Márcio de Carvalho Formiga

Background: Guided bone regeneration is a reliable technique for treating alveolar ridge deficiencies, especially in cases of severe maxillary atrophy. This case report describes the clinical management of a partially edentulous female patient presenting horizontal bone resorption in the anterior maxilla. Methods: Horizontal ridge augmentation was performed using a titanium mesh in combination with a xenogeneic particulate bovine bone graft and a resorbable collagen membrane, without the use of autogenous bone. After 10 months of healing, the titanium mesh was removed, and a bone sample was collected using a trephine drill for histological analysis, which confirmed new cortical bone formation with osteocytes in close contact with graft particles. Two implants were then placed, followed by soft tissue conditioning with provisional restorations and final prosthetic rehabilitation. Results: Histological analysis confirmed new cortical bone formation with osteocytes in close contact with graft particles. At the 7‐year follow‐up, clinical and radiographic assessments demonstrated stable bone volume and successful implant osseointegration. Conclusion: Within the limitations of this case report, the findings suggest that a xenogeneic particulate bone substitute used without autogenous bone, in combination with a titanium mesh and a resorbable collagen membrane, may represent a viable approach for reconstruction of severely atrophic ridges, enabling long‐term esthetic and functional outcomes. Key points: Reconstruction of a severely atrophic anterior maxillary ridge was performed using guided bone regeneration with a titanium mesh, a xenogeneic particulate bovine bone graft, and a resorbable collagen membrane, without autogenous bone harvesting. Histological analysis demonstrated new cortical bone formation in close contact with residual graft particles at the time of implant placement. Clinical and radiographic follow‐up over 7 years demonstrated maintenance of peri‐implant bone levels and stable esthetic and functional outcomes. Plain language summary: Severe bone loss in the upper front jaw can make dental implant treatment challenging, particularly when both function and appearance are important. Traditional bone grafting procedures often require harvesting the patient's own bone, which may increase treatment complexity and postoperative discomfort. This case report describes the reconstruction of a severely atrophic anterior maxillary ridge using guided bone regeneration with a titanium mesh, a bovine‐derived bone substitute, and a resorbable collagen membrane, without autogenous bone harvesting. After healing, two dental implants were placed to support a fixed prosthetic restoration. Histological analysis showed new bone formation around the graft particles. Clinical and radiographic evaluations over a 7‐year follow‐up demonstrated stable bone volume, healthy peri‐implant tissues, and long‐term functional and esthetic success. Although this report describes a single patient, the findings suggest that this approach may be a less invasive alternative for selected cases requiring reconstruction of severe horizontal bone defects before implant placement.

Background and Clinical Significance: Immediate implant placement in mandibular molars represents a clinical challenge due to lower trabecular bone density and anatomical limitations of the interradicular septum. Osseodensification has been proposed as an alternative to improve primary stability in sites with low bone quality. Case Presentation: This report describes the case of a 54-year-old female patient with a mesial root fracture in the lower right first molar, treated by atraumatic extraction followed by immediate implant placement using a densifying drilling protocol. After careful root removal, the interradicular septum was expanded using Versah burs at 1200 rpm, allowing placement of a 4.0 × 7 mm Implacil Duecone implant with a final insertion torque of 25 Ncm. The residual gap was filled with a xenogeneic bone substitute and covered with a dense polytetrafluorethylene membrane for alveolar preservation. Healing progressed uneventfully and, after four months, adequate bone formation was observed, enabling prosthetic rehabilitation with a single ceramic crown. After 4 postoperative years we could find peri-implant tissue stability. Conclusions: The clinical outcome supports current evidence indicating that osseodensification may enhance initial stability and predictability of immediate implants placed in posterior mandibular regions.

