Minimal Bone Loss Research Articles

Advancing the clinical use of zirconia dental implants: a comprehensive review of outcomes, innovations and challenges

Zirconia dental implants have gained attention as an alternative to titanium implants. They offer superior aesthetics, biocompatibility, and appeal for metal-free restorations. This review examines zirconia implants clinical performance, mechanical properties, and design and surface treatment innovations. The analysis includes studies from 2008 to 2020, evaluating survival rates, bone loss, and challenges with osseointegration and mechanical fragility. Clinical evidence suggests that zirconia implants exhibit survival rates similar to titanium implants, with minimal marginal bone loss and favorable soft tissue outcomes. One-piece designs show better performance due to reduced mechanical failure risk. However, zirconia's brittleness remains limited, especially in high-stress areas like the posterior mandible. Advances in zirconia formulations and surface treatments, such as sandblasting and acid etching, have improved osseointegration and clinical success. Although short-and medium-term studies are promising, the absence of long-term data raises concerns regarding the durability and performance of zirconia implants. Further research is needed to address osseointegration variability, refine surface modification techniques, and explore hybrid implant designs combining zirconia and titanium for enhanced mechanical strength. In conclusion, while zirconia implants offer significant potential as a titanium alternative, ongoing research, and long-term clinical trials are essential for their widespread acceptance in modern implantology.

Clinical Assessment of the Relationship of Dental Implant Materials (Titanium and Zirconia) and Peri-Implantitis: A Systematic Review

Abstract Objective This study analyzed clinical parameters to assess whether dental implant material is a risk factor for peri-implantitis. Methods A literature search was performed on PubMed Central, Cochrane, PubMed/MEDLINE, Embase, and Scopus. The PICO strategy involved healthy patient, partially or fully edentulous, receiving at least one dental implant; zirconia or titanium dental implants; comparison involving assessment of whether there were differences in the risk of peri-implantitis among different materials used for dental implants; clinical parameters. Quality assessment was performed using the modified Jadad scale. Results Nineteen articles met the inclusion criteria. BoP did not have statistically significant differences comparing zirconia and titanium implants or natural teeth. MBL had diversified results; sometimes, it was higher in zirconia implants than titanium; otherwise, there was no significant difference. Comparing implants with natural teeth, MBL was lower in titanium implants over prolonged observation periods, and greater severity was found in the zirconia group. Notably, natural teeth had minimal bone loss. Zirconia implants demonstrated reduced plaque accumulation and minimal microbial contamination compared to titanium implants and control teeth. The quality assessment was considered poor to low in 9 studies and good to excellent in 10. The development of peri-implantitis was influenced by several patient-specific and clinical factors, underscoring the need to adopt a comprehensive and personalized approach to implant dentistry and peri-implantitis prevention. Conclusion It was not possible to draft any solid conclusion for the relationship between implant material and peri-implantitis.

The Influence of Patient-, Site-, and Implant-Related Factors on Marginal Bone Levels of Dental Implants in a Rural Population in China: A Retrospective Study.

Limited research is available on implant treatment outcomes in rural populations. This may be due to the presence of various barriers, such as access to oral health care, resources, health literacy, and education. The aim of this study was to evaluate the influence of patient-, site-, and implant-related factors on marginal bone levels of dental implants in a rural population in China. A retrospective study was conducted using data from a private dental office. Subjects included in this study received dental implants as part of their routine dental treatment. Information on age, gender, smoking status, diabetes, heart disease, jaw location, restorative type, loading protocol, survival rate, implant length, and diameter was collected. Marginal bone loss was recorded as the largest value at either the mesial or distal aspect on peri-apical radiographs. Descriptive and inferential statistics were performed along with linear regression analysis. Overall, 428 implants were placed in 90 subjects over an average follow-up period of 453 days. No implant failures were recorded. The average marginal bone loss was 0.10 mm, with 80.6% of implants showing no marginal bone loss. The extent of marginal bone loss was greater in the mandible (0.13 ± 0.25) than in the maxilla (0.08 ± 0.19). An increase in implant diameter by 1 mm resulted in 0.08 mm of marginal bone loss, indicating wider diameter implants are associated with more bone loss. Age was also positively correlated with marginal bone loss, increasing by 0.002 mm per year. No differences were found for gender, smoking, diabetes, heart disease, restoration type, and immediate loading. Dental implant therapy in a rural Chinese population demonstrated high survival rates and minimal marginal bone loss. Factors such as age, implant location, and diameter influenced bone loss. This study fills a critical gap in understanding implant outcomes specifically within rural settings, highlighting the need for tailored approaches to enhance patient access and care in these communities. Further research is needed to explore these relationships and assess implant outcomes in rural populations.

