International Journal of Oral Implantology, 02/2023

This review focuses on intrasocket reactive tissue and its impact on extraction socket healing. It summarises the current knowledge about intrasocket reactive tissue from a histopathological and biological perspective and discusses the mechanisms by which residual intrasocket reactive tissue can have a positive or negative effect on healing. Additionally, it provides an overview of the various hand and rotary instruments that are currently used for intrasocket reactive tissue debridement. The review also discusses preserving intrasocket reactive tissue as a socket sealing material and the benefits this may offer. It presents clinical cases where either removal or preservation of intrasocket reactive tissue was adopted following extraction and prior to alveolar ridge preservation. Future studies are needed to investigate the suggested beneficial effects of intrasocket reactive tissue on socket healing outcomes. Keywords: alveolar ridge preservation, granulation tissue, granulomatous tissue, socket healing, tooth extraction, wound healing The authors report no conflicts of interest relating to this study.

Purpose: To describe a novel, noninvasive, intraoral optical scanning–based approach for characterising the buccolingual profile of peri-implant tissues using a 3D surface defect map. Materials and methods: Intraoral optical scans of 20 isolated dental implants with peri-implant soft tissue dehiscence in 20 subjects were captured. The digital models were then imported into image analysis software, where an examiner (LM) performed a 3D surface defect map analysis characterising the buccolingual profile of the peri-implant tissues in respect to the adjacent teeth. Ten linear divergence points that were 0.5 mm apart in a corono-apical direction were identified at the midfacial aspect of the implants. Based on these points, the implants were grouped into three different buccolingual profiles. Results: The method for creating the 3D surface defect map of isolated implant sites was outlined. Eight implants displayed pattern 1 (coronal profile of peri-implant tissues more lingual/palatal than their apical portion), six implants exhibited pattern 2 (opposite of pattern 1) and six sites showed pattern 3 (relatively uniform and “flat”). Conclusions: A novel method for assessing the buccolingual profile/position of peri-implant tissues using a single intraoral digital impression was proposed. The 3D surface defect map visualises the volumetric differences in the region of interest compared to the adjacent sites, allowing for objective quantification and reporting of profile/ridge deficiencies of isolated sites. Keywords: dental implant, digital data, optical scanning, pilot study, STL file The authors do not have any financial interests, either directly or indirectly, in the products or information mentioned in this paper.

Purpose: To investigate the accuracy of a novel sleeveless implant surgical guide by comparing it with a conventional closed-sleeve guide and a freehand approach. Materials and methods: Custom resin maxillary casts with corticocancellous compartments were used (n = 30). Seven implant sites were present per max-illary cast, corresponding to healed (right first molar and left first premolar, second premolar, and first molar) and extraction sites (right canine and central incisors). The casts were assigned into three groups: freehand (FH), conventional closed-sleeve guide (CG) and sleeveless guide (SG) groups. Each group comprised 10 casts and 70 implant sites (30 extraction sites and 40 healed sites). Digital planning was used to design 3D printed conventional closed-sleeve and sleeve-less surgical templates. The primary study outcome was implant deviation. Results: At extraction sites, the largest difference between groups occurred in angular deviation, where the SG group (3.80 ± 1.67 degrees) exhibited ~1.6 times smaller deviation relative to the FH group (6.02 ± 3.44 degrees; P = 0.004). The CG group (0.69 ± 0.40 mm) exhibited smaller coronal horizontal deviation compared to the SG group (1.08 ± 0.54 mm; P = 0.005). For healed sites, the largest difference occurred for angular deviation, where the SG group (2.31 ± 1.30 degrees) exhibited 1.9 times smaller deviation relative to the CG group (4.42 ± 1.51 degrees; P < 0.001), and 1.7 times smaller deviation relative to the FH group (3.84 ± 2.14 degrees). Significant differences were found for all parameters except depth and coronal horizontal deviation. For the guided groups, there were fewer significant differences between healed and immediate sites compared to the FH group. Conclusion: The novel sleeveless surgical guide showed similar accuracy to the conventional closed-sleeve guide.   Keywords: accuracy, computer-assisted, dental implants, guided surgery, immediate implant placement The authors report no conflicts of interest related to this study.

Purpose: To make a comparative estimation of the positional accuracy of dental implants inserted using selective laser melting and computerised stackable surgical guides produced through digital light processing for patients with maxillary terminal dentition. Materials and methods: Twenty-four dental implants were inserted in partially edentulous patients who were treated for tooth loss and required fixed prosthodontic rehabilitation. Virtually designed prosthetically driven fixation bases with stackable surgical osteotomy guides were used for bone reduction after tooth extraction and osteotomy preparation, respectively. The inserted implants were divided into two equal groups according to the type of surgical guide used, either cobalt-chromium guides fabricated through selective laser melting or resin guides produced by digital light processing. The final actual implant position was compared to the preoperative planned position and the coronal and apical deviations were calculated in millimetres, and angular deviation measurements in degrees. Results: A t test was used for comparison (P < 0.05). The mean coronal, apical and angular deviation for the implants positioned using a stackable guide made by digital light processing were greater than those for implants positioned using cobalt-chromium guides fabricated through selective laser melting. Highly significant differences were found between both groups for all the measurements. Conclusions: Within the limitations of this study, cobalt-chromium stackable surgical guides produced by selective laser melting are more accurate than resin guides produced through digital light processing. Keywords: 3D printing, implant, laser sintering, stackable guide, surgical guide The authors report no conflicts of interest related to this study.

This article presents the first reported case series of three cases of aspiration of a dental implant screwdriver, which was successfully removed by flexible bronchoscopy. The report highlights preventive measures that can be taken in the dental office and the clinical signs and symptoms of the presence of a dental implant screwdriver in the bronchial tree. The nine reports published to date on this phenomenon are reviewed and compared, and an action protocol for dental practitioners, anaesthetists and pulmonologists is proposed to address this emergency. Some early and late complications are also described. Keywords: bronchoscopy, clinical protocol, dental instrument, respiratory aspiration The authors report no conflicts of interest related to this study.