Objectives: To evaluate the influence of implant–abutment connection design, implant diameter, and simulated marginal bone loss on fracture resistance and failure patterns of dental implant systems. Materials and Methods: A total of 180 implant–abutment assemblies were tested, including Morse taper (MT) and internal hex (IH) connections with diameters of 3.5, 4.0, and 5.0 mm. Implants were embedded at two simulated bone levels (0 and 3 mm) and loaded at 30° until failure, in accordance with ISO 14801:2015. Fracture resistance (N) was analyzed using three-way ANOVA. Results: Connection type, implant diameter, bone level, and their interactions significantly affected fracture resistance (p < 0.001). Internal hex implants showed a marked diameter-dependent increase in resistance and greater reduction under simulated bone loss, particularly in reduced diameters. In contrast, Morse taper implants demonstrated similar resistance values regardless of implant diameter or bone level. Failure patterns also differed between systems: internal hex implants exhibited cervical implant fractures in reduced diameters, whereas Morse taper implants showed progressive abutment deformation and/or abutment fracture without implant body fracture. Conclusions: Implant fracture resistance is strongly influenced by implant–abutment connection geometry. Within the limitations of this static in vitro study, MT systems demonstrated diameter-independent mechanical stability and prosthetic-controlled failure patterns, whereas IH systems were highly sensitive to diameter reduction and simulated bone loss.

Background: Primary stability and long-term osseointegration depend on bone healing surrounding dental implants. Implant macrogeometry is crucial for controlling insertion torque and the biological reaction of peri-implant bone. This study assessed the impact of an implant design meant to lessen cortical bone compression on early bone healing. Methods: Forty titanium prototype implants (3 × 6 mm) were equally divided into Control (standard macrogeometry) and Test (macrogeometry with healing chambers) groups. Initial insertion torque was measured in vitro using synthetic bone blocks. Subsequently, an in vivo rabbit tibia model was used (n = 10 implants per group) to assess early healing. At 21 days, histological sections were analyzed for bone-to-implant contact (BIC%) at three cervical positions (C1, C2, and C3). Additionally, digital radiographs of the cervical region were evaluated using RGB color mapping, where distinct color channels quantified varying degrees of bone density. Results: The in vitro insertion torque for the Control group was significantly greater than the Test group (8.01 vs. 5.70 Ncm). The in vivo histomorphometric analysis indicated improved integration for the Test design, showing substantially higher BIC% at the C2 (59.30% vs. 40.30%) and C3 (42.10% vs. 17.90%) positions. Furthermore, radiographic RGB analysis revealed that the Test group possessed a higher blue channel contribution, indicating greater mineralized tissue density. Conclusions: These results imply that modifying implant macrogeometry to lower insertion torque and minimize cortical bone compression favorably enhances early cervical bone healing and osseointegration.

Objective: This study aimed to evaluate peri-implant tissue changes during early osseointegration using a combined approach of digital radiographic analysis, RGB pseudocolorization, and histomorphometry in a sheep tibia model. Materials and Methods: Thirty titanium implants were placed in the tibiae of six adult sheep and evaluated at 14 and 28 days post-implantation. Digital periapical radiographs were acquired, grayscale values and RGB channel intensities were measured using Fiji/ImageJ, and compared with histological parameters (bone tissue, collagen, and medullary spaces) quantified from picrosirius–hematoxylin-stained sections. Manual overlay of radiographic and histological images was performed to ensure spatial correspondence of regions of interest. Statistical analyses assessed differences over time and correlations between image data and histological composition. Results: Radiographic grayscale values and histologically measured bone and collagen increased significantly from 14 to 28 days (p < 0.01), while medullary spaces decreased (p < 0.001), indicating progressive bone formation and matrix maturation. RGB analysis revealed significant increases in green channel intensity and decreases in red channel intensity (p < 0.05), while the blue channel remained stable. At 14 days, strong correlations were observed between blue channel intensity and bone tissue (r = 0.81; p = 0.015), and between green channel intensity and collagen (r = 0.98; p < 0.001). Visual overlays demonstrated alignment between radiographic high-density zones and histologically dense bone regions. Conclusions: RGB pseudocolorized radiographic analysis, correlated with histological findings, offers a non-invasive and reproducible method for early detection of peri-implant tissue maturation. This feasibility correlation study provides a foundation for future investigations integrating imaging, histology, and biomechanical testing.

