Publications

  • Nicola De Angelis · Eugenio Sorrenti · Claudio Modena · Stefano Benedicenti
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    ABSTRACT: Dental implants have been used for the last 20 years. With the latest modern developments, however, minimally invasive protocols and immediate implants are currently used. The aim of this study was to evaluate the primary stability of a new implant design. Thirty immediate implants were placed and they all achieved successful osseointegration. Primary stability was reached with all the implants after the first apical threads. Within the limitations of the present study, the immediate implant approach seems to be a predictable treatment option, especially in conjunction with a specifically designed implant system.
    No preview · Article · Feb 2016 · Biotechnology & Biotechnological Equipment
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    ABSTRACT: Introduction: The aim of this randomized clinical trial was to compare torque recordings at insertion time and 1 week post-placement between immediately loaded orthodontic miniscrews and an unloaded control group. Trial design: This RCT was designed as parallel with an allocation ratio of 1:1. Methods: Eligibility criteria to enroll patients were: needs of fixed orthodontic treatment, no systemic disease, absence of using drugs altering bone metabolism. All patients were consecutively treated in a private practice and the miniscrews were placed by the same author. Patients received ORTHOImplant (3M Unitek) miniscrews and they were blindly divided in two groups: group 1 screws were unloaded between T0 and T1, group 2 received immediately loaded screws with NiTi coil. For each patient, maximum insertion torque (MIT) was evaluated at T0. After 1 week, without loading, the screw torque was measured again (T1) and at the end of the treatment maximal removal torque was evaluated (T2). Torque variation in the first week was considered as the primary outcome. Randomization: A randomization list was created for the group assignment, with an allocation ratio of 1:1. Blinding: The study was single blinded in regard of the statistical analysis. Results: Patients enrolled in the clinical trial were 51 for a total of 81 miniscrews. The recruitment started in November 2012 and the observation period ended in August 2014. Twenty-six and twenty-five patients were analysed in group 1 and 2, respectively. The MIT mean in each placement time was 18.25 Ncm (SD = 3.00), 11.41 Ncm (SD = 3.51) and 10.52 Ncm (SD = 5.14) at T0, T1, and T2 time, respectively. In group 1, the torque decrease between T1 and T0 was statistically higher compared to group 2 (P value = 0.003). Statistically significant effects of the placement times on MIT were found (P value <0.0001). No serious harm was observed. Limitations: This study was performed using only direct force on the miniscrew and not using the miniscrew as an indirect anchorage. It was not possible to obtain quantitative data on bone quality or root proximity to miniscrews. Conclusions: A significant stability loss was observed in the first week in both groups; Group 1 showed a statistically higher torque loss in the first week when compared to the immediately loaded group. There were statistically significant effects of the measurement times on MIT and of the miniscrew location on MIT. The overall failure rate was 7.4%. Trial registration: This trial was not registered. Protocol: The protocol was not published before trial commencement.
    No preview · Article · Jan 2016 · The European Journal of Orthodontics
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    ABSTRACT: Photobiomodulation (PBM) has been used in clinical practice for more than 40 years. Unfortunately, conflicting literature has led to the labelling of PBM as a complementary or alternative medicine approach. However, past and ongoing clinical and research studies by reputable investigators have re-established the merits of PBM as a genuine medical therapy, and the technique has, in the last decade, seen an exponential increase in the numbers of clinical instruments available, and their applications. This resurgence has led to a clear need for appropriate experimental models to test the burgeoning laser technology being developed for medical applications. In this context, an ethical model that employs the protozoan, Paramecium primaurelia, is proposed. We studied the possibility of using the measure of oxygen consumption to test PBM by irradiation with an infrared or near-infrared laser. The results show that an 808nm infrared laser diode (1W; 64J/cm2) affects cellular respiration in P. primaurelia, inducing, in the irradiated cells, a significantly (p < 0.05) increased oxygen consumption of about 40%. Our findings indicate that Paramecium can be an excellent tool in biological assays involving infrared and near-infrared PBM, as it combines the advantages of in vivo results with the practicality of in vitro testing. This test represents a fast, inexpensive and straightforward assay, which offers an alternative to both traditional in vivo testing and more expensive mammalian cellular cultures. 2015 FRAME.
