Objectives To analyze a modified biphasic phycogenic biomaterial in comparison with anorganic bovine bone in maxillary sinus floor elevation in humans. Material and methods Eight male patients in need of bilateral two‐stage sinus floor elevation were consecutively recruited for this randomized split‐mouth study. A combination of autogenous cortical bone (ACB, 20%) and anorganic bovine bone (ABB, 80%) (ACB + ABB group) or ACB (20%) and modified biphasic phycogenic material (BP, 80%) (ACB + BP group) were randomly assigned to graft each sinus. Patients were followed up for 6 months post‐surgery when bone samples were collected for analysis. Results Radiographically, bone height gain was statistically higher in the ACB + ABB versus the ACB + BP group. While the analysis of the biological compartments showed differences in non‐mineralized tissue (39.15 ± 20.97% vs. 65.87 ± 28.59%, ACB + ABB vs. ACB + BP respectively; p = .018) and remnant biomaterial particles (22.62 ± 17.01% vs. 7.96 ± 8.57%, respectively; p = .028), the percentage of mineralized tissue (38.23 ± 17.55% vs. 24.14 ± 24.66%, respectively; p = .398) showed no statistically significant difference. In contrast, ACB + ABB biopsies showed higher Musashi‐1‐positive cells per mm2 compared to ACB + BP biopsies (811.49 ± 875.30 vs. 236.90 ± 280.81; p < .018), where the fusiform cells corresponded mainly with fibroblasts, as demonstrated by ultrastructural analysis. Conclusion Both combinations of materials exhibited bone formation after 6 months of healing in the maxillary sinus cavity. However, the combination with biphasic phycogenic biomaterial induced a higher radiographical vertical resorption and graft collapse in comparison with the combination with anorganic bovine bone, possibly due to a higher remodeling of the graft.

Aim: The aim of this study was to examine the clinical and histological differences of using a combination of alloplastic beta triphasic calcium phosphate (β-TCP) and a cross-linked collagen membrane versus autologous platelet-rich fibrin (PRF-L) in ridge preservation after dental extraction. Material and methods: Fifty-one patients were included in this observational case-series study. Dental extractions were performed, after which 25 patients were grafted with β-TCP and 26 with PRF-L. After four months of healing, clinical, radiological, histomorphometric and histological evaluations were performed. Results: A significantly higher percentage of mineralized tissue was observed in samples from the PRF-L grafted areas. Cellularity was higher in PRF-L grafted areas (osteocytes in newly formed bone per mm2 = 123.25 (5.12) vs. 84.02 (26.53) for PRF-L and β-TCP, respectively, p = 0.01). However, sockets grafted with PRF-L showed a higher reduction in the bucco-lingual dimension after four months of healing (2.19 (0.80) vs. 1.16 (0.55) mm, p < 0.001), as well as a higher alteration in the final position of the mid muco-gingival junction (1.73 (1.34) vs. 0.88 (0.88) mm, p < 0.01). Conclusion: PRF-L concentrate accelerates wound healing in post-extraction sockets in terms of new mineralized tissue component. However, the use of β-TCP biomaterial appears to be superior to maintain bucco-lingual volume and the final position of the muco-gingival junction.

