Aim
The objective of this proof‐of‐concept study was to investigate the effects of a new guided bone regeneration technique with a tissue engineering approach.
Materials and Methods
This single ...cohort observational study evaluated the outcome of the leucocyte‐ and platelet‐rich fibrin (L‐PRF) Block for horizontal bone augmentation in the maxilla. The L‐PRF Block is prepared by mixing a particulated biomaterial with chopped L‐PRF membranes at a 50:50 ratio and adding liquid fibrinogen to glue all together. Horizontal augmentation was assessed linearly and volumetrically immediately after surgery and 5–8 months later by matching consecutive cone beam computed tomography (CBCTs).
Results
Ten patients (mean age of 50.7 years ±17.2) representing 15 sites with horizontal alveolar deficiencies were included. Superimposition of pre‐operative and posthealing CBCT scans showed an average linear horizontal bone gain of 4.6 mm (±2.3), 5.3 mm (±1.2) and 4.4 mm (±2.3), measured at 2, 6 and 10 mm from the alveolar crest, respectively. The volumetric gain was 1.05 cm3 (±0.7) on average. The resorption rate after 5–8 months was 15.6% (±6.7) on average.
Conclusions
L‐PRF Block may be a suitable technique to augment deficient alveolar ridges.
Peri‐implantitis can be explained using a multicausality model. Many factors are involved in the etiology of peri‐implantitis, but patient compliance also plays a key role. Oral hygiene, attending ...recall visits, smoking behavior, and therapy comprehension are relevant factors that contribute to peri‐implant health. The clinician should create the most optimal conditions for patients to facilitate adequate oral self‐care and to help patients improve their oral hygiene skills. Implementation of a supportive periodontal therapy program is mandatory to control inflammation and plaque accumulation, as well as to keep the incidence of peri‐implant diseases low. Patient compliance, including plaque control and dental follow‐up, must be optimal. Consequently, precautions must be taken with patients treated with dental implants.
Subgingival debridement is the part of nonsurgical therapy which aims to remove the biofilm without intentionally removing the cementum or subgingival calculus. The objective of this review was to ...describe the end point of this therapy, the different methods used and how often it should be carried out. The literature shows that several methods are currently available for subgingival debridement, namely hand instrumentation, (ultra)sonic instrumentation, laser, photodynamic therapy and air‐polishing. None of these methods seems superior to any other regarding clinical benefits or microbiological differences. However, less treatment discomfort is reported using laser, photodynamic therapy or air‐polishing compared with hand‐ and/or (ultra)sonic instrumentation. Subgingival debridement can be carried out when, during supportive periodontal therapy, pockets of 5 mm or deeper are detected.
Sinus floor elevation (SFE) is a standard surgical technique used to compensate for alveolar bone resorption in the posterior maxilla. Such a surgical procedure requires radiographic imaging pre- and ...postoperatively for diagnosis, treatment planning, and outcome assessment. Cone beam computed tomography (CBCT) has become a well-established imaging modality in the dentomaxillofacial region. The following narrative review is aimed to provide clinicians with an overview of the role of three-dimensional (3D) CBCT imaging for diagnostics, treatment planning, and postoperative monitoring of SFE procedures. CBCT imaging prior to SFE provides surgeons with a more detailed view of the surgical site, allows for the detection of potential pathologies three-dimensionally, and helps to virtually plan the procedure more precisely while reducing patient morbidity. In addition, it serves as a useful follow-up tool for assessing sinus and bone graft changes. Meanwhile, using CBCT imaging has to be standardized and justified based on the recognized diagnostic imaging guidelines, taking into account both the technical and clinical considerations. Future studies are recommended to incorporate artificial intelligence-based solutions for automating and standardizing the diagnostic and decision-making process in the context of SFE procedures to further improve the standards of patient care.
Background
Furcation involvement and attachment loss are major predictors of tooth loss. The aim of this study was to describe specific designs for papilla preservation flaps (PPFs) and minimally ...invasive surgery to be used in compromised molars and report proof‐of‐principle data with 3 to 16‐year follow‐up in severely compromised molars due to the presence of combined furcation and intrabony defects.
Methods
Forty‐nine subjects with furcated molars and deep intrabony defects were treated with PPFs, application of periodontal regenerative devices. Improvement as a consequence of therapy was defined as tooth retention, reduction in horizontal and vertical furcation involvement, decrease in probing depths, and increases in clinical attachment level. Subjects were maintained with regular supportive periodontal care.
