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Clinical and Radiological Outcomes for Guided Implant Placement in Sites Preserved with Bioactive Glass Bone Graft after Tooth Extraction: A Controlled Clinical Trial

Clinical and Radiological Outcomes for Guided Implant Placement in Sites Preserved with Bioactive... Article Clinical and Radiological Outcomes for Guided Implant Placement in Sites Preserved with Bioactive Glass Bone Graft after Tooth Extraction: A Controlled Clinical Trial 1 1, 1 2 3 Priyanka Baskaran , P.S.G. Prakash *, Devapriya Appukuttan , Maryam H. Mugri , Mohammed Sayed , 1 4 5 3 Sangeetha Subramanian , Mohammed Hussain Dafer Al Wadei , Zeeshan Heera Ahmed , Harisha Dewan , 3 6 7 8 9, Amit Porwal , Thodur Madapusi Balaji , Saranya Varadarajan , Artak Heboyan , Gustavo V. O. Fernandes * 10, and Shankargouda Patil * Department of Periodontology and Oral Implantology, SRM Dental College, Ramapuram Campus, Chennai 600089, India; pbaskaran94@gmail.com (P.B.); devapriyamds@gmail.com (D.A.); sangeetha_doc@yahoo.com (S.S.) Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Jazan University, Jazan 45412, Saudi Arabia; dr.mugri@gmail.com Department of Prosthetic Dental Sciences, College of Dentistry, Jazan University, Jazan 45412, Saudi Arabia; Citation: Baskaran, P.; Prakash,P drsayed203@gmail.com (M.S.); harisha.dewan@yahoo.com (H.D.); aporwal2000@gmail.com (A.P.) Department of Restorative Dental Science, King Khalid University, Abha, 61421, Saudi Arabia; Appukuttan, D.; Mugri, M.H.; moalwadai@kku.edu.sa Sayed, M.; Subramanian, S.; Department of Restorative Dental Sciences, College of Dentistry, King Saud University, Al Wadei, M.H.D.; Ahmed, Z.H.; Riyadh 11451, Saudi Arabia; aheera@ksu.edu.sa Dewan, H.; Porwal, A.; et al. Clinical Tagore Dental College and Hospital, Chennai 600089, India; tmbala81@gmail.com and Radiological Outcomes for Department of Oral Pathology and Microbiology, Sri Venkateswara Dental College and Hospital, Guided Implant Placement in Sites Chennai 600089, Tamil Nadu, India; vsaranya87@gmail.com Preserved with Bioactive Glass Bone 8 Department of Prosthodontics, Faculty of Stomatology, Yerevan State Medical University after Mkhitar Graft after Tooth Extraction: A Con- Heratsi, Str. Koryun 2, Yerevan 0025, Armenia; heboyan.artak@gmail.com trolled Clinical Trial. Biomimetics Periodontics and Oral Medicine Department, University of Michigan School of Dentistry, Ann Arbor, MI 48109, USA; gustfern@umich.edu 2022, 7, 43. https://doi.org/10.3390/ Department of Maxillofacial Surgery and Diagnostic Sciences, Division of Oral Pathology, biomimetics7020043 College of Dentistry, Jazan University, Jazan 45142, Saudi Arabia Academic Editor: Mehmet Sarikaya * Correspondence: akashpsg@gmail.com (P.S.G.P.); gustfern@umich.edu (G.V.O.F.); dr.ravipatil@gmail.com (S.P.) Received: 20 February 2022 Accepted: 25 March 2022 Abstract: The goal of the study was to evaluate marginal bone loss (MBL) after 1-year implant place- Published: 13 April 2022 ment using a guided implant surgical (GIS) protocol in grafted sockets compared to non-grafted Publisher’s Note: MDPI stays neu- sites. We followed a parallel study design with patients divided into two groups: grafted group tral with regard to jurisdictional (Test group, n = 10) and non-grafted group (Control, n = 10). A bioactive glass bone graft was used claims in published maps and institu- for grafting. A single edentulous site with a minimum bone height ≥11 mm and bone width ≥6 mm tional affiliations. confirmed by cone-beam computerized tomography (CBCT) was chosen for implant placement. Tapered hybrid implants that were sandblasted and acid-etched (HSA) were placed using the GIS protocol and immediately loaded with a provisional prosthesis. MBL and implant survival rates (ISR) were assessed based on standardized radiographs and clinical exams. Patients were followed Copyright: © 2022 by the authors. Li- up for 1-year post-loading. MBL after one year, in the control group, was −0.31 mm ± 0.11 mm (me- censee MDPI, Basel, Switzerland. sial) and −0.28 mm ± 0.09 mm (distal); and in the test group was −0.35 mm ± 0.11 mm (mesial) and This article is an open access article −0.33 mm ± 0.13 mm (distal), with no statistical significance (p > 0.05). ISR was 100% in both groups distributed under the terms and con- after one year. ISR was similar between groups and the marginal bone changes were comparable ditions of the Creative Commons At- tribution (CC BY) license (https://cre- one year after functional loading, without statistical significance, suggesting that bioactive glass ativecommons.org/licenses/by/4.0/). permitted adequate bone formation. The GIS protocol avoided raising flaps and provided a better position to place implants, preserving the marginal bone around implants. Keywords: bioactive glass; CBCT; dental implants; flapless technique guided implant surgery; implant planning; minimally invasive surgical technique; surgical guides Biomimetics 2022, 7, 43. https://doi.org/10.3390/biomimetics7020043 www.mdpi.com/journal/biomimetics Biomimetics 2022, 7, 43 2 of 12 1. Introduction The post-extraction remodeling of the alveolar socket can exert horizontal and verti- cal dimensional changes on the underlying bone [1,2]. The preservation of the extraction socket is vital to prevent potential morbidity and collapse in the implant sites [3]. Various socket preservation techniques, such as bone grafts with or without membranes, have been studied and implemented, demonstrating predictable outcomes by retaining the ridge dimensions for implant fixture placement [4]. Bioactive glass is a time-tested regenerative biomaterial with osteoconductive prop- erties. It has the advantages of enhanced biocompatibility, resorption at the right time, ion leaching properties, and the conduciveness to support the migration and proliferation of osteogenic cells [5]. The grafting material used for socket augmentation prior to implant placement was a synthetic bioactive bone