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Purpose: To clinically evaluate oral implant restorations placed by undergraduate students in the dental clinical curriculum at KU Leuven (Belgium) in terms of function and esthetics. Materials and methods: A retrospective observational cohort study was designed. The esthetic and functional evaluations of implant-supported restorations placed in the framework of the undergraduate implant dentistry clinical training program using White/Pink Esthetic Score (WES/PES) and visual analog scale (VAS) scoring was performed. Furthermore, complications were registered based retrospectively on the patient's medical file. The following research questions were stipulated: (1) How well do implant-supported restorations placed by undergraduate students perform esthetically? and (2) Which complications occurred and how were these managed? Results: Between August 2008 and July 2014 (6 academic terms), 251 implants (Brånemark System Mk III, Nobel Biocare) were placed in 113 patients by 155 students (> 40% of all students enrolled in the training program). Of these implants, 228 were restored in 101 patients by 118 students with varying restoration types. Esthetic scoring of the restorations in 83 of these patients revealed a satisfying mean WES of 8.14 ± 2.09 (out of 10) and PES of 9.56 ± 3.14 (out of 14). Complications were registered in 18.9% of the cases. Discussion: Clinical training in implant dentistry for undergraduates contributes to the development of advanced skills in the dental student's Master education. Overall, patients were satisfied with their implant-supported restorations. Implant and restoration success rates and complication incidence were confirmed by long-term data in the oral implant literature.

Purpose: To propose diffuse osteomyelitis as risk indicator for peri-implantitis following the loss of several dental implants in patients that present with highly sclerotic bone areas. Materials and Methods: A total of six “nightmare cases”—three of which were treated at the Department of Periodontology of the University Hospitals of the Catholic University Leuven and three of which were referred there for a second opinion—were retrospectively analyzed using radiographs obtained via contact with referring clinicians in order to fully reconstruct the treatment pathway and dental history for each of these patients. Results: All patients suffered from early implant failures and/or severe peri-implantitis with bone loss and crater formation up to the apical level, as well as the loss of all or nearly all implants. Re-examination of their preand postoperative CBCTs, in combination with several bone biopsies, confirmed the diagnosis of a diffuse sclerosing osteomyelitis in the treated area. Osteomyelitis could be linked to a longstanding history of chronic and/or therapyresistant periodontal/endodontic pathology. Conclusion: The current retrospective case series seems to suggest that diffuse osteomyelitis should be considered as a risk indicator for severe peri-implantitis. Keywords: bone quality, bone density, dental implants, implant failure, peri-implantitis

The aim of the present study was to compare leukocyte- and platelet-rich fibrin (L-PRF) membranes with a connective tissue graft (CTG) in combination with a coronally advanced flap (CAF) in the treatment of Miller Class I or II localized gingival recessions. A randomized controlled clinical trial with 17 recessions in each group was initiated; the control group received treatment with CAF+CTG, and the test group received CAF+L-PRF. The following variables were measured before treatment and after 1, 3, and 6 months: gingival recession depth (RD), gingival recession width (RW), gingival thickness (GT), probing depth (PD), clinical attachment level (CAL), and keratinized tissue height (KTH). Also, the root coverage percentage (RC), the pain score, postoperative complications, and the root coverage esthetic score (RES) were recorded after surgery. Both treatments presented significant improvements in the RD, RW, and CAL at 1, 3, and 6 months. CTG achieved a significantly higher RC at 1, 3, and 6 months and a significantly higher RES score at 6 months. L-PRF presented a significantly lower pain score and less postoperative complications. Both strategies were effective for the treatment of localized gingival recessions. The CTG obtained higher RC and esthetic results, and L-PRF had less pain and postsurgical complications.

Purpose: To clinically evaluate oral implant restorations placed by undergraduate students in the dental clinical curriculum at KU Leuven (Belgium) in terms of function and esthetics. Materials and methods: A retrospective observational cohort study was designed. The esthetic and functional evaluations of implant-supported restorations placed in the framework of the undergraduate implant dentistry clinical training program using White/Pink Esthetic Score (WES/PES) and visual analog scale (VAS) scoring was performed. Furthermore, complications were registered based retrospectively on the patient's medical file. The following research questions were stipulated: (1) How well do implant-supported restorations placed by undergraduate students perform esthetically? and (2) Which complications occurred and how were these managed? Results: Between August 2008 and July 2014 (6 academic terms), 251 implants (Brånemark System Mk III, Nobel Biocare) were placed in 113 patients by 155 students (> 40% of all students enrolled in the training program). Of these implants, 228 were restored in 101 patients by 118 students with varying restoration types. Esthetic scoring of the restorations in 83 of these patients revealed a satisfying mean WES of 8.14 ± 2.09 (out of 10) and PES of 9.56 ± 3.14 (out of 14). Complications were registered in 18.9% of the cases. Discussion: Clinical training in implant dentistry for undergraduates contributes to the development of advanced skills in the dental student's Master education. Overall, patients were satisfied with their implant-supported restorations. Implant and restoration success rates and complication incidence were confirmed by long-term data in the oral implant literature.