Results
At 1 year, 100% of maxillary and 92% of mandibular molars showed improvements. Improvements were not observed in molars with baseline hypermobility: two mandibular molars with hypermobility were extracted at the 1‐year follow‐up. Improvement in vertical sub‐classification was observed in 87.5% of maxillary and in 84.6% of mandibular molars. One‐year improvements could be maintained over the 3 to 16‐year follow‐up.
Conclusions
PPFs and periodontal regeneration can be applied and provide clinical benefits to severely compromised molars due to the combined presence of furcation involvement and deep intrabony defects. These results were obtained in cases with an interdental peak of bone and gingival margin coronal to the furcation entrance in well‐maintained and compliant subjects. Randomized controlled clinical trials with medium‐ to long‐term follow‐up are needed to confirm these findings.
Objectives
Evaluate in a case series the clinical applicability of a regenerative approach for treatment of peri‐implant lesions based on papilla preservation flaps (PPF) and minimally invasive ...surgery (MIST).
Material and methods
Twenty‐one deep peri‐implant defects in 21 patients were surgically accessed applying PPF and MIST. The exposed implant surface was decontaminated with the sequential application of mechanical devices and chemical agents. Bone substitutes alone or in combination with a collagen barrier were applied, according to the anatomy of the peri‐implant lesion. Clinical and radiographic measurements were collected at baseline, post‐surgery, 1 and 5 years.
Results
Primary wound closure was obtained in 100% of the sites and maintained in 90% of the sites at 1 week. Bleeding on probing (BOP) was reduced from 100% at baseline to 28.6% at 1 year and to 42.8% at 5 years. The 1‐year pocket reduction was 3.9 ± 1 mm. Residual probing depths (PD) were 4.1 ± 0.9 mm. PD remained stable up to 5 years. The radiographic bone gain was 2.5 ± 1.2 mm (mesial) and 2.5 ± 1.1 (distal) at 1‐year and 2.3 ± 1.3 mm (mesial) and 2.6 ± 1.4 mm (distal) at 5 years. The radiographic resolution of the defect was 70.4% ± 19% (mesial) and 70.2% ± 22% (distal) at 1 year and 64.2% ± 21% (mesial) and 67.7% ± 21% (distal) at 5 years. All implants survived up to 5 years. A composite outcome of disease resolution shows consistent 1‐year clinical improvements at all the treated sites and substantial 5‐year stability.
Conclusions
PPF and MIST can be successfully applied for the regenerative treatment of peri‐implant defects.
Aim
The modified minimally invasive surgical technique (M‐MIST) optimizes wound stability in the treatment of intrabony defects. Short‐term observations show similar results as with flap alone or ...adjunctive regenerative materials. This study aims to compare the stability of the long‐term outcomes, complication‐free survival, and costs of the three treatment options.
Materials and Methods
Forty‐five intrabony defects in 45 patients were randomized to M‐MIST alone (N = 15), combined with enamel matrix derivative (M‐MIST + EMD, N = 15), or EMD plus bone‐mineral‐derived xenograph (M‐MIST + EMD + BMDX, N = 15). Supportive periodontal care (SPC) and necessary re‐treatment were provided for 10 years.
Results
Three subjects were lost to follow‐up. Clinical attachment level differences between 1 and 10 years were −0.1 ± 0.7 mm for M‐MIST, −0.1 ± 0.8 mm for M‐MIST + EMD, and −0.3 ± 0.6 mm for M‐MIST + EMD + BMDX (p > .05 for within‐ and between‐group differences). Four episodes of recurrence occurred in the M‐MIST group, four in the M‐MIST + EMD group, and five in the M‐MIST + EMD + BMDX group. No significant differences in complication‐free survival were observed between the three groups (p = .47). Complication‐free survival was 7.46 years (95% confidence interval: 7.05–7.87) for the whole population. The M‐MIST + EMD + BMDX group lost one treated tooth. Data indicated no significant inter‐group difference of the total cost of recurrence over 10 years. When the baseline cost of treatment was considered, the total cost was lower for M‐MIST alone.
Conclusions
Teeth with deep pockets associated with intrabony defects can be successfully maintained over the long term with either M‐MIST alone or by adding a regenerative material in the context of a careful SPC programme. M‐MIST alone provided similar short‐ and long‐term benefits as regeneration, at a lower cost. These findings need to be confirmed in larger, independent studies.
Aim
To investigate the influence of various surgical techniques for sinus augmentation on the volumetric changes of graft, membrane and the post‐operative discomfort.