graft material (NovaBone® Dental Morsels, No- vaBone Products, Alachua, Fl,USA) with calcium phosphosilicate as the active compo- nent. The material is osteostimulatory and the osteoconductive composite of bioceramic containing oxides of silicon, calcium, sodium, and phosphorous [6]. The material, once placed into the socket, comes into contact with the aqueous body fluid initiating chemical reaction at the surface of the graft. There is a release of sodium, silica, calcium, and phos- phate ions. The silica released forms silanol groups (Si-OH) on the surface which repoly- merize into a silica-rich layer; simultaneously, there is the precipitation of amorphous cal- cium phosphates which undergo crystallization into hydroxyl carbonate apatite. This stimulates osteoblast recruitment, proliferation, and differentiation. Furthermore, contin- uous ion release transforms the graft material into a porous scaffold that promotes new bone formation [7–10]. Fiorelliniet al. [11], based on their systematic review, suggested that implants placed in grafted edentulous sites using the conventional placement technique had an implant survival rate (ISR) comparable to implants placed on a native bone (without bone grafts). Similarly, Urban et al. [12] observed a 100% cumulative implant survival rate at six years post-loading in thirty-six previously grafted sites. The quality and quantity of the available alveolar bone determine the long-term sta- bility of implants. In recent times, the outcome of therapy has been evaluated based on implant survival and minimal marginal bone loss (MBL) post-functional loading. Barone et al. [13] and Simion et al. [14] suggested that sockets that received bone grafts were re- stored with implants that had greater marginal bone loss. Standardizing implant placement can overcome the drawbacks of conventional sur- geries, such as improper angulation and the incorrect positioning of dental implants. Ex- tensive flap elevation can decrease the supra-periosteal blood supply [15]. Guided implant surgery could offer a solution to these challenges. GIS is a process of planning the implant surgery based on CBCT and computer-aided design (CAD)/computer-assisted navigation technology. It is a routine clinical procedure with a predictable outcome and high success rate. A fully guided surgical implant protocol employs a surgical guide to assist the clini- cian, from the initial step (osteotomy) to implant placement, using driving sleeves innately present within the guide. Surgical guides provide higher predictability and accuracy in transferring the virtual implant position to the patient’s mouth compared to half-guided surgery [16]. A major advantage of the GIS technique is that the blood vessels around the implants are preserved, as there is no flap elevation. This helps in reducing MBL. Tal- laricoet al. observed lower MBL rates with computer-guided implant placement com- pared to conventional implant placement [17]. Reducing MBL rates is an important factor for implant survival. The use of GIS could result in reduced MBL. This study aimed to evaluate and compare the MBL and implant survival rates (ISR) in graft sites with a bioactive glass, one year after implant placement, using a GIS protocol with immediate functional loading compared to sites without graft- ing. Biomimetics 2022, 7, 43 3 of 12 2. Materials and Methods 2.1. Trial Design The study was conducted after receiving ethical clearance from the Institutional Re- view Board (SRMDC/IRB/2018/MDS/No.502) SRM Dental College, Chennai, India. This study followed a prospective controlled clinical trial (CCT) design based on a cohort of consecutive patients with an allocation ratio of 1:1. Patients were recruited from the out- patient clinics of the Department of Periodontology, SRM Dental College. Written in- formed consent was obtained from all participants after a thorough explanation of the aims and objectives of the study. All interventions were in accordance with the ethical standards of the revised Helsinki Declaration for Biomedical Research involving human subjects. This clinical trial was registered at Clinicaltrials.gov (ID:CTRI/2019/09/021168). The present study was reported based on the CONSORT statement [18], and followed the EQUATOR guidelines. 2.2. Sample Size Calculation A sample size calculation was done based on results from an earlier study by Pozzi et al. [19], with 5% alpha error and 80% power based on MBL measurements, with ten implants per group for a total of 20 implants. 2.3. Inclusion and Exclusion Criteria Inclusion criteria were: (i) age between 19–50 years; (ii) good oral hygiene and stable periodontal status; (iii) single edentulous sites with healthy teeth on both sides; (iv) mini- mum bone height ≥11 mm and bone width ≥ 6 mm during baseline CBCT evaluation; (v) willingness to participate in the study and comply with the necessary study requirements, including follow-up for one year. Exclusion criteria included (i) patients with a habit of chronic intake of analgesics; (ii) patients under treatment with bisphosphonates and corticosteroids; (iii) current smokers (>10 cigarettes per day); (iv) loss of any bony wall during the extraction or augmentation; (v) extraction sites associated with failed endodontic treatment; (vi) trauma associated fracture and sub-gingivally extending fracture lines that cannot be endodontically re- stored; (vii) tooth with poor prognosis; (viii) residual root stumps; (ix) pregnant and lac- tating female patients; (x) untreated periodontitis; (xi) presence of parafunctional habits; (xii) immunocompromised patients; (xiii) active infection or severe inflammation at the site of implant placement, evaluated by the presence of purulent secretion. 2.4. Blinding The operator and primary outcome assessors were blinded regarding the recruitment and the sites included in the study (both groups). The patients were not blinded to the intervention. 