Chinese Journal of Oral Implantology

Preface for the key column on bone grafting materials

2023, 28(5): 302-303. DOI: 10.12337/zgkqzzxzz.2023.10.001

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Inflammatory modulation and applications of biomaterials in oral bone regeneration

Zhang Yufeng, Wang Yulan

2023, 28(5): 304-309. DOI: 10.12337/zgkqzzxzz.2023.10.002

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Significant progress has been made in the field of oral bone regeneration, with growing recognition of the pivotal role played by inflammation regulation. Temporal and contextual regulation of inflammation is essential for achieving successful bone repair. In the context of oral bone regeneration, biomaterials are employed as scaffolds/bone grafts to promote bone tissue formation in defect areas. The intrinsic properties of biomaterials may impact the inflammatory process and its regulation. Additionally, biomaterials can serve as carriers for immuno-modulatory drugs, further influencing bone regeneration. A comprehensive understanding of how biomaterials modulate inflammatory responses holds the potential to accelerate the development of novel bone regeneration materials. This review provides an overview of the current status of research on biomaterials in the context of oral bone regeneration and inflammation response, summarizing the laboratory advancements. The aim is to provide clinicians and researchers with a theoretical foundation for the selection and development of regenerative materials.

Application research of platelet-rich fibrin in immediate implantation in the aesthetic area

Li Yongli, Qi Yuanzheng, Jiao Junjie, Han Xiao, Wang Junyan, Shi Ruining, Zhou Yanmin, Zhao Jinghui

2023, 28(5): 310-314. DOI: 10.12337/zgkqzzxzz.2023.10.003

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Objective To explore the clinical application value of platelet-rich fibrin in immediate implantation in the aesthetic area. Methods 24 cases of maxillary anterior teeth that could not be retained were retrospectively collected from January 2021 to January 2022 in our hospital. The residual roots were removed, and implants were placed at the same time. The subjects were randomly assigned to two groups (n=12). The control group received a combination of bone substitute and collagen membrane, while the experimental group received a combination of bone substitute and platelet-rich fibrin to guide bone regeneration and soft tissue augmentation. A total of 24 implants were implanted. Results Through clinical research and follow-up observation, the clinical results of the experimental group and the control group were similar. The effect of platelet-rich fibrin in immediate implantation in the aesthetic area was good. The implants had achieved stable osseointegration, the implant dentures had good function, and the patients were satisfied. Conclusion For immediate implantation cases in aesthetic areas, under the premise of strict grasp of surgical indications and operation skills, platelet-rich fibrin can effectively promote the augmentation of soft and hard tissue, and can be popularized in clinical applications.

Application of bone substitutes in the incisive canal for implant placement

Yang Bo, Man Yi

2023, 28(5): 315-319. DOI: 10.12337/zgkqzzxzz.2023.10.004

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Due to the prevalence of insufficient remaining alveolar bone or excessive expansion of the incisive canal in the maxillary central incisor region, the stability of implants may be affected. Titanium implants into incisor canals may cause a series of complications such as nasopalatine canal cyst, postoperative short-term sensory disturbance, implant failure, and so on. In order to solve this clinical problem, this study explored and practiced the application of bone substitutes in the incisive canal for implant placement. The application of various bone substitutes in the incisive canal for implant placement was reviewed and analyzed in this paper. Combined with a clinical case of bone substitutes used in the incisive canal for implant placement, the clinical effect of bone substitutes in the incisive canal for guided bone regeneration and implant placement was demonstrated. The implant osseointegration was good and the aesthetic outcome was satisfactory. Re-examination after 6 months showed that the soft tissue around the implant was stable and there was no obvious bone resorption. The use of bone substitutes to guide the internal osteogenesis of the incisive canal can provide three-dimensional bone support for the implant, which is helpful in obtaining good implant stability and anterior aesthetic effect. It has been reported in the literature that different materials, such as autogenous bone, allograft bone or mixed bone substitute, or autogenous bone mixed bone substitute, can achieve the internal osteogenesis of the incisive canal.

Selection of bone graft materials in vertical bone augmentation surgery

Zhang Xiaohan, Lv Mingyue, Zhang Shiwen, Yuan Quan

2023, 28(5): 320-326. DOI: 10.12337/zgkqzzxzz.2023.10.005

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The success and long-term stability of implant treatment are closely related to an adequate bone volume at the implant site. Vertical bone defects have detrimental effects on the function and aesthetic outcomes of implant treatment. Various regenerative procedures, such as guided bone regeneration, Onlay technique, titanium mesh technique, and Inlay technique, require the use of bone graft materials to achieve the regeneration of bone height. This article provides a comprehensive literature review of the bone graft materials used in different surgical techniques for vertical bone augmentation, including their effects, advantages, and limitations. The aim is to provide decision-making support for clinical practice in oral implant therapy.

