in Journal of Periodontology (in press)
A classification for peri-implant diseases and conditions was presented. Focused questions on the characteristics of peri-implant health, peri-implant mucositis, periimplantitis, and soft- and hard-tissue deficiencies were addressed. Peri-implant health is characterized by the absence of erythema, bleeding on probing, swelling, and suppuration. It is not possible to define a range of probing depths compatible with health; of more importance are the clinical signs of inflammation. Peri-implant health can exist around implants with reduced bone support.The main clinical characteristic of peri-implant mucositis is bleeding on gentle probing. Erythema, swelling, and/or suppuration may also be present. An increase in probing depth is often observed in the presence of peri-implant mucositis due to swelling or decrease in probing resistance. There is strong evidence from animal and human experimental studies that plaque is the etiological factor for peri-implant mucositis. Peri-implantitis is a plaque-associated pathological condition occurring in tissues around dental implants, characterized by inflammation in the peri-implant mucosa and subsequent progressive loss of supporting bone. Peri-implantitis sites exhibit clinical signs of inflammation, bleeding on probing, and/or suppuration, increased probing depths and/or recession of the mucosal margin in addition to radiographic bone loss. The evidence is equivocal regarding the effect of keratinized mucosa on the longterm health of the peri-implant tissue. It appears, however, that keratinized mucosa may have advantages regarding patient comfort and ease of plaque removal. Case definitions in day-to-day clinical practice and in epidemiological or diseasesurveillance studies for peri-implant health, peri-implant mucositis, and periimplantitis were introduced. The proposed case definitions should be viewed within the context that there is no generic implant and that there are numerous implant designs with different surface characteristics, surgical and loading protocols. It is recommended that the clinician obtain baseline radiographic and probing measurements following the completion of the implant-supported prosthesis.
in Clinical Oral Investigations (2019)
Objective : To explore patient-related outcomes measures (PROMs) of piezocision-assisted orthodontic treatment compared to aconventional orthodontic treatment using customized appliance. Materials and methods : Twenty-four adult patients requiring orthodontic treatment for mild-to-moderate overcrowding in both jaws were randomly assigned to a test group, treated with a piezocision-assisted orthodontic treatment, or to a control group, where piezocision was not applied. The patient-related outcomes were recorded using a 0–10 visual analog scale (VAS). Daily analgesic consumption and pain level were also recorded following the placement of the orthodontic appliance in both groups and after the piezocision procedure in the test group. Moreover, levels of apprehension and satisfaction were also assessed in both groups. Results : In the piezocision group, over the 7-day period, paracetamol consumption was comparable after the placement of the orthodontic appliance and after the piezocision surgery. Pain levels after the orthodontic and the surgical procedure decreased with time (p < 0.0001) but remained globally higher after piezocision (p = 0.0056). Significantly, more patients of the piezocision group reported that they would undergo the treatment again (p = 0.033) and that they greatly appreciated the duration of treatment(p = 0.0008). However, the level of apprehension was significantly higher in the piezocision group compared to the test group(p =0.012). Conclusions : Although, the degree of apprehension before the surgery and higher pain level in the piezocision group, PROMs emphasized similar pain killer consumption in both group and revealed high acceptance and satisfaction with piezocision approach. Clinical relevance : The benefit of piezocision-assisted orthodontic treatment seems to be relevant from a patient perspective. Trial registration : NCT03406130
in Orthodontie Française (2019)
Introduction: The duration of orthodontic treatment in adults remains a barrier for some patients. Some surgical techniques have been developed in order to accelerate orthodontic tooth movement. The technique of corticotomies is effective in decreasing the orthodontic treatment time but remains invasive, leading to significant postoperative consequences. Materials and Methods: Minimally invasive techniques without muco-periosteal flap elevation have been developed: corticision, micro-osteoperforations, piezopuncture and piezocision. Results: The piezocision procedure seems to be the best compromise to accelerate orthodontic tooth movement while respecting a specific surgical and orthodontic protocol. The piezocision surgery allows the addition of biomaterials in cases of dehiscence and/or fenestration on the alveolar bone associated with moderate to severe overcrowding. Conclusion: According to current publications, minimally invasive corticotomy techniques can be viewed as a new therapeutic tool in the acceleration of orthodontic tooth movement.
in European Journal of Orthodontics (2019)
OBJECTIVE: The aim of this study was to investigate the effects of piezocision (surgical protocol with sutures) in orthodontic treatment using CAD/CAM (computer-aided design and computer-aided manufacturing) customized orthodontic appliances. DESIGN: The study is designed as a parallel group, randomized controlled trial (RCT). SETTING: University Hospital. ETHICAL APPROVAL: The study was approved by the ethic committee of the University Hospital Liege, Belgium. SUBJECTS AND METHODS: This RCT was conducted on 24 adult patients requiring orthodontic treatment to release mild overcrowding. Patients were all treated with a customized appliance and randomly assigned by means of sealed envelopes containing group codes to either a test group treated with piezocision or a control group without any further treatment. A blinded orthodontist validated appliance removal or further adjustments based on the model study. OUTCOME MEASURES: The overall treatment time and the time between archwire changes were recorded. Moreover, clinical and radiological features such as tooth resorption, gingival recessions, and the presence of scars were evaluated. RESULTS: A total of 24 patients (12 control and 12 test) completed the study. The overall treatment time was significantly shorter in the test group than the control group. Likewise, the time difference between all arch changes was significantly lower when piezocision was performed, except for the first arch at the mandible and the last arches at both maxillae. During the fine-tuning phase, no significant difference was found between the two groups. All periodontal and radiographic parameters remained stable from the start to the end of treatment in both the groups. However, minor scars were found in 66 per cent cases. LIMITATIONS: This trial was a single-centre trial. CONCLUSIONS: Piezocision seems to be an effective method to accelerate orthodontic treatment in cases of mild overcrowding. However, the effect was only observed during the alignment phase and a greater efficiency was found in the maxilla. The technique may be contraindicated in patients with a high smile line since the risk of slight scarring exists. REGISTRATION: ClinicalTrails.gov (Identifier: NCT03406130).