2.5. Implants A total of twenty dental implants (n = 20), tapered hybrid sandblasted and acid- etched (HSA, Dio-Navi , Busan, Korea), were placed in patients with single edentulous sites which had previously been subjected to tooth extraction. The sites were clinically divided according to whether they received bioactive glass bone graft (Calcium Phospho- silicate [CPS] morsels (NovaBone Morsels, Alachua, FL, USA) (test group, n = 10) or fol- lowed the natural healing process (i.e., non-grafted sites) (control group, n = 10). The study protocol flow chart is illustrated in Figure 1. Biomimetics 2022, 7, 43 4 of 12 Figure 1. Schematic representation of the study protocol. 2.6. Interventions A single experienced surgeon (P.S.G.) performed the surgical procedures. The clini- cal and radiographic parameters were recorded individually by two different investiga- tors (J.C., A.K.) who were blinded to the recruitment and procedures. The sites chosen for Biomimetics 2022, 7, 43 5 of 12 implantation received previously bioactive glass bone grafts or followed natural healing after extraction. After six months, the patients underwent implant placement following a specific protocol. After administering local anesthesia (2% lidocaine with 1:80000 adrenaline), the pa- tient was asked to rinse the mouth with 0.12% chlorhexidine solution for 30 s. The surgical guide was placed in position and stabilized over the patient’s teeth. The guide had been prepared earlier using a three-dimensional guided navigation software (CBCT). The GIS kit was used to prepare the osteotomy sites for implant placement. The pilot drill was initially driven through the sleeve present in the surgical guide following the manufac- turer’s instructions. Subsequent osteotomies were carried out using the drilling protocol provided by the manufacturer. Once the final osteotomy was carried out, implant inser- tion was done through the sleeve in the surgical guide with an insertion torque greater than 35 N.cm using an implant driver. All the implants were placed equi-crestally. The stability was measured after remov- ing the surgical guide, followed by the placement of a prosthetic abutment, and was re- stored functionally (Figure 2). The same surgical protocol was observed for both the con- trol and test groups. All patients received postoperative instructions. Patients were in- structed to rinse with 0.2% chlorhexidine digluconate twice daily for two weeks. Analge- sic medications (Ibuprofen, 500 mg) were prescribed a day thrice for three days. Figure 2. (a) Superimposition of CBCT for surgical guide preparation; (b) Stabilization of the surgi- cal guide; (c) Osteotomy site preparation through the surgical guide using an initial pilot drill; (d) Subsequent osteotomies in the sequence of the drilling protocol; (e) Implant insertion; (f) Implant equi-crestally placed; (g) Abutment placed; (h) Provisional restoration. 2.7. Clinical and Radiographic Outcomes Clinical parameters evaluated were full-mouth plaque scores (F-MPS) [20], full- mouth bleeding scores (F-MBS) [21], site-specific plaque scores (S-SPS), site-specific bleed- ing scores (S-SBS), peri-implant sulcus depth (P-ISD) (using a plastic probe, Hu-Friedy [PCV11KIT12], with a probing force of 0.2 N to 0.3 N), along with peri-implant abutment attachment level (P-IAL) and position of relative gingival margin (PGM) [22]. A radiographic assessment of mean marginal bone loss (MBL) was performed with radiovisiography [23]. A standardization of the radiographs was performed using a cus- tomized silicon bite block to index the dentitions that are fixed with the metal bar of the holding device. Radiographs were obtained using a standardized long cone parallel tech- nique. The digital images obtained were superimposed using SOPRO Imaging (v. 2.40). The dimensions obtained measured the marginal bone loss (MBL) at the mesial and distal aspects. Biomimetics 2022, 7, 43 6 of 12 2.8. Follow-Up Clinical parameters of S-SPS, S-SBS, P-ISD, P-IAL, and PGM were evaluated at six months and 1-year post-functional loading. The MBL and implant survival rate (ISR) were assessed at 1-year post-functional loading (Figures 3a–e and 4a–d). Figure 3. (a) Evaluation of site-specific plaque score using a disclosing agent; (b) Evaluation of the site-specific bleeding score; (c) Measurement of peri-implant sulcus depth; (d) Measurement of peri- implant abutment attachment level; (e) Measurement of the position of the relative gingival margin. Biomimetics 2022, 7, 43 7 of 12 Figure 4. Measurement of marginal bone loss (MBL). (a) Immediately post-functional loading (Con- trol); (b) 1-year post-functional loading (Control); (c) Immediately post-functional loading (test); (d) 1-year post-functional loading (Test). 2.9. Statistical Analysis Data management and analysis were performed using Statistical Package for Social Science (SPSS, v.17, for Microsoft Windows). An independent t-test was applied for the intergroup comparison of F-MPI, F-MBI, P-ISD, PGM, MBL, and ISR. Mann–Whitney test U was applied for an intergroup comparison of S-SPS, and S-SBS. A comparison of all the clinical and radiographic parameters within the groups was analyzed through paired t- test and Wilcoxon signed-rank test. Pearson’s correlation coefficient test correlated the clinical and radiographic parameters of both the control and test groups. In all the statis- tical tests, a p-value ≤ 0.05 was considered to be significant. 