Misch, Craig M.
Page 203 - 204

Dragonas, Panagiotis / Katsaros, Theodoros / Schiavo, Julie / Galindo-Moreno, Pablo / Avila-Ortiz, Gustavo
Page 213 - 232
Purpose: The evidence pertaining to the contribution of the sinus membrane to new bone formation following maxillary sinus augmentation procedures is equivocal. The purpose of this study was to analyse the evidence currently available on the osteogenic capacity of the sinus membrane following maxillary sinus augmentation procedures, and the effect of local delivery of recombinant human bone morphogenic proteins (rhBMPs) on the bone-forming potential of the sinus membrane.
Materials and methods: An electronic search was conducted using six different databases to identify controlled trials, prospective and retrospective cohort studies, case series and case reports, as well as preclinical (animal) studies reporting on new bone formation in close proximity with the sinus membrane after maxillary sinus augmentation procedures, assessed through histological and/or histomorphometrical evaluation, on the basis of pre-established eligibility criteria.
Results: No clinical studies were identified. Twenty-six preclinical studies were included in the review. Nine of them supported the osteogenic potential of the sinus membrane, while eight reported no evidence of osteogenicity from the sinus membrane. The nine remaining studies reported on the local effect of rhBMPs. The majority of these nine studies reported enhanced new bone formation in the sinus membrane region.
Conclusions: The sinus membrane contains pluripotent mesenchymal cells with the capacity to differentiate and participate in the process of new bone formation. However, the findings from the studies selected in this systematic review do not consistently support that the sinus membrane significantly contributes to new bone formation following maxillary sinus augmentation procedures.

Bassi, Francesco / Cicciù, Marco / Di Lenarda, Roberto / Galindo Moreno, Pablo / Galli, Fabio / Herford, Alan Scott / Jokstad, Asbjørn / Lombardi, Teresa / Nevins, Myron / Sennerby, Lars / Schierano, Gianmario / Testori, Tiziano / Troiano, Giuseppe / Vercellotti, Tomaso / Stacchi, Claudio
Page 235 - 239
Purpose: Piezoelectric bone surgery was introduced into clinical practice almost 20 years ago as an alternative method for cutting bone in dental surgical procedures, in an attempt to reduce the disadvantages of using conventional rotary instruments. The aim of this Consensus Conference was to evaluate the current evidence concerning the use of piezoelectric surgery in oral surgery and implantology.
Materials and methods: Three working groups conducted three meta-analyses with trial sequential analysis, focusing on the use of piezoelectric surgery in impacted mandibular third molar extraction, lateral sinus floor elevation and implant site preparation. The method of preparation of the systematic reviews, based on comprehensive search strategies and following preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, was discussed and standardised.
Results: Moderate/low evidence suggests that piezoelectric surgery is significantly associated with a more favourable postoperative course (less pain, less trismus) after impacted mandibular third molar extraction than conventional rotary instruments. Moderate evidence suggests that implants inserted with piezoelectric surgery showed improved secondary stability during the early phases of healing compared with those inserted using a drilling technique. Strong/moderate evidence suggests that piezoelectric surgery prolongs the duration of surgery in impacted mandibular third molar extraction, sinus floor elevation and implant site preparation, but it is unclear whether the slight differences in duration of surgery, even if statistically significant, represent a real clinical advantage for either operator or patient. Weak evidence or insufficient data are present to draw definitive conclusions on the other investigated outcomes.
Conclusions: Further well-designed trials are needed to fully evaluate the effects of piezoelectric surgery, especially in implant site preparation and sinus floor elevation.

Bianconi, Stefano / Wang, Hom-Lay / Testori, Tiziano / Fontanella, Fabrizio / Del Fabbro, Massimo
Page 241 - 252
Purpose: Implant primary stability has long been considered a prerequisite for successful osseointegration. However, achieving stability may be difficult when placing implants in wide postextractive bone defects. The purpose of this study was to conduct a clinical and radiographic investigation of bone modifications at porous-structured implants inserted with or without primary stability.
Materials and methods: Fifty porous-structured implants were inserted in the posterior sockets of 50 consecutive patients 2 months after tooth extraction, combined with allogeneic bone and a resorbable membrane. The implants were divided into two groups according to insertion torque: spinner (spinning at 35 Ncm, n = 23) and stable (stable at 35 Ncm, n = 27). Implant stability was assessed by resonance frequency analysis from baseline to 6-month function. Follow-up took place 3 years after implant placement.
Results: At baseline, the implant stability quotient was undetectable in the spinner group and averaged 75.07 ± 5.84 in the stable group. At uncovering, the implant stability quotient increased to 71.33 ± 4.42 and 77.97 ± 3.30 in the spinner and stable group, respectively (P < 0.001). After 6 months of loading, no between-group difference in implant stability quotient was found (P = 0.13). Marginal bone level changes were similar between groups at all follow-ups, averaging −0.41 ± 0.77 mm and −0.15 ± 0.53 mm at 36-month follow-up in the spinner and stable group, respectively (P = 0.35). No implant failed throughout the observation period. Neither biological nor mechanical complications occurred.
Conclusion: Implants with a moderately rough surface and a porous-structured body may osseointegrate even without primary stability.

Alves, Luciana Bastos / Coelho, Tayane da Rocha Costa / de Azevedo, Roberto Almeida / dos Santos, Jean Nunes / Neves, Frederico Sampaio / Cury, Patricia Ramos
Page 255 - 266
Purpose: The present study aimed to identify the systemic risk indicators associated with peri-implant mucositis and peri-implantitis in individuals with implant-supported fixed prostheses.
Materials and methods: In this cross-sectional study, clinical evaluations of periodontal and peri-implant conditions were performed by a single examiner in a sample of 71 volunteers with 360 implants. Peri-implant mucositis was defined as the occurrence of bleeding on probing in association with redness and swelling or suppuration, without bone loss. Peri-implantitis was defined based on a radiograph of bone loss ≥ 3 mm and/or a probing depth ≥ 6 mm with bleeding and/or suppuration on probing. The systemic factors evaluated were obesity, hormone replacement therapy, osteopaenia and osteoporosis, high blood pressure and hypercholesterolaemia. Logistic models were applied to assess the associations between peri-implant diseases and systemic factors.
Results: Mucositis and peri-implantitis were found in 83.1% and 16.9% of the individuals, respectively. The regression analysis showed that obesity (prevalence ratio = 5.23; 95% confidence interval, 1.91 to 96.83; P = 0.01) and high systolic blood pressure (prevalence ratio = 4.23; 95% confidence interval, 1.66 to 12.87; P = 0.03) were associated with peri-implantitis at the individual and implant levels, respectively. No systemic factor was associated with peri-implant mucositis (P ≥ 0.06).
Conclusion: Obesity and high systolic blood pressure were associated with peri-implantitis, whereas no systemic factor was associated with peri-implant mucositis. Future prospective studies are required to confirm these as true risk factors. Patients with obesity and/or high systolic blood pressure could be informed of the likely association with peri-implantitis, preferably before implant placement.