Vincenzo Iorio-Siciliano

The impact of a laser-microtextured collar on crestal bone level and clinical parameters under various placement and loading protocols.

PURPOSE Physical attachment of connective tissue fibers to a laser-microtextured (8- and 12-μm grooves) surface on the collar of an implant has been demonstrated using human histology. Related clinical research has suggested that this microtextured surface may help to decrease initial bone loss after implant placement. The aim of this retrospective study was to compare crestal bone heights and clinical parameters between implants with laser-microtextured and machined collars placed and loaded with different protocols. MATERIALS AND METHODS This study evaluated 300 single implants in 300 patients (155 men, 145 women; mean age: 49.3 years; range: 45 to 75 years). One hundred sixty implants with laser-microtextured collars (L) and 140 with machined collars (M) were used. Implants were grouped into the treatment categories of immediate placement, delayed placement, immediate nonocclusal loading, and delayed loading. For all groups, crestal bone level, attachment level (CAL), Plaque Index, and bleeding on probing were recorded at baseline and 6, 12, and 24 months after loading with the definitive restoration. RESULTS Nine implants were lost (four L and five M). The type of implant and timing of placement and loading showed no significant influence on survival rates. A mean CAL loss of 1.12 mm was observed during the first 2 years in the M group, while the mean CAL loss observed in the L group was 0.55 mm. Radiographically, L group implants showed a mean crestal bone loss of 0.58 mm, compared to 1.09 mm for the M group. CONCLUSION A laser-microtextured surface on the implant collar may mitigate the negative sequelae associated with peri-implant bone loss, regardless of the placement and loading protocols used.

Clinical Outcomes Following Regenerative Therapy of Non-Contained Intrabony Defects Using a Deproteinized Bovine Bone Mineral Combined With Either Enamel Matrix Derivative or Collagen Membrane

BACKGROUND The purpose of this study is to compare clinical outcomes in the treatment of deep non-contained intrabony defects (i.e., with ≥70% 1-wall component and a residual 2- to 3-wall component in the most apical part) using deproteinized bovine bone mineral (DBBM) combined with either enamel matrix protein derivative (EMD) or collagen membrane (CM). METHODS Forty patients with multiple intrabony defects were enrolled. Only one non-contained defect per patient with an intrabony depth ≥3 mm located in the interproximal area of single- and multirooted teeth was randomly assigned to the treatment with either EMD + DBBM (test: n = 20) or CM + DBBM (control: n = 20). At baseline and after 12 months, clinical parameters including probing depth (PD) and clinical attachment level (CAL) were recorded. The primary outcome variable was the change in CAL between baseline and 12 months. RESULTS At baseline, the intrabony component of the defects amounted to 6.1 ± 1.9 mm for EMD + DBBM and 6.0 ± 1.9 mm for CM + DBBM sites (P = 0.81). The mean CAL gain at sites treated with EMD + DBBM was not statistically significantly different (P = 0.82) compared with CM + DBBM (3.8 ± 1.5 versus 3.7 ± 1.2 mm). No statistically significant difference (P = 0.62) was observed comparing the frequency of CAL gain ≥4 mm between EMD + DBBM (60%) and CM + DBBM (50%) or comparing the frequency of residual PD ≥6 mm between EMD + DBBM (5%) and CM + DBBM (15%) (P = 0.21). CONCLUSION Within the limitations of the present study, regenerative therapy using either EMD + DBBM or CM + DBBM yielded comparable clinical outcomes in deep non-contained intrabony defects after 12 months.