Anterior Glenohumeral Instability

➢ Anterior glenohumeral instability is a complex orthopaedic problem that requires a detailed history, a thorough physical examination, and a meticulous review of advanced imaging in order to make individualized treatment decisions and optimize patient outcomes.➢ Nonoperative management of primary instability events can be considered in low-demand patients, including elderly individuals or younger, recreational athletes not participating in high-risk activities, and select in-season athletes. Recurrence can result in increased severity of soft-tissue and osseous damage, further increasing the complexity of subsequent surgical management.➢ Surgical stabilization following primary anterior instability is recommended in young athletes who have additional risk factors for failure, including participation in high-risk sports, hyperlaxity, and presence of bipolar bone loss, defined as the presence of both glenoid (anteroinferior glenoid) and humeral head (Hill-Sachs deformity) bone loss.➢ Several surgical treatment options exist, including arthroscopic Bankart repair with or without additional procedures such as remplissage, open Bankart repair, and osseous restoration procedures, including the Latarjet procedure.➢ Favorable results can be expected following arthroscopic Bankart repair with minimal (<13.5%) bone loss and on-track Hill-Sachs lesions following a primary instability event. However, adjunct procedures such as remplissage should be performed for off-track lesions and should be considered in the setting of subcritical glenoid bone loss, select high-risk patients, and near-track lesions.➢ Bone-grafting of anterior glenoid defects, including autograft and allograft options, should be considered in cases with >20% glenoid bone loss.

ОЦЕНКА ИММУНО-МОРФОЛОГИЧЕСКИХ ПАРАМЕТРОВ ЛОКАЛЬНОГО ОЧАГА ХРОНИЧЕСКОГО ПЕРИАПИКАЛЬНОГО ВОСПАЛЕНИЯ ПРИ ПРОВЕДЕНИИ ДЕНТАЛЬНОЙ ВНУТРИКОСТНОЙ ИМПЛАНТАЦИИ

Subject of study. In the current period, complex rehabilitation of patients with orthopedic structures supported by intraosseous dental implants is the leading method. Clinical situations of implant placement in areas of chronic periapical inflammation aren’t uncommon, while destructive forms of chronic periodontitis are characterized by processes that affect innate immunological reactions, which, in turn, affects osteoreparative processes, contributing to bone loss and complications. To minimize bone loss in the area of the extracted tooth, various methods of alveolar ridge preservation are currently proposed, however, there is a shortage of studies that study the quality of bone tissue and the inflammatory component. The purpose of the study is to analyze and evaluate the morphological and immunological indicators of the focus of chronic periapical inflammation in various forms of chronic periodontitis for dental intraosseous implantation using a delayed protocol. Methodology. The study, characterized by a two-component design, included a clinical and laboratory examination of 60 dental patients. The first stage was a study of the indicators of phagocytosis of neutrophils in the separated tooth socket and a histological study of trephine biopsy specimens of the alveolar bone with calculation of the inflammation index in various forms of chronic periodontitis; at the second stage, 12–14 weeks after tooth extraction, before implant installation, the morphological characteristics of the bone biomaterial were studied, conducting a comparative analysis of the indicators of patients with socket preservation using the generally accepted method and without preservation. Results. Based on the results of the study, it was concluded that predictors of inflammatory complications were found in patients. regardless of the form of chronic periodontitis: significantly increased rates of wound neutrophil phagocytosis, and a histological index of bone tissue inflammation higher than the control data. The study of morphological parameters before the installation of intraosseous dental implants in patients with conservation of the socket of extracted teeth with chronic periodontal foci according to the generally accepted method made it possible to register histological signs of chronic intraosseous inflammation that persisted after 12–14 weeks.