Reflections on the sole application of xenograft of low substitution rate for maxillary sinus floor elevation

Wu Shiyu, Chen Zhuofan, Huang Baoxin, Chen Zetao, Liu Yuanxiang

2023, 28(5): 327-331. DOI: 10.12337/zgkqzzxzz.2023.10.006

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The maxillary sinus floor elevation is a key technique for restoring the vertical bone volume in the patient’s posterior region. However, the maxillary sinus floor elevation still has limitations such as significant trauma, sometimes requiring a second surgical area, and a long treatment cycle. These limitations are closely related to its osteogenic mechanism and the bone augmentation protocol. The article summarizes the evolution of the “gold standard” of bone augmentation materials for maxillary sinus floor elevation from the perspectives of spatial maintenance ability and new bone formation quality based on the mechanism of sinus cavity osteogenesis, then focuses on the current clinical application status of simply using deproteinized bovine bone matrix, in order to provide ideas for standardized clinical treatment and conversion research.

SLA-processed 3D printing and forging of TC4 surface implants in an animal model of hyperglycemia

Lin Qian, Han Zekui, Song Zhenyu, Che Di, Duan Feng, Wang Xinyu

2023, 28(5): 332-339. DOI: 10.12337/zgkqzzxzz.2023.10.007

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Objective To perform a comparative study of the surface properties and osseointegration ability of SLA-treated 3D printed and forged TC4 implants. Method The optimal SLA conditions were mapped and applied to the implants. Implants were implanted into rabbits, and comparative studies of the osseointegration ability of each group of implants were performed at 4, 8, and 12 weeks after surgery. Result The results of repeated measures ANOVA showed that the effect of time on the osseointegration capacity was statistically significant (P<0.001). The difference in the osseointegration rate of similar implants in Group A (hyperglycemic group) and Group B (normoglycemic group) was not statistically significant at different time periods (P=0.075, P=0.129, P=0.56, and P=0.662). The difference in the osseointegration rates of the 2 implants in groups A and B was not statistically significant (P=0.664, P=0.886, P=0.828) during the same time period. Conclusion After the novel optimized SLA treatment, both 3D printed and forged TC4 implants formed a micro- and nanoscale pitted rough surface with good hydrophilicity and suitable roughness. Both had good osseointegration ability in hyperglycemic rabbits and normoglycemic rabbits. The SLA-treated 3D-printed TC4 implants had similar osseointegration ability as the forged TC4 implants in both hyperglycemic rabbits and normoglycemic rabbits.

Horizontally ridge reconstruction using titanium mesh with tenting screw vs. autologous bone graft: a retrospective study

Zhou Lin, Ding Jiamin, Xing Yifeng, Lin Yanjun, Wu Dong

2023, 28(5): 340-346. DOI: 10.12337/zgkqzzxzz.2023.10.008

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Objective The aim of this retrospective study was to evaluate the horizontal bone gain at the different levels of alveolar bone using a titanium screw as a reference plane by titanium mesh with tent screw and autologous bone grafting. Methods Sixteen patients and 23 measured points were enrolled in this study. CBCT data immediately and 6 months after bone grafting were measured at crestal (CW), midway (MW), and basal (BW) levels and reconstructed for area measurement using a titanium screw as the reference plane. The exposure of titanium mesh or not had been evaluated. Results There were no statistical differences between the titanium mesh and onlay grafting, and measured levels at CW, MW, and BW, the exposed titanium mesh and not exposed one. The width absorption ratio of titanium mesh and onlay grafting group or at CW, MW, and BW were almost the same. The area of bone gained and absorption ratio were almost the same without statistical differences. However, the width absorption ratio of the exposed titanium mesh at CW, MW, and BW was significantly higher than the not exposed one. Thin biotype was a main factor in the exposure of titanium mesh. The exposed titanium mesh at the late phase can also achieve clinically accepted bone gain after certain anti-inflammatory treatments. Conclusion Ti-mesh with tenting screw technique and autologous bone graft can achieve clinically acceptable bone augmentation effect. However, the absorption ratio significantly increased if exposed.