in Archives of Oral Biology (2019), 102
Objective: Leukocyte- and platelet-rich fibrin (L-PRF) represents a natural, low-cost product which may promote tissue healing by mechanisms not fully elucidated. Diabetes mellitus (DM) disrupts bone healing by inducing inflammation and oxidative stress (OS), mechanisms regulated by microRNAs (miRs). The aim of the present study was to investigate the microRNA-21 (miR-21) involvement in diabetic bone regeneration using L-PRF alone or in combination with a standard grafting material. Design: After the induction of diabetes (alloxan 100 mg/kg), four cranial osteotomies were made in diabetic (n=12) and non-diabetic (n=12) rabbits: one was left empty and the remaining three were grafted with LPRF, bovine hydroxyapatite (Bio-Oss®) and L-PRF+Bio-Oss®. Two and eight weeks postoperatively, the samples were harvested for miR-21 expression (Real-time RT-PCR) and enzyme-linked immunosorbent assay analyses. Results: Diabetic rabbits showed decreased miR-21 and matrix metalloproteinase-9 (MMP-9) protein expression while increased malondialdehyde (MDA) levels two weeks postoperatively; however, there were no significant differences in miR-21 and MMP-9 levels between diabetic and non-diabetic rabbits in samples taken eight weeks postoperatively. Application of L-PRF and L-PRF+Bio-Oss® improved miR-21 and MMP-9 and decreased MDA levels while Bio-Oss® alone enhanced superoxide dismutase (SOD) activity levels in diabetic rabbits. Conclusion: L-PRF alone or in combination with bovine hydroxyapatite as bone graft could be beneficial in DM since it seems to improve inflammation-modulatory miR-21 expression and decreases oxidative stress.
in Journal of Maxillofacial Surgery (2018), 47(2), 349-356
in International Orthodontics (2018)
in Angiology (2018)
in RENERS, Michèle (Ed.) Periodontology (2018)
in Calcified Tissue International (2017)
Diabetes mellitus (DM) has been associated with increased bone fracture rates, impaired bone regeneration, delayed bone healing, and depressed osteogenesis. However, the plausible pathogenic mechanisms remain incompletely understood. The aim of the present systematic review was to investigate whether oxidative stress (OS) plays a role in altered characteristics of diabetic bone under in vivo conditions. An electronic search of the MEDLINE (via PubMed) and Embase databases was performed. In vivo animal studies involving DM and providing information regarding assessment of OS markers combined with analyses of bone histology/histomorphometry parameters were selected. A descriptive analysis of selected articles was performed. Ten studies were included in the present review. Both bone formation and bone resorption parameters were significantly decreased in the diabetic groups of animals compared to the healthy groups. This finding was consistent regardless of different animal/bone models employed or different evaluation periods. A statistically significant increase in systemic and/or local OS status was also emphasised in the diabetic groups in comparison to the healthy ones. Markers of OS were associated with histological and/or histomorphometric parameters, including decreased trabecular bone and osteoid volumes, suppressed bone formation, defective bone mineralisation, and reduced osteoclastic activity, in diabetic animals. Additionally, insulin and antioxidative treatment proved to be efficient in reversing the deleterious effects of high glucose and associated OS. The present findings support the hypotheses that OS in the diabetic condition contributes at least partially to defective bone features, and that antioxidative supplementation can be a valuable adjunctive strategy in treating diabetic bone disease, accelerating bone healing, and improving osteointegration.
in Journal of Oral Implantology (2017)
Advances in Computer-Aided Design and Manufacturing (CAD-CAM) composite materials and chair-side CAD-CAM systems offer a new landscape for the implant dentistry. Digital workflows are increasingly used, especially for single-unit restorations, and they allow straightforward and cost-effective protocols that improve patient satisfaction. The efficacy of immediate loading on single implants has been demonstrated (1, 2). Currently, to 12 promote osseointegration, the use of resin-based provisional crowns out of occlusion is recommended for immediate loading. Such protocols require several appointments and a significant contribution of the dentist and the lab technician, which affects overall treatment cost. On the other hand, CAD-CAM composites, especially Polymer-Infiltrated Ceramic Network (PICN), are now competing with ceramics for definitive single-unit restorations, notably due to their better machinability (faster and in lower-thickness milling, with les edge chipping) (3) (4), the absence of post-milling firing and the ease of in-mouth adjustments. In particular, their higher resilience and lower elasticity modulus could indicate them for immediate loading of implants. Intraoral scanning (IOS) of single-unit implants right after surgery and the chair-side manufacturing of a PICN crown would allow delivery of a resilient final tooth on the same day. The aim of these two case reports is to describe, as a technical note, an innovative approach for a straightforward and cost-effective replacement of a single missing tooth in the posterior region, as a proof of concept.
in International Journal of Periodontics and Restorative Dentistry (2016), 36(6),
The primary objective of this pilot study was to evaluate a new socket preservation technique involving the intentional expansion of the extraction socket buccal plate using a flapless internal corticotomy and biomaterials. A total of 11 patients requiring tooth extraction were enrolled in this study. The aim of this technique was to maintain or improve the hard and soft tissue contour of the ridge after tooth extraction. All surgical sites healed uneventfully. Significant alveolar bone dimension changes were observed in the coronal region of the ridge (-1.4 ± 0.9 mm); however, it was only slightly lower at the medium (-0.35 ± 0.7 mm) and apical levels (-0.3 ± 0.8 mm) (P > .05). The ridge dimensional changes were significantly higher in the buccal aspect than in the palatal aspect in all patients. Vertical bone resorption was not significant. Concerning the soft tissue contour, the horizontal distance between the preoperative and postoperative buccal profiles ranged from 0.94 to -2.88 mm. The proposed ridge preservation technique may help maintain the volume of the healed ridge but cannot completely prevent contour changes after tooth extraction.
