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Peri-implantitis is an inflammatory disease affecting tissues surrounding dental implants. Although it represents a common complication of dental implant treatments, the underlying mechanisms have not yet been fully described. The aim of this study is to identify the role of titanium nanoparticles released form the implants on the chronic inflammation and bone lysis in the surrounding tissue. We analyzed the in vitro effect of titanium (Ti) particle exposure on mesenchymal stem cells (MSCs) and fibroblasts (FU), evaluating cell proliferation by MTT test and the generation of reactive oxygen species (ROS). Subsequently, in vivo analysis of peri-implant Ti particle distribution, histological, and molecular analyses were performed. Ti particles led to a time-dependent decrease in cell viability and increase in ROS production in both MSCs and FU. Tissue analyses revealed presence of oxidative stress, high extracellular and intracellular Ti levels and imbalanced bone turnover. High expression of ZFP467 and the presence of adipose-like tissue suggested dysregulation of the MSC population; alterations in vessel morphology were identified. The results suggest that Ti particles may induce the production of high ROS levels, recruiting abnormal quantity of neutrophils able to produce high level of metalloproteinase. This induces the degradation of collagen fibers. These events may influence MSC commitment, with an imbalance of bone regeneration.

Purpose The present study evaluated osteopenia (OPN) and osteoporosis (OP) as risk factors for dental implant failure and repeat failure. Methods We performed a retrospective study on over 100 randomly selected patients per analysis to determine the effect of health status, smoking status, sex, implant location and operative conditions on first and second (re-implantation) implant survival. Analyses were conducted first using chi-squared test, followed by multiple logistic regression for significant variables. Results In the cohort examining the effect of myriad risk factors on second implant survival, it was found that OPN and OP greatly impacted implant survival, wherein patients with osteoporosis or osteopenia had significantly more implant failures (p = 0.0353). Sex and operative conditions had no effect on implant survival, while implant location showed a notable effect wherein significantly more failures occurred in the maxilla vs mandible (p = 0.0299). Upon finding that OPN and OP have a significant effect on second implant survival, we conducted an additional study focusing on the impact of health status. Based on the multiple logistical regression analysis, we found that OPN and OP are the most significant factor in first implant survival (p = 0.0065), followed by diabetes (p = 0.0297). Importantly, it was observed that early implant failure is also significantly correlated with osteoporosis (p = 0.0044). Conclusion We show here a marked relationship in which the risk of first and second implant failure are significantly higher in patients with osteoporosis and osteopenia.

Immediate vs. Late Implantation Replacing Multiple Adjacent Missing Teeth in the Anterior Maxilla, presented by Dr. Devorah Schwartz-Arad.

The Chapter describes the challenges and surgical solutions for fix prosthetic reconstruction of severe atrophic edentulous ridges, especially the maxillary alveolar ridge. Achieving an esthetic and functional implant supported restoration in the maxillary jaw is challenging, especially following severe atrophy. Inadequate alveolar ridge width and height frequently impedes dental implant placement or trajectory, influencing the esthetic outcome. The presented standard of care is given for surgical reconstruction of severe atrophic edentulous maxilla, combined several surgical therapies for vertical and/or horizontal augmentation via autologous onlay bone graft (AOBG) augmentation, maxillary sinus and/or subnasal augmentation if necessary, soft tissue manipulation, and more. This combination of surgical techniques should be considered as a reliable, safe, and very effective method to obtain a high bone graft survival rate following a high long‐term implant survival rate.