3. Results Twenty-four edentulous sites requiring implant placement in the anterior or pre-mo- lar sites were selected between February 2019 and April 2019. After phase I therapy, pa- tients willing to participate in the whole study period and fill out the inclusion criteria were categorized into two groups. However, two patients in each group declined the par- ticipation, thus resulting in a total of 20 patients, with 10 in each group. The parameters were evaluated at three intervals (baseline, after six months, and after 1-year post func- tional loading). Uniform sample distribution was evident in both groups based on age and gender distribution, as no statistically significant difference was observed (p > 0.05). Clinical parameters, such as S-SPS and S-SBS in the control and test groups, did not show any statistical differences between time points, indicating a healthy peri-implant tissue during loading and a proper peri-implant maintenance post-loading (p > 0.05). In the control group, PISD decreased at one year (3.23 mm ± 0.26 mm) from baseline (3.44 mm ± 0.29 mm), and from 6 months (3.40 mm ± 0.24 mm). Similarly, the relative position of the gingival margin showed statistically significant gains at one year (2.50 mm ± 0.52 Biomimetics 2022, 7, 43 8 of 12 mm) compared to the baseline (3.20 mm ± 0.63 mm), and at six months (2.90 mm ± 0.56 mm). It indicates a significant coronal creeping of the peri-implant mucosa at the one year period in the control group (p < 0.05) (Table 1). Table 1. Intragroup comparison of clinical parameters between baseline, 6 months, and 1 year in control and test group. Clinical Parameter Timeline Control Test Between baseline to 6 months 0.31 0.00 Site-Specific Plaque Score Between baseline to 1 year 0.15 −1.41 (S-SPS) (%) Between 6 months to 1 year 0.31 −1.00 Between baseline to 6 months 0.31 0.00 Site-Specific Bleeding Score Between baseline to 1 year 0.15 −1.41 (S-SBS) (%) Between 6 months to 1 year 0.31 −1.00 Between baseline to 6 months 0.12 0.16 Peri-Implant Sulcus Depth Between baseline to 1 year 0.01 * 0.003 * (PISD) (mm) Between 6 months to 1 year 0.01 * 0.003 * Between baseline to 6 months 0.08 0.03 * Relative Position of Gingival Margin Between baseline to 1 year 0.01 * 0.01 * (PGM) (mm) Between 6 months to 1 year 0.03 * 0.08 * p < 0.05 was considered as statistically significant. In the test group, P-ISD significantly decreased at one year (3.27 mm ± 0.34 mm) post- loading and was considerably lower compared to the baseline (3.45 mm ± 0.35) and at six months (3.42 mm ± 0.39 mm). The relative position of the gingival margin (PGM) showed a significant gain at six months and one year compared to the baseline (3.40 mm ± 0.51 mm). It indicates a coronal creeping of the peri-implant mucosa during the one-year fol- low-up (p < 0.05) (Table 1). The intergroup comparison of the clinical parameters such as S-SPS, S-SBS, P-ISD, and PGM at baseline, six months, and one year revealed no significant differences (p > 0.05). These data suggest that patients from both groups had good oral hygiene habits and maintained plaque control measures. There was decreased plaque accumulation and the subjects were free from active peri-implant diseases, leading to an improved soft tissue attachment level (Table 2). Table 2. Intergroup comparison of clinical parameters at 6 months and 1 year. Parameter Timeline Control Test p-Value 6 months 15.00 ± 12.91 12.50 ± 13.17 0.66 S-SPS 1 year 17.50 ± 12.07 17.50 ± 12.07 1.00 6 months 15.00 ± 12.91 12.50 ± 13.17 0.66 S-SBS 1 year 17.50 ± 12.07 17.50 ± 12.07 1.00 6 months 3.40 ± 0.24 3.42 ± 0.39 0.11 PISD 1 year 3.23 ± 0.26 3.27 ± 0.34 0.52 6 months 2.90 ± 0.56 3.00 ± 0.66 0.85 PGM 1 year 2.50 ± 0.52 2.70 ± 0.48 0.20 Marginal bone loss (MBL) was compared between groups at one-year post-loading. Both the groups showed similar MBL at the mesial and distal aspects at 1-year post-load- ing, i.e., 0.31 mm in the mesial aspect and 0.28 mm in the distal aspect of the control group; and 0.35 mm in the mesial and 0.33 mm in the distal part of the test group, without any statistical significance (p > 0.05). This indicates that the bone levels had shifted apically with a minimal and comparable amount of MBL in both groups (Table 3). Biomimetics 2022, 7, 43 9 of 12 Table 3. Comparison of mean marginal bone loss (MBL) changes between control and test group after one year. Period Parameter Group Mean ± Sd F-Value p-Value (Year) Mesial mean MBL Control 0.31 ± 0.11 1 0.01 0.89 (M-MBL) (mm) Test 0.35 ± 0.11 Distal mean MBL Control 0.28 ± 0.09 1 1.90 0.18 (D-MBL) (mm) Test 0.33 ± 0.13 MBL = Marginal bone loss. When correlating the clinical with radiographic parameters, the results were nega- tively correlated with S-SPS, S-SBS, and P-ISD with MBL. The results showed a positive correlation between the relative position of the gingival margin and MBL. However, none of these comparisons approached statistical significance (p > 0.05) (Table 4). Table 4. Pearson’s correlation of clinical and radiographic parameters at one year in the control and test group. Radiographic Parameter Mesial Mean Distal Mean Clinical Parameters Crestal Bone Level Crestal Bone (M-MCBL) Level (D-MCBL) R-value −0.19 −0.11 Site-specific Plaque CONTROL p-value 0.59 0.74 score R-value 0.08 −0.003 (S-SPS) TEST p-value 0.80 0.99 R-value −0.19 −0.11 Site-specific Bleeding CONTROL p-value 0.59 0.74 Score R-value 0.08 −0.003 (S-SBS) TEST p-value 0.80 0.99 R-value −0.56 −0.51 Peri Implant Sulcus CONTROL p-value 0.09 0.12 Depth R-value 0.15 0.11 (PISD) TEST p-value 0.67 0.74 R-value 0.14 0.21 Relative Position of CONTROL p-value 0.69 0.54 Gingival Margin R-value 0.04 0.27 (PGM) TEST p-value 0.89 0.44 4. Discussion Dental implants serve to provide predictable long-term restorative solutions for missing teeth. Minimizing damage to the underlying alveolar bone can serve to enhance the success and survival rate of dental implants. Several strategies are used to prevent alveolar bone resorption, including atraumatic flapless tooth extraction [24], bone grafts, membranes, and additional surgical procedures [25]. This study assessed the implant sur- vival rate (ISR) and marginal bone loss (MBL) in mesial and distal sites of dental implants placed with guided implant surgical protocol (GIS) in sockets with bioactive glass grafts compared to non-grafted sites after one year of functional loading. Our findings showed that both groups had similar marginal bone loss in the mesial and distal aspects. Pozziet al. (2014) [19] observed an MBL of 0.80mm in the conventional group and 0.71mm in the computer-guided group after one year of