in Clinical Oral Implants Research (2016)
Aims: The primary objective of this study was to compare the in vivo performance, namely in terms of quantity of newly formed bone and bone-to-material contact (osteoconductivity), of three hydroxyapatite-based biomaterials (HA) of different origins (natural or synthetic) or manufacturing process in a sinus lift model in rabbits. The secondary objective was to correlate the findings with the physical and topographical characteristics of the biomaterials. Materials and Methods: Two bovine HA manufactured with different processes (bovine hydroxyapatites [BHA] and cuttlebone hydroxyapatite [CBHA]) and a synthetic hydroxyapatite (SHA) sintered at high temperature were characterised with scanning electronic microscopy (SEM) and the measurement of specific surface area (BET). The materials were implanted in a sinus lift model in rabbits; histological and histomorphometric evaluation using non-decalcified sections was performed at 1, 5 and 12 weeks after implantation. Results: The studied biomaterials displayed a different surface topography. The two natural HA displayed significantly higher bone quantities (P = 0.0017; BHA vs. SHA, P = 0.0018 and CBHA vs. SHA, P = 0.033) at 5 and 12 weeks compared to the synthetic one (SHA). Moreover, the osteoconductivity (bone-to-material contact) was significantly higher in the BHA group compared to the two other groups (P = 0.014; BHA vs. SHA, P = 0.023 and BHA vs. CBHA, P = 0.033). Conclusion: HA-based biomaterials from diverse origins and manufacturing processes displayed different topographical characteristics. This may have influenced different regenerated bone architecture observed; more bone was found with natural HA compared to the synthetic one, and significantly higher bone-to-material contacts were found with BHA.
in Clinical Oral Implants Research (2016)
Abstract Aims: The objective of this study was to assess prospectively the outcomes of extra-narrow diameter implants (XNDI) placed in teenage patients as a temporary restorative option. Material and Methods: Twenty consecutive young patients presenting one or several missing teeth received XNDI that were immediately restored with composite, Polymethylmethacrylate (Acrylic) or ceramic crown. Clinical and radiographical outcomes were assessed for a minimum follow-up period of 1 year. Additionally, each patient completed retrospectively a satisfaction questionnaire using Visual Analog Scale (VAS). Results: A total of 30 implants were placed and followed for a period of 1–7.4 years (mean: 3.59 years). One implant failed after 3 weeks and was replaced successfully. No further biological complications occurred during the follow-up period, leading to an implant survival rate of 96.6%. The patient satisfaction evaluations displayed high levels of comfort and function. Conclusion: Immediately restored XNDI to replace missing teeth on teenager patients seems to be an effective temporary restorative option to replace missing teeth in young patients. Composite or ceramic crowns should be preferred. Clinical trials with long-term follow-ups and the assessment of passive egression are needed.
in Journal of Dental Research (2016)
AIMS : This randomized controlled trial aimed to evaluate the benefits and clinical outcomes of piezocision, which is a minimally invasive approach to corticotomy that is used in orthodontic treatments. MATERIALS AND METHODS : Twenty-four adult patients presenting with mild overcrowdings were randomly allocated to either a control group that was treated with conventional orthodontics or a test group that received piezo-assisted orthodontics. The piezocisions were performed 1 wk week after the placement of the orthodontic appliances. Neither grafting material nor sutures were used. All patients were followed every 2 wk, and archwires were changed only when they were no longer active. The periods required for the completion of the overall orthodontic treatments were calculated, and the periodontal parameters were evaluated at baseline and at the end of the orthodontic treatment. Patient-centered outcomes were assessed with a visual analog scale; analgesic use following the procedures was also recorded. RESULTS : The patient characteristics were similar between the 2 groups. The overall treatment time was significantly reduced by 43% in the piezocision group as compared with the control group. In both groups, periodontal parameters (i.e., recession depth, pocket depth, plaque index, and papilla bleeding index) remained unchanged between the baseline and treatment completion time points. No increase in root resorption was observed in either group. Scars were observed in 50% of the patients in the piezocision group. Analgesic consumption was similar following orthodontic appliance placement and piezocision surgery. Patient satisfaction was significantly better in the piezocision group than in the control group. CONCLUSION : In these conditions, the piezocision technique seemed to be effective in accelerating orthodontic tooth movement. No gingival recessions were observed. The risk of residual scars might limit the indications for piezocision in patients with a high smile line (ClinicalTrials.gov NCT02590835)
in Journal of Clinical Periodontology (2015)
AIMS: The primary objective was to assess the occurrence rate of Medication-Related OsteoNecrosis of the Jaw (MRONJ) after dental extraction in patients treated with Anti-Resorptive Drugs (ARD) for OsteoPorosis (OP) or for oncological reasons. The secondary objective was to compare the extraction techniques regarding the occurrence of MRONJ. MATERIALS AND METHODS: A systematic search in PubMed/MEDLINE, EMBASE and LILACS databases was performed. Prospective studies considering human patients treated with ARD and providing information regarding the occurrence of MRONJ after dental extraction were selected. Meta-analysis for incidence of MRONJ at the patient level was performed. The effect of administration route and surgical technique on MRONJ was evaluated. RESULTS: The risk of MRONJ after dental extraction was significantly higher in patients treated with ARD for oncological reasons (3.2%) than in those treated with per os ARD for OP (0.15%) (p<0.0001). Dental extraction performed with adjusted extraction protocols decreased significantly MRONJ development. Potential risk indicators such as concomitant medications and pre-existing osteomyelitis were identified. CONCLUSION: The risk of MRONJ after dental extraction in patients treated with ARD exists, especially in patients treated for oncologic reasons. This risk tends to decrease with adjusted extraction protocols. This article is protected by copyright. All rights reserved.