Root cause analysis of 3 cases of adverse events involving swallowing and aspiration in dental implant procedures

Jiao Mingxiu, Bao Xianjing, Chen Haixia

2023, 28(5): 347-350. DOI: 10.12337/zgkqzzxzz.2023.10.009

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Objective The retrospective analysis was conducted on three cases of adverse events involving swallowing and aspiration in our hospital by applying the root cause analysis method. Methods The root causes of the events were identified in terms of systematic processes by creating a cause-and-effect diagram. Results The root causes of these incidents were identified in the system process: the lack of standardized preventive measures, insufficient patient evaluation, inadequate preoperative precautionary measures, and treatment positions that could easily result in swallowing and aspiration. Conclusion To address these three root causes, specific improvement measures were implemented: conducting adequate preoperative patient evaluations, enhancing preoperative precautionary measures, adjusting patient treatment positions, strengthening preventive measures during procedures, and enhancing supervision of such incidents.

Meta-analysis of tenting technique for alveolar ridge augmentation

Gong Jiaming, Zhao Ruimin, Lang Xin, Yu Zhanhai, Yuan Zhenfei

2023, 28(5): 351-357. DOI: 10.12337/zgkqzzxzz.2023.10.010

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Objective To systematically evaluate the efficacy of applying the tent technique (TT) in alveolar ridge augmentation. Methods The PubMed, Embase, Scopus, Cochrane Library, CNKI, Wanfang, and SinoMed databases were electronically searched from April 1, 2002 to October 10, 2022 to identify clinical trials that employed TT in alveolar ridge augmentation. Results A total of 9 studies were included, of which 7 referred to horizontal ridge augmentation and 2 referred to vertical ridge augmentation. Meta-analysis indicated that TT had similar performance in horizontal ridge augmentation [MD=0.89, 95% CI (-0.07, 1.85), P=0.07] and postoperative complications compared with guided bone regeneration (GBR) [RR=3.90, 95% CI (0.85, 17.96), P=0.08]. Furthermore, TT had significantly less bone resorption than GBR and Onlay graft [MD=-3.98, 95% CI (-6.32, -1.65), P=0.0008], which could obtain more vertical ridge augmentation than the latter [MD=1.09, 95% CI (0.38, 1.81), P=0.003]. In terms of implant placement rate, their performance was as expected. Conclusion TT, as an alternative technique for alveolar ridge augmentation, achieves similar or better bone incremental performance than GBR or Onlay graft.

Progress of demineralized dentin matrix as scaffold material for dental stem cells

Wu Daomin, Bao Jibo, Zhu Qiuyan, Xie Zhigang

2023, 28(5): 358-363. DOI: 10.12337/zgkqzzxzz.2023.10.011

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Tissue engineering uses the cooperation of cells, bioactive materials and extracellular matrix to achieve tissue regeneration. As a scaffold material in tissue engineering, demineralized dentin matrix can simulate extracellular matrix microenvironment, promote odontogenic differentiation of stem cells, and be used for regeneration of dental pulp, dentin and periodontal tissues. In dental tissue engineering, demineralized dentin matrix and dental stem cells are used to repair dental pulp exposure and root regeneration, which can reproduce the anatomical structure and function of dental tissues in the body. It is expected to replace the traditional pulp capping agent to repair damaged teeth in the future, replace the traditional implant for restoration, and realize tooth regeneration.

Application and research progress of customized additive manufactured titanium mesh in bone augmentation for oral implantation

Wang Lingxu, Wang Fangfang, Wang Penglai

2023, 28(5): 364-370. DOI: 10.12337/zgkqzzxzz.2023.10.012

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Guided bone regeneration (GBR) is a popular method for bone augmentation in oral implant restoration. Titanium mesh has become increasingly prevalent due to its excellent mechanical properties and support fixation. However, traditional prefabricated titanium mesh has limitations, such as poor fitting with the alveolar bone shape, which can result in complications such as wound tearing, mucosal damage, and titanium mesh exposure. Additive manufacturing technology, such as 3D printing, allows for the customization of customized titanium mesh with varying shapes, thicknesses, and porosity. This customized approach not only upholds the excellent mechanical properties and biocompatibility of traditional titanium meshes but also achieves high-precision bone grafting through meticulous preoperative design and digital virtual reconstruction. Such an approach not only streamlines the surgical procedure and shortens surgery time, but also simplifies the surgeon’s operations and reduces trauma to patients. However, in clinical application, even though postoperative complications have decreased, issues such as the exposure of the titanium mesh persist and require careful attention. Despite the considerable clinical potential of titanium mesh from customized manufacturing, in-depth subsequent research is crucial to enhance its effectiveness. This article provides an overview of the current clinical application and research status of customized additive manufactured titanium mesh.

