Paolo De Angelis

Background: Vertical implant positioning may influence peri-implant health outcomes and long-term stability; however, the impact of baseline vertical implant positioning relative to adjacent teeth remains unclear. The aim of this systematic review and meta-analysis was to assess the association between baseline vertical implant positioning and peri-implant clinical and radiographic outcomes. Methods: The Cochrane Central Register, PubMed, SCOPUS, and Web of Science were searched. Vertical implant positioning relative to adjacent teeth was assessed using two radiographic reference distances: implant platform to cemento-enamel junction (IP–CEJ) and implant platform to adjacent interproximal alveolar bone level (IP–ABL). The primary outcome was peri-implant marginal bone loss (MBL). Secondary outcomes included implant survival and success rates, peri-implant mucositis and peri-implantitis prevalence. Risk of bias was assessed using the Moga checklist, and certainty of evidence was evaluated according to GRADE. Results: Four studies including 267 implants fulfilled the inclusion criteria. The pooled mean baseline IP–CEJ and IP–ABL distances were 4.69 mm (95% CI 2.05 to 7.32) and 2.13 mm (95% CI 1.29 to 2.98), respectively. The pooled mean marginal bone loss after at least 12 months, based on three studies, was 0.21 mm (95% CI −0.28 to 0.70). Conclusions: The available evidence is insufficient to determine whether baseline IP–CEJ or IP–ABL distances are associated with peri-implant outcomes or to identify an optimal range of vertical implant positioning. The findings should be interpreted cautiously because the certainty of evidence is very low, highlighting the need for prospective studies with long-term follow-up.

Background: Identification of healthy bone margins is a critical step in the surgical resective treatment of medication‐related osteonecrosis of the jaw (MRONJ). Fluorescence‐guided surgery (FGS) has been proposed as a method to identify resection margins and improve clinical outcomes. The purpose of this review was to systematically evaluate the success rate of FGS. Materials and Methods: The Cochrane Central Register, PubMed, Scopus and Web of Science databases were searched. Success was defined as the absence of exposed necrotic bone with full mucosal coverage and no signs of MRONJ recurrence, assessed at overall follow‐up. The risk of bias was evaluated using the Newcastle‐Ottawa Scale, the Moga Index and the GRADE approach. The PRISMA protocol was followed to evaluate and present the results. Results: Nine studies met the inclusion criteria, comprising a total of 285 patients. Of the 314 lesions treated with FGS, 285 achieved complete healing during a mean follow‐up of 13.0 months, with an overall success rate of 88.54%. The fluorescence modalities used included autofluorescence, tetracycline‐induced fluorescence and near‐infrared fluorescence imaging with indocyanine green. Conclusion: Fluorescence‐guided surgery appears to be a promising adjunctive tool for the surgical management of MRONJ, contributing to high success rates.

Background/Objectives: This retrospective study aimed at evaluating the clinical performance of non-engaging abutments in multi-unit implant-supported prostheses and assessing the influence of abutment combinations and clinical variables on biological and technical outcomes. Methods: Forty patients with 90 implants and 40 fixed dental prostheses were involved. The study population was divided into three groups: 17 patients (8 males, 9 females) in the first group, 16 patients (7 males, 9 females) in the second, and 7 patients (2 males, 5 females) in the third. All patients received multi-unit implant restorations in a private practice between January 2021 and December 2023, and each prosthesis was in function for one year after delivery, with a mean follow-up of 2.17 ± 0.32 years. Restorations involved non-engaging abutments alone or in combination with engaging abutments or multi-unit abutments. Clinical parameters included implant and prosthesis survival rates, probing pocket depth, bleeding on probing, marginal bone loss, and the prevalence of biological and technical complications. For the comparison between the three groups, the analysis of variance was used to compare group means. When appropriate, Tukey’s post hoc test was applied for multiple comparisons. The significance level was set at p < 0.05. Results: The implant and prosthesis survival rates were both 100%. Mean marginal bone loss was 0.53 ± 0.33 mm, and mean probing pocket depth was 4.2 ± 0.75 mm. No cases of peri-implantitis were observed. Mucositis prevalence was 11.11% at the implant level. No significant differences were found among different abutment combinations for biological outcomes or complications. The technical complication rate was 5%. Conclusions: Non-engaging abutments demonstrated favorable short-term clinical outcomes with minimal biological and technical complications. They may represent a reliable option for the restoration of multi-unit prostheses, although long-term studies are needed.