loading, which depicted less bone loss for the computer-guided group. Similarly, Tallaricoet al. (2018) [17] found that computer-guided Biomimetics 2022, 7, 43 10 of 12 implant placement reduced the marginal bone loss compared to the free-hand placement over a five-year follow-up after implant placement. The computer-guided group had sig- nificantly lower MBL, with a difference of 0.2mm at 1-year and 0.4mm at 5-year post- loading. These findings broadly support our result that GIS may help limit marginal bone loss. The type of surgical procedure may play a large role in bone remodeling. Maintain- ing the architecture of the tissues (soft and hard) around the dental implant and respecting the dynamism of the bone in the healing/remodeling process are critical drivers for suc- cess [26]. Using GIS may help to overcome possible drawbacks of the conventional im- plant placement by avoiding flap elevation, enabling proper angulation, and the accurate positioning of the implants. This is conducive to immediate functional loading, allowing a better remodeling of the underlying local tissues. This can minimize bone loss and help in long-term stability. Another variable examined was the implant survival rate (ISR). The recent literature reveals that dental implants have a high implant survival rate (96.4%) at ten years post- placement [27]. In this study, we assessed ISR after one year of post-functional loading. The ISR was similar for both groups, with a 100% survival rate. Tallarico et al. [17] and Pozzi et al. [19] demonstrated similar results, highlighting 100% ISR for the computer- guided group. Bone remodeling directly affects the primary implant stability. Stability is deter- mined by the quality and quantity of bone, the type of implant (geometry, diameter, length, and surface characteristics), and surgical techniques [28,29]. The biomaterial used in grafting may influence secondary stability. Bone graft materials are involved in peri- implant bone remodeling and osteoconduction [30,31], leading to new bone formation at the implant surface [32]. The dental implant used in this study was the tapered hybrid, sandblasted and acid-etched (HSA). Sandblasting and acid-etching techniques improved the bone-to-implant contact (BIC), positively affecting implant stability and reducing bone loss. A study based on the sandblasting technique demonstrated that it accentuated and stimulated osteoblasts to adhere to the implant surface, thereby increasing the rates of bone formation [33]. Similarly, acid-etched implants have also shown high survival rates up to 92.9% in long-term follow-up studies with 17 years of observation [33]. The regenerative material used in the present study was bioactive glass morsels. It has osteoconductive activity and serves as a scaffold. Bioactive glass has a brittle structure and has been termed a supercooled liquid. When bioactive glass morsels contact body fluids, they undergo ionic dissolution and glass degradation. The consequent rise in pH of the local microenvironment favors bone regeneration causing enhanced osteoid for- mation and mineralization [10]. Our findings may be partly due to the high quality of the implant characteristic, regenerative material used, and GIS protocol. The well-preserved extraction socket underwent natural and favorable healing, offering the best environment for plentiful osteoblasts to help in bone formation. The amount of bone healing was com- parable in both groups, indicating that bioactive glass is a promising scaffold material. Jung et al. [34] and Ten Heggeler et al. [35] reported that bone substitutes could limit the alveolar resorption after tooth extraction, but not prevent the alveolar bone's physiological resorption, especially in molar areas. Our findings suggest that either grafted and non-grafted groups had a reduced S-SPS and S-SBS, ensuring the presence of suitable connective tissue attachment, providing a low level of gingival inflammation. The progressive reduction of P-ISD and positive cor- onal shift in the PGM of both groups was evident, establishing a soft tissue barrier with the transmucosal component of the implant. Thus, it enhanced the resistance to probing, showed a better mucosal barrier, maintained a reduced P-ISD, and gained in the relative gingival margin position, leading to a reduced peri-implant attachment loss in both groups. The limitation of this study was that the sample size was relatively small at 20 sites. GIS is technique-sensitive. Beginners or less experienced clinicians could show operator bias. Future studies with greater sample sizes should analyze the clinical and radiological Biomimetics 2022, 7, 43 11 of 12 parameters over a long period to provide a fuller picture of the benefits of the GIS protocol in grafted sockets. Different implant designs and surfaces should also be examined to con- firm and validate these findings. 5. Conclusions Within the limitations of this study, the guided implant surgical (GIS) protocol ap- pears to be promising, and provides reliable, predictable treatment results, with a reduc- tion in marginal bone loss and improved implant survival rate. The GIS protocol avoided raising flaps and provided a better position to place implants, preserving the marginal bone around implants. The bioactive glass used for grafting permitted adequate bone for- mation and is a promising scaffolding material. Future research on GIS can serve to vali- date these findings and provide optimized, customized treatment plans for patients, lim- iting human error, and improving treatment outcomes. Author Contributions: Conceptualization, P.B., P.S.G.P., D.A.; methodology, M.H.M., M.S.; soft- ware, S.S., M.H.D.A.W.; validation, H.D., A.P.; formal analysis, T.M.B., S.V.; investigation A.H.; re- sources, G.V.O.F.; data curation, S.P.; writing—original draft preparation, P.B.,P.S.G.P., D.A., S.S., M.H.D.A.W., H.D., Z.H.A. and A.P.; writing—review and editing, T.M.B., S.V.,A.H., G.V.O.F., S.P.; visualization, P.B.; supervision, S.P.; project