Edentulism and terminal dentition are still considered significant problems in the dental field, posing a great challenge for surgical and restorative solutions especially with immediate loading protocols. When the implant placement is planned immediately after extraction with irregular bone topography or there is an un-leveled alveolar ridge topography for any other reason, bone reduction may be required to level the alveolar crest in order to create the desired bone architecture allowing for sufficient bone width for implant placement and to insure adequate inter-arch restorative space. Bone reduction protocols exist in analog and digitally planned methodologies, with or without surgical guides to achieve the desired bone level based upon the desired position of the implants with regard to the restorative outcome. The objective of this paper was to scrutinize the literature regarding the practice of bone reduction in conjunction with implant placement, and to review different types of bone reduction surgical guides. Results: The literature reveals different protocols that provide for bone reduction with a variety of bone reduction methods. The digitally-planned surgical guide based on Cone-Beam computerized tomography (CBCT) scan reconstructed data can improve accuracy, reduce surgical time, and deliver the desired bone level for the implant placement with fewer surgical and restorative complications. The clinician’s choice is based on personal experience, training, and comfort with a specific guide type. Conclusions: Bone reduction, when required, is an indispensable step in the surgical procedure to attain suitable width of bone in anticipation of implant placement ideally determined by the desired tooth position and required restorative space based on material selection for the chosen framework design, i.e., hybrid, monolithic zirconia. Additionally, bone reduction and implant placement can be accomplished in the same surgical procedure, minimizing trauma and the need for two separate interventions.

This randomized controlled clinical trial evaluated the effect of mineralized plasmatic matrix (MPM), comprised of synthetic graft and platelet concentrates, on new bone formation and volume stability over time in maxillary sinus lifting (MSL). Unilateral MSL was performed in 20 patients with either beta-tricalcium phosphate (β-TCP) or MPM grafts (10 sinuses each). Six months postsurgery, specimens were obtained with a trephine bur prior to implant placement in 39 cases. Volumetric changes in sinus augmentation were analyzed between 1 week (T-I) and 6 months (T-II) postsurgery. Histomorphometric and histological analyses of biopsy samples revealed mean new bone percentages of 35.40% ± 9.09% and 26.92% ± 7.26% and residual graft particle areas of 23.13% ± 6.16% and 32.25% ± 8.48% in the MPM and β-TCP groups, respectively (p < 0.05). The mean soft-tissue areas in the MPM and β-TCP groups were 41.48% ± 8.41% and 40.83% ± 8.86%, respectively (p > 0.05). Graft reductions between baseline and 6-months postprocedure in the β-TCP and MPM groups were 17.12% ± 13.55% and 14.41% ± 12.87%, respectively, with significant graft volume reduction observed in both groups (p < 0.05) while there is no significant difference between MPM and β-TCP groups (p > 0.05). Thus, MPM, representing growth factors in a fibrin network, increases new bone formation and has acceptable volume stability in MSL procedures

Aim: Long-term studies addressing the outcomes of single immediate implantation and provisionalization at the maxillary esthetic zone are needed. The current study aimed to assess such outcomes along a follow-up period of up to 18 years. Materials and methods: The current study is a continuation follow-up of our previously published up to 6-year follow-up study, dated between the years 2002–2008, performed in a private clinical practice in Tel-Aviv, Israel. A total of 15 patients (23 implants) who had been treated for single-tooth replacement at the maxillary esthetic zone since 2002, underwent clinical and radiographic follow-up evaluations. Primary outcomes included mean Marginal Bone Levels (MBL), with Bleeding on Probing (BOP), implant success rate, prosthetic and esthetic complications evaluated as secondary outcomes. Results: The implant success rate was at 100%. Bone remodeling processes were observed over the follow-up period, with 0.9 mm mean marginal bone loss observed during the first 6 years of observation, followed by −0.13 ± 0.06 mm mean loss after 6 to 18 years. The last finding suggests bone deposition, as reported by other studies (Donati et al., 2012). At the final radiographic evaluation, a mean MBL of 1.35 mm ± 0.16 was demonstrated. No differences with respect to implant type or site were found. A generalized absence of BOP and esthetic complications occurred in two cases as a result of continuous adjacent teeth eruption versus obvious implant ankylosis. Conclusions: Adhering to careful clinical protocols and 3D bone to implant considerations while immediately placing an anterior implant, this treatment approach offers both stable and esthetically acceptable results for the replacement of missing teeth at the maxillary esthetic zone.

