Luca Signorini

Background/Objectives: This retrospective study assessed the accuracy of implant positioning with dynamic computer-aided implant surgery (dCAIS) for Toronto Bridge fabrication, using a conometric prosthetic concept and a new intraoral splinting technique (CLIKSS). It compared discrepancies across various anatomical regions, bone qualities, and implant sites. Methods: This study involved 52 patients undergoing full-arch rehabilitation (17 in the mandible, 30 in the maxilla, and 5 in both), with 366 implants placed (125 in the mandible, 241 in the maxilla; 128 in post-extraction sites, and the remainder in healed sites). All implants were immediately loaded. Precision was assessed by measuring linear and three-dimensional (3D) angular deviations between planned and actual implant positions. Results: Measurement errors for apical linear and 3D deviations at the apex and entry point ranged from 0.24 ± 0.10 to 0.55 ± 0.57 mm, and angular deviations varied from 0.32 ± 0.65° to 0.35 ± 0.71°. Maxillary measurements were significantly higher at the entry, apical, and vertical levels, even when comparing anterior and posterior regions with the corresponding mandibular areas, while no differences were found in the angular deviation. Significant discrepancies were observed among different mandibular bone types. Maxillary post-extraction sites exhibited significantly greater deviations than mandibular sites in all parameters except angular deviation. No significant differences were found between healed and post-extraction sites within the same jaw. Conclusions: dCAIS improved implant placement accuracy, leading to predictable prosthetic outcomes, especially during parallel multi-implant insertions. This report introduced dCAIS for conometric/biconometric implant placement combined with the innovative CLIKSS technique as an effective intraoral split method for this prosthesis connection.

Background/Objectives: Guided bone regeneration (GBR) is a regenerative technique used to treat maxillary osseous defects to enable implant placement for prosthetic rehabilitation. It is generally performed with the use of barrier membranes and bone substitute materials of human or animal origin. Here, we report the clinical and histological outcomes of a horizontal GBR, treated using only synthetic biomaterials. Methods: A graft of nanocrystalline hydroxyapatite (NH) embedded in a silica gel matrix was used to fill a horizontal bone defect. The graft was covered with a titanium-reinforced dense polytetrafluoroethylene (TR-dPTFE) membrane, and primary closure was completed and maintained for 10 months. Then, the site was re-opened for membrane removal and implant insertion. During implant bed preparation, a bone biopsy was obtained for histological evaluation. A metal–ceramic crown was fitted, and the 5-year follow-up after prosthetic loading showed clinical and radiographically healthy tissues. Results: Histological examination revealed good integration of the biomaterial into the surrounding tissues, which were composed of lamellar bone trabeculae and connective tissue. New bone formation occurred not only around the NH granules but even inside the porous amorphous particles. Conclusions: The combination of NH and the TR-dPTFE membrane produced good clinical and histological results, which remained stable for 5 years.

Gingival recession, defined as the apical migration of the gingival margin relative to the cementoenamel junction, is a noteworthy complication associated with orthodontic treatment. Its prevalence ranges from 3% to 38% among orthodontically treated patients and is influenced by multiple factors, including treatment mechanics, individual periodontal phenotype, and oral hygiene. The buccal surfaces of maxillary and mandibular teeth are particularly susceptible to post-treatment recession. Contributing factors include the application of excessive or improperly distributed orthodontic forces, tooth movement into areas with thin periodontal tissue, and plaque accumulation around orthodontic appliances. Effective prevention and management of gingival recession require a multidisciplinary approach. Key preventive strategies include comprehensive pre-treatment periodontal assessment, applying light and controlled forces, and strict oral hygiene maintenance during treatment. Post-treatment monitoring is essential for early detection and timely intervention. In cases where significant gingival recession develops, mucogingival surgical techniques, such as coronally advanced flaps or connective tissue grafts, offer predictable outcomes for the reconstruction of gingival tissues and stabilizing periodontal health. Collaboration between orthodontists and periodontists is crucial to optimize functional and aesthetic outcomes and ensure long-term stability of the dento-periodontal complex. Tailored treatment planning and early clinical intervention represent the cornerstone of successful orthodontic therapy with minimal periodontal risk.

Objective: This study aims to present a fully digital protocol—Total Digital Concept (TDC®)—for immediate loading full-arch implant rehabilitation utilizing a prefabricated definitive prosthesis, thereby eliminating the need for provisional restorations and reducing treatment time.Materials and Methods: A case series involving patients with terminal or edentulous dentition was treated using the TDC® workflow. The protocol integrates advanced digital technologies, including intraoral scanning, facial analysis, virtual diagnostic wax-up, and CAD/CAM manufacturing. Based on STL data from digital wax-ups aligned with 2D facial photography, implant planning was prosthetically driven. Surgical guides and final prostheses were fabricated preoperatively. Implants were placed using a fully guided approach, and definitive screw-retained prostheses were delivered within the same surgical session.Results: The digital-to-clinical translation showed high accuracy, allowing immediate delivery of pre-fabricated definitive prostheses without modification. No intraoperative complications occurred, and postoperative follow-up at 1, 2, 6, and 12 months confirmed the stability of both implants and prostheses. Patient satisfaction was high due to minimal appointments and immediate functional and aesthetic outcomes.Conclusions: The TDC® workflow demonstrates that full-arch implant rehabilitations with immediate loading and delivery of definitive prostheses are clinically feasible through a digital approach. This technique offers enhanced efficiency, precision, and patient satisfaction. However, despite its promising outcomes, current scientific evidence on fully digital full-arch workflows remains limited. Further clinical trials must validate its long-term predictability and broaden its applicability in routine implant practice.

Introduction:The success of dental implants largely depends on the quality of osseointegration, a complex biological process regulated by several molecular markers. This study aims to evaluate the expression of three key osteogenic biomarkers—Runx2, osteopontin (OPN), and osteocalcin (OCN)—during bone regeneration in critical-size defects treated with biomaterials.Materials and Methods:Critical bone defects were surgically created in rabbit calvariae and filled with various bone substitute materials. Samples were collected at defined healing intervals. Histological, histomorphometric, and immunohistochemical analyses were performed to assess Runx2, OPN, and OCN expression patterns and their association with the newly formed bone tissue.Results:Runx2 was predominantly expressed in early healing phases, indicating active osteoblastic differentiation. OPN showed strong localization in the mineralization fronts, while OCN expression increased in later phases, correlating with bone matrix maturation. Differences in biomarker expression were observed depending on the type of graft material used.Discussion:The temporal and spatial expression patterns of Runx2, OPN, and OCN confirm their pivotal role in different stages of osteogenesis. These findings suggest that monitoring these biomarkers can provide valuable insights into bone substitutes' biological behavior and the osseointegration quality.Conclusion:The differential expression of osteogenic markers in response to bone substitutes offers a valuable tool for evaluating the regenerative potential of biomaterials in implant dentistry. Further research is recommended to validate these results in clinical settings.