A 3D-Planned Inward Fragmentation Technique for the Removal of Impacted Mandibular Third Molars: A Case Series.

Background/Objectives: The extraction of impacted mandibular third molars (M3Ms) carries significant risks, especially regarding the inferior alveolar nerve (IAN). This study aimed to evaluate the effectiveness of a 3D-planned inward fragmentation technique (3Dp-IFT) to improve surgical outcomes, reduce complications, and preserve bone structure in cases involving complex M3M impactions. Methods: Twenty-three patients aged between 18 and 36 years requiring M3M removal were included. Preoperative planning involved the use of cone-beam computed tomography (CBCT) for precise localization of the furcation area, followed by the creation of a 3D navigation template using PlastyCAD software version 1.7. The surgical procedure was performed under local anesthesia, with meticulous endoscopic assistance to ensure accurate access and minimize trauma. Postoperative outcomes, such as bone loss, pain, swelling, and mouth opening range, were carefully measured. The data were systematically organized and analyzed descriptively using Microsoft Excel. Results: No disturbances to the IAN or lingual nerve were observed. The mean buccal bone loss was 2.2 mm, with a standard deviation of 1.2 mm. Postoperative pain and swelling were generally low, with significant reductions within the first week. The use of the 3D navigation template significantly improved surgical access, enhancing safety and minimizing complications. Conclusions: The 3Dp-IFT technique represents a significant advancement in the minimally invasive removal of M3M by allowing precise access to critical anatomical areas while minimizing bone loss and postoperative complications. This approach is particularly beneficial for complex cases involving M3M near the IAN, thereby improving surgical safety and patient outcomes.

Exploring Anatomical Variations in the Bony Architecture of the Greater Palatine Canal in Dry Bones.

Introduction The greater palatine canal (GPC) holds significant clinical importance due to its role in providing access to the branches of the maxillary division of the trigeminal nerve. Anatomical variations within this posterior maxillary region can complicate the surgical anatomy, making the identification of vital structures challenging. Therefore, a thorough understanding of both normal anatomy and common anatomical variations of the GPC is essential to minimize perioperative complications during surgical procedures.This study aims to investigate the bony architecture of the GPC in dry bones to identify anatomical variations and address significant lacunae in our current understanding of this structure. Despite its impact on the management of various dental and surgical procedures, there remains a limited and sometimes inconsistent knowledge of the normal and variant anatomy of the GPC.Existing literature often lacks comprehensive detail regarding the range of anatomical variations and their implications for surgical approaches. By systematically documenting these variations, this study aims to bridge these gaps in knowledge, justify the need for continued research in this area, and highlight its potential clinical implications. Materials and methods In total, 30 dried and intact adult skull specimens were selected, consisting of 19 males (63.3%) and 11 females (36.7%). The selection criteria included an intact hard palate with fully erupted third molars and an intact lateral nasal wall on both sides. The presence of erupted third molars was used to assess the degree of bone resorption, ensuring that only specimens with minimal bone loss were included. The exclusion criteria ruled out specimens with major craniofacial deformities, excessive bone resorption, and signs of advanced age. The bony walls of the GPC were observed by passing a black wire made of rubber material with a consistent diameter (approximately 5 mm), allowing us to qualitatively assess the bore of the canal. Results In four out of 30 specimens (13.3%), significant variations were noted in the bony medial wall of the GPC. Of these, three specimens were male (75%) and one was female (25%). These variations have been categorized into four distinct types for clarity and analysis. Type 1, in a male specimen, showed a deficiency in the lower segment of the bony medial wall of the left GPC above the greater palatine foramen. Type 2, in a male specimen, had a small bar of bone in the left GPC midway between the foramen and the pterygopalatine fossa. Type 3, in a female specimen, exhibited a small bar of bone above the greater palatine foramen on the right side, with no wall above it. Type 4, in a male specimen, displayed a bar of bone above the greater palatine foramen on the right side, with the medial wall completely absent on the left side. Conclusion The study identified anatomical variations in the bony architecture of the GPCbased on dry bone specimens. While these findings offer insights into potential variations that could affect surgical procedures, their clinical implications need validation through patient-based studies. Understanding these variations is crucial for improving preoperative planning and reducing surgical risks, but recommendations should be cautious given the limited sample size. Further research with larger samples and clinical validation is needed to fully understand the embryological basis and potential impact on surgical practice.