Platelet rich fibrin (PRF) is an autologous biological product which becomes popular day by day and available in a wide variety of fields in medicine. Platelet concentrates which are introduced at the early 90s have evolved over the years. The use such autologous materials have become trendy in recent years to encounter demanding expectations of patients, improve treatment success and maximize patient comfort. Despite its increasing use in dentistry and oral surgery, the most indications and effects are still being discussed. PRF is easily accepted by patients because of its low cost, easy to receive, low donor morbidity, low postoperative complication and infection rate. This biomaterial may be a solution for patients who have strong negative beliefs about the use of allografts and xenografts or who are afraid of complications during the grafting procedure. The objectives of these technologies are to use their synergistic effect to improve the hard and soft tissue regeneration. PRF in oral surgery are used for alveolar bone reconstruction, dental implant surgery, sinus augmentation, socket preservation, osteonecrosis, oroantral fistula closure, struggling with oral ulcers, preventing swelling and edema constitution. This chapter aims to review the clinical applications of platelets in oral surgery and the role of molecular components in tissue healing.

Background/Objectives: Various bone substitutes have been recommended to augment the horizontal gap following immediate implantation. The purpose of this study was to compare the effectiveness of an autogenous mineralized dentin graft or a deproteinized bovine bone in horizontal gap augmentation following immediate implant placement in the maxillary anterior region. Methods: A total of 110 patients underwent tooth extraction followed by immediate implant placement. The patients were divided into two groups. The first group received an autogenous mineralized dentin graft (the test group) while the second group received a deproteinized bovine bone (the control group) to augment the horizontal gap. Preoperative (T0), immediate postoperative (T1), and 1-year postoperative (T2) cone beam computed tomography scans were taken from all the patients. Linear measurements were recorded 1 mm (R1) and 5 mm (R2) points apical to the implant platform at both T1 and T2 time intervals. Pink Esthetic Scores and prosthetic complications were evaluated as well. Results: There were 57 patients with a mean age of 45.42 ± 9.86 (range 24–63 years) selected as the test group and 53 patients with a mean age of 40.28 ± 11.69 (range 20–63 years) as the control group. The mean reduction in the buccal bone plate at R1 was 6.39 ± 3.78% in the test group and 6.99 ± 5.01% in the control group (p > 0.05). The mean reduction in the buccal bone plate at R2 was 5.46 ± 4.98% in the test group and 6.77 ± 7.60% in the control group (p < 0.05). The PES and prosthetic-related complications were shown to be negligible between the groups (p > 0.05). Conclusions: The efficiency of using an autogenous mineralized dentin graft for horizontal gap augmentation showed similar results in comparison to using a deproteinized bovine bone in relation to buccolingual socket reduction following immediate implantation.

This study aims to evaluate the effects of customized zirconia barrier membranes produced for guided bone regeneration (GBR) approaches on bone healing researched with histological and histomorphometric methods. The digital modeling was used to create zirconia barrier membranes suitable for the defect on the tibia bone. The membranes were designed using a 3D software system and transferred to the CAD/CAM software system in stl. Afterward, zirconia discs (1400 Mpa) (Aconia BSM- D98 × 16, HT+, Germany) were milled and sintered. Titanium mesh, titanium reinforced d-PTFE, and zirconia barrier membranes were used to cover the defects. As a control group, one defect was left empty. 3 and 6 weeks of the healing term, preparates were obtained from each group after animals were sacrificed. New bone formation, amount of the remaining grafts and tissue response parameters were analyzed histomorphometrically and histologically. The highest percentage of newly formed bone in the early period was observed in the titanium mesh membrane group (26.39 ± 5.38); In the late period, this rate was highest in the zirconia group (64.42 ± 9.95). However, no statistically significant difference was found in both periods between the groups. The amount of residual graft progressed at a low level in both periods without any difference in the other groups except the control group. In the 3rd and 6th weeks, the amount of new bone formation was the lowest in the control group. No foreign body reaction or necrosis was observed in any of the defects. With the limitation of the study, it has been concluded that effective results can be obtained with customized zirconia barrier membranes in GBR procedures.