Background: The purpose of the study was to analyze the efficacy of platelet-rich fibrin (PRF) as a single augmentation material for complicated cases of maxillary sinus floor elevation, resulting from membrane perforation or previous infections. Methods: Implant insertion in the posterior region of the maxilla was simultaneously performed with maxillary sinus floor augmentation. Schneiderian membrane elevation can be accompanied by extremely serious sinus membrane perforation, due to accidental tearing or intended incision for mucocele removal. PRFs were placed in the sinus cavity both for membrane sealing and sinus floor grafting. Radiological, histological and micro-CT analyses were performed. Implant survival was assessed every 6 months for 1 to 4 years, with a mean follow up of 1.8 years, after prosthetic loading. Radiological examinations were performed on CBCT at 9 and 12 and 36 months postoperatively and revealed improved degrees of radiopacity. Results: 19 implants were simultaneously placed in the course of nine maxillary sinus floor augmentation surgeries, with successful outcomes in terms of bone grafting and implant integration. New bone formation was evidenced 12 months postoperatively on radiological examination, micro-CT analysis, and histological analysis of a harvested bone segment from the augmented maxillary sinus. The mean gain in bone height of the sinus floor augmentation was 6.43 mm, with a maximum of 9 mm. The mean amount of vital bone obtained from histologic assessment was 52.30%, while bone volume/tissue volume ratio in micro-CT 3D had a mean of 50.32%. Conclusions: PRF may be considered as an alternative treatment for a single surgery of sinus augmentation with simultaneous implant placement, even in complicated cases with significant sinus membrane tearing.

Background: Various conditions may lead to bony deficiency in the anterior maxilla. The present study evaluated esthetic (PES—pink esthetic score and WES—white esthetic score) results after augmentation of the anterior atrophic maxilla using cancellous bone-block allograft followed by implant placement and late (conventional) loading. Methods: Cohort study that included 33 patients with missing teeth in the upper anterior region characterized by extensive bone loss. Allogeneic cancellous bone-blocks were used for augmentation. Six months later, a dental implant was inserted. After a waiting time of an additional six-months, implant exposure and reconstruction were performed. The mean follow-up period was 62.93 ± 17.37 months (range 19–82 months). Results: The mean value of PES/WES was 17.8 ± 2.78. All patients had a PES/WES value above 12 (threshold value defined as clinically acceptable esthetics). The mean value of PES was 9.0 ± 1.79 and the mean value of WES was 8.8 ±1.84. Conclusions: Bone augmentation of the anterior atrophic maxilla using cancellous block-allograft and late loading supports achievement of a predictable esthetic result with long-term stability of soft and hard tissues around implant-supported reconstructions.

Impression technique is one of the factors affecting restoration fit accuracy, which is a major aspect influencing its survival. The purpose of this study is to compare, in vivo, the effect of two commonly used Vinyl Polysiloxane (VPS) impression techniques on the metal framework fitting of fixed partial dentures. Ninety-two consecutive patients, diagnosed as partially edentulous, treated by fixed partial denture restorations, participated in the study. Group 1-impressions (n = 44) were subjected to the 1-step technique, while group 2 impressions (n = 48) were subjected the 2-step technique. Three accuracy assessment common methods: probe, tactile sense and radiographic test, were used to validate the clinical fit of the metal framework. Misfit was defined as even one test failure. Twenty-one (22.8%) out of 92 metal frameworks exhibited metal frameworks misfit, whereas the other 71 (77.2%) were found to be accurate. Group 1 presented significantly (p = 0.04) more metal frameworks misfit, 14/44 (31.8%) vs. 7/48 (14.6%). Restoration location (maxilla vs. mandible) had no statistically significant impact on the results (p = 0.461). The use of the VPS putty/wash 2-step impression technique is recommended to improve the clinical fit of fixed partial denture restorations.

Background and Objectives: Maintenance of a firm and long-term stable osseointegration is the primary goal of implant dentistry. Time is used to define implant failure characteristics. Early implant failure (EIF) occurs up to one year after loading. Recent studies indicated an association between proton pump inhibitors (PPI) therapy and failure of osseointegration. The present study assessed whether the use of PPIs is a risk factor to EIF. Materials and methods: A retrospective cohort study including 687 patients and 2971 dental implants. The study group (PPIs users) comprised 17.3% (119) individuals and 18.7% (555) implants. The remaining cohort (82.7% (568) individuals and 81.3% (2416) implants) served as control. The information was taken from the patients’ files. The following information was collected: age, gender, physical status, systemic diseases, HbA1C values before and after implant-supported prosthesis delivery in cases of diabetes mellitus, smoking, implant location, number of implants per individual, bone augmentation, implant brand, length and width, and EIF. EIF was defined as implant removal within a period of up to 12 months from loading. Results: EIF in PPIs vs. non-PPIs users was 19.3% vs. 14.3% (p = 0.16) at patient level and 5.4% vs. 3.5% at implant level (p = 0.03). Univariate analysis yielded factors significantly associated with PPIs use, including older age, physical status of the American Society of Anesthesiology (ASA) 3, hypertension, hyperlipidemia, diabetes mellitus, osteoporosis, cardiovascular accident (CVA), location (anterior mandible), shorter and narrower implants, and higher number of implants per individual. Multivariate analysis yielded statistically significant OR of 1.91; p = 0.01 for EIF following PPIs use and 2.3; p < 0.001 for location in anterior mandible. Conclusions: Patients and their healthcare providers are advised to carefully consider the potential risks of taking PPIs prior to dental implant surgery. Further research is needed to confirm these risks and elucidate systemic and local factors that may be involved in such outcomes.