Progress of implant treatment for patients with type III and IV osteogenesis imperfecta

Tian Cong, Zhou Liwei, Li Mengquan

2023, 28(5): 371-376. DOI: 10.12337/zgkqzzxzz.2023.10.013

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Patients with osteogenesis imperfecta have twice the risk of tooth loss compared to the general population. It is necessary to find a suitable method for restoration after tooth loss in these patients. Many of these patients have fragile and porous bones, and some severe cases require long-term use of bisphosphonates, which poses a challenge for implant restorations. Currently, there is an increasing number of cases involving implant treatments for patients with types III and IV severe osteogenesis imperfecta. This article reviews the medical histories, surgical procedures, and follow-up outcomes of implant treatments of patients with these two types. Based on relevant literature research, it is deemed feasible for these patients to undergo implant treatments, providing a reference for clinicians performing implant restorations in patients with types III and IV osteogenesis imperfecta.

Accuracy study of digital implant surgical guides for immediate implant placement in the esthetic zone

Jiang Zhongwei, Zhou Hongli, Yang Beining

2023, 28(5): 377-382. DOI: 10.12337/zgkqzzxzz.2023.10.014

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Immediate implant placement is proven as a predictable surgical option with similar success rates, but shorter treatment time compared with delayed implant placement. It even allows for immediate restoration to meet the patient’s aesthetic needs with maximum preservation of hard and soft tissues. However, immediate implant placement in the aesthetic zone is technically challenging due to the morphology of the extraction socket and various surgical factors. Conventional freehand manipulation struggles against the resistance of the dense palatal bone plate, potentially leading to aesthetic or biological complications when the implant deviates buccally. With the development and maturation of computer-assisted technology, digital implant guides have been widely used in implant surgery, which can significantly improve accuracy compared with freehand techniques. However, there is a paucity of studies that have reported the accuracy and influencing factors of immediate implant placement using these digital guides. This article reviews the accuracy and influencing factors of digital surgical guides for immediate implant placement in the aesthetic zone.

Exploration of ideological and political education in undergraduate teaching of dental implantology

Li Xiaojing, Liu Ran, Zhen Li, Mei Dongmei, Liu Zhao, Li Fan, Xu Hao, Teng Minhua, Wang Dashan, Zhao Baodong

2023, 28(5): 383-386. DOI: 10.12337/zgkqzzxzz.2023.10.015

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Ideological and political education is of great significance in the teaching work of undergraduate students, and it needs to be integrated into the entire process of education and teaching. Classroom teaching is the main channel, and it is important to align the teaching of various professional courses with ideological and political theory courses, which is an important way to achieve the full process and comprehensive education of teaching work. Based on the characteristics of dental implantology, this paper analyzes the necessity of integrating ideological and political education into the teaching of dental implantology, and the formulation of teaching design and implementation plan, to achieve the multiple integration effects of Ideological and political education, professional education and humanistic education, to establish a solid foundation for the cultivation of high-quality dental implant professionals.

The application of a blended learning mode in standardized residency training in implant dentistry

Tian Sirui, Deng Yu, Gao Jing, Zhao Baohong

2023, 28(5): 387-391. DOI: 10.12337/zgkqzzxzz.2023.10.016

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Objective To explore the effects of applying a blended learning mode combining microlecture with problem-based learning (PBL) and case-based learning (CBL) in the standardized residency training in implant dentistry (referred to as “residency training”). Methods Thirty-four residents training in the Department of Dental Implantology from January to July 2022 were selected as the control group (traditional learning mode) and 32 residents training in the Department of Dental Implantology from January to July 2023 were selected as the experimental group (blended learning mode). The learning effectiveness of the two modes was assessed by assessment scores and questionnaires at the end of the training. Results The results of the test group were higher than those of the control group in all theoretical (basic knowledge, case analysis) and operational tests (history taking, clinical examination, diagnosis, treatment design, medical record writing and operational skills), and the differences were statistically significant except for medical record writing (P < 0.05). According to the results of the questionnaire survey, the blended learning mode is more likely to improve the learning interest of the residents. At the same time, the results of the blended learning mode group were higher than those of the control group in terms of enhancing independent learning, teamwork, and comprehensive clinical ability, and these differences were statistically significant (P<0.05). Conclusion The effect of the blended learning mode is significantly better than that of the traditional learning mode, which helps to improve the clinical diagnosis and treatment level of implant dentistry and comprehensive quality of residents.

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