    Full-text · Dataset · Jul 2015
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    Full-text · Dataset · Jul 2015
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    ABSTRACT: Photobiomodulation (PBM) has been used in clinical practice for more than 40 years. To clarify the mechanisms of action of PBM at cellular and organism levels, we investigated its effect on Paramecium primaurelia (Protozoa) irradiated by a 808 nm infrared diode laser with a flat-top handpiece (1 W in CW). Our results lead to the conclusion that: 1) The 808 nm laser stimulates the P. primaurelia without a thermal effect. 2) The laser effect is demonstrated by an increase in swimming speed and in food vacuole formation. 3) The laser treatment affects endogenous adenosine triphosphate (ATP) production in a positive way. 4) The effects of irradiation dose suggest an optimum exposure time of 50 s (64 J/cm(2) of fluence) to stimulate the Paramecium cells; irradiation of 25 s shows no effect or only mild effects and irradiation up to 100 s does not increase the effect observed with 50 s of treatment. 5) The increment of endogenous ATP concentration highlight the positive photobiomodulating effect of the 808 nm laser and the optimal irradiation conditions by the flat-top handpiece. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Full-text · Article · Jun 2015 · Photochemistry and Photobiology
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    ABSTRACT: Les contentions linguales font partie des contentions orthodontiques. Leurs qualités dépendent de plusieurs facteurs. Le but de cette étude est d’évaluer l’adhésion entre différents fils et composites utilisés comme contentions linguales.
    No preview · Article · May 2015 · International Orthodontics
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    ABSTRACT: In daily orthodontic clinical practice retention is very important, and lingual retainers are part of this challenge. The failure of lingual retainers may be due to many factors. The aim of this study was to assess the retention forces and mechanical behavior of different types of wires matched with different kinds of composites in lingual retainers. A tensile test was performed on cylindrical composite test specimens bonded to orthodontic wires. The specimens were constructed using four different wires: a straight wire (Remanium .016×.022″ Dentaurum), two round twisted wires (Penta One .0215″ Masel, Gold Penta Twisted .0215″ Gold N'braces) and a rectangular braided wire (D-Rect .016×.022″ Ormco); and three composites: two micro-hybrids (Micro-Hybrid Enamel Plus HFO Micerium, and Micro-Hybrid SDR U Dentsply) and a micro-nano-filled composite (Micro-Nano-Filled Transbond LR 3M). The test was performed at a speed of 10mm/min on an Inström device. The wire was fixed with a clamp. The results showed that the bonding between wires and composites in lingual fixed retainers seemed to be lowest for rectangular smooth wires and increased in round twisted and rectangular twisted wires where the bonding was so strong that the maximum tension/bond strength was greater than the ultimate tensile strength of the wire. The highest values were in rectangular twisted wires. Concerning the composites, hybrid composites had the lowest interface bonding values and broke very quickly, while the nano- and micro-composites tolerated stronger forces and displayed higher bonding values. The best results were observed with the golden twisted wire and reached 21.46MPa with the Transbond composite. With the rectangular braided wire the retention forces were so high that the Enamel Plus composite fractured when the load exceeded 154.6N/MPa. When the same wire was combined with the Transbond LR either the wire or the composite broke when the force exceeded 240N. The results of this study show that, when selecting a lingual retainer in daily clinical practice, not only must the patient's compliance and dependability be considered but also the mechanical properties and composition of different combinations of composites and wires. Copyright © 2015 CEO. Published by Elsevier Masson SAS. All rights reserved.