in Journal of Clinical Periodontology (2015), 42(S16), 152157
Abstract AIMS: Over the past decades, the placement of dental implants has become a routine procedure in the oral rehabilitation of fully and partially edentulous patients. However, the number of patients/implants affected by peri-implant diseases is increasing. As there are--in contrast to periodontitis--at present no established and predictable concepts for the treatment of peri-implantitis, primary prevention is of key importance. The management of peri-implant mucositis is considered as a preventive measure for the onset of peri-implantitis. Therefore, the remit of this working group was to assess the prevalence of peri-implant diseases, as well as risks for peri-implant mucositis and to evaluate measures for the management of peri-implant mucositis. METHODS: Discussions were informed by four systematic reviews on the current epidemiology of peri-implant diseases, on potential risks contributing to the development of peri-implant mucositis, and on the effect of patient and of professionally administered measures to manage peri-implant mucositis. This consensus report is based on the outcomes of these systematic reviews and on the expert opinion of the participants. RESULTS: Key findings included: (i) meta-analysis estimated a weighted mean prevalence for peri-implant mucositis of 43% (CI: 32-54%) and for peri-implantitis of 22% (CI: 14-30%); (ii) bleeding on probing is considered as key clinical measure to distinguish between peri-implant health and disease; (iii) lack of regular supportive therapy in patients with peri-implant mucositis was associated with increased risk for onset of peri-implantitis; (iv) whereas plaque accumulation has been established as aetiological factor, smoking was identified as modifiable patient-related and excess cement as local risk indicator for the development of peri-implant mucositis; (v) patient-administered mechanical plaque control (with manual or powered toothbrushes) has been shown to be an effective preventive measure; (vi) professional intervention comprising oral hygiene instructions and mechanical debridement revealed a reduction in clinical signs of inflammation; (vii) adjunctive measures (antiseptics, local and systemic antibiotics, air-abrasive devices) were not found to improve the efficacy of professionally administered plaque removal in reducing clinical signs of inflammation. CONCLUSIONS: Consensus was reached on recommendations for patients with dental implants and oral health care professionals with regard to the efficacy of measures to manage peri-implant mucositis. It was particularly emphasized that implant placement and prosthetic reconstructions need to allow proper personal cleaning, diagnosis by probing and professional plaque removal.
in Réalites Cliniques: Revue Européenne d'Odontologie (2015), 26(n°1),
Nous sommes tous bien conscients de la problématique liée au remodelage osseux après extraction dentaire, en particulier dans la zone esthétique. Les conséquences cliniques sont telles que le recours à des techniques de régénération tissulaire est souvent nécéssaire pour la pose de l'implant et pour assurer des résultats esthétiques. Cet article vise à démontrer l'efficacité d'un protocole d'optimisation tissulaire basé sur la préservation du capital osseux et sur l'optimisation des tissus gingivaux lors d'une extraction dentaire dans la zone esthétique. L'objectif de cet article est de suggérer un processus décisionnel en matière de technique chirurgicale, reposant d'une part sur l'examen clinique initial et, d'autre part, sur une excellente compréhension du concept biologique.
in Journal of Oral Implantology (2015)
Narrow diameter implants (NDIs) are increasingly produced and used in implant dentistry especially since the introduction of new and more resistant materials. The objective of the present study was to evaluate the clinical performance of NDIs (3.3 mm) placed in thin alveolar crests. Methods: Twenty consecutive patients needing implant-supported fixed partial dentures and presenting an alveolar thickness ≤ 6 mm were treated with one or several NDIs. The surgical protocol was chosen according to the clinical situation: °1 flapless; °2 mini-cervical flap; 3° wide flap; 4° wide flap + guided bone regeneration (GBR). Implants were immediately loaded if the primary stability was higher than 20 Ncm. Implant survival and success, prosthodontic success rates and patient-centered outcomes were evaluated after a follow-up period of 1 year. Results: A total of 39 implants were placed in 20 patients, 12 and 27 implants in the anterior regions and in the posterior mandible, respectively. All implants but one reached an insertion torque higher than 20 Ncm and were loaded within 48 hours. The implant survival and success rates both reached 94.7 %. The need for GBR was avoided in 60 % of the implant sites. The mean peri-implant bone remodeling after a follow-up period of 1 year was -0.35 mm at the implant level. Peri-implant bone remodeling was higher in the posterior region, when the alveolar crest was thinner than 4 mm and GBR was required in addition.Conclusion: The use of NDIs to restore partial edentation in sites with limited horizontal bone thickness seems to be an effective treatment option that prevented GBR in the majority of the present cases. Immediate provisionalization of NDIs does not seem to impair the results.
in Journal of Clinical Periodontology (2015), 42
Osteoporosis affects millions of elderly patients, and anti-resorptive drugs (ARD) such as bisphosphonates (BP) represent the first-line therapy. Despite the benefits related to the use of these medications, osteonecrosis of the jaw is a significant complication in a subset of patients receiving these drugs. CASE PRESENTATION: This report documents a case of dramatic bisphosphonate-related osteonecrosis associated with periodontitis and dental implant removal in an osteoporotic patient treated with per os bisphosphonates for an uninterrupted period of 15 years. CONCLUSION: The aim of this report was to discuss the administration period of BP in the treatment of osteoporosis, the decision-making and clinical management of severe MRONJ and the indications for dental implant placement in these specific patients.