administration, P.S.G.P. All authors have read and agreed to the published version of the manuscript. Funding: This research received no external funding. Institutional Review Board Statement: The study was conducted in accordance with the ethical standards of the revised Helsinki Declaration for Biomedical Research involving human subjects and approved by the Institutional Review Board of SRM Dental college, Chennai, India (SRMDC/IRB/2018/MDS/No.502) Informed Consent Statement: Informed consent was obtained from all subjects involved in the study and writted informed consent was taken from all patients. Data Availability Statement: Not applicable. Acknowledgments: The authors thank the radiographic parameter assessor (A. Kannan, MDS) from the Department of Oral Medicine and Radiology, SRM Dental College, Ramapuram, Chennai, for his valuable support and help during the clinical trial. Conflicts of Interest: The authors declare no conflict of interest. References 1. Pietrokovski, J.; Massler, M. Alveolar ridge resorption following tooth extraction. J. Prosthet. Dent. 1967, 17, 21–27. 2. Johnson, K. A study of the dimensional changes occurring in the maxilla following tooth extraction. Aust. Dent. J. 1969, 14, 241– 3. Iasella, J.M.; Greenwell, H.; Miller, R.L.; Hill, M.; Drisko, C.; Bohra, A.A.; Scheetz, J.P. Ridge preservation with freeze-dried bone allograft and a collagen membrane compared to extraction alone for implant site development: A clinical and histologic study in humans. J. Periodontol. 2003, 74, 990–999. 4. Avila-Ortiz, G.; Chambrone, L.; Vignoletti, F. Effect of alveolar ridge preservation interventions following tooth extraction: A systematic review and meta-analysis. J. Clin. Periodontol. 2019, 46 (Suppl. 2), 195–223. https://doi.org/10.1111/jcpe.13057. 5. Mahato, A.; Kundu, B.; Mukherjee, P.; Nandi, S.K. Applications of Different Bioactive Glass and Glass-Ceramic Materials for Osteoconductivity and Osteoinductivity. Trans. Indian Ceram. Soc. 2017, 76, 149–158. https://doi.org/10.1080/0371750X.2017.1360799. 6. Cannillo, V.; Salvatori, R.; Bergamini, S.; Bellucci, D.; Bertoldi, C. Bioactive Glasses in Periodontal Regeneration: Existing Strategies and Future Prospects—A Literature Review. Materials. 2022, 15, 2194. 7. Hench, L.L. The story of Bioglass®. J Mater Sci Mater Med. 2006, 17, 967–978. 8. Jones, J.R. Review of bioactive glass: from Hench to hybrids. Acta Biomater. 2013, 9, 4457–4486. 9. Bodhare, G.H; Kolte, A.P; Kolte, R.A. and Shirke, P.Y. Clinical and radiographic evaluation and comparison of bioactive bone alloplast morsels when used alone and in combination with platelet-rich fibrin in the treatment of periodontal intrabony defects—A randomized controlled trial. J Periodontol. 2019, 90, 584–594. 10. Skallevold, H.E.; Rokaya, D.; Khurshid, Z.; Zafar, M.S. Bioactive Glass Applications in Dentistry. Int J Mol Sci. 2019, 20, 5960. doi: 10.3390/ijms20235960. Biomimetics 2022, 7, 43 12 of 12 11. Fiorellini, J.P.; Nevins, M.L. Localized ridge augmentation/preservation. A systematic review. Ann. Periodontol. 2003, 8, 321–327. 12. Urban, I.A.; Jovanovic, S.A.; Lozada, J.L. Vertical ridge augmentation using guided bone regeneration (GBR) in three clinical scenarios prior to implant placement: A retrospective study of 35 patients 12 to 72 months after loading. Int. J. Oral Maxillofac. Implant. 2009, 24, 502–510. 13. Barone, A.; Orlando, B.; Cingano, L.; Marconcini, S.; Derchi, G.; Covani, U. A randomized clinical trial to evaluate and compare implants placed in augmented versus non-augmented extraction sockets: 3-year results. J. Periodontol. 2012, 83, 836–846. 14. Simion, M.; Jovanovic, S.A.; Tinti, C.; Benfenati, S.P. Long-term evaluation of osseointegrated implants inserted at the time or after vertical ridge augmentation: A retrospective study on 123 implants with 1-5 year follow-up. Clin. Oral Implant. Res. 2001, 12, 35–45. 15. Pisoni, L.; Ordesi, P.; Siervo, P.; Bianchi, A.E.; Persia, M.; Siervo, S. Flapless versus traditional dental implant surgery: Long- term evaluation of crestal bone resorption. J. Oral Maxillofac. Surg. 2016, 74, 1354–1359. 16. Bover-Ramos, F.; Viña-Almunia, J.; Cervera-Ballester, J.; Peñarrocha-Diago, M.; García-Mira, B. Accuracy of Implant Placement with Computer-Guided Surgery: A Systematic Review and Meta-Analysis Comparing Cadaver, Clinical, and In Vitro Studies. Int. J. Oral Maxillofac. Implant. 2018, 33, 101–115. 17. Tallarico, M.; Esposito, M.; Xhanari, E.; Caneva, M.; Meloni, S.M. Computer-guided vs freehand placement of immediately loaded dental implants: 5-year postloading results of a randomised controlled trial. Eur. J. Oral Implant. 2018, 11, 203–213. 18. Schulz, K.F.; Altman, D.G.; Moher, D. CONSORT 2010 statement: Updated guidelines for reporting parallel group randomised trials. Trials 2010, 11, 1–8. 19. Pozzi, A.; Tallarico, M.; Marchetti, M.; Scarfò, B.; Esposito, M. Computer-guided versus free-hand placement of immediately loaded dental implants: 1-year post-loading results of a multicentre randomised controlled trial. Eur. J. Oral Implant. 2014, 7, 229–242. 20. O’Leary, T.J.; Drake, R.B.; Naylor, J.E. The plaque control record. J. Periodontol. 1972, 43, 38. 21. Ainamo, J.; Bay, I. Problems and proposals for recording gingivitis and plaque. Int. Dent. J. 1975, 25, 229–235. 22. Sathya Ramanathan, B.D.S.; Prakash, M.P.; Appukuttan, M.D.; Sangeetha Subramanian, B.D.S.; Victor, D.J. Microbial Assessment of Two Different Abutment Designs in Peri-implant Sulcus and Implant Abutment Interface: A Case Control Postloading Study. Int. J. Periodontics Restor. Dent. 2020, 40, e119-26. 23. Fernández, A.F.; Mahmud, A.-A.F.J.; Carrió, C.P.; Oltra, D.P.; Conejero, J.; Diago, M.P. Radiological assessment of peri-implant bone loss: A 12-month retrospective study. J. Clin. Exp. Dent. 2011, 5, e430-4. 24. Fickl, S.; Zuhr, O.; Wachtel, H.; Bolz, W.; Huerzeler, M. Tissue alterations after tooth extraction with and without surgical trauma: A volumetric study in the beagle dog. J. Clin. Periodontol. 