    No preview · Article · May 2015 · International orthodontics
  • Nicola De Angelis · Catherine Yumang · Stefano Benedicenti
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    ABSTRACT: The aim of this study was to determine the efficacy of the lateral advanced flap in root-coverage procedures for mandibular incisors and to evaluate pain after treatment. A total of 15 patients who required treatment for gingival recessions were selected from the University of Genoa Laser and Restorative Dentistry Department. The inclusion criteria were the presence of at least one 3-mm gingival recession defect of a mandibular incisor and 3 mm or more of keratinized tissue width on the immediately adjacent tooth. One calibrated masked examiner performed the clinical measurements, including recession depth and width, probing depth, clinical attachment level, and keratinized tissue width. Patients were checked 7, 14, and 30 days after surgery and were included in supportive periodontal maintenance every 4 months. Further follow-ups were done at the first, third, and fifth year postsurgery when the same baseline assessment parameters were recorded according to the root-coverage esthetic score (RES). Numeric score recorded pain evaluations showed a mean of 3 at the day of the surgery, 2 in the first day after the surgery, and no significant scores were referred in the following days. Mean recession depth was 3.2 ± 1.3 mm at baseline; at 5 years, RES showed a positive increase of all scores. The laterally coronally advanced surgical technique was very effective in treating isolated gingival recessions. It combined the esthetic and root-coverage advantages of the coronally advanced flap with the increased gingival thickness and keratinized tissue associated with the lateral gingival flap.
    No preview · Article · Mar 2015 · The International journal of periodontics & restorative dentistry
  • Nicola De Angelis · Marco De Lorenzi · Stefano Benedicenti
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    ABSTRACT: The purpose of this case series was to report the clinical outcomes and histologic findings of vertical ridge augmentation using a combination of titanium mesh and recombinant human platelet-derived growth factor BB (rhPDGF-BB). Two patients were included, and anorganic bovine bone particles were used. The bone graft was mixed with rhPDGF-BB and loaded onto the bony defect up to the level of the adjacent alveolar crest. A preadapted titanium mesh was placed over the grafted region; no areas of the grafted region were exposed. Postoperative healing was without complications. During reentry surgery for removal of the titanium mesh, all implants could be placed according to the prosthetic design. This report demonstrates the remarkable efficacy of guided bone regeneration using a combination of titanium mesh and rhPDGF for vertical ridge augmentation, thus expanding the indications for implant therapy and allowing recovery of the three-dimensional esthetic architecture in a severely resorbed alveolar ridge.
    No preview · Article · Mar 2015 · The International journal of periodontics & restorative dentistry
  • M. Alex Mathews · B. S. Jagdish Pai · Stefano Benedicenti
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    ABSTRACT: This review article first delves into the intricacies and basic mechanisms of photobiomodulation as proven by scientific research. This paper intends to give insights into studies correlating photobiomodulation in the sphere of osseointegration and bone regeneration, which are as yet evidence based in peer reviewed literature. The assimilated and collated matter is from five electronic databases (MEDLINE, EMBASE, PubMed, CINAHL, and Cochrane Database of Randomised Clinical Trials) and is a studious inquiry into both clinical and laboratory studies. The search criteria used keywords of “Photobiomodulation,” “Biostimulation,” and “low level laser therapy (LLLT)” in association with the term “Osseointegration.” The search was based on whether the studies hinged on the use of photobiomodulation or LLLT in the in vivo or in vitro effects on implant integration, bone healing around implants, cell culture on implant material, and the dosage and time of therapy. The search yielded 42 studies out of which 37 met the criteria for selection. Excluded studies differed from the primary objective of applying low level laser therapy to effect a biologic modulation on the body&apos;s own healing and reparative mechanisms. This review conclusively demonstrates the effectiveness of treatment protocols of photobiomodulation for osseointegration, specifically toward biostimulatory effects on cells and their interactions with implant surfaces and substantiates evidence of a bimodal or biphasic response of dosage and energy levels.
    No preview · Article · Jan 2015
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    ABSTRACT: Background This work evaluated the accuracy and safety of a protocol for minimally-invasive flapless zygomatic implant placement that uses computer-guided stereolithographic mucosa-supported surgical templates.MethodsA total of six zygomatic implants were placed in three formalin-fixed human cadaver heads, with edentulous and severely atrophic posterior maxillae. CT scans of each cadaver head were performed after zygomatic implant placement, to evaluate the lateral error (LE) at implant tip and base, and the angular error (AE) of the implant body.ResultsExcluding the implant placed outside the drilling channel, the LE at the implant base was less than 1 mm in all cases. The average LE at the tip was 3.86 mm, and the AE was less than 6° in all cases, with an average of 4.5°.Conclusion Computer-guided minimally-invasive flapless zygomatic implant surgery remains challenging. Careful planning and perfect stability of the surgical guide are essential. Copyright © 2015 John Wiley & Sons, Ltd.