Background : Implant surface is a key-factor to achieve osseointegration. Surface modifications have been proposed to accelerate the integration process and shorten loading times below 3 mo. in the mandible and maxilla. Some authors suggested that part of MBL (marginal bone loss) might result from disuse atrophy; others reported reduced MBL after implementing shorter healing periods rather than longer ones. The effects of early loading, especially of implants with a B+ surface, on MBL is poorly documented.Aim/Hypothesis : To evaluate peri-implant marginal bone loss around implants with a B+ modified surface loaded 4 (4 w) or 8 weeks (8 w) after implant placement in the mandible and in the maxilla. Marginal bone loss was compared between both groups at the milestone of 1-year after delivery of the final prosthesis.Material and Methods : A randomized controlled clinical trial (NCT03059108) was set-up in which single implants were placed according to a 1-stage protocol and randomly assigned to two distinct loading groups-test (4 w after placement) or control (8 w). Implants were followed until the 1-year post-loading milestone. Variables that might affect the MBL were-age, gender, smoking, alcohol consumption, bone type, width of bone crest, soft tissue thickness, width of keratinized mucosa, mesio-distal distance to adjacent teeth and prosthetic abutment height. The distance between the implant to the adjacent teeth, the MBL on the mesial and distal sides and the bone levels of the adjacent teeth were recorded on periapical xrays with the Image J software. Each image was internally calibrated with the known implant diameter. The R software was used for the statistical analyses. The Wilcoxon rank sum test and the general linear model with pair-wise comparisons of means further evaluated by Tukey contrasts were used.Results : A total of 29 patients (mean age 42, 25-58) received one implant each, 27 in the maxilla, 14 were loaded after 4 w. Change in MBL between placement and loading measured on the mesial (M) and distal (D) sides was statistically significant within each group (S, P < 0.001).No difference was observed between groups. From loading to the 1-year milestone, bone loss for the 4 w group was 0.17 ± 0.38 mm and 0.18 ± 0.22 mm on the M and D sides, respectively. For the 8 w group, M marginal bone increased by 0.09 ± 0.44 mm; on the D side marginal bone decreased by 0.13 ± 0.45 mm. Differences between 4 w and 8 w were not statistically significant (NS, P = 0.24, P = 0.68, M and D, respectively). Differences between groups at each time point were NS ( P > 0.20) either. MBL after 1 year of loading was −0.23 ± 0.41 mm and −0.20 ± 0.32 mm on the M and D sides, respectively for the 4 w group; it was 0.00 ± 0.54 mm and −0.18 ± 0.43 mm for the 8 w group. None of the variables affected the MBL in a significant way, for any groups at any time point. Conclusion and Clinical Implications: Early loading after 4 weeks of C1 implants with a B+ modified surface did not affect the MBL when compared to loading after 8 weeks, ...

ObjectivesTo compare the marginal bone level around implants with a thin multi‐phosphonate coated surface after either an early or conventional loading protocol.Material and methodsA randomized pilot clinical trial was conducted. Dental impressions were obtained after either 4 (test) or 8 weeks (control) and single crowns screwed‐in 2 weeks later. Several variables were evaluated including radiographical marginal bone level (MBL), patient's level variables, and those related to the restoration and surrounding tissues. These data were obtained at several time points up to a 1‐year follow‐up.ResultsThirty‐four patients were included in the study, 18 assigned to the test group. No differences at implant placement were detected for tissue thickness, keratinized mucosa, nor any other clinical or radiological variable. At the time of impressions, tissue was thinner in the test group (2.30 (0.46) versus 2.78 (0.66) mm, test versus control, respectively; p = .012) so shorter abutments were used in this group. Regardless, no significant changes in marginal bone level were detected neither within group along time nor between groups. The average MBL at the 1‐year follow‐up was −0.15 (0.32) versus −0.22 (0.37) (p = .443) (test versus control, respectively). None of the clinical or radiological variables evaluated had a determinant influence on the MBL at any visit nor group.ConclusionThe use of implants with a multi‐phosphonate coated surface for early loading offers successful radiographical outcomes 1 year after loading. MBL over time was not affected by taking the impressions 4 or 8 weeks after implant placement and loading them 2 weeks later.

PurposeTo evaluate the clinical and radiographic outcomes of single‐tooth implant restorations using one‐piece, internally connected, screw‐retained, computer‐aided design and computer‐aided manufactured monolithic zirconia restorations fabricated on regular diameter implants.Material and methodsFollowing a 2‐stage surgical procedure, 22 implants placed in anterior and posterior areas in 21 partially edentulous patients (mean age of 55 years; 9 males/12 females) were evaluated in terms of plaque index, pocket probing depth, bleeding on probing, level of oral hygiene (OH), signs of mucositis/peri‐implantitis, esthetic score (ES), gingival zenith position (GZP), papilla index score, the thickness of peri‐implant gingiva, radiographic marginal bone loss, and technical complications. Implants and restorations were prospectively followed from the insertion of the restoration (baseline), up to 12‐months post‐loading.ResultsA 100% implant survival rate resulted after loading; one implant was lost before loading. Clinically, patients performed an adequate OH, and tissues were kept healthy. Probing depth showed a slightly lower value at baseline compared to any follow‐up examination (2.26 [0.94] at baseline vs. 2.53 [0.66] mm at 12 months). ES, GZP, and the thickness of the peri‐implant gingiva improved throughout the course of the study. Radiographically, average marginal bone level (MBL) was 0.40 (0.40) mm after 1‐year follow‐up with no differences in average MBL at all time points. Technically, after 1 year of clinical function, neither abutment fracture nor any other serious complications occurred. Hence, prosthetic reconstruction survival rate was 100%.ConclusionsClinical outcomes of single‐tooth implant restorations using internally connected, screw‐retained, computer‐aided design and computer‐aided manufacturing monolithic zirconia abutments can be considered a reliable treatment alternative after 1‐year clinical observation.