Purpose: Screw‐retained implant crowns are a common solution to rehabilitate single or multiple edentulous sites. Angulated screw channel (ASC) abutments have been developed as a new system of connection to correct the angulation of the implant and avoid a possible undesired emergence of the access hole. The purpose of this systematic review was to examine available literature related to the effects of ASC abutments in rehabilitating single implant crowns.Methods: A protocol was registered in the PROSPERO database (ID = CRD42022295521). An electronic search of the Cochrane Central Register of Controlled Trials and Trial Protocols, MEDLINE, SCOPUS, and Web of Science was performed up to January 16, 2024. Additionally, a manual search was carried out. The meta‐analysis used a fixed or a random effects model, based on the heterogeneity between the studies, focusing on binary and continuous data. A risk of bias assessment was performed (NOS or MOGA et al.) The outcomes assessed were peri‐implant marginal bone level, probing pocket depth (PPD), the prevalence of technical and mechanical complications, implant and prosthesis survival rates, and esthetics. Statistical significance was set at p < 0.05.Results: The searches resulted in a total of 10 studies included in the meta‐analysis. The mean implant and prosthesis survival rates were respectively 99% (absolute quantity = 243) and 100% (absolute quantity = 239) with non‐statistically significant differences observed in single crowns supported by ASC abutments compared to cemented restorations, in terms of marginal bone loss (MBL) (p = 0.22), PPD (p = 0.08), risk of complications (p = 0.53), and esthetics (p = 0.47). Follow‐up intervals ranged from 14 days to more than 3 years.Conclusions: Data based on this systematic review suggest that the clinical and radiographic outcomes of single implants restored using ASC are promising if compared to the outcomes relating to screw‐retained single crowns.

Purpose: The purpose of this systematic review and meta‐analysis was to analyze the clinical and radiographic outcomes of patients rehabilitated using a single implant supporting a crown with a cantilever extension or two implants supporting two single crowns.Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta‐analyses (PRISMA) 2020 guidelines, a systematic review of relevant literature published from 2000 was conducted in the Cochrane Library, Scopus, and MEDLINE databases. Moreover, a manual search was performed. A meta‐analysis of the resulting data was carried out. Peri‐implant marginal bone level, probing pocket depth, prevalence of technical and mechanical complications, implant survival rate, and prosthesis survival rate were assessed.Results: The meta‐analysis showed a non‐statistically significant change in the peri‐implant marginal bone level and probing pocket depth in the cantilever group and revealed a non‐significant prevalence of technical complications, showing a 27% rate in the cantilever group. The analysis of the prosthesis survival rate in the cantilever group showed a mean survival rate of 99% while the comparison of the implant survival between the two groups revealed an odds ratio of 0.50.Conclusions: The use of a single implant supporting a crown with a cantilever extension does not result in lower implant survival rate if compared with two implants supporting two single crowns. Moreover, a high prosthesis survival rate was observed in the cantilever group even if the high prevalence of complications should be carefully considered by the clinician.

Thanks to the use of new digital technologies and innovations in materials, there has been an increasing interest in subperiosteal implants. These implants are considered to be helpful for the rehabilitation of severe jaw atrophies, as they overcome some disadvantages of endosseous implantology. In the present clinical retrospective study, 18 patients were treated and the clinical outcomes of the treatment were recorded after 12 months of follow-up.

Angulated-screw channels (ASCs) allow the clinician to employ screw-retained restorations in almost all cases, as the access hole can be moved away from the vestibular portion of the crown, where it would jeopardize the final esthetic result. The objective of this study was to compare screw-retained restorations employing ASCs with restorations cemented on angled abutments. In this study, 30 subjects, equally divided into two groups: group 1 (cemented restorations on angulated abutments) and group 2 (screw-retained restorations adopting ASCs), were treated and retrospectively compared after 2 years using the pink esthetic score (PES) and the white esthetic score (WES). All restorations were in use at the last follow-up, with a survival rate of 100%. Three mechanical complications were observed (2 chippings and 1 crown came loose), with a success rate of 93% in group 1 and 87% in group 2 (p > 0.05). No statistically significant differences were reported regarding the esthetic outcome; the marginal bone loss (MBL) showed better results for the screw-retained restorations, both at the distal aspect (group 1 = 0.98 mm ± 0.16; group 2 = 0.45 mm ± 0.06; p = 0.006) and at the mesial aspect (group 1 = 1.04 ± 0.27; group 2 = 0.45 ± 0.005; p < 0.001). From an esthetical perspective, screw-retained restorations with ASCs and cemented restorations on angulated abutments are both effective means of restoring implants; both have excellent esthetic outcomes, but screw-retained restorations have reduced bone loss when compared to cemented ones but are more prone to mechanical complications. Still, our results must be cautiously observed given the reduced dimension of our sample. Larger studies are needed to confirm our findings.