    No preview · Article · Jan 2015 · International Journal of Medical Robotics and Computer Assisted Surgery
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    ABSTRACT: Objective: Photobiostimulation and photobiomodulation (PBM) are terms applied to the manipulation of cellular behavior using low intensity light sources, which works on the principle of inducing a biological response through energy transfer. The aim of this investigation was to identify a laboratory assay to test the effect of an infrared diode laser light (808 nm) on cell fission rate. Materials and methods: Sixty cells of Paramecium primaurelia were divided in two groups of 30. The first group (test group) was irradiated, at a temperature of 24°C, for 50 sec by a 808 nm diode laser with a flat top handpiece [1 cm of spot diameter, 1 W in continuous wave (CW), 50 sec irradiation time, 64 J/cm(2) of fluence]. The second group (control group) received no laser irradiation. All cells were transferred onto a depression slide, fed, and incubated in a moist chamber at a temperature of 24°C. The cells were exposed and monitored for 10 consecutive fission rates. Changes in temperature and pH were also evaluated. Results: The exposed cells had a fission rate rhythm faster than the control cells, showing a binary fission significantly (p<0.05) shorter than unexposed cells. No significant effects of laser irradiation on pH and temperature of Paramecium's lettuce infusion medium were observed. Conclusions: The 808 nm infrared diode laser light, at the irradiation parameters used in our work, results in a precocious fission rate in P. primaurelia cells, probably through an increase in metabolic activity, secondary to an energy transfer.
    Full-text · Article · Jan 2015 · Photomedicine and Laser Surgery
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    ABSTRACT: Photobiomodulation (PBM) has been used in clinical practice for more than 40 years. Unfortunately, conflicting literature has led to the labelling of PBM as a complementary or alternative medicine approach. However, past and ongoing clinical and research studies by reputable investigators have re-established the merits of PBM as a genuine medical therapy, and the technique has, in the last decade, seen an exponential increase in the numbers of clinical instruments available, and their applications. This resurgence has led to a clear need for appropriate experimental models to test the burgeoning laser technology being developed for medical applications. In this context, an ethical model that employs the protozoan, Paramecium primaurelia, is proposed. We studied the possibility of using the measure of oxygen consumption to test PBM by irradiation with an infrared or nearinfrared laser. The results show that an 808nm infrared laser diode (1W; 64J/cm2) affects cellular respiration in P. primaurelia, inducing, in the irradiated cells, a significantly (p < 0.05) increased oxygen consumption of about 40%. Our findings indicate that Paramecium can be an excellent tool in biological assays involving infrared and near-infrared PBM, as it combines the advantages of in vivo results with the practicality of in vitro testing. This test represents a fast, inexpensive and straightforward assay, which offers an alternative to both traditional in vivo testing and moreexpensive mammalian cellular cultures.
    Full-text · Article · Jan 2015 · Alternatives to laboratory animals: ATLA
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    ABSTRACT: Summary OBJECTIVE : To evaluate the primary stability of different shaped miniscrews through the acquisition of data regarding maximum insertion torque, pullout force, and a radiodiagnosic evaluation of bone characteristics. Sixty fresh porcine bone samples were scanned by computed tomography (CT) and cone-beam computed tomography (CBCT). By means of a dedicated software, CT and CBCT images were analysed to measure the insertion-site cortical thickness, cortical density, and marrow bone density. Sixty miniscrews of 12 different types were implanted with no predrilling pilot hole in the bone samples. Every device was tightened by means of a digital torque screwdriver and torque data were collected. Subsequently, pullout tests were performed. Spearman and Pearson correlations were employed to compare any relationship between continuous variables. Different types of miniscrews did not show statistically significant differences in their torque value (P = 0.595), instead a significant difference was revealed by considering their load measures (P = 0.039). Cortical bone thickness resulted strongly correlated both with value of load (P < 0.001), and modestly with torque measures (P = 0.004). A strong positive correlation was found between CT and CBCT both for cortical density (P < 0.001) and marrow bone density (P < 0.001). Bone characteristics play the major role in miniscrews primary stability. © The Author 2014. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.
