Our previous work has shown that total osseous reconstruction of large discontinuity hemimandibulectomy, critical-sized defects can be achieved easily in 8-year-old Macaca fascicularis monkeys (Boyne 1996). However the literature has indicated that animal aging decreases the BMP induction of stem cells in rats and in other rodent species. It was necessarily important that the rhBMP-2 be demonstrated in non-human primates to determine if this reduction in effectiveness also existed in the higher animals phylogenetically. The purpose of this study was to operate aged non-human primates duplicating the model used in middle-aged animals to demonstrate regeneration of hemimandibulectomy defects. This age group could be extrapolated to the 80-year-old clinic patient. Six non-human primates aged 20 years were rendered edentulous posteriorly and the mandibles allowed to heal. Three months postoperatively bilateral hemimandibulectomies were performed. The defects received BMP in a collagen sponge (Helistat) using a dose level of 0.75 mg of rhBMP-2. After the manner previously reported by Boyne (1996, 1999), at the end of four months the surgical sites were exposed by mucoperiosteal flap demonstrating complete regeneration of the critical-sized defects. The animals received two dental implants in restored areas. The implants were brought into function approximately four months later, and were allowed to function for eight months in all cases. The results indicate that the regeneration of mandibular critical-sized defects by the use of rhBMP-2 in aged animals is comparable to that of the middle-aged group. This study indicates that aged non-human primates, chronologically comparable to 80-year-old humans, respond as favorably to rhBMP-2 as do the middle-aged animals. Extrapolating the results to the clinical level, one would expect that rhBMP-2 would produce a comparable result in the regeneration of large hemimandibulectomy-type defects in clinical human patients.

In comparison with the traditional drilling procedures, Er:YAG laser can be considered efficient in surgery of the bone without inducing irreversible damages, even if it is possible to observe the presence of some carbonized amorphous tissue in the early part of the healing process. This tissue is progressively resorbed in a way similar to a bone graft and doesn't impede the bone formation and osseointegration processes. Further clinical and histological studies are necessary to better define this amorphous tissue and an efficient and safe operative protocol in the surgery of bone with an Er:YAG laser.

Randomised controlled trial PURPOSE. To assess whether there are any clinical benefits to placing single dental implants either 0.5 or 1.5 mm subcrestally in healed bone crests. MATERIALS AND METHODS.Sixty partially edentulous patients at six centres requiring two single implant-supported crowns had both sites randomly allocated according to a split-mouth design to either 0.5 mm or 1.5 mm subcrestal implant placement; implants in aesthetic areas were submerged for 3 months while those in non-aesthetic areas were not. Provisional acrylic crowns were fitted and replaced with definitive metal-ceramic crowns after 2 months. Patients were followed up to 5 years after loading. Outcome measures were: crown and implant failures, complications, aesthetics assessed using the pink esthetic score (PES), peri-implant marginal bone level changes, and patient preference, recorded by blinded assessors. RESULTS.Two patients dropped out. There were no statistically significant differences in failure rate (out of 58 patients, four implants failed in the 0.5 mm group versus one in the 1.5 mm group; difference = -5.17%; 95% CI -10.87% to 0.53%; P = 0.250) or complications (out of 58 patients eight complications occurred in eight patients from the 0.5 mm group versus five complications in five patients from the 1.5 mm group (difference = -5.17%; 95% CI -14.01% to 3.67%; P = 0.453) between groups. At 5 years after loading, the mean pink aesthetic scores were 10.89 ± 2.30 and 10.79 ± 2.41 in the 0.5 and 1.5 mm groups, respectively, a difference that was not statistically significant (P = 0.943). Patients from the 0.5 mm group lost on average 0.53 ± 1.43 mm peri-implant marginal bone, and those in the 1.5 mm group lost 0.31 ± 0.98 mm, a statistically significant difference (0.26 mm; 95% CI 0.05 to 0.47; P = 0.016). Patients did not prefer any depth of implant placement over the other. There were no differences in outcomes between centres. CONCLUSIONS.No clinically appreciable differences were noted when placing implants surrounded by at least 1 mm of bone 0.5 mm or 1.5 mm subcrestally. Clinicians are therefore free to choose which strategy they prefer.CONFLICT OF INTEREST STATEMENT. Anthogyr (Sallanches, France), the manufacturer of the implants used in this investigation, partially funded this trial and donated the implants and prosthesis components; however, all data was the property of the authors, and the sponsor did not interfere with the conduct of the trial or the publication of its results in any way.

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