Purpose: To prospectively assess marginal bone loss and implant survival with Astra Tech (Dentsply Sirona, Charlotte, NC, USA) (group A) and Brånemark (Nobel Biocare, Zurich, Switzerland) (group B) implants in a split-mouth study conducted over a 20-year follow-up period. Materials and methods: A total of 95 implants (n = 50, group A and n = 45, group B) were randomly placed in the left or right side of the maxilla or mandible in 18 patients. Clinical and radiographic examinations were performed, and results were reported at 5, 10, 15 and 20 years after insertion of the prosthesis. Results: Ten patients were followed up for 20 years (n = 26 implants, group A and n = 25 implants, group B). No implant loss or prosthetic failures were observed. After 20 years of follow-up, no significant differences in marginal bone loss were found between both implant groups (P = 0.25). The proportion of marginal bone loss ≥ 0.5 mm was not significantly different between implant types (P > 0.05), and no statistically significant relationships were found between marginal bone loss and time (P ≥ 0.05). More specifically, there was no significant difference in marginal bone level between year 20 and baseline in group A (P = 0.70), whereas a difference of 0.5 to 1.0 mm was found in group B (P = 0.15). Conclusions: After 20 years of follow-up, marginal bone loss around screw-shaped titanium implants was clinically insignificant. Furthermore, no significant differences in survival and marginal bone loss were found between group A and B implants over the follow-up period. Keywords: bone remodelling, implant system, marginal bone level, osseointegration, split-mouth design Conflict-of-interest statement: The authors declare there are no conflicts of interest relating to this study.

Purpose: Sinus floor elevation (SFE) and simultaneous implant placement is predictable and reproducible. However, the graft material for the antral cavity remains a topic of debate. Considering the high osteogenic potential of the sinus membrane, most graft materials are generally accepted. This study aimed to assess the outcome of simultaneous SFE and implant placement, using leukocyte- and platelet-rich fibrin (L-PRF) as a sole graft material. Materials and Methods: This study was designed as a single cohort prospective study. Clinical and radiographic measurements (cone beam computed tomography [CBCT]) were performed immediately after implant placement and at abutment connection (6 months later). The amount of newly formed bone was linearly recorded on cross-sectional images. Four measurements (mesial, distal, buccal, palatal) were registered with the axis of the implant as reference. Results: Six lateral and 22 transalveolar SFEs were performed in 26 patients with simultaneous implant placement. Six months after surgery, 27/29 implants were clinically integrated. The mean vertical bone gain was 3.4 ± 1.2 mm and 5.4 ± 1.5 mm for transalveolar SFE and lateral SFE, respectively. The level of the new sinus floor was in all cases in continuation with the apex of the implant, and the peri-implant crestal bone height was stable. Conclusion: L-PRF as a sole graft material during simultaneous SFE and implant placement proved to be a practical, safe, and economical subsinus graft material, resulting in natural bone formation.

Purpose: The leukocyte- and platelet-rich fibrin block (L-PRF block) is a composite graft that combines a xenograft that is acting as a scaffold with L-PRF membranes that serve as a bioactive nodule with osteoinductive capacity. This study evaluated the properties of the L-PRF block and its components in terms of release of growth factors, cellular content, and structure. Materials and Methods: The concentration of transforming growth factor-β1 (TGF-β1), vascular endothelial growth factor (VEGF), platelet-derived growth factor-AB (PDGF-AB), and bone morphogenetic protein-1 (BMP-1) released by an L-PRF membrane and an L-PRF block were examined with ELISA for five time intervals (0 to 4 hours, 4 hours to 1 day, 1 to 3 days, 3 to 7 days, 7 to 14 days). Those levels in L-PRF exudate and liquid fibrinogen were also evaluated. The cellular content of the liquid fibrinogen, L-PRF membrane, and exudate was calculated. The L-PRF block was also analyzed by means of a microcomputed tomography (micro-CT) scan and scanning electron microscopy (SEM). Results: TGF-β1 was the most released growth factor after 14 days, followed by PDGF-AB, VEGF, and BMP-1. All L-PRF blocks constantly released the four growth factors up to 14 days. L-PRF membrane and liquid fibrinogen presented high concentrations of leukocytes and platelets. The micro-CT and SEM images revealed the bone substitute particles surrounded by platelets and leukocytes, embedded in a dense fibrin network. Conclusion: The L-PRF block consists of deproteinized bovine bone mineral particles surrounded by platelets and leukocytes, embedded in a fibrin network that releases growth factors up to 14 days. Keywords: blood platelets, cell count, fibrinogen, growth factors, scanning electron microscopy, tissue engineering