Less-Invasive Technique for Non-stabilized Mandibular Fracture in Mouse Models.

Non-stabilized fractures can be made at mandibular sites in mice, thus making it possible to analyze bone repair using an endochondral ossification mode. To most accurately reflect this process in vivo, it is necessary to have a standardized protocol to avoid excessive bone loss and soft tissue damage, particularly at the mandibular site, an anatomical site characterized by minimal access. To our knowledge, we describe for the first time a less-invasive protocol of non-stabilized mandibular fracture in mice. Adult mice are anesthetized with isoflurane and receive a preoperative dose of buprenorphine by subcutaneous injection. A submandibular approach is performed, with a skin incision made along the inferior border of the mandible. The masseter muscle is elevated in a subperiosteal plane along the mandibular ramus with a periosteal elevator. A vertical and complete fracture of the ramus is performed from the basilar border to the coronoid notch (between condylar and coronoid processes), using a piezoelectric bone surgery device under saline serum irrigation at the basilar edge and scissors to complete the fracture of the mandibular ramus. The skin approach is closed by silk sutures. This detailed procedure for non-stabilized mandibular fractures offers an efficient procedure allowing minimal bone loss and soft tissue damage. This technique ensures successful and consistent results to accurately reflect the process of endochondral bone repair in mouse models.

Arthroscopic Anterior and Inferior Labral Repair for Traumatic Shoulder Instability

Background: Anterior glenohumeral instability is common in the young and athletic population and can develop from a dislocation or subluxation event. Avulsion of the anterior inferior glenoid labrum (Bankart lesion) occurs in over 90% of these events. In patients who have unsuccessful conservative management or present with a high risk for redislocation, surgical intervention is indicated. This video presents our technique for arthroscopic anterior and inferior labral repair. Indications: In addition to those patients who have unsuccessful conservative management, surgical management of anterior glenohumeral instability is indicated in patients who are at high risk for redislocation after an initial instability event. These patients include young age and participation in contact sports. Generally, glenoid bone loss over 25% warrants open bony augmentation, but arthroscopic bony augmentation techniques are evolving. Further, the management of “near-track” lesions, or “on-track” lesions with a small distance to dislocation value, remains controversial. Technique Description: This procedure is performed in the lateral decubitus position. A second anterior portal is created distal and lateral to the first anterior portal, entering the shoulder joint just above the subscapularis. The anterior-inferior labrum is prepared with an arthroscopic elevator, followed by a rasp and superior labral anterior and posterior burr. A suture tape is then shuttled around the labrum and the anchor drilled in the appropriate position at the glenoid rim, not violating the cartilage. Anchor placement occurs from an inferior to a superior fashion until the entire labral injury is repaired. Results: This video presents a technique to achieve arthroscopic fixation of an anterior-inferior labral tear in a young athlete with anterior glenohumeral instability. Patients are taken through 3 phases of rehabilitation before return to sport-specific activities, such as contact sports, around 6 months postoperatively. Return-to-sport rates for contact and collision athletes range from 80% to 100%, with recurrent rates ranging from 5% to 20%. Discussion/Conclusion: Arthroscopic anterior-inferior labral repair is a useful technique for minimally invasive glenohumeral stabilization in indicated patients who have minimal glenoid bone loss. Portal placement, labral mobilization, and glenoid preparation are paramount in optimizing the healing potential of the fixation construct. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Arthroscopic Bone Block Stabilization for Anterior Shoulder Instability with Subcritical Glenohumeral Bone Loss.