    Full-text · Article · Dec 2014 · The European Journal of Orthodontics
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    ABSTRACT: Abstract Background data: Low back pain is a common, highly debilitating condition, whose severity is variable. This study evaluated the efficacy of treatment with Ga-Al-As diode laser (980 nm) with a large diameter spot (32 cm(2)), in association with exercise therapy, in reducing pain. Objective: The present study aimed to evaluate the pain reduction efficacy of treatment with the Ga-Al-As diode laser (980 nm) in combination with exercise therapy, in patients with chronic low back pain (CLBP). Methods: This study evaluated 100 patients with CLBP (mean age 60 years) who were randomly assigned to two groups. The laser plus exercises group (Laser+EX: 50 patients) received low-level laser therapy (LLLT) with a diode laser, 980 nm, with a specific handpiece [32 cm(2) irradiation spot size, power 20 W in continuous wave (CW), fluence 37.5J/cm(2), total energy per point 1200 J] thrice weekly, and followed a daily exercise schedule for 3 weeks (5 days/week). The exercises group (EX: 50 patients) received placebo laser therapy plus daily exercises. The outcome was evaluated on the visual analogue pain scale (VAS), before and after treatment. Results: At the end of the 3 week period, the Laser+EX group showed a significantly greater decrease in pain than did the EX group. There was a significant difference between the two groups, with average Δ VAS scores of 3.96 (Laser+EX group) and 2.23 (EX group). The Student's t test demonstrated a statistically significant difference between the two groups, at p<0.001. Conclusions: This study demonstrated that the use of diode laser (980 nm) with large diameter spot size, in association with exercise therapy, appears to be effective. Such treatment might be considered a valid therapeutic option within rehabilitation programs for nonspecific CLBP.
    No preview · Article · Sep 2014 · Photomedicine and Laser Surgery
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    ABSTRACT: In 2010, one of the authors proposed that lasers could be used to enhance the decontaminating action of sodium hypochlorite (NaOCl). The authors conducted a study to compare the disinfection efficacy of laser-activated irrigation (LAI) by using a photon-induced photoacoustic streaming (PIPS) tip with conventional irrigation and specifically LAI's ability to remove bacterial film formed on root canal walls.
    Full-text · Article · Aug 2014 · Journal of the American Dental Association (1939)
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    ABSTRACT: In this controlled prospective study, 53 patients treated at four study centers were randomly assigned to receive either (test) implants with platform switching built into their design or similar nonplatform-switched controls (same manufacturer, surface treatment, etc) for treatment of single and multiple edentulous sites in all four quadrants. Radiographs taken at the time of implant placement, definitive restoration delivery, and 1-year follow-up found significantly less crestal bone loss around the test implants (0.25 mm) compared to the controls (0.65 mm). Notably, bone loss around the control implants had declined by the 1-year follow-up point.
    No preview · Article · Jun 2014 · The International journal of periodontics & restorative dentistry
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    ABSTRACT: Objective and background: Odontomas are hamartomatous developmental malformations of the dental tissues. We present a retrospective study of recent clinical experience using erbium-doped yttrium aluminum garnet (Er:YAG) (wavelength 2940 nm) and chromium-doped yttrium scandium gallium garnet lasers (Er,Cr:YSSG) (wavelength 2780 nm) for the surgical treatment of these lesions, and score postsurgical pain. Materials and methods: This retrospective study comprised 35 odontomas treated at the Department of Oral Pathology and Laser-Assisted Surgery, San Martino Hospital, University of Genoa, Italy. Of 35 Caucasian patients (23 male, 12 female; ages 8-35; odontomas localized at various oral subsites) those in Group 1 (n=25) had odontomas excised by laser (Er:YAG laser operating at 2940 nm, pulse width 100 msec, curved handpiece, truncated cone HPX tip, 400 μm with energy output 250-400 mJ per pulse, frequency 15 Hz; and Er, Cr: YSGG laser, power 3.5 W, frequency 20 Hz, 55% air/45% water spray, H (hard tissue) mode, pulse width 190-750 μsec variable). In Group 2 (n=10) odontomas were excised by conventional surgery. Pain was assessed using a visual analog scale (VAS). Clinical outcome was determined at 6-12 months. Results: Complete responses were achieved in 100% of the laser-treated odontomas, which compares favorably with reported results of conventional surgery. A statistically significant difference in VAS score was found between patients treated with traditional scalpel surgery (median=4.00) and those who underwent laser surgery (median=3.00). Conclusions: In treating odontomas, a laser surgery protocol effectively minimizes pain, maintains an excellent clinical outcome, and requires minimal additional treatment time compared with conventional surgery.