Background: Within medicine, it is common to use risk prediction tools towards clinical decision making. One of the most widely accepted assessment tools is the American Society of Anesthesiologists Physical Status (ASA PS) classification. Oral and maxillofacial procedures performed in an ambulatory setting would be considered low risk for the procedure itself. However, little is known concerning the impact of ASA PS on surgical outcomes. The aim of the present research was to evaluate the effect of ASA PS classification on early implant failure (EIF). Methods: Retrospective cohort study based on dental records. All treatments were performed by experienced oral and maxillofacial surgeons and experienced prosthodontists. Inclusion criteria: ASA physical status 1,2,3, consecutive individuals. Variables included the following: age, gender, implant location, implant length, implant width, smoking, and early implant failure. Results: Univariate tests at the patient level showed no statistically difference between the different classifications of ASA PS (1,2,3). Multivariate model using logistic regression at individual level showed that two factors were found to be associated with an increased risk for EIF—augmented bone and implant brand. Conclusions: ASA PS 3 is not a contraindication for implant-supported prostheses. EIF in ASA PS 3 is not significantly different from ASA PS 1,2. In contrast, factors such as bone augmentation and implant brand might be significant risk factors for EIF, regardless of ASA PS.

Background: This study compared the influence of three different radial spacers (60,90,120 microns) on the marginal gap adaptation by using computer-aided manufacturing (CAD-CAM) for producing monolithic zirconia reinforced lithium silicate (ZLS) ceramic crowns. Methods: A total of 45 abutment acrylic teeth were divided into three groups of different radial spacers (60, 90, and 120 microns). In each group 15 teeth were scanned by Omnicam intra oral scanner and ZLS crowns were ground. For each unit the marginal gap was evaluated at four regions of interest by scanning electronic microscope (SEM). To compare the marginal gap between the three groups a one-way ANOVA with post-hoc Bonferroni test was preformed (α = 0.05). Results: The marginal gap for a 60 microns (162.99 ± 16.25 µm) radial spacer was found significantly higher than 90 (41.85 ± 3.57 µm) and 120 (41.85 ± 5.3 µm) microns radial spacers (p < 0.05). Between 90- and 120-micron radial spacers no difference was obtained. (p < 0.05). Conclusions: A radial spacer of 60 microns showed a significantly higher marginal gap compared to 90 and 120 microns and was not clinically accepted (>120 microns). For both 90 and 120 microns the marginal gap was clinically accepted (<120 microns) with no difference between the groups. The radial spacer which should be optimum for CELTRA® DUO crowns is 90 microns.

Background: Individuals with tooth agenesis often present a significant clinical challenge for dental practitioners. This retrospective study evaluated clinical and radiological long-term functional and esthetic outcomes following restoration using primary teeth to support fixed all-ceramic prosthesis in patients with teeth agenesis. Methods: Patients with teeth agenesis and at least one year follow-up were included. Examinations included panoramic X-ray, clinical examination and family history records. Only primary teeth without permanent teeth underneath were chosen. All ceramic fixed restorations were used. All data were collected from patient files. Outcome parameters included: restoration parameters (restoration survival, restoration fractures, restoration detachment, restoration replacement, and secondary caries), plaque index, and gingival index. Results: The study included 58 porcelain restorations inserted in 25 individuals; mean age 12 ± 2.1 years (range 10–19 years); mean number of missing teeth 12.3 ± 9 (range 6–12). Mean follow-up 48±6 months (range 12–60 months). All restorations survived up to last follow-up, rendering a survival rate of 100%. Restorations outcome – porcelain chipping (9%), detachment (2%), no restoration replacement nor secondary caries, mean gingival index - 0.7 ± 0.5 and mean plaque index - 0.9 ± 0.3. Conclusions: In tooth agenesis, restoration using primary teeth to support fixed all-ceramic prosthesis is a viable treatment alternative.

Two critical factors that influence the accuracy of an impression include the proper manipulation of the impression materials and the technique used to make the impression. The purpose of this study was to clinically evaluate the effect of different mixing techniques on the accuracy of vinyl polysiloxane (VPS) impressions by assessing metal framework fit of fixed partial restorations. The study included 92 consecutive patients diagnosed with partial edentulism and treated with fixed partial denture restorations. The mixing technique was one of the two following mixing methods: hand mixing technique (45 patients), with the putty material mixed according to the manufacturer’s instructions; or mechanical mixing technique (47 patients), with the putty material mixed by a Pentamix device. Under both mixing methods, vinyl polysiloxane was used as the impression material. Two impression techniques were randomly used by the operators (One/Two-stage putty –wash impression techniques). The accuracy of the metal framework restorations was tested clinically and radiologically, resulting in significant statistical difference (p = 0.04) between different mixing techniques. The mechanical mixing produced more accurate restorations (metal framework misfit only in 14.9% of patients vs. hand mixing 31.1%). Regarding the impression techniques, the two-stage impression technique was found to be significantly more accurate (p = 0.04), resulting in 14.6% ill-fitted metal frameworks vs. 31.8%, in the one-stage technique. It can be concluded that mechanical mixing yields more accurate impressions leading to more accurate restorations, especially when combined with two-stage impression technique.