The management options for anterior shoulder instability with minimal bone loss or with critical bone loss are well established. However, there is less clear evidence to guide management for patients with subcritical bone loss, the spectrum of pathology where soft tissue repair alone is prone to higher rates of failures. In this range of bone loss, likely around 13.5% to 20%, the goal of surgery is to restore function and stability while limiting morbidity. As with many procedures in the shoulder, this decision should be tailored to patient anatomy, functional goals, and risk factors. This article provides a review of our current understanding of subcritical bone loss and treatment strategies as well as innovations in management. While surgeons have largely understood that restoration of anatomy is important to optimize outcomes after stabilization surgery, there is increasing evidence that reconstructing bony anatomy and addressing both osseous and soft tissue structures yields better results than either alone. Even in the setting of subcritical bone loss, there is likely a benefit to combined osseous augmentation with soft tissue management. Additionally, there is new evidence to support management of even on-track humeral lesions when the distance to dislocation is sufficiently small, particularly for athletes. Surgeons must balance bony and soft tissue restoration to achieve optimal outcomes for anterior instability with subcritical bone loss. There are still significant limitations in the literature and several emerging techniques for management will require further study to prove their long-term efficacy. Beyond surgery, there should be a focus on a collaborative treatment strategy with the surgeon, patient, and therapists to achieve high-level function and minimize recurrence.

The Efficacy of Body-Weight Supported Treadmill Training and Neurotrophin-Releasing Scaffold in Minimizing Bone Loss Following Spinal Cord Injury.

Spinal cord injury (SCI) can lead to significant bone loss below the level of the lesion increasing the risk of fracture and increased morbidity. Body-weight-supported treadmill training (BWSTT) and transplantation strategies using neurotrophins have been shown to improve motor function after SCI. While rehabilitation training including BWSTT has also been effective in reducing bone loss post-SCI, the effects of transplantation therapies in bone restoration are not fully understood. Furthermore, the effects of a combinational treatment strategy on bone post-SCI also remain unknown. The aim of this study was to determine the effect of a combination therapy including transplantation of scaffold-releasing neurotrophins and BWSTT on the forelimb and hindlimb bones of a T9-T10 contused SCI animals. Humerus and tibia bones were harvested for Micro-CT scanning and a three-point bending test from four animal groups, namely injury, BWSTT (injury with BWSTT), scaffold (injury with scaffold-releasing neurotrophins), and combinational (injury treated with scaffold-releasing neurotrophins and BWSTT). BWSTT and combinational groups reported higher biomechanical properties in the tibial bone (below injury level) and lower biomechanical properties in the humerus bone (above injury level) when compared to the injury and scaffold groups. Studied structural parameters, including the cortical thickness and bone volume/tissue volume (BV/TV) were also higher in the tibia and lower in the humerus bones of BWSTT and combinational groups when compared to the injury and scaffold groups. While no significant differences were observed, this study is the first to report the effects of a combinational treatment strategy on bone loss in contused SCI animals and can help guide future interventions.

From surface to success: How implant surfaces shape osseointegration

The field of dental implantology has significantly advanced to address the multifaceted impacts of tooth loss, encompassing physical, functional, emotional, psychological, and social dimensions. Dental implants serve as reliable solutions, ensuring stability, minimal bone loss, and absence of pain or infection. Central to their success is the surface modification of implants, which profoundly influences osseointegration—the process crucial for establishing a functional bond between bone and implant. This review explores various physical modifications of dental implant surfaces, focusing on macro, micro, and nano-level alterations. Macro-level modifications optimize implant geometry and thread design to enhance initial stability and long-term fixation. Micro-level modifications, including grit blasting and acid etching, increase surface roughness to facilitate mechanical interlocking and cell adhesion. Nano-level modifications, such as hydrophilic coatings and bioceramic enhancements, enhance surface energy and promote osteoblastic differentiation, thereby accelerating osseointegration. These surface modifications represent a critical frontier in implant dentistry, promising improved clinical outcomes and patient satisfaction through enhanced integration and reduced healing times.