Stage-specific therapeutic strategies of medication-related osteonecrosis of the jaws: a systematic review and meta-analysis of the drug suspension protocol

ObjectiveThe most debated topic about medication-related osteonecrosis of the jaws (MRONJ) is its therapy, as there are no definitive guidelines. The aims of this systematic review were (a) to outline the best therapeutic approach according to the stage at diagnosis and (b) to perform a meta-analysis to assess whether the drug-holiday protocol may be or not an effective method in the management of MRONJ patients.Materials and methodsThe systematic review was performed following the PRISMA principles. Results were screened according to inclusion and exclusion criteria regarding staging before/after treatment, follow-up, and information provided by the authors. For statistical analysis, linear variables are reported as means and standard deviations, medians, and inter-quartile range (IQR); normality of data, according to the distribution of complete healing (primary outcome variable), was assessed with the Kolmogorov-Smirnov test. A p value < 0.05 was considered statistically significant for all tests.ResultsThirteen studies were selected out of 1480. None of them was case-controlled or randomized. Conservative approach showed good results at early stages, but heterogeneous result at advanced stages (100% stage 0, stage I range 81–97%, stage II range 63.6–100%, stage III 73%). Surgical approach showed heterogeneous results at all stages (stage I range 0–100%, stage II range 52–100%, stage III range 50–100%). Statistical analysis showed a significantly higher prevalence of completely healed sites in patients who followed the drug-holiday protocol.ConclusionsThe results suggest that the current stage-specific approach for MRONJ therapy is based on a sound clinical rationale. Conservative treatment appears to yield better outcomes at early stages, while further investigations are needed to elucidate the best protocols for the management of advanced stages. The drug-holiday protocol statistically promotes complete healing after oral surgery procedures but the application should be dictated by the condition of each patient.Clinical relevanceAt present, early MRONJ stages should be primarily treated by means of a conservative approach while more advanced stages must be carefully evaluated. Individual decisions should be made for every single case even with respect to the drug-holiday protocol.

Soft tissue conditions and marginal bone levels of implants with a laser‐microtextured collar: a 5‐year, retrospective, controlled study

AIM To compare clinical and radiographic outcomes of implants with a Laser-Lok®-microtextured collar to implants with a resorbable blast textured (RBT) collar after a 5-year follow-up period. MATERIALS AND METHODS Thirty-four implants with a Laser-Lok®-microtextured collar (test group [TG]) and 31 implants with an RBT collar (control group [CG]) were placed in 45 non-smoking, periodontally healthy patients. The full-mouth plaque score, full-mouth bleeding score, number of sites with plaque, and the number of sites with bleeding on probing (BOP) were recorded at baseline, and at 1-, 2-, 3-, 4-, and 5-year follow-up. Probing depth (PD) and mucosal recession were assessed at baseline and after the 5-year follow-up period. The radiographic marginal bone loss (MBL) was calculated by subtracting the bone level at the time of crown insertion from the bone level at the 5-year follow-up. RESULTS An implant survival rate of 94% and of 90% was reported for the TG and the CG, respectively. No statistical differences were found between the study groups for presence of plaque (10.1% vs. 25%) or for number of sites with BOP (10.3% vs. 23%). The differences between both study groups were statistically significant for mean MBL (0.81 ± 0.24 vs. 2.02 ± 0.32 mm), mean PD (2.32 ± 0.44 vs. 4.25 ± 0.87 mm), and mean mucosal recession (0.16 ± 0.3 vs. 0.22 ± 0.3 mm). CONCLUSIONS Within the limitations of this study, results suggest that the laser-microtextured implant collar surface may provide more favorable conditions for the attachment of hard and soft tissues, and reduce the level of MBL.

Clinical, radiographic, and esthetic evaluation of immediately loaded laser microtextured implants placed into fresh extraction sockets in the anterior maxilla: a 2-year retrospective multicentric study.