Purpose: Osteotome sinus floor elevation (OSFE) is a technique aimed at simplifying implant placement in the posterior atrophic maxilla. The necessity of bone grafting under the elevated sinus membrane has been widely debated. The aim was to compare the evolution over 5 years of implant stability in sites grafted or left ungrafted. Materials and methods: A total of 12 patients (9 female and 3 male) presenting ≤ 4 mm initial bone height (IBH) in the posterior maxillary sites were recruited. Implants (n = 37) were placed using OSFE. According to the randomisation, the sinuses received either bone graft (n = 20, control group) or no graft (n = 17, test group). Patients received both these treatments when both sinuses fulfilled the inclusion criteria. Control assessments were performed 1 week, 10 weeks, 12 weeks, and then 1 year, 3 years and 5 years after the implant placement. Periapical radiographs were taken and the implant stability quotient (ISQ) was measured at different time points. Results: At implant surgery, the mean ISQ was 58.9 ± 11.2 for the test group and 53.8 ± 10.2 for the control group; it plummeted 10 weeks after the implant placement and rose thereafter. Five years after the implant placement, the mean ISQ reached 80.8 ± 4.2 for the control group, and 79.7 ± 4.3 for the test group. The difference between the groups was not significant. The IBH significantly affected implant stability at implant insertion and 5 years after the implant insertion, but not at the other time points. Conclusions: The implants performed using OSFE in ungrafted sites were as stable as the implants placed in grafted sites. Keywords: bone graft, implant stability quotient (ISQ), osteotome sinus floor elevation (OSFE), posterior maxilla, resonance frequency analysis (RFA) Conflict of interest statement: All authors report no conflict of interest.

Aim: The objective of this systematic review was to evaluate the diagnostic value of CBCT compared with 2D imaging and clinical gold standard techniques in peri-implant bone defect detection and measurement. Materials and methods: Literature search was performed using MEDLINE, Embase and Web of Science databases up to July 2017. Clinical, ex vivo, in vitro and animal studies that assessed and measured peri-implant bone defects using different imaging modalities were included in this review. Two reviewers performed data extraction and qualitative analysis. The methodological quality of each study was reviewed using the QUADAS-2 tool. Results: The initial search revealed 2849 unique papers. Full-text analysis was performed on 60 articles. For the present review, nine studies were considered eligible to be included for qualitative analysis. CBCT performed similar to intraoral radiography in mesiodistal defect detection and measurements. Additional buccolingual visualisation and volumetric and morphological assessment of peri-implant bone defects are major advantages of 3D visualisation with CBCT. Nevertheless, one must be aware of metal artefacts masking osseointegration, shallow bony defects and other peri-implant radiolucencies, thus impeding early diagnosis of intrabony lesions. Conclusions: The present review did not provide evidence to support the use of CBCT as standard postoperative procedure to evaluate peri-implant bone. Up to date, we are clinically forced to remain with intraoral radiography, notwithstanding the inherent limitations related to restricted field of view and two-dimensional overlap. A 3D imaging approach for postoperative implant evaluation is crucial, making further development of an optimised and artefact-free CBCT protocol indispensable. Keywords: bone defects, CBCT, imaging, implant dentistry, peri-implantitis

Objective: To describe a case of breast carcinoma metastasis combined with pulpitis-like pain complaints in a mandibular molar. Although metastasis from distant sites to the mandible is unusual, it should be considered in the differential diagnosis of patients referred for endodontic treatment. Summary: A 54-year-old female with carcinoma of the breast was referred to the endodontic department for root canal treatment of tooth 47. After endodontic treatment, her pain disappeared, but periodontal problems persisted. Because hypoesthesia of the lip and chin, in combination with periodontal complaints, were noticed during follow-up appointments, a more aggressive process was suspected. Additional investigations with cone beam computed tomography (CBCT) and magnetic resonance imaging (MRI) revealed a metastasis in the mandibular molar area. Metastatic carcinomas may rarely mimic pulpal or periapical pathology. Failure to diagnose them may result in serious consequences for the patient. Patients with a history of malignancy and suffering from oral pain that is not completely resolved after therapy should undergo specific diagnostic tests to exclude a neoplastic aetiology for their symptoms. Interpretation: Follow-up of endodontic treatments is necessary to see if symptoms dissolve and to consider if the diagnosis should be modified. Endodontists are well qualified to detect oral metastases. Metastases from distant sites to the oral cavity are uncommon, but should be considered in the differential diagnosis. Keywords: endodontic diagnosis, endodontic-periodontal relations, metastasis Conflict-of-interest statement: The authors declare there are no conflicts of interest in this study.