To radiographically monitor sinus membrane swelling after lateral sinus floor elevation surgery at short and long healing periods. Materials and Methods: For 26 patients seeking posterior maxillary implant-supported reconstruction, 32 lateral sinus floor elevations were performed using Piezosurgery. Sinus membranes were grafted using synthetic calcium phosphate bone substitutes, and graft volume was measured in cubic centimeters for each case. Cone beam computed tomography (CBCT) examination was conducted preoperatively in all patients and for each grafted sinus at 1 day (n
Background: Macro- and micro-geometry are among the factors influencing implant stability and potentially determining loading protocol. The purpose of this study was to test a protocol for early loading by controlling implant stability with the selection of fixtures with different thread depth according to the bone density of the implant site. Materials and Methods: Patients needing implant therapy for fixed prosthetic rehabilitation were treated by inserting fixtures with four different thread diameters, selected based on clinical assessment of bone quality at placement (D1, D2, D3, and D4, according to Misch classification). Final insertion torque (IT) and implant stability quotient (ISQ) were recorded at baseline and ISQ measurements repeated after one, two, three, and four weeks. At the three-week measurement (four weeks after implant replacement), implants with ISQ > 70 Ncm were functionally loaded with provisional restorations. Marginal bone level was radiographically measured 12 months after implant insertion. Results: Fourteen patients were treated with the insertion of forty implants: Among them, 39 implants showing ISQ > 70 after 3 weeks of healing were loaded with provisional restoration. Mean IT value was 82.3 ± 33.2 Ncm and varied between the four different types of bone (107.2 ± 35.6 Ncm, 74.7 ± 14.0 Ncm, 76.5 ± 31.1 Ncm, and 55.2 ± 22.6 Ncm in D1, D2, D3, and D4 bone, respectively). Results showed significant differences except between D2 and D3 bone types. Mean ISQ at baseline was 79.3 ± 4.3 and values in D1, D2, D3, and D4 bone were 81.9 ± 2.0, 81.1 ± 1.0, 78.3 ± 3.7, and 73.2 ± 4.9, respectively. Results showed significant differences except between D1 and D2 bone types. IT and ISQ showed a significant positive correlation when analyzing the entire sample (p = 0.0002) and D4 bone type (p = 0.0008). The correlation between IT and ISQ was not significant when considering D1, D2, and D3 types (p = 0.28; p = 0.31; p = 0.16, respectively). ISQ values showed a slight drop at three weeks for D1, D2, and D3 bone while remaining almost unchanged in D4 bone. At 12-month follow-up, all implants (39 early loading, 1 conventional loading) had satisfactory function, showing an average marginal bone loss of 0.12 ± 0.12 mm, when compared to baseline levels. Conclusion: Matching implant macro-geometry to bone density can lead to adequate implant stability both in hard and soft bone. High primary stability and limited implant stability loss during the first month of healing could allow the application of early loading protocols with predictable clinical outcomes.
Background: Implant surface topography is a key element in achieving osseointegration. Nanostructured surfaces have shown promising results in accelerating and improving bone healing around dental implants. The main objective of the present clinical and histological study is to compare, at 4 and 6 weeks, (w) bone-to-implant contact in implants having either machined surface (MAC), sandblasted, large grit, acid-etched implant surface (SLA) medium roughness surface or a nanostructured calcium-incorporated surface (XPEED®). Methods: 35 mini-implants of 3.5 × 8.5 mm with three different surface treatments (XPEED® (n = 16)—SLA (n = 13)—MAC (n = 6), were placed in the posterior maxilla of 11 patients (6 females and 5 males) then, retrieved at either 4 or 6w in a randomized split-mouth study design. Results: The BIC rates measured at 4w and 6w respectively, were: 16.8% (±5.0) and 29.0% (±3.1) for MAC surface; 18.5% (±2.3) and 33.7% (±3.3) for SLA surface; 22.4% (±1.3) and 38.6% (±3.2) for XPEED® surface. In all types of investigated surfaces, the time factor appeared to significantly increase the bone to implant contact (BIC) rate (p < 0.05). XPEED® surface showed significantly higher BIC values when compared to both SLA and MAC values at 4w (p < 0.05). Also, at 6w, both roughened surfaces (SLA and XPEED®) showed significantly higher values (p < 0.05) than turned surface (MAC). Conclusions: Nanostructured Calcium titanate coating is able to enhance bone deposition around implants at early healing stages.
Background and purpose Early postoperative reactions occur following lateral sinus floor elevation (LSFE). This article radiographically describes, quantifies, and measures these early postoperative changes inside grafted maxillary sinus area. Materials and Methods In 24 patients, 31 maxillary sinuses were performed using piezosurgery and grafted by bioceramic materials. Cone beam computed tomography was done preoperatively and then postoperatively, randomly, at either day 1 (n = 6), 2 (n = 11), 3 (n = 8), or 7 (n = 6) and at 6 months for all patients. Membrane thickening and subsequent swelling ratio, submucosal edema, and air bubbles inside grafted area were noted and measured. Inflammation was classified as mild, moderate, or severe. Results Preoperative mean membrane thickness was 0.75 mm then following LSFE it significantly increased at days 1, 2, 3, and 7 and was respectively 2.36, 4.14, 6.05, and 6.63 mm. Mean swelling ratio significantly increased over time and was 11.37, 13.73, 16.34 and 35.78 at days 1, 2, 3, and 7, respectively. Submucosal edema height was noted in 24 cases. It had a mean value of 3.35 mm and increased significantly with time. Inflammation inside grafted area was mild in 7, moderate in 15, and severe in 9 of the cases. It significantly increased with time. Apical air bubble was present in 19 cases and had mean dimensions of 6.6 × 4.6 mm. No inflammatory signs were noted at 6 months. Conclusions Inflammatory reactions are always noted following LSFE and tend to increase with time reaching peak values at 7 days. All inflammatory changes significantly subsided at 6 months.
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