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Sviluppo e validazione di procedure innovative per l'aumento osseo peri-implantare
No full textLa deiscenza peri-implantare (BD) è l’esposizione, sull’aspetto vestibolare dell’impianto, della superficie ruvida di un impianto. Le BD sono una evenienza comune quando impianti di diametro standard vengono posizionati in regioni anatomiche della cavità orale come le regioni posteriori mascellari e mandibolari. Inoltre, una BD può formarsi durante la fase iniziale di guarigione di un impianto come conseguenza del riassorbimento verticale e orizzontale del piatto osseo vestibolare peri-implantare (PBBP) dopo il posizionamento implantare.
La presenza di una BD residua dopo una procedura ricostruttiva è stata associata elevata incidenza di mucosite peri-implantare e peri-implantite (Schwarz et al. 2012). Inoltre, quando veniva indotta una peri-implantite, la sua progressione era più rapida rispetto a quella indotta su impianti circondati da osso (Monje et al. 2019).
Di conseguenza, lo scopo di questa tesi di Dottorato è stato valutare l’efficacia di una nuova tecnica di gestione dei tessuti molli (la Sub-periosteal Peri-implant Augmented Layer, SPAL; Trombelli et al. 2018), rispondendo alle seguenti domande:
1. Qual è l’efficacia della SPAL, contestuale al posizionamento implantare, nel prevenire o correggere una BD?
2. Esistono differenze nelle condizioni dei tessuti peri-implantari a breve termine in pazienti trattati con SPAL rispetto a pazienti che presentavano un PBBP spesso (≥ 2 mm) al posizionamento implantare?
3. E’ possible effettuare un aumento osseo su siti con BD combinando la tecnica SPAL e un blocco di osso bovino (bDBBM)?
4. Qual è l’efficacia della SPAL nel trattamento di difetti ossei causati dalla peri-implantite?
Sono stati condotti i seguenti studi:
I.TROMBELLI L, SEVERI M, PRAMSTRALLER M, FARINA R (2019) A simplified soft tissue management for peri-implant bone augmentation. The International Journal of Oral and Maxillofacial Implants 34, 197–204.
II. TROMBELLI L, PRAMSTRALLER M, SEVERI M, SIMONELLI A, FARINA R (2020a)
Peri-implant tissue conditions at implants treated with Sub-periosteal Peri-implant Augmented Layer technique: A retrospective case series. Clinical Oral Implant Research 31, 992-1001.
III. TROMBELLI L, SEVERI M, ORTENSI L, FARINA R (2021) Peri-implant bone augmentation by the sub-periosteal peri-implant augmented layer technique and a bovine-derived bone block: A case report Clinical Advance in Periodontics, ahead of print, doi: 10.1002/cap.10172
IV. TROMBELLI L, SEVERI M, FARINA R, SIMONELLI A (2020b) Sub-periosteal peri-implant augmented layer technique to treat peri-implantitis lesions Clinical Advance in Periodontics, 0, 1-6
Sulla base della presente evidenza possono essere tratte le seguenti conclusioni:
1. La tecnica SPAL rappresenta un valido approccio chirurgico semplificato associato a un basso livello di complicanze nel trattamento della BD e nell’aumento orizzontale dei tessuti peri-implantari.
2. Dopo 6 mesi di carico protesico, i pazienti trattati con SPAL mostrano una infiammazione mucosa limitata associata a una ridotta profondità di sondaggio e quantità adeguata di mucosa cheratinizzata. Negli impianti trattati con SPAL, tuttavia, il livello osseo radiografico interprossimale è risultato apicale rispetto alla sua posizione ideale.
3. La combinazione di SPAL e bDBBM può essere usata con successo per ottenere un incremento nello spessore del tessuto vestibolare nella porzione più coronale di un impianto esposto.
4. La tecnica SPAL con o senza CTG può risultare in una remissione clinical di difetti legati alla peri-implantite di Classe Ib/Ic technique with or without additional CTG. Quanto questi effetti possano essere mantenuti a lungo termine ed estesi a difetti di differente configurazione deve ancora essere valutato.The purpose of this Ph.D. thesis was to evaluate the effectiveness of a novel surgical soft tissue management (the Sub-periosteal Peri-implant Augmented Layer, SPAL; Trombelli et al. 2018) by addressing the following questions:
1. What is the clinical effectiveness of SPAL technique in the preventing or correcting a peri-implant bone dehiscence or at implant placement?
2. Is there any difference in peri-implant tissue conditions on the short-term at patients receiving SPAL technique compared to patients with adequate thickness (≥ 2 mm) of PBBP at implant placement?
3. May bone augmentation be performed successfully at peri-implant dehiscence sites with a combination of SPAL and a deproteinized bovine bone mineral (DBBM) block?
4. What is the clinical effectiveness of SPAL technique in the regenerative treatment of peri-implantitis bone defects?
On the basis of the produced evidence, the following conclusions can be drawn:
1. SPAL technique represents a valuable simplified approach in the prevention or correction of peri-implant bone dehiscence
2. After 6 months of prosthetic loading, patients treated with SPAL technique show limited peri-implant mucosal inflammation in association with shallow PD and adequate KM. At implants receiving SPAL technique, however, interproximal RBL was found apical to its ideal position.
3. The combination of SPAL and bDBBM may be successfully used to achieve an increase in buccal tissue thickness at the most coronal portion of an exposed implant.