in European Journal of Oral Implantology (2015), 8(3), 233-244
PURPOSE: To evaluate the effectiveness of a bone substitute covered with a resorbable membrane versus open flap debridement for the treatment of periodontal infrabony defects. MATERIALS AND METHODS: Ninety-seven patients with one infrabony defect, which was 3 mm or deeper and at least 2 mm wide were randomly allocated either to grafting with a bone substitute covered with a resorbable barrier (BG group) or open flap debridement (OFD group) according to a parallel group design in five European centres. Blinded outcome measures assessed tooth loss, complications, patient's satisfaction with treatment and aesthetics, changes in probing attachment levels (PAL), probing pocket depths (PPD), gingival recessions (REC), radiographic bone levels (RAD) on standardised periapical radiographs, plaque index (PI) and marginal bleeding index (MBI). RESULTS: 49 patients were randomly allocated to the BG group and 48 to the OFD group. At baseline there were more mobile teeth in the BG group (29 versus 15). One year after treatment two patients dropped out from the BG group and no teeth were lost. Three complications (minor postoperative wound dehiscence) occurred in the BG group versus none in the OFD group, where the difference was not statistically significant. The BG group obtained significantly greater statistical PAL gain (mean difference = -0.8 mm, 95%CI [-1.51; -0.03], P = 0.0428), PPD reduction (mean difference = -1.1 mm, 95%CI [-1.84; -0.19], P = 0.0165) and RAD gain (mean difference = -1.2 mm, 95%CI [-2.0; -0.4], P = 0.0058) compared to the OFD group. No statistically significant differences between the groups were observed for gingival recession, or the patient's satisfaction with the treatment and aesthetics. There were some statistically significant differences between the centres for PAL and PPD with the Italian centres reporting better outcomes. CONCLUSIONS: The use of a bone substitute covered with a resorbable membrane yielded significantly better statistical clinical outcomes than open flap debridement in the treatment of periodontal infrabony defects deeper than 3 mm, with regard to PAL gain, PPD reduction and RAD gain.
in Journal of Clinical Periodontology (2013)
AIM: The objective of this study was to compare two different periodontal plastic surgery procedures to treat Miller's class I recession: a coronally advanced flap (control group) versus the pouch technique (test group), both of which were associated with connective tissue graft. METHODS: Forty consecutive patients were included, with 20 patients being allocated for each group. The level of recession coverage, the keratinized tissue (KT) quantity, gingival aesthetics (PES) and post-operative outcomes were assessed for a follow-up period of 6 months. RESULTS: After 6 months, both techniques allowed for the excellent mean root coverage of 96.3 ± 12.1% in the control group and of 91.3 ± 17.6% in the test group. Complete root coverage was achieved in 89.5% (17/19) and 79% (15/19) of the recession cases in the control and the test groups respectively. A significant increase in KT height (p = 0.0011) was observed in the test group. A significant improvement in the pink aesthetic score was found in the two groups, but gingival texture displayed significantly better results in the test group (p < 0.0001). No significant difference between the two groups was found in terms of the morbidity outcomes. Pain killer consumption was similar in the two groups and significantly decreased over time. CONCLUSIONS: Both surgical techniques are relevant in treating Miller's class I recession. The pouch technique seems to increase the height of KT better and provides good gingival-related aesthetic outcomes.
in Alpha Omega France (2013), 160
in Clinical Implant Dentistry and Related Research (2013)
BACKGROUND: The positive effect of leukocyte- and platelet-rich fibrin (L-PRF) on osteogenesis has been widely described in vitro. However, clinical and preclinical studies are very little and controversial in demonstrating a significant beneficial effect of L-PRF in bone regeneration. PURPOSE: The goal of the present study was to compare the potential effect of L-PRF in a standardized model. MATERIALS AND METHODS: A total of 72 hemispheres were implanted on the calvaria of 18 rabbits and filled with three different space fillers: L-PRF, bovine hydroxyapatite (BHA), BHA + L-PRF, and an empty hemisphere was used as control. Six rabbits were sacrificed at three distinct time points: 1 week, 5 weeks, and 12 weeks. Histological and histomorphometrical analyses were carried out. RESULTS: At the early phase of bone regeneration (1 week), from a descriptive analysis, a higher proportion of connective tissue colonized the regeneration chamber in the two groups containing BHA particles. Nevertheless, no statistical differences were found within the four groups in terms of bone quantity and quality at each timepoint (p = .3623). CONCLUSIONS: According to the present study, L-PRF does not seem to provide any additional effect on the kinetics, quality, and quantity of bone in the present model of guided bone regeneration.
in Missika, Patrick (Ed.) 25 cas d'école en implantologie (2013)
in Clinical Implant Dentistry and Related Research (2013), 15(3),
Aim: The first objective of this study was to qualitatively and quantitatively assess the bone formation process, particularly the long-term behavior and three-dimensional volume stability of subsinusal bone regeneration, using titanium (Ti) or bovine hydroxyapatite (BHA) granules, in a rabbit model. The second objective was to evaluate the effect of the hydration of the BHA particles with a therapeutic concentration of doxycycline solution on the osteogenesis and biomaterial resorption. Materials and Methods: Rabbits underwent a double sinus lift procedure using one of three materials: grade 1 porous Ti particles, BHA, or BHA hydrated with doxycycline solution (0.1 mg/ml) (BHATTC). Animals were sacrificed after 1 week, 5 weeks, or 6 months. Samples were analyzed using µCT and nondecalcified histology. Results: The materials used in each of the three groups allowed an optimal bone formation; bone quantities and densities were not statistically different between the three groups. At 6 months, more stable three-dimensional volume stability was found with Ti and BHATTC (p = .0033). At 5 weeks and 6 months, bone to material contact corroborating osteoconduction was significantly higher with BHA and BHATTC than with Ti (p < .0001). Conclusions and Clinical Implications: Even though the studied biomaterials displayed different architectures, they are relevant candidates for sinus lift bone augmentation prior to dental implants because they allow adequate three-dimensional stability and osteogenesis. However, to recommend the clinical use of Ti, both an observation on the drilling effects of Ti particles and clinical trials are needed.
