The objective of this clinical trial was the analysis of 2 methods for engineering of autologous bone grafts for maxillary sinus augmentation with secondary implant placement. Group 1 (8 patients, 12 sinuses): cells of mandibular periosteum were cultured in a good manufacturing practice laboratory (2 weeks) with autologous serum and then transferred onto a collagen matrix. After another week, these composites were transplanted into the sinuses. In group 2A (2 patients, 3 sinuses), cells of maxillary bone were cultivated with autologous serum for 2 weeks, seeded onto natural bone mineral (NBM, diameter [Ø] ¼ 8 mm) blocks, and cultivated for another 1.5 months. These composites were transplanted into the sinuses. Group 2B (control, 3 patients, 5 sinuses) received NBM blocks alone. In the course of implant placement 6 (group 1) and 8 (group 2) months later, core biopsy were taken. Clinical follow-up period was 1 to 2.5 years in group 1 and approximately 7 years in groups 2A and 2B. New vital bone was found in all cases at median densities of 38% (n ¼ 12) in group 1, 32% in group 2A (n ¼ 3), and 25% in group 2B (n ¼ 5). Differences between group 1 and 2B as well as 2A and 2B were statistically significant (p ¼ 0.025). No adverse effects were seen. All methods described were capable of creating new bone tissue with sufficient stability for successful implant placement.

Background and Aims:Polishing may increase the surface roughness of composites, with a possible effect on bacterial growth and material properties. This preliminary in vitro study evaluates the effect of three different polishing systems (PoGo polishers, Enhance, Venus Supra) on six direct resin composites (Gradia Direct, Venus, Venus Diamond, Enamel Plus HFO, Tetric Evoceram, Filtek Supreme XT). Materials and Methods:For each composite, 12 square specimens were prepared: 9 specimens were polished, three for each different method, while three specimens were used as controls. Surface roughness was determined with AFM by measuring Root Mean Square (RMS) of average height.Results:PoGo polisher determined a significantly rougher surface, versus controls, in 5 out of 6 composites evaluated. Some significant differences from unpolished controls were observed also for Enhance polishing. Polishing with Venus Supra did not result in any significant difference in surface roughness versus controls. No differences were observed between different polishing systems.Conclusions:These preliminary results suggest that Venus Supra polishing system could determine a smoother composite surface if compared to the other polishing systems tested. On this basis, we are conducting an in vivo study to evaluate bacterial colonization on some combinations of composites and polishing protocols.

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Inferior alveolar nerve (IAN) transposition surgery may cause some degree of sensory impairment. Accurate and reproducible tests are mandatory to assess IAN conduction capacity following nerve transposition. In this study subjective (heat, pain and tactile-discriminative tests) and objective (electrophysiological) assessments were performed in 10 patients receiving IAN transposition (bilaterally in 8 cases) in order to evaluate any impairment of the involved nerves one year post-operatively. All patients reported a tingling, well-tolerated sensation in the areas supplied by the mental nerve with no anaesthesia or burning paresthesia. Tactile discrimination was affected the most (all but 1 patient). No action potential was recorded in 4 patients' sides (23.5%); 12 sides showed a decreased nerve conduction velocity (NCV) (70.5%) and 1 side normal NCV values (6%). There was no significant difference in NCV decrease between partial and total transposition sides, if examined separately. Nerve conduction findings were related 2-point discrimination scores, but not to changes in pain and heat sensitivity. These findings show that lateral nerve transposition, though resulting in a high percentage of minor IAN injuries, as determined by electrophysiological testing, provides a viable surgical procedure to allow implant placement in the posterior mandible without causing severe sensory complaints. Considering ethical and forensic implications, patients should be fully informed that a certain degree of nerve injury might be expected to occur from the procedure. Electrophysiological evaluation is a reliable way to assess the degree of IAN dysfunction, especially if combined with a clinical examination. Intraoperative monitoring of IAN conduction might help identify the pathogenetic mechanisms of nerve injury and the surgical steps that are most likely to harm nerve integrity.

The maxillary tuberosity region is becoming increasingly involved in preprosthetic surgery as part of a comprehensive implant treatment planning. The lower success rates in osteointegrated implant placements seen in the posterior regions of the upper maxilla as compared to the anterior regions of the jaws, most often come from bone quality types and the presence of the maxillary sinus. In order to overcome these limitations and obtain a successful result in such a demanding area, several authors suggest that long implants (15.0 to 20.0 mm long) should be placed in the maxillary tuberosity region as an alternative to sinus floor elevation. The challenges frequently associated with the surgical placement of "maxillary tuberosity implants" (MTI), can be reduced through a "Ridge Expansion Osteotomy" (REO) procedure as described by Summers (1994). This indeed improves the recipient bed bone quality and causes no bone overheating. In order to improve this technique performed for MTI, in co-operation with Ing. Albanese G, authors have developed different prototypes of modified osteotomes. A case report using these new instruments is presented. Clinical and radiographic evaluations are obtained.

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The objective of this clinical trial was the analysis of 2 methods for engineering of autologous bone grafts for maxillary sinus augmentation with secondary implant placement. Group 1 (8 patients, 12 sinuses): cells of mandibular periosteum were cultured in a good manufacturing practice laboratory (2 weeks) with autologous serum and then transferred onto a collagen matrix. After another week, these composites were transplanted into the sinuses. In group 2A (2 patients, 3 sinuses), cells of maxillary bone were cultivated with autologous serum for 2 weeks, seeded onto natural bone mineral (NBM, diameter [Ø] ¼ 8 mm) blocks, and cultivated for another 1.5 months. These composites were transplanted into the sinuses. Group 2B (control, 3 patients, 5 sinuses) received NBM blocks alone. In the course of implant placement 6 (group 1) and 8 (group 2) months later, core biopsy were taken. Clinical follow-up period was 1 to 2.5 years in group 1 and approximately 7 years in groups 2A and 2B. New vital bone was found in all cases at median densities of 38% (n ¼ 12) in group 1, 32% in group 2A (n ¼ 3), and 25% in group 2B (n ¼ 5). Differences between group 1 and 2B as well as 2A and 2B were statistically significant (p ¼ 0.025). No adverse effects were seen. All methods described were capable of creating new bone tissue with sufficient stability for successful implant placement.

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