    No preview · Article · Jan 2014 · Photomedicine and laser surgery
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    Tosun Tosun · Stefano Benedicenti
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    ABSTRACT: The Erbium laser (Er:YAG, 2940 nm wavelength) with its high absorption in water and low penetration depth in soft and hard oral tissues, enables a high ablation depth control in bone surgery. This precise control offers a major advantage, especially in lateral approach sinus-grafting procedures, where often a thin bone wall is present. The pulse-duration control offered by erbium lasers dramatically affects clinical results in terms of ablation capability. Temporal profiles of dental Er:YAG lasers reveal that there are two distinct types of pulse profiles: Square Pulse and Gaussian. The aim of the present retrospective study is to make a clinical comparison of Square Pulse Er:YAG versus Gaussian Er:YAG lasers in maxillary sinus surgeries. The study consists of two groups: Square Pulse vs Gaussian. In the Square Pulse group, an articulated-arm-based Er:YAG device (LightWalker, Fotona) that produces a Variable Square Pulse (VSP) beam profile was used. The Square Pulse group consists of 7 cases with 10 sinus lifting procedures. The laser power settings used were 400 mJ x 10 Hz = 4 W, 50 µsec pulse duration, 44% air, 33% water spray. In the Gaussian group, a fiber delivery Er:YAG device (VersaWave, Hoya ConBio), which has not been available commercially since June 2011, was used. In the Gaussian group, there were 6 cases with 9 sinus lifting procedures. The power settings of the Gaussian group were 400 mJ x 15 Hz = 6 W, 300 µsec fixed pulse duration, under copious water/air cooling. The surgeon evaluated the clinical usefulness of the instruments by Visual Analog Scale (VAS) according to the parameters of handling, visibility of the surgical field, irrigation, bone cutting speed, working time duration, scoring each on a scale from "poor" 0 (zero) to "perfect" 10. Membrane rupture rate was registered as either absent or present. The Square Pulse group showed only one membrane rupture and shorter preparation times. According to the data collected during sinus surgeries, the VSP Er:YAG laser was found to be more effective in comparison with a fixed pulse duration Gaussian profile beam laser.
    Full-text · Article · Jan 2014
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    ABSTRACT: The aesthetic outcome of an implant-supported restoration is first of all dependent on the soft tissue volume. Because the labial bone plate resorbs in every direction after tooth extraction, even when an implant is placed immediately, most patients end up with compromised aesthetics. In this parallel-designed, randomized clinical trial, participants were randomly assigned to the test group (immediate load post-extractive implant treated with subepithelial connective tissue graft placed using the tunnel technique in the labial area) and control group (immediate load post-extractive implant treated without raising a flap) with an allocation ratio of 1:1. Both groups received deproteinized bovine bone mineral. Patients were observed at baseline, crown insertion, 1-year follow-up, and 2-year follow-up. Clinical, radiological and aesthetic parameters were recorded to assess primary treatment outcomes. A random permuted block system was blindly generated ensuring uniformity of the patient allocation during the trial by randomly distributing three participants to the test and three participants to the control group every six treated patients. At the 2-year examination, all 47 implants were successfully integrated, demonstrating stability and healthy peri-implant soft tissues as documented by standard clinical parameters. The results showed a soft tissue remodeling of -10% in thickness and -18% in highness in the non-grafted group, whereas in the grafted group there was a gain of 35% in thickness and a slight reduction of -11% in highness. Test group reported an increase of aesthetic result (mean pink aesthetic score [PES] 8) compared with control group (mean PES 6.65). This prospective study demonstrates the effectiveness of placing a soft tissue graft at the time of immediate implant placement in the aesthetic zone. At the 2-year follow-up, test group revealed a better aesthetic outcomes and stable facial soft tissues compared with control group.
    Full-text · Article · Dec 2013 · Clinical Implant Dentistry and Related Research

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