2008, 35, 356–363. https://doi.org/10.1111/j.1600-051X.2008.01209.x. 25. Kotsakis, G.; Chrepa, V.; Marcou, N.; Prasad, H.; Hinrichs, J. Flapless alveolar ridge preservation utilizing the “socket-plug” technique: Clinical technique and review of the literature. J. Oral Implant. 2014, 40, 690–698. https://doi.org/10.1563/AAID-JOI- D-12-00028. 26. Borges, H.; Correia, A.R.M.; Castilho, R.M.; Fernandes, G.V.O. Zirconia Implants and Marginal Bone Loss: A Systematic Review and Meta-Analysis of Clinical Studies. Int. J. Oral Maxillofac. Implant. 2020, 35, 707–720. https://doi.org/10.11607/jomi.8097. 27. Strnad, J.; Urban, K.; Povysil, C.; Strnad, Z. Secondary stability assessment of titanium implants with an alkali-etched surface: A resonance frequency analysis study in beagle dogs. Int. J. Oral Maxillofac. Implant. 2008, 23, 502–512. 28. Topcuoglu, T.; Bicakci, A.A.; Avunduk, M.C.; Sahin Inan, Z.D. Evaluation of the effects of different surface configurations on stability of miniscrews. Sci. World J. 2013, 2013, 396091. 29. Davies, J.E. Mechanisms of endosseous integration. Int. J. Prosthodont. 1998, 11, 39–401. 30. Raghavendra, S.; Wood, M.C.; Taylor, T.D. Early wound healing around endosseous implants: Review of the literature. Int. J. Oral Maxillofac. Implant. 2005, 20, 425–431. 31. Coelho, P.G.; Jimbo, R. Osseointegration of metallic devices: Current trends based on implant hardware design. Arch. Biochem. Biophys. 2014, 561, 99–108. 32. Velasco-Ortega, E.; Alfonso-Rodríguez, C.A.; Monsalve-Guil, L.; España-López, A.; Jiménez-Guerra, A.; Garzón, I.; Alaminos, M.; Gil, F.J. Relevant aspects in the surface properties in titanium dental implants for the cellular viability. Mater. Sci. Eng. C 2016, 64, 1–10. https://doi.org/10.1016/j.msec.2016.03.049. 33. Velasco-Ortega, E.; Jimenez-Guerra, A.; Monsalve-Guil, L.; Ortiz-Garcia, I.; Nicolas-Silvente, A.I.; Segura-Egea, J.J.; Lopez- Lopez, J. Long-Term Clinical Outcomes of Treatment with Dental Implants with Acid Etched Surface. Materials 2020, 13, 1553. https://doi.org/10.3390/ma13071553. 34. Jung, R.E.; Siegenthaler, D.W.; Hammerle, C.H. Postextraction tissue management: A soft tissue punch technique. Int. J. Periodontics Restor. Dent. 2004, 24, 545–553. 35. Ten Heggeler, J.M.; Slot, D.E.; Van der Weijden, G.A. Effect of socket preservation therapies following tooth extraction in non- molar regions in humans: A systematic review. Clin. Oral Implant. Res. 2010, 22, 779–788. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Biomimetics Multidisciplinary Digital Publishing Institute

Clinical and Radiological Outcomes for Guided Implant Placement in Sites Preserved with Bioactive Glass Bone Graft after Tooth Extraction: A Controlled Clinical Trial

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Article Clinical and Radiological Outcomes for Guided Implant Placement in Sites Preserved with Bioactive Glass Bone Graft after Tooth Extraction: A Controlled Clinical Trial 1 1, 1 2 3 Priyanka Baskaran , P.S.G. Prakash *, Devapriya Appukuttan , Maryam H. Mugri , Mohammed Sayed , 1 4 5 3 Sangeetha Subramanian , Mohammed Hussain Dafer Al Wadei , Zeeshan Heera Ahmed , Harisha Dewan , 3 6 7 8 9, Amit Porwal , Thodur Madapusi Balaji , Saranya Varadarajan , Artak Heboyan , Gustavo V. O. Fernandes * 10, and Shankargouda Patil * Department of Periodontology and Oral Implantology, SRM Dental College, Ramapuram Campus, Chennai 600089, India; pbaskaran94@gmail.com (P.B.); devapriyamds@gmail.com (D.A.); sangeetha_doc@yahoo.com (S.S.) Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Jazan University, Jazan 45412, Saudi Arabia; dr.mugri@gmail.com Department of Prosthetic Dental Sciences, College of Dentistry, Jazan University, Jazan 45412, Saudi Arabia; Citation: Baskaran, P.; Prakash,P drsayed203@gmail.com (M.S.); harisha.dewan@yahoo.com (H.D.); aporwal2000@gmail.com (A.P.) Department of Restorative Dental Science, King Khalid University, Abha, 61421, Saudi Arabia; Appukuttan, D.; Mugri, M.H.; moalwadai@kku.edu.sa Sayed, M.; Subramanian, S.; Department of Restorative Dental Sciences, College of Dentistry, King Saud University, Al Wadei, M.H.D.; Ahmed, Z.H.; Riyadh 11451, Saudi Arabia; aheera@ksu.edu.sa Dewan, H.; Porwal, A.; et al. Clinical Tagore Dental College and Hospital, Chennai 600089, India; tmbala81@gmail.com and Radiological Outcomes for Department of Oral Pathology and Microbiology, Sri Venkateswara Dental College and Hospital, Guided Implant Placement in Sites Chennai 600089, Tamil Nadu, India; vsaranya87@gmail.com Preserved with Bioactive Glass Bone 8 Department of Prosthodontics, Faculty of Stomatology, Yerevan State Medical University after Mkhitar Graft after Tooth Extraction: A Con- Heratsi, Str. Koryun 2, Yerevan 0025, Armenia; heboyan.artak@gmail.com trolled Clinical Trial. Biomimetics Periodontics and Oral Medicine Department, University of Michigan School of Dentistry, Ann Arbor, MI 48109, USA; gustfern@umich.edu 2022, 7, 43. https://doi.org/10.3390/ Department of Maxillofacial Surgery and Diagnostic Sciences, Division of Oral Pathology, biomimetics7020043 College of Dentistry, Jazan University, Jazan 45142, Saudi Arabia Academic Editor: Mehmet Sarikaya * Correspondence: akashpsg@gmail.com (P.S.G.P.); gustfern@umich.edu (G.V.O.F.); dr.ravipatil@gmail.com (S.P.) Received: 20 February 2022 Accepted: 25 March 2022 Abstract: The goal of the study was to evaluate marginal bone loss (MBL) after 1-year implant place- Published: 13 April 2022 ment using a guided implant surgical (GIS) protocol in grafted sockets compared to non-grafted Publisher’s Note: MDPI stays neu- sites. We followed a parallel study design with patients divided into two groups: grafted group tral with regard to jurisdictional (Test group, n = 10) and non-grafted group (Control, n = 10). A bioactive glass bone graft was used claims in published maps and institu- for grafting. A single edentulous site with a minimum bone height ≥11 mm and bone width ≥6 mm