ACL Repair: Rationale and When to Consider Over Reconstruction

Background: Anterior cruciate ligament (ACL) restoration has been divided into repair versus reconstructive approaches. We present an ACL repair using FiberTape sutures as an internal brace and an adjustable cortical button fixation on the femur. Indications: ACL rupture is a condition in which restoration is essential to regaining adequate knee function. ACL repair may be indicated in patients with an acute tear (<4 weeks), Sherman classification type I or II tear, 35 years old or older, and with a mild-to-moderate activity level. Technique Description: ACL tightrope repair initially requires identification of the ACL tear. Following, there is femoral wall preparation and the creation of a drill tunnel in the femoral and tibial walls. FiberRing sutures are passed through the intact portion of the ACL as many times as desired. An ACL Tightrope is then fed through the FiberRing sutures. The ACL Tightrope and cortical button are passed through the femoral tunnel. FiberTape sutures are passed through a tibial tunnel to act as an internal brace. Range of motion and tension is assessed and adjusted as needed. Results: Patients meeting indications for ACL repair and undergoing repair via Tightrope implants may have outcomes comparable to counterparts undergoing ACL reconstruction. Patient-completed functional knee scores, such as International Knee Documentation Committee (IKDC), Knee Injury and Osteoarthritis Outcome Score (KOOS), and Lysholm, are similar between the 2 restoration techniques. However, younger patients undergoing an ACL repair appear to have a higher failure rate compared with reconstruction. Conclusion: ACL repair can be an adjuvant treatment option with acute femoral sided tears. Caution should be exercised when performing this procedure on younger, higher level athletes. In our technique, use of adjustable cortical button minimizes bone loss on femoral wall while providing adequate fixation. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Association between Gastric Cancer and Osteoporosis: A Longitudinal Follow-Up Study Using a National Health Sample Cohort.

Gastric cancer (GC) survivors may be more likely to develop osteoporosis. However, few studies on the relationship between GC and osteoporosis have been conducted on large patient populations. We aimed to determine the incidence of osteoporosis and identify related factors by comparing patients with GC and matched controls using the Korean National Health Insurance Service-National Sample Cohort (KNHIS-NSC). This study included 9078 patients with GC and 36,312 controls (1:4 propensity score-matched for sex, age, residence, and income). The hazard ratio (HR) for osteoporosis was significantly greater for GC patients than for controls according to Charlson Comorbidity Index (CCI) score-adjusted models (adjusted HR = 1.13). Kaplan-Meier analysis revealed that the cumulative incidence of osteoporosis during the follow-up period commencing from the index date was significantly greater in GC patients than in the controls (p = 0.0087). A positive correlation of osteoporosis with GC was detected for those aged < 65 years, males, and those with CCI scores = 0. In conclusion, the study findings suggest that men with GC aged < 65 years may be at an increased risk for osteoporosis. Research into additional risk factors and the optimal timing of interventions are needed to prevent fractures and minimize bone loss in GC survivors.

Arthroscopic Bankart versus Open Latarjet; Short-to-Mid-Term Outcomes of Recurrence and Patient-Reported Outcomes in Patients with Recurrent Anterior Shoulder Dislocation

Objectives This retrospective comparative study compared the short to mid-term outcomes of arthroscopic Bankart repair and open Latarjet procedures in patients with recurrent anterior shoulder instability. Methods Patients who underwent either arthroscopic Bankart repair or open Latarjet procedures between 2008 and 2020, with at least one year of follow-up, were included. Arthroscopic Bankart repairs were performed on shoulders with minimal glenoid bone loss (&lt;15%), and the Latarjet procedure was performed if the preoperative computed tomography (CT) scan showed a 15% bone loss on the glenoid side or 30-40% humeral head bone loss. Their surgery results and patient-reported outcome measures (PROMs) were assessed using the Oxford Shoulder Score (OSS) and Shoulder Pain and Disability Index (SPADI). Results 133 patients were analyzed in Latarjet (n = 67) and Bankart groups (n = 66). Before surgery, the two groups of patients were similar regarding surgery side, hand dominance, education level, occupation difficulty level, and smoking (P&gt;0.05). However, Latarjet’s patients were younger (32 vs. 35, P=0.04), had a higher proportion of males (96% vs. 82%, P=0.01), and had a significantly shorter follow-up period (3.2 vs. 6.4 years, P&lt;0.001) than the Bankart group. There was no significant difference between the Latarjet and Bankart groups regarding the follow-up’s OSS score (37 vs. 36; P=0.94) and SPADI score (22 vs. 24, P=0.80). Dislocation was observed in only one patient (1.5%) in the Latarjet group (P=1.0). Subluxation was observed in 5 patients (7.5%) of the Latarjet group and three patients (4.5%) of the Bankart group (P=0.4). The overall instability rate was similar (P&gt;0.05). Conclusion Our findings suggest that both arthroscopic Bankart repair and open Latarjet are reliable techniques in short to mid-term follow-up based on the glenoid bone loss cut-off of 15%. Level of Evidence Therapeutic Level III

