Matteo Deflorian

Prevention and treatment of postoperative infections after sinus elevation surgery: clinical consensus and recommendations.

Introduction. Maxillary sinus surgery is a reliable and predictable treatment option for the prosthetic rehabilitation of the atrophic maxilla. Nevertheless, these interventions are not riskless of postoperative complications with respect to implant positioning in pristine bone. Aim. The aim of this paper is to report the results of a clinical consensus of experts (periodontists, implantologists, maxillofacial surgeons, ENT, and microbiology specialists) on several clinical questions and to give clinical recommendations on how to prevent, diagnose, and treat postoperative infections. Materials and Methods. A panel of experts in different fields of dentistry and medicine, after having reviewed the available literature on the topic and taking into account their long-standing clinical experience, gave their response to a series of clinical questions and reached a consensus. Results and Conclusion. The incidence of postop infections is relatively low (2%–5.6%). A multidisciplinary approach is advisable. A list of clinical recommendation are given.

Immediate implant placement and provisionalization of maxillary anterior single implants

An inevitable loss of soft and hard tissue after tooth extraction often results in a compromised site for anterior implant esthetics in both vertical and horizontal dimensions. Immediate implant placement and provisionalization has been a viable option for replacing failing maxillary anterior teeth as it preserves the vertical existing osseous and gingival architecture. With the simultaneous addition of soft- and hard-tissue grafts, the peri-implant horizontal tissue topography can also be maintained. The esthetic success of immediate implant placement and provisionalization procedures is influenced by a number of factors that can be identified as patient-dependent or clinician-dependent. This article describes in detail the process of patient selection, indications, contraindications, diagnosis, treatment planning and treatment execution required to achieve functional and esthetic success with immediate implant placement and provisionalization.

A Retrospective Analysis of the Effectiveness of the Longevity Protocol for Assessing the Risk of Implant Failure

BACKGROUND A new, computerized diagnostic tool, called the Longevity Protocol, was recently developed to predict implant failure. The present retrospective analysis was undertaken to assess the prognostic validity of this protocol. MATERIALS AND METHODS A selected group of patients who had been treated with implants over the past 10 years at six dental clinics and experienced implant failure were included in the analysis. Another group of patients with similar characteristics, not experiencing implant failure, was used as control. In April of 2015, data about each of the patients was entered into the Longevity Protocol database. For each patient, the risk assessment produced by the protocol was compared to whether the implants eventually failed. The implant failure predictions and actual implant failures were compared. RESULTS The Longevity Protocol analyzed the possible failure of 595 implants placed in 221 patients (323 implants placed in 138 patients classified as low risk, 180 implants placed in 55 patients classified as moderate risk, and 92 implants placed in 28 patients classified as high risk). The actual percentage of implant failure in the three groups was 10%, 15%, and 22%, respectively. The differences between the groups were statistically significant. The sensitivity and specificity of the Longevity Protocol was 84.9% and 11.90% in the high/moderate risk group and 47.17% and 32.74% in the low risk group, respectively. CONCLUSIONS Statistically significant results were obtained. The Longevity Protocol reliably identified patients who risked implant failure. The protocol appears to be an important tool for prognosis assessment.

Alveolar socket preservation with demineralised bovine bone mineral and a collagen matrix

Purpose The aim of the present study was to evaluate the healing of post-extraction sockets following alveolar ridge preservation clinically, radiologically, and histologically. Methods Overall, 7 extraction sockets in 7 patients were grafted with demineralised bovine bone mineral and covered with a porcine-derived non-crosslinked collagen matrix (CM). Soft tissue healing was clinically evaluated on the basis of a specific healing index. Horizontal and vertical ridge dimensional changes were assessed clinically and radiographically at baseline and 6 months after implant placement. For histological and histomorphometric analysis, bone biopsies were harvested from the augmented sites during implant surgery 6 months after the socket preservation procedure. Results Clinically, healing proceeded uneventfully in all the sockets. A trend towards reduced horizontal and vertical socket dimensions was observed from baseline to the final examination. The mean width and height of resorption were 1.21 mm (P=0.005) and 0.46 mm (P=0.004), respectively. Histologically, residual xenograft particles (31.97%±3.52%) were surrounded by either newly formed bone (16.02%±7.06%) or connective tissue (50.67%±8.42%) without fibrous encapsulation. The CM underwent a physiological substitution process in favour of well-vascularised collagen-rich connective tissue. Conclusions Socket preservation using demineralised bovine bone mineral in combination with CM provided stable dimensional changes of the alveolar ridge associated with good re-epithelialisation of the soft tissues during a 6-month healing period.

Simplified Protocol for Relining Provisional Prosthesis on Natural Abutments: A Technical Note

This article describes a simplified technique for relining provisional prostheses on natural abutments that can be applied to this specific type of tooth preparation with feather-edge finish line. Starting from a diagnostic wax-up, a provisional fixed restoration is constructed, containing all the correct structural information. This includes the controlled depth of the prosthetic margin into the gingival sulcus, the emergence profile, and the area from the emergence profile to the gingival third. Chair time is saved during the clinical procedures because the finishing and polishing steps are shortened, and the resulting provisional restoration is precise and highly biocompatible. This technique allows for a simple and quick relining and finishing procedure and for the delivery of an esthetic and biocompatible provisional restoration.