Objectives:To assess the clinical, radiographic, and esthetic outcomes of implants with a laser microtextured collar placed in the anterior region of the maxilla at the time of tooth extraction and immediately temporized. Methods:Forty-six Tapered Internal Laser-Lok BioHorizons implants were immediately placed and immediately restored with nonfunctional loading in 46 patients (24 men and 22 women) with a thick gingival biotype, ideal gingival level/contour, and postextraction intact walls. Survival rate, cortical bone loss, and periimplant mucosal responses were evaluated at 6, 12, and 24 months. Results:Survival rate was 95.6%. Mean mesial and distal marginal bone loss, 24 months after installation, were 0.58 mm (SD = 0.53; range, 0.17–1.15) and 0.57 mm (SD = 0.70; range, 0.42–1.10), respectively. A mesial and distal papilla regrowth mean of 1.8 and 1.5 mm, respectively, were found. The midfacial soft tissue levels showed 0.12 mm of mean recession after 24 months. Conclusion:Immediate implants with a laser microtextured surface restored at the day of surgery, may be considered as a predictable procedure in terms of implant survival and hard and soft tissue remodeling.

Influence of Platform-Switched, Laser-Microtextured Implant on Marginal Bone Level: A 24-Month Case Series Study.

PURPOSE The aim of this case series study was to evaluate clinical and radiographic changes of soft and hard tissues around tapered, platform-switched, laser-microtextured implants 24 months after crown placement. MATERIALS AND METHODS Twenty tapered, platform-switched, laser-microtextured collar implants were placed in 20 patients. Full-mouth plaque score, full-mouth bleeding score, probing depth, and mucosal recession were recorded at the time of crown cementation and after 24 months follow-up. The marginal bone-level changes at the mesial and distal aspects of the implants were calculated by subtracting from baseline and 24-month implant marginal bone level. RESULTS In terms of the full-mouth plaque score and full-mouth bleeding score, tapered, platform-switched, laser-microtextured implants showed statistically significant improvements at 6 months when compared to baseline (P < .001). Statistically significantly deeper probing depths (P < .001) were found when comparing baseline and at 24 months at mesial, lingual, and distal sites. However, no statistically significant difference was found at the buccal aspects (P = .064). Radiographic marginal bone loss at 2-year follow-up for tapered, platform-switched, laser-microtextured implants was 0.72 ± 0.16 mm and 0.67 ± 0.15 mm at the mesial and distal sites, respectively. CONCLUSION Within the limits of this study, tapered, platform-switched, laser-microtextured implants maintained marginal bone level (less than 1 mm radiographic bone loss) as well as limited mucosa recession over a 2-year period.

Clinical Influence of Micromorphological Structure of Dental Implant Bone Drills

Background Considerations about heat generation, wear, and corrosion due to some macrostructural bur components (e.g., cutting lips, rake angle, flute, and helix angle) have been widely reported. However, little is known about how the microstructural components of the implant drill surface can influence the implant drill lifetime and clinical performance. Aim To investigate accurately the surface morphology of surgical bone drill, by means of multivariate and multidimensional statistical analysis, in order to assess roughness parameters able to predict the evolution of tribological phenomena linked to heat development, wear, and corrosion occurring in clinical use. Materials and Methods The surfaces of implant drills approximately 2.0mm in diameter made by five manufacturers were examined by means of confocal microscope with white light laser interferometry, obtaining several surface roughness parameters. Statistical multivariate analysis based on discriminant analysis showed, for each cut-off, the parameters which discriminate the manufacturers. Results The microstructural parameters used by discriminant analysis evidenced several differences in terms of drill surface roughness between the five manufacturers. Conclusions The observed surface roughness difference of drills is able to predict a different durability and clinical performance especially in heat generation and wear onset.

Clinical Outcomes of Socket Preservation Using Bovine-Derived Xenograft Collagen and Collagen Membrane Post–Tooth Extraction: A 6-Month Randomized Controlled Clinical Trial

The aim of this study was to evaluate the clinical remodeling of the alveolar socket following the application of bovine-derived xenograft collagen and collagen membrane compared to natural spontaneous healing during the first 6 months following tooth extraction. A total of 20 patients with 20 fresh alveolar sockets were randomly allocated into a test or control group. After a 6-month follow-up period, surgical reentry was performed and implants were placed. Significant statistical differences were recorded in terms of vertical and horizontal bone changes between the test and control groups. Within the limitations of this study, socket preservation procedures may provide more favorable conditions for subsequent implant placement.