is loaded in the fibre (as free or nanohybrid) whereas the combination of free Dic and HT-Dic can allow a further tuning of release profile. In vivo experiments show a reduction of inflammatory responses associated with Dic-loaded fibers. Thus, a proof of principle is provided for a novel class of bioactive sutures integrating advanced controlled-release technologies.

A macro- and nanostructure evaluation of a novel dental implant.

Success in implant dentistry also comes from the implant macrodesign and nanostructure of its surface. Titanium implant surface treatments have been shown to enhance osseointegration, maximize bone healing, and bone-to-implant contact for predictable clinical results. The aim of the study, was to evaluate the geometric macrodesign and the surface nanostructure of a novel dental implant full contact covering (FCC) obtained by electrochemical procedures. FCC implants were analyzed by scanning electronic microscope, profilometer, and x-ray photoelectron spectroscopy and compared with commercial sandblasted and sandblasted, large-grit acid-etched dental implants. Sample analysis allowed to distinguish the different implant macrodesigns, the step and the profile of the coils that cover the fixture, and the surface characteristics. FCC implant showed novel macro-characteristic of crestal module, coils, and apical zone compared with sandblasted and sandblasted and acid-etched dental implants. Moreover, the FCC nanostructure surface showed roughness values statistically higher than the 2 other surfaces, with a more homogeneity in a peaks and valleys arrangement. Finally, the x-ray photoelectron spectroscopy analysis detected differences between the examined surfaces, with the presence of several contaminants according to the different treatment procedures. Research on new macrostructures and nano morphology should result in a better qualitative and quantitative osseointegration response, with a predictability of the clinical results and long-term success of the implants.

Autogenous calvarial bone graft harvest: intraoperational complications.

In the field of maxillofacial reconstructive surgery, the authors take into consideration the autogenous calvarial bone graft harvest technique for the correction of maxilla bone defects and examine some salient aspects such as technical problems and possible surgical complications.