in International Journal of Oral and Maxillofacial Implants (2013), 28(2), 393-402
Aim: Sub-sinusal bone regeneration procedures are reliable procedures that are known to be efficient with the use of biomaterials alone. Nevertheless, many types of biomaterials are available, and their efficacy in terms of bone formation and resorption rate have rarely been compared. This study aimed to compare the bone formation, resorption rate, osteoconductivity and 3D volume changes of three biomaterials often used for alveolar ridge augmentation. Materials and Methods: Rabbits underwent a double sinus lift procedure using three different types of space fillers: bovine hydroxyapatite (BHA), beta calcium phosphate (ß-TCP) and biphasic calcium phosphate (BCP). Animals were sacrificed at 1 week, 5 weeks and 6 months. Samples were subjected to X-ray microtomography and histology. Qualitative analysis was performed on non-decalcified sections, and quantitative histomorphometric analysis was conducted using SEM. Volume variations of bone augmentations were calculated at different time points. Results: All three particulated biomaterials proved to be effective in promoting osteogenesis. At 6 months, biomaterial resorption rates were significantly different across the 3 groups (p<0.0001). The highest resorption rate was found with β-TCP, in which only 6.7% of the baseline particle surface remained. At 6 months, bone was in close contact with the BHA particles, constituting a composite network; in contrast, BCP particles were often surrounded by soft tissues. In each group, no significant difference in volume variations were found at the different time point. Conclusions and clinical implications: Despite the limitations of the study, the three particulated space-filling biomaterials proved to be efficient to promote osteogenesis. High resorption rates and complete replacement of the biomaterials by bone seemed to withstand intrasinusal pressure. Further investigations in humans should consider longer follow-up periods.
in Clinical Oral Implants Research (2013)
Introduction: The aesthetic results of implant restoration in the anterior maxilla are particularly related to the soft tissue profile. Although socket preservation techniques appear to reduce bone remodelling after tooth extraction, there is still few investigations assessing the external soft tissue profile after such procedures. The goal of the present study was to describe an accurate technique to evaluate soft tissue contour changes after performing socket preservation procedures. The secondary objective was to apply the newly develop measuring method to a specific socket preservation using a “saddled” connective tissue graft combined with the insertion of slowly resorbable biomaterials into the socket. Materials and Methods: A total of 14 patients needing tooth replacement in the aesthetic region were included to receive a socket preservation procedure using a connective tissue graft. Impressions were taken before the tooth extraction (baseline) and at 2, 4, and 12 weeks after the procedure. The corresponding plaster casts were scanned, and the evolution of the soft tissue profile in relation to the baseline situation was assessed using imaging software. Results: The measuring technique allowed assessing the soft tissue profiles accurately at different level of the alveolar process. The insertion of a saddled connective tissue appeared to compensate significantly for the horizontal and vertical bone remodelling after a socket preservation procedure in most regions of the alveolar crest. After 12 weeks, the only significant change was located in the more cervical and central region of the alveolar process and reached a mean of 0.76 mm. Conclusion: Within the limitations of this study, we found that a saddled connective tissue graft combined with a socket preservation procedure could almost completely counteract the bone remodelling in terms of the external soft tissue profile. The minor changes found in the cervical region might disappear with the emergence profile of the prosthodontic components. The described technique might therefore enhance the aesthetic outcomes when a tooth has to be replaced in the aesthetic zone. The described protocol can be used to further compare the effectiveness of different extraction socket preservation protocols in randomised controlled trials.
in Clinical Oral Implants Research (2013), 24(5),
Aim: The inclusion of biomaterial particles used for alveolar bone regeneration in a carrier or in binding agents such as collagen gel or fibers is of interest as a means to help with surgical handling. However, the possible influence of collagen on bone tissue response to biomaterials is poorly studied. The objective of the present study was to investigate, in a sub-sinus bone augmentation model in rabbits, the effect of collagen at different stages of the osteogenesis process. Histologic, histomorphometric and volumetric analyses were performed. Materials and methods: Rabbits underwent a double sinus lift procedure using bovine hydroxyapatite (BHA), collagenated bovine hydroxyapatite (BHAColl), and prehydrated and collagenated porcine hydroxyapatite (PHAColl). Animals were sacrificed at 1 week, 5 weeks or 6 months. Samples were subjected to X-ray micro-tomography and histology. Qualitative analysis was performed on the non-decalcified sections and quantitative histomorphometric analyses were conducted using scanning electron microscopy (SEM). Volume variations of bone augmentations were calculated at different time points. Results: The three biomaterials allowed an optimal bone formation and were able to equally withstand sinusal reexpansion. A comparable percentage of new bone, as well as 3D volume stability, was found between the groups at each time point. However, the PHAColl resorption rate was significantly higher than the rates in other groups (P = 0.0003), with only 3.6% of the particles remaining at 6 months. At 1 week, both collagenated groups displayed the presence of inflammatory cells although BHA did not show any sign of inflammation. At 5 weeks and 6 months, the inflammatory process had disappeared completely in the BHAColl groups, whereas some inflammatory-like cells could still be observed around the remaining particles of PHAColl. Conclusions and clinical implications: Within the limitations of this study in rabbits, the findings showed the presence of inflammatory-like cells at the early stage of bone regeneration when collagenated xenogenic biomaterials were used compared to xenogenic granules alone. Nevertheless, similar bone formation occurred and comparable 3D volumes were found at 6 months in the different groups.
in Journal of Clinical Periodontology (2012), 9
AIMS: Multiple surgical protocols using biomaterials have been proposed to limit the typical post-extraction bone resorption. However, because of the heterogeneity of the studies, particularly the differences in assessment methods, it is difficult to determine the superiority of one technique over another. The objective of this study was to describe a new radiographic method to draw a map of alveolar bone remodelling after alveolar ridge preservation procedures to compare different surgical techniques more accurately. The newly developed measuring method was applied to a case series describing a specific preservation technique. MATERIALS AND METHODS: Fourteen extraction sites (in 14 patients) located in the upper anterior maxilla were treated with bovine hydroxyapatite (0.25- to 1-mm particles) and a saddled connective tissue graft. A radiographic three-dimensional assessment of the hard tissues was performed at baseline and 3 months after the procedure. Standardized horizontal measurements were taken at three corono-apical levels (-2, -5 and -9 mm) and at three mesio-distal levels (mesial, centre and distal) in the buccal and palatal aspects. Vertical measurements were also recorded in nine regions superior to the alveolar crest. The measurements were performed by two independent observers and intra- and inter-observer effects were evaluated. RESULTS: No inter- and intra-observer effects were found when analysing the measurements from these two observers. The horizontal dimension of the crest decreased by 1.6 mm (20%) in the cervical regions (-2 mm level), decreased moderately, by 1 mm (12%), at the -5 mm level and decreased very little, 0.5 mm (6%), at the apical (-8 mm) level. The losses were always significantly higher in the buccal than in the palatal aspect. Buccally, the maximal bone remodelling at the cervical level remained below 1 mm. Vertical bone resorption was homogeneous and<1 mm in the nine measured regions. DISCUSSION: The radiographic measuring methodology proved to be reproducible. It can be applied in other clinical settings. It successfully assessed the alveolar ridge preservation technique (BHA+saddle connective tissue graft).
