Paolo Pesce, DDS, PhD/Francesco Pera, DDS, PhD/Paolo Setti, DDS/Maria Menini, DDS, PhD: Purpose: To evaluate the accuracy and precision of a digital scanner used to scan four implants positioned according to an immediate loading implant protocol and to assess the accuracy of an aluminum framework fabricated from a digital impression. Materials and Methods: Five master casts reproducing different edentulous maxillae with four tilted implants were used. Four scan bodies were screwed onto the low-profile abutments, and a digital intraoral scanner was used to perform five digital impressions of each master cast. To assess trueness, a metal framework of the best digital impression was produced with computer-aided design/computer-assisted manufacture (CAD/CAM) technology and passive fit was assessed with the Sheffield test. Gaps between the frameworks and the implant analogs were measured with a stereomicroscope. To assess precision, three-dimensional (3D) point cloud processing software was used to measure the deviations between the five digital impressions of each cast by producing a color map. The deviation values were grouped in three classes, and differences were assessed between class 2 (representing lower discrepancies) and the assembled classes 1 and 3 (representing the higher negative and positive discrepancies, respectively). Results: The frameworks showed a mean gap of < 30 μm (range: 2 to 47 μm). A statistically significant difference was found between the two groups by the 3D point cloud software, with higher frequencies of points in class 2 than in grouped classes 1 and 3 (P < .001). Conclusion: Within the limits of this in vitro study, it appears that a digital impression may represent a reliable method for fabricating full-arch implant frameworks with good passive fit when tilted implants are present.

The aim of the present systematic review was to investigate the effect of residual bone height (RBH) and vertical bone gain on new bone formation (NBF) and graft shrinkage after lateral sinus lifts using different biomaterials. Methods: An electronic search was conducted on three databases to identify randomized controlled trials (RCTs) published until January 2021 with at least one follow-up at 6 months and at least five patients treated, comparing biomaterials used for maxillary sinus augmentation with a lateral approach. Graft volumetric changes, RBH, vertical bone gain, implant failure, and post-operative complications were evaluated. The risk of bias was assessed using the Cochrane tool. Results: We used 4010 identified studies, of which 21 were RCTs. Overall, 412 patients and 533 sinuses were evaluated. Only three publications had an overall low risk of bias. After 6 months, xenograft (XG) showed the least volume reduction (7.30 ± 15.49%), while autogenous graft (AU) was the most reabsorbed (41.71 ± 12.63%). NBF appeared to not be directly correlated with RBH; on the contrary, the overall linear regression analysis showed that NBF significantly decreased by 1.6% for each mm of postoperative vertical graft gain. This finding suggests that the greater the augmentation, the lower the NBF. A similar tendency, with a regression coefficient even higher than the overall one, was also observed with alloplast (AP) and XG. Conclusions: The present results suggested that NBF was essentially independent of preoperative bone height. On the contrary, the smaller the volume was of the graft placed, the higher the amount of new bone formed, and the smaller the graft shrinkage was. Minimizing the augmentation volume might be beneficial to graft healing and stability especially when using AP and XG.

Paolo Pera, MD, DDS, PhD/Maria Menini, DDS, PhD/Paolo Pesce, DDS, PhD/Marco Bevilacqua, DDS/Francesco Pera, DDS, PhD/Tiziano Tealdo, DDS, MS, CDT: Purpose: To compare clinical outcomes of immediate vs delayed implant loading in edentulous maxillae with full-arch fixed prostheses. Materials and Methods: Two patient groups were identified for this study: (1) the test group (TG), which included 34 patients (19 women, 15 men; mean age 56.7 years) treated with the Columbus Bridge Protocol with 4 to 6 postextractive implants loaded within 24 hours (163 implants total); and (2) the control group (CG), which included 15 patients (6 women, 9 men; mean age 59.96 years) treated with a traditional two-stage delayed loading rehabilitation using 6 to 9 implants inserted in healed sites (97 implants total). All patients were rehabilitated with full-arch fixed prostheses in the maxilla. Results: At the 10-year follow-up, no difference in the implant cumulative survival rate between the TG (93.25%) and CG (94.85%) was found. Mean bone loss was significantly lower in the TG (mean: 2.11 mm) compared to the CG (mean: 2.65 mm). All original prostheses were maintained and functioning satisfactorily. Conclusion: Maxillary full-arch immediate loading represents a valid alternative to the traditional delayed loading rehabilitation.