The Long-Term Esthetic and Radiographic Outcome of Implants Placed in the Anterior Maxilla after Ridge Preservation, Combining Bovine Xenograft with Collagen Matrix.

The objective of the study was to evaluate the long-term esthetic and radiographic results of implants placed in the anterior maxilla after ridge preservation, combining bovine xenograft with collagen matrix. Fifteen patients who required a single tooth extraction because of fracture, root resorption, or extended caries were included in the study. After extraction, all sites were grafted using Deproteinized Bovine Bone Mineral (DBBM) with collagen and covered by a resorbable collagen matrix (CM). Five months after socket grafting, implants were successfully installed. The implant diameter range was between 3.8 and 4.2 mm. All patients were monitored for over 7 years, both clinically and radiographically. Three independent observers evaluated the long-term esthetic outcome, employing the Pink Esthetic Score (PES) technique. Over a period exceeding seven years, a 100% survival rate was observed for all 15 implants, with minimal marginal bone loss. The mean PES was 11.40 (±1.44) at the first assessment and 11.38 (±1.63) at the second assessment. The difference was not statistically significant (p = 0.978), and the scores of PES measurements indicated excellent esthetic results even after seven years. Based on these preliminary results, it seems that placing collagen bovine bone in a fresh extraction socket, covered with a collagen matrix, can preserve the alveolar ridge and provide long-term stable esthetic results.

Multivariate analysis of the effect of keratinized mucosa on peri-implant tissues with platform switching: A retrospective study.

In recent years, platform switching implant treatment has been increasing, which is believed to minimize bone loss around the implant after placement. However, there have been no reports on the relationship between keratinized mucosa width (KMW) and bone loss and soft tissue recession in platform switching implants. We evaluated the effect of the KMW on the amount of bone loss and soft tissue recession around a platform switching implant retrospectively using multivariate analysis. This one-year retrospective study included 91 implants in 48 patients. Age, sex, a history of periodontitis, implant location, oral hygiene status, and the KMW were included as explanatory variables to evaluate bone loss (BL) and buccal gingival height (GH). Generalized estimating equations (GEEs) were used to evaluate the effect of the KMW on platform switching peri-implant tissues. The mean bone loss on the mesial (ΔBLm), distal (ΔBLd), and buccal (ΔBLb) sides of the implant were 0.16 ± 0.27 mm, 0.19 ± 0.34 mm, and 0.24 ± 0.50 mm, respectively, at 1 year after superstructure placement. The mean amount of change of GH (ΔGH) on the buccal side was 0.30 ± 0.47 mm. After correcting for confounders using GEEs, the results suggested that KMW <1.5 mm was a significant factor (P < 0.001) for bone loss over time in ΔBLm, ΔBLd, and ΔBLb. In addition, for soft tissues on the buccal side, KMW <1.5 mm was a significant factor for ΔGH reduction over time (P < 0.001). Keratinized mucosa width ≥1.5 mm was associated with a higher probability less hard and soft tissue recession around the platform switching implant after 1 year from superstructure placement.