Doctoral thesis (2011)
Dental implants are nowadays a reliable solution to replace missing teeth and have been widely documented. However, they require a minimal bone quantity (in height and thickness). But alveolar bone defects are very frequent, for instance due to periodontitis, traumatism or acute dental infection. Moreover, a simple tooth extraction leads to significant bone resorption. Therefore, alveolar bone regeneration is often necessary in order to place implants and to restore the patient's dentition with implant-supported prosthesis. Even though alveolar bone reconstructions have been considered as traumatic, especially due to the need of a second surgical site for bone harvesting, techniques have evolved with the introduction of biomaterials. However, it is difficult to compare the influences of such biomaterials on osteogenesis and to elaborate on the advantages of one product over another. The overall objective of this thesis is to contribute to the understanding of the biological concept of alveolar bone regeneration, in particular sinus lift and socket preservation procedures. The influence of biomaterials on bone regeneration has been emphasized through preclinical and clinical studies. The number of commercially available biomaterials for bone regeneration is growing every day and some materials are not supported by strong scientific data in the literature. The first part of this thesis (Chapter 1) is dedicated to the characterization of several biomaterials often used in dentistry. The impact of their various characteristics on osteogenesis has been reviewed, from chemical aspect to micro- and macromorphology. Furthermore, a data sheet integrating the physico-chemical and morphological properties of each studied biomaterial has been developed as a tool for clinicians. Sinus floor elevation has often been considered as a bone graft. In 1996, a consensus conference on “sinus lift” took place and the procedure was qualified as “sinus bone-graft”. But new scientific evidence has shown that this qualification is not justified. Chapter 2 aims at understanding the physiology and the biological model of sub-sinusal bone augmentation by using either a simple blood clot, autogenous bone chips or biomaterials (BHA) as space fillers under the lifted sinusal membrane. If bone formation did occur with the 3 types of space fillers, the augmented volumes significantly dropped with the blood clot or the autogenous bone chips but remained stable with BHA. Therefore, a slowly resorbable biomaterial such as BHA might be suitable in sub-sinusal bone augmentation to prevent the re-expansion process. Understanding the biological concept of sinus lift procedures, several authors demonstrated the clinical efficacy of biomaterials when used alone in this specific model. Nevertheless, biomaterials known to be resorbable led to a lamellar bone architecture that might not be able to maintain the volume of the regenerated tissue over time. Moreover, many types of biomaterials are available and scientific evidence of short and long-term performance of newly introduced biomaterials is still poor. Chapter 3 aims at comparing the performances, in terms of bone formation, resorption rate and 3-D stability, of four calcium phosphate-based biomaterials often used for sub-sinusal bone augmentation, in a rabbit model. Particulated space-filling biomaterials seemed to be more efficient to promote osteogenesis compared to paste-like biomaterials. Highly resorbable biomaterials appeared to withstand intrasinusal pressure after a period of six months in rabbits. Non- or slowly resorbable biomaterials are of great interest in the dental field because the long-term stability of 3-D bone augmentation is a key factor for dental implant and aesthetic outcomes. Therefore, the mechanical and non-resorbable properties of titanium, known to be highly compatible in vivo and highly resistant to body fluid corrosion, are potential advantages for bone augmentation prior to dental implantation. Nevertheless, the use of titanium particles as space fillers in bone regeneration was weakly reported in the literature from a histological point of view. Thus, Chapter 4 compares the behavior and the effect of porous titanium particles versus the well-documented BHA. Even though both biomaterials allowed osteogenesis and adequate 3-D stability, the bone architecture, and more specifically the amount of bone-to-material contact (BMC), was significantly different. Inclusion of the particles in a carrier or in binding agents such as a collagen gel or fibers might be of interest in order to ease surgical handling. However, the possible influence of those collagen carriers on bone tissue responses remains poorly investigated. The objective of Chapter 5 was to investigate the effect of collagen at different stages of the osteogenesis process, still in the same rabbit model. The findings clearly showed the presence of inflammatory cells at an early stage of bone regeneration when collagenated xenogenic biomaterials were used compared to collagen-free xenogenic granules. Nevertheless, despite the transient inflammation, the final quantity of newly formed bone was similar in the various groups. The last two chapters of this thesis take some of the preclinical findings of the previous chapters to the clinical field. The objective of Chapter 6 was to assess the clinical outcome of a minimalized sub-sinusal bone augmentation procedure using only biomaterials, simultaneously with the placement of 102 non-submerged implants in 40 patients. Implant and prosthodontic survival rates as well as complications were evaluated after a follow-up period of 2 to 6 years. This clinical trial emphasized that, if the amount of remaining bone height is sufficient to ensure implant primary stability, their placement can be performed simultaneously with sinus lifting, even in a non-submerged fashion. This procedure reduces the number of surgeries and the time before prosthetic rehabilitation. The objective of Chapter 7 was to to develop a new method to objectively evaluate in humans the 3-D volume variation of alveolar socket preservation over time by means of computed tomography and 3-D image analysis. Short summary: Before placing dental implants, alveolar bone regeneration is often required due to bone defects caused by periodontitis, traumatism or even a simple tooth extraction. Bone augmentation surgical procedures have very much evolved thanks to a better understanding of biological processes and to the introduction of biomaterials. The overall objective of this thesis is to bring a contribution to the understanding of the biological concept of alveolar bone regeneration, and in particular sinus lift and socket preservation procedures. The influence of biomaterials on bone regeneration has been emphasized through preclinical and clinical studies.