4. SPAL technique with or without additional CTG may result in the clinical remission of Class Ib/Ic peri-implantitis defects. Whether and to what extent these beneficial effects may be maintained long-term needs be carefully assessed
Correction of Peri‐Implant Buccal Bone Dehiscence Following Sub‐Periosteal Peri‐Implant Augmented Layer Technique With Either Block or Particulate Xenograft: A Retrospective Study
No full textObjective: To evaluate the effectiveness of Sub-periosteal Peri-implant Augmented Layer (SPAL) technique performed with deproteinized bovine bone mineral (DBBM), delivered either as particulate (pDBBM) or block (bDBBM), in correcting a peri implant bone dehiscence (PIBD). Implants showing a thick (≥ 2 mm) peri-implant buccal bone plate (PBBP) at placement were also examined. Material and Methods: Patients with a PIBD ≥ 1 mm, treated with SPAL with either pDBBM (SPALparticulate) or bDBBM (SPALblock), and patients with an implant showing a PBBP ≥ 2 mm at insertion (CONTROL) were included. Re-entry was performed either at 6 months (SPAL groups) or 3 months (CONTROL). The rate of patients presenting no PIBD at re-entry was the primary outcome. Bone dehiscence height (BDH) and width (BDW), thickness of buccal tissues (BTT) and marginal bone level (MBL) were secondary outcomes. Results: Thirty-nine implants in 39 patients (14 in SPALparticulate,14 in SPALblock and 11 in CONTROL) were analyzed. No PIBD were found in SPALparticulate whereas in SPALblock one PIBD was present. Two patients in CONTROL presented a PIBD. A reduction in both BDH and BDW was observed in both SPALparticulate (2.7 ± 1.6 mm for BDH and 3.9 ± 0.2 mm for BDW) and SPALblock (2.5 ± 1.8 mm for BDH and 3.8 ± 1.1 mm for BDW). SPALblock showed a higher BTT than SPALparticulate at re-entry (3.6 ± 1.3 mm for SPALblock and 2.6 ± 0.6 mm for SPALparticulate, p = 0.0160). All groups showed similar MBL. Conclusion: SPAL performed with either a pDBBM or bDBBM is similarly effective in correcting a PIBD as well as in increasing BTT
Sub-periosteal peri-implant augmented layer technique for horizontal bone augmentation at implant placement
No full textIn the present study, a novel surgical technique, namely the sub-periosteal peri-implant augmented layer (SPAL), to increase hard and soft tissue dimensions at the most coronal portion of an implant will be thoroughly described. The surgical buccal access at the time of implant placement first consisted of a split-thickness flap to raise the most superficial mucosal layer, followed by the elevation of the periosteal layer which was detached from the buccal cortical bone plate (BCBP). A full-thickness flap was elevated on the oral aspect. A xenograft was used to fill the space between the periosteal layer and the BCBP, and the periosteal layer was sutured to the oral flap. The mucosal layer was coronally advanced and sutured to submerge both the graft and the implants. At implant uncovering at 4 months, an increase in the thickness (>2 mm) of the buccal peri-implant tissues was observed. A free gingival graft was used to enhance the dimensions of buccal keratinized mucosa. The SPAL technique may represent a surgical option for the horizontal augmentation of peri-implant tissue thickness
Peri‐Implant Bone Augmentation by the Sub‐Periosteal Peri‐Implant Augmented Layer Technique and a Bovine‐Derived Bone Block: A Case Report
No full textBackground: When used with deproteinized bovine bone mineral (DBBM) delivered as a particulate, the sub-periosteal peri-implant augmented layer (SPAL) technique was effective in completely correcting up to 92% of peri-implant buccal bone dehiscences. The use of a DBBM block (bDBBM), however, may result in an improvement of the peri-implant bone dehiscence as well as a relevant lateral bone augmentation since its mechanical properties may ensure a better dimensional stability at flap manipulation than particulate DBBM. The aim of the present a proof-of-principle case report is to investigate if SPAL may be successfully used to obtain bone augmentation at peri-implant dehiscence sites when used with bDBBM.Case presentation: Lateral bone augmentation was performed using the SPAL technique at two implants showing a buccal peri-implant bone dehiscence immediately after their placement. A partial-thickness flap was elevated, leaving the periosteal layer on the buccal cortical bone plate. The periosteal layer was, in turn, elevated to create a pouch, which was used to stabilize a bDBBM graft at the peri-implant buccal bone dehiscences. At re-entry, exposed implant surfaces were completely covered by new thick hard tissue up to their most coronal portion. A free epithelial-connective tissue graft was used to augment the peri-implant soft tissue phenotype.Conclusion: When used to accommodate bDBBM over the most coronal portion of an exposed implant, SPAL may successfully lead to an increase in peri-implant buccal tissue thickness
Minimal invasiveness in the surgical treatment of intraosseous defects: A systematic review
No full textThe modern approach to regenerative treatment of periodontal intraosseous defects should aim at maximizing the clinical outcomes while minimizing the invasiveness (pain, complications, aesthetic impairment, chair time, and costs) of the procedure. The present systematic review evaluated the effect of flap design, regenerative technology, and perioperative and postoperative adjunctive protocols on invasiveness. Overall, the results of the 13 included trials indicate that: (a) the elevation of a single (buccal or lingual) flap positively influences the intensity of postoperative pain and improves the quality of early wound healing compared with double flaps; (b) while the adjunctive use of a membrane is associated with significantly longer surgery-related chair time and higher postoperative pain, the adjunctive use of enamel matrix derivative at sites receiving a graft significantly reduces postoperative pain; also, graft materials showed no significant impact on invasiveness; (c) open flap debridement performed through the elevation of a single flap may lead to substantial clinical improvements of the lesion with reduced surgery-related chair time and costs, thus representing a promising alternative to regenerative treatment. However, for such an approach, a histological evaluation of the nature of the reconstructed tissues is still lacking, and the presurgery conditions (eg, probing depth, defect severity, and defect morphology), which may benefit in terms of invasiveness, have not yet been defined; and (d) intraoperative and postoperative low-level laser biostimulation of the defect site may favorably modulate the postoperative course
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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