Conversion of failed revision total knee arthroplasty in arthrodesis with modular nail maintaining the uncemented femoral stem in patient with extensor mechanism insufficiency: a case report

BackgroundThe transition from revision total knee arthroplasty (RTKA) to arthrodesis involves the replacement of cemented femoral and tibial stems with a modular nail designed for arthrodesis. This conversion process is associated with challenges such as bone loss, blood loss, and prolonged surgical durations. Effectively addressing these complexities through a less invasive surgical approach could be pivotal in enhancing patient outcomes and minimizing associated complications.Case presentationA 75-year-old white Caucasian female patient with a revision total knee arthroplasty (RTKA) performed with a modular uncemented rotating-hinge system, reporting an history of recurrent patellar dislocation, was referred to our institution after a fall resulting in periprosthetic tibial plateau fracture. The fracture was treated with open reduction and internal fixation, but afterwards the patient had been unable to walk again. Tibial stem was mobilized, and extensor mechanism was insufficient due to chronic incomplete quadriceps tendon rupture. The femoral stem was stable, so we decided to convert the rotating-hinge in a arthrodesis with an uncemented modular knee fusion nail maintaining the previous femoral stem.ConclusionsThe result was a successful arthrodesis with minimal bone and blood loss, reduced operative time, and optimal functional outcome at the one-year follow-up. This case highlights the advantage of using a modular knee revision platform system that gives the opportunity to convert a RTKA in arthrodesis.

Chenopodium Ambrosioides Linn Mitigates Bone Loss in Rats with Periodontitis.

Periodontitis is an inflammatory disease that causes bone loss. Some patients do not respond well to the classic treatment and need therapies that minimize bone loss, the main sequel of the disease. Chenopodium ambrosioides L. has stood out due to its anti-inflammatory and anti-oxidative activities. However, no study has yet investigated its effect on periodontitis. This study aimed to evaluate the bone protective effect of Chenopodium ambrosioides L. (CAL) extract on ligature-induced periodontitis model in rats. For this, a pre-clinical assay was performed, using male Wistar rats divided into 3 groups: Naive (N) (n=6), not submitted to any procedure; Saline (SAL) (n=6), submitted to ligature-induced periodontitis and receiving 2 ml/kg of 0.9% saline solution; and CAL extract, which was subdivided into 3 subgroups (n=6/subgroup) receiving the CAL at 3 (CAL3), 10 (CAL10) or 30 mg/kg (CAL30). All agents were given, by oral gavage, 30 min before periodontitis induction and daily until euthanasia (11th day). By then, maxillae were removed for macroscopic, histological, and histometric analyses. Kidneys, liver, and stomach were collected to evaluate the safety of CAL extract. High-performance liquid chromatography (HPLC) assay was used to investigate the flavonoid content in the extract. Chenopodium ambrosioides L. extract at 30mg/kg showed a reduction by 58% in bone loss marked by an increase (+35%) in the number of osteoblasts and a reduction (-51%) on the number of osteoclasts (p< 0.05). No significant alteration in the liver, kidney, or stomach was seen. Rutin was the main flavonoid found. In summary, it was observed that Chenopodium ambrosioides L. extract has shown important anti-inflammatory and bone anabolic and anti-resorptive properties without causing toxicity in the main organs. Rutin, as the main flavonoid of the extract, seems to be responsible for the beneficial effect of this agent.

Clinical performance of implant-assisted removable partial dentures using implant surveyed crowns: a systematic review and meta-analysis.

This study aimed to evaluate the clinical performance of implant-assisted removable partial dentures (IARPD) with surveyed crowns, also known as implant-crown-retained removable partial dentures (ICRPDs). Electronic searches of MEDLINE/PubMed, the Cochrane Central Register of Controlled Trials, the Web of Science, and the Korea Citation Index were performed according to the established search terms for ICRPD. A literature search was conducted for studies published in English or Korean until September 2023, using the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. A total of 216 journals were searched, and 31 eligible studies were selected based on the inclusion and exclusion criteria. One systematic review included five case reports of ICRPD. Nine retrospective studies evaluated implant survival/success rate, implant failure cases, marginal bone loss, periodontal status, clinical complications, and patient satisfaction. Twenty-one case reports published in Korea showed good prognoses. According to the findings of this systematic review, ICRPD has a reasonable survival/success rate, minimal bone loss, and high patient satisfaction.