in Journal of Osteology and Biomaterials (2011), 2
The efficacy of grafting materials for alveolar bone regeneration procedures has been repeatedly corroborated by clinical and scientific evidence. Although an ever growing number of biomaterials are available on the market, the origins, material characteristics, bioactivity and osteoconductive properties of these products are not always known by clinicians, hence often hampering an adequate product selection. The purpose of this contribution was to provide an overview of five different types of osteoconductive grafting materials frequently used in dentistry (Bio-Oss®, Cerasorb M™, Bone Ceramic®, Natix®, Genos®) and to summarize their physico-chemical and morphological characteristics at the macro- and micro-scale. Furthermore, the influence of these properties on the in vivo behaviour of these biomaterials is discussed. The results of this study are presented as data sheets, which may prove helpful for clinicians in the design of their treatment strategies.
in Clinical Oral Implants Research (2011), 22(5), 538-545
Aim: The first objective of the present study was to compare the short- and long-term 3D volume stability of sub-sinusal bone regeneration in rabbits using different space fillers. The second objective was to assess qualitatively and quantitatively the early bone formation process and long-term behavior of the regenerated bone. Materials and methods: Fifteen rabbits underwent a double sinus lift procedure using: blood clot (Clot), autogenous bone chips (Auto) and bovine hydroxyapatite (BHA). Animals were euthanized at 1 week, 5 weeks and 6 months. Samples were subjected to X-ray microtomography and histology. Variations in the volume of bone augmentations were calculated at different time points. Qualitative analysis was performed using 7 μm sections and quantitative histomorphometric analyses were carried out using scanning electron microscopy. Results: From baseline (100%) to 5 weeks, the augmented volumes declined to 17.3% (Clot), 57.6% (Auto) and 90.6% (BHA). After 6 months, only 19.4% (Clot) and 31.4% (Auto) of initial volumes were found, while it remained more stable in the BHA group (84%). At 1 week, an initial osteogenesis process could be observed in the three groups along the bone walls. At 5 weeks, despite a significant decline in the volume, newly formed bone density was higher with Clot and Auto than with BHA. At 6 months, bone densities were statistically similar in the three groups. However, after 6 months, the surface invaded by newly formed bone (regenerated area) was significantly higher when BHA was used as space filler. In the BHA group, the biomaterial area slightly decreased from 42.7% (1 week) to 40% (5 weeks) and 34.9% (6 months) and the density of the composite regenerated tissue (bone+BHA) reached >50% at 6 months. Conclusions and clinical implications: The three space fillers allowed bone formation to occur. Nevertheless, augmented volumes declined in the Clot and Auto groups, while they remained stable with BHA. A slowly resorbable biomaterial might be suitable in sub-sinusal bone augmentation for preventing the re-expansion process and for augmenting the density of the regenerated tissues.
in Le point (2010), 218(Janvier -Février), 27-30
in International Journal of Oral and Maxillofacial Implants (2010)
in Journal of Periodontology (2009), 80(8), 1220-30
BACKGROUND: This descriptive study reviewed the 1- to 15-year survival rates of fixed implant rehabilitations in the edentulous maxilla. METHODS: An electronic search was conducted, and cohort studies with 1- to 15-year follow-ups were identified by two independent reviewers. The implant and prosthodontic survival rates were reviewed at 1-, 3-, 5-, 10-, and 15-year endpoints. Descriptive analysis includes surface characteristics, bone-augmentation procedure, prosthetic design, and implant number and distribution along the edentulous maxilla. RESULTS: Thirty-three studies, including 1,320 patients and 8,376 implants, were selected for analysis. The overall calculated implant survival rates ranged from 94% (1 year) to 87.7% (15 years). The implant survival rates for rough-surface implants ranged from 97% (1 year) to 98% (15 years); machined implants showed survival rates of 92% to 87.7%; respectively. Implants placed in native bone had greater survival rates than those placed in augmented bone. The prosthodontic survival rate ranged from 98.2% at 1 year to 92.1% at the 10-year endpoint, and it was only influenced by the implant number and distribution. CONCLUSIONS: Implants with rough surfaces showed a statistically higher survival rate than machined implants at all intervals. Implants placed in augmented bone had a statistically lower survival rate, except for rough-surface implants, for which no statistical difference between augmented and non-augmented bone survival rates was found. Machined implants showed a stable survival rate only when placed in native bone. When machined implants were placed in augmented bone, the survival rate decreased significantly at each study endpoint. The prosthetic design, veneering material, and the number of prostheses per arch had no influence on the prosthodontic survival rate. Implant number and distribution along the edentulous maxilla seemed to influence the prosthodontic survival rate.
in Revue d'Odonto-Stomatologie (2008), 37(1), 3-17
L’élévation du plancher sinusal est une technique permettant de placer des implants d’une longueur suffisante au niveau du maxillaire postérieur. Depuis qu’elle a été initialement décrite dans les années 80, cette technique a beaucoup évolué. A l’heure actuelle, on peut considérer cette approche comme prédictible, simple et réalisable au fauteuil sous anesthésie locale. Cet article vise d’abord à expliciter clairement le phénomène biologique du « sinus-lift », ensuite, de décrire le protocole chirurgical que nous appliquons à l’Université de Liège (Belgique) et de le confronter avec la littérature scientifique existante.
in Revue d'Odonto-Stomatologie (2008)
Sinus floor elevation is a technique allowing implant placement in the posterior edentulous maxilla when residual bone height is limited. This technique has evolved a lot since it has been first introduced in the eighties. Nowadays, this approach is considered as predictable, simple and practicable under local anaesthesia. This present article aims at understanding clearly the biological phenomenon of “sinus- lift”. Moreover, the surgical protocol used at the University of Liège is considered didactically and reasoned according to the scientific literature.