Materials and Methods
Eighteen ...patients in need of bilateral sinus floor elevation (SFE) were assigned to lateral SFE, transcrestal SFE and intralift procedures. CBCT images taken at baseline, 1 week and 6 weeks were analysed for volumetric changes in graft and Schneiderian membrane. Questionnaires were used to analyse post‐op discomfort.
Results
The overall average graft volume obtained after 1 week was 1.87 cm3 (range 0.12–4.72 cm3). Volumes decreased after 6 weeks to an overall mean volume of 1.33 cm3 (range 0.10–4.29 cm3 – average decrease of 27.6%). After 6 weeks, the amount of graft volume decreased in every treatment option, ranging from −23.13% for the tSFE, over −24.55% for the lSFE, to −33.71% for the IL. Although all treatment options correspond in an increase in Schneiderian membrane volume, no statistically significant correlation between this increase and loss of graft volume could be obtained for all treatments (p = 0.97).
Conclusion
All SFE techniques provided sufficient graft volume for implant treatment. All techniques provoke a partially transient swelling of the Schneiderian membrane. All techniques resulted in a decrease in graft volume after 6 weeks; however, no significant differences were obtained between treatments. Furthermore, no statistical significant correlation between the post‐operative swelling of the Schneiderian membrane and reduction in graft volume at 6 weeks could be obtained.
Aim
Alveolar ridge resorption following tooth extraction often renders a lateral bone augmentation inevitable. Some patients, however, suffer from severe early (during graft healing, Eres) and/or ...late (during follow‐up, Lres) graft resorption. We explored the hypothesis that the “individual phenotypic dimensions” may partially explain the degree of such resorptions.
Materials and Methods
Patients who underwent a guided bone regeneration (GBR) procedure were screened for inclusion according to the following criteria: (1) a relatively symmetrical maxillary arch; (2) an intact contra‐lateral alveolar bone dimension; (3) the availability of a pre‐operative cone‐beam CT (CBCT); (4) a CBCT taken immediately after GBR, and (5) at least one CBCT scan ≥6 months after surgery. CBCT scans from different timepoints were registered and imported into the Mimics software (Materialise, Leuven, Belgium). Bone dimensions of the contra‐lateral site of the augmentation, representing the “individual phenotypical dimension (IPD) of the alveolar crest”, were superimposed on the augmented site and registered accordingly. As such, Eres and Lres could be measured over time, in relation to the IPD (in two dimensions; per millimetre apically from the alveolar crest, in the centre of the GBR), as well as in three dimensions (the entire GBR, 2 mm away from the mesial, distal, and apical border for standardization).
Results
A total of 17 patients (23 augmented sites) were included. After Eres, the outline of the augmentation was in general located ±1 mm outside the IPD, but ≥1.5 years after GBR, it further moved towards the IPD (85% within 0.5 mm distance).
Conclusions
Within the limitations of this study, the results indicate that the dimensions of a lateral bone augmentation are defined by the “individual phenotypic bone boundaries” of the patient.
The leukocyte- and platelet-rich fibrin block (L-PRF block) is a composite graft that combines a xenograft that is acting as a scaffold with L-PRF membranes that serve as a bioactive nodule with ...osteoinductive capacity. This study evaluated the properties of the L-PRF block and its components in terms of release of growth factors, cellular content, and structure.
The concentration of transforming growth factor-β1 (TGF-β1), vascular endothelial growth factor (VEGF), platelet-derived growth factor-AB (PDGF-AB) and bone morphogenetic protein-1 (BMP-1) released by a L-PRF membrane (mb) and a L-PRF block were examined with ELISA for five time intervals (0 to 4 hours, 4 hours to 1 day, 1 to 3 days, 3 to 7 days, 7 to 14 days). Those levels in L-PRF exudate and liquid fibrinogen were also evaluated. The cellular content of the liquid fibrinogen, L-PRF membrane and exudate was calculated. The L-PRF block was also analyzed by means of a microCT scan and scanning electron microscopy (SEM).
TGF-β1 was the most released growth factor after 14 days, followed by PDGF-AB, VEGF, and BMP-1. All L-PRF blocks constantly released the four growth factors up to 14 days. L-PRF membrane and liquid fibrinogen presented high concentration of leukocytes and platelets. The microCT and SEM images revealed the bone substitute particles surrounded by platelets and leukocytes, embedded in a dens fibrin network.
The L-PRF block consists of deproteinized bovine bone mineral particles surrounded by platelets and leukocytes, embedded in a fibrin network that releases growth factors up to 14 days.
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