Implant-supported fixed rehabilitations are a reliable solution to restore aesthetics and function to edentulous patients. Currently, practitioners can use digital flow with computer-aided design & computer-aided manufacturing (CAD/CAM) technology to enhance their productivity by reducing working time and providing more comfort to patients. This report presents a clinical case in which the digital flow was used to restore the inferior edentulous arch in a 55-year-old female patient with an implant-based Misch's FP3 denture. Digital technology provides tridimensional planning, surgical computed guides, and printed temporary rehabilitation. This case report portrays the feasibility and ease that the digital flow provides for both the surgeon and the patient.

Digital workflow has become an important tool for surgical dentistry and helps clinicians plan and treat several conditions. The excessive gingival display, also known as a gummy smile, is one of the conditions where digital planning and 3D-printed surgical guides bring benefits to both patients and surgeons, by increasing the accuracy of the execution, as close as possible, to the proposed planning. The objective of this case report is to show a case of altered passive eruption treated with aesthetic crown lengthening with the use of a 3D-printed surgical guide. After the patient accepted the proposed treatment plan, a surgical guide was printed according to the digital planning. The surgery had an initial gingivectomy guided by the 3D-printed guide, and after raising the mucoperiosteal flap, osteotomy was also guided by a 3D-printed guide. After three months, the patient was sent to the prosthodontist to replace a composite veneer on the left upper central incisor, with the margins exposed after the gingival healing. With 30 months of follow-up, the patient presents great margin stability and periodontal health. The use of digital workflow appears to facilitate the predictability of periodontal aesthetic treatments and may have more applicability shortly.

Objetivo: comparar a estabilidade primária de implantes com macrogeometria contendo câmaras de descompressão entre as arcadas. Material e métodos: após a seleção dos pacientes conforme critérios de inclusão/exclusão préestabelecidos, 26 implantes (Maestro, Implacil De Bortoli – São Paulo/SP, Brasil) foram colocados na região posterior (13 na maxila e 13 na mandíbula; 3,5 mm de diâmetro e comprimentos de 7 mm e 9 mm, nas regiões de molares e pré-molares), 1 mm abaixo da crista óssea. Em seguida, foram avaliados o torque de inserção e o quociente de estabilidade primária (ISQ) no momento da instalação do implante. As restaurações definitivas metalocerâmicas parafusadas foram entregues três meses depois. Resultados: não houve correlação estatisticamente significativa entre o torque de inserção e o quociente de estabilidade do implante no momento da instalação (p > 0,05). Houve uma diferença significativa apenas para os valores de torque abaixo de 32 Ncm. Valores de torque iniciais menores apresentaram valores ISQ menores. Quando o torque ficou na faixa de 40 a 60 Ncm, não houve diferença significativa no valor do ISQ. O quociente médio de estabilidade não apresentou diferença significativa na comparação entre as arcadas. Conclusão: a estabilidade primária dos implantes instalados na mandíbula e na maxila foi similar em valores de ISQ. Palavras-chave: Implantes dentários; Estabilidade primária; Osseointegração; Desenho do implante; Câmara de descompressão.

Background: Tooth loss causes alveolar bone resorption, which may hinder the ability of implant placement. Socket preservation with immediate implant placement is one of the methods used to reduce bone resorption. In this retrospective study, we evaluated the influence of the use of dense polytetrafluoroethylene (d-PTFE) membranes on alveolar preservation after tooth extraction and with the installation of immediate dental implants. Methods: In this retrospective study, one hundred and four patients were divided into two groups: immediate implant and gap filling with heterogenous bone graft (control group, 52 patients) or immediate implant, gap filling with heterogenous bone graft, and covering with a d-PTFE membrane with dimensions of 12 × 24 mm, which was intentionally left exposed to the oral cavity (test group, 52 patients). Tomographic data were obtained before and 12 months after the surgical procedures. Results: The membranes exposed in the oral cavity showed no infection. Volumetric analyses revealed a statistically significant difference in alveolar ridge resorption for the control and d-PTFE groups, 16.75% and 4.55%, respectively. Conclusions: Intentionally exposed d-PTFE membranes showed minimal complications. Based on the volumetric results, alveolar ridge preservation with d-PTFE membranes was superior to the bone graft alone in immediate implant placement.