Purpose: The aim of this article is to analyze the incidence of undiagnosed obstructive sleep apnea (OSA) in patients affected by dento-skeletal malformation. We also evaluated the patterns most affected by the condition and calculated the post surgical changes. Methods: We conducted a retrospective cohort study on 71 patients including 35 men and 36 women. The patients studied were affected by dento-skeletal class II and III malformations and underwent bimaxillary orthognathic surgery in all cases. Patients were evaluated with polysomnography before surgery and at least 6 months after surgery to assess any improvement or worsening of the apnea hypopnea index (AHI) index. Regarding AHI evaluation criteria, an AHI > 5 was considered indicative of OSA, 4 < AHI < 5 was considered borderline and AHI < 4 was considered indicative of non-OSA. We also considered demographic variables like age at the time of intervention and gender, and anatomical variables like the pattern of the dento-skeletal deformity and the presence or absence of maxillary hypoplasia. Qualitative variables were described as absolute and relative frequencies, while quantitative variables were summarized as mean and standard deviation. To quantitatively express the relationship between two variables, the correlation coefficient was calculated. The covariance array was used to evaluate multiple correlations. Results: Our study shows that there is a significant percentage (33%) of patients who undergo orthognathic surgery with an AHI > 5 and also a percentage of patients (11%) who can be considered to be “borderline.” It emerges that the pattern most at risk is the one characterized by retruded maxilla and patients with dento-skeletal class II. Considering the post surgical period, the statistical analysis shows that after surgery, only 8% of malformed patients present an AHI > 5, compared to the 20.5% described in the Italian population. Conclusions: In patients who receive orthognathic surgery, the presence of obstructive sleep apnea is significantly higher than in the general population. When planning the surgical correction of a dento-skeletal malformation, the surgeon must aim not only for the esthetics results, but also for proper stomatognathic and respiratory function; this cannot be achieved without taking polysomnography information into account.

Purpose: The aim of this article is to analyze the incidence of undiagnosed obstructive sleep apnea OSA in patients affected by dento-skeletal malformation. We also evaluated the patterns most affected by the condition and calculated the post surgical changes. Methods: We conducted a retrospective cohort study on 71 patients including 35 men and 36 women. Patients were evaluated with Polysomnography before surgery and at least 6 months after surgery to assess any improvement or worsening of the apnea hypopnea index AHI index. Regarding AHI evaluation criteria an AHI > 5 was considered indicative of OSA, 4 5, com-pared to 20.5% described in the Italian population. Conclusion: In patients who receive orthognathic surgery the presence of Obstructive Sleep Apnea is significantly higher than in the general population. When planning the surgical correction of a dentoskeletal malformation, the surgeon must aim not only to the aesthetics results, but also to a proper stomatognathic and respiratory function, this cannot be done without taking poly-somnography information into account.

In cases of severe horizontal atrophy, implant placement requires bone reconstruction procedures. The aim of this randomized controlled trial is to compare the outcomes of bone augmentation with simultaneous implant placement using the shell technique to the outcomes of guided bone regeneration (GBR) in cases of severely horizontal bone atrophy. This study was designed as a monocentric, parallel-group, randomized controlled trial with a six-month follow-up. Among the primary outcomes of this study, peri-implant bone regeneration and peri-implant bone defect closure were selected. Forty-four patients were recruited and equally divided between two groups. In the GRB group, a horizontal regeneration of 2.31 ± 0.23 mm was observed opposed to a horizontal regeneration of 2.36 ± 0.17 mm in the shell group (p = 0.87). A volumetric increase was observed in both groups, with an increase of 0.30 ± 0.12 cm³ in the GBR group and an increase of 0.39 ± 0.09 cm³ in the shell group, highlighting a significant difference between the two groups (p = 0.02). In conclusion, bone augmentation with simultaneous implant placement using the shell technique or guided bone regeneration in horizontal bone atrophy are both predictable therapeutic options.