tional affiliations. confirmed by cone-beam computerized tomography (CBCT) was chosen for implant placement. Tapered hybrid implants that were sandblasted and acid-etched (HSA) were placed using the GIS protocol and immediately loaded with a provisional prosthesis. MBL and implant survival rates (ISR) were assessed based on standardized radiographs and clinical exams. Patients were followed Copyright: © 2022 by the authors. Li- up for 1-year post-loading. MBL after one year, in the control group, was −0.31 mm ± 0.11 mm (me- censee MDPI, Basel, Switzerland. sial) and −0.28 mm ± 0.09 mm (distal); and in the test group was −0.35 mm ± 0.11 mm (mesial) and This article is an open access article −0.33 mm ± 0.13 mm (distal), with no statistical significance (p > 0.05). ISR was 100% in both groups distributed under the terms and con- after one year. ISR was similar between groups and the marginal bone changes were comparable ditions of the Creative Commons At- tribution (CC BY) license (https://cre- one year after functional loading, without statistical significance, suggesting that bioactive glass ativecommons.org/licenses/by/4.0/). permitted adequate bone formation. The GIS protocol avoided raising flaps and provided a better position to place implants, preserving the marginal bone around implants. Keywords: bioactive glass; CBCT; dental implants; flapless technique guided implant surgery; implant planning; minimally invasive surgical technique; surgical guides Biomimetics 2022, 7, 43. https://doi.org/10.3390/biomimetics7020043 www.mdpi.com/journal/biomimetics Biomimetics 2022, 7, 43 2 of 12 1. Introduction The post-extraction remodeling of the alveolar socket can exert horizontal and verti- cal dimensional changes on the underlying bone [1,2]. The preservation of the extraction socket is vital to prevent potential morbidity and collapse in the implant sites [3]. Various socket preservation techniques, such as bone grafts with or without membranes, have been studied and implemented, demonstrating predictable outcomes by retaining the ridge dimensions for implant fixture placement [4]. Bioactive glass is a time-tested regenerative biomaterial with osteoconductive prop- erties. It has the advantages of enhanced biocompatibility, resorption at the right time, ion leaching properties, and the conduciveness to support the migration and proliferation of osteogenic cells [5]. The grafting material used for socket augmentation prior to implant placement was a synthetic bioactive bone graft material (NovaBone® Dental Morsels, No- vaBone Products, Alachua, Fl,USA) with calcium phosphosilicate as the active compo- nent. The material is osteostimulatory and the osteoconductive composite of bioceramic containing oxides of silicon, calcium, sodium, and phosphorous [6]. The material, once placed into the socket, comes into contact with the aqueous body fluid initiating chemical reaction at the surface of the graft. There is a release of sodium, silica, calcium, and phos- phate ions. The silica released forms silanol groups (Si-OH) on the surface which repoly- merize into a silica-rich layer; simultaneously, there is the precipitation of amorphous cal- cium phosphates which undergo crystallization into hydroxyl carbonate apatite. This stimulates osteoblast recruitment, proliferation, and differentiation. Furthermore, contin- uous ion release transforms the graft material into a porous scaffold that promotes new bone formation [7–10]. Fiorelliniet al. [11], based on their systematic review, suggested that implants placed in grafted edentulous sites using the conventional placement technique had an implant survival rate (ISR) comparable to implants placed on a native bone (without bone grafts). Similarly, Urban et al. [12] observed a 100% cumulative implant survival rate at six years post-loading in thirty-six previously grafted sites. The quality and quantity of the available alveolar bone determine the long-term sta- bility of implants. In recent times, the outcome of therapy has been evaluated based on implant survival and minimal marginal bone loss (MBL) post-functional loading. Barone et al. [13] and Simion et al. [14] suggested that sockets that received bone grafts were re- stored with implants that had greater marginal bone loss. Standardizing implant placement can overcome the drawbacks of conventional sur- geries, such as improper angulation and the incorrect positioning of dental implants. Ex- tensive flap elevation can decrease the supra-periosteal blood supply [15]. Guided implant surgery could offer a solution to these challenges. GIS is a process of planning the implant surgery based on CBCT and computer-aided design (CAD)/computer-assisted navigation technology. It is a routine clinical procedure with a predictable outcome and high success rate. A fully guided surgical implant protocol employs a surgical guide to assist the clini- cian, from the initial step (osteotomy) to implant placement, using driving sleeves innately present within the guide. Surgical guides provide higher predictability and accuracy in transferring the virtual implant position to the patient’s mouth compared to half-guided surgery [16]. A major advantage of the GIS technique is that the blood vessels around the implants are preserved, as there is no flap elevation. This helps in reducing MBL. Tal- laricoet al. observed lower MBL rates with computer-guided implant placement com- pared to conventional implant placement [17]. Reducing MBL rates is an important factor for implant survival. The use of GIS could result in reduced MBL. This study aimed to evaluate and compare the MBL and implant survival rates (ISR) in graft sites with a bioactive glass, one year after implant placement, using a GIS protocol with immediate functional loading compared to sites without graft- ing. Biomimetics 2022, 7, 43 3 of 12 2. Materials and Methods 2.1. Trial Design The study was conducted after receiving ethical clearance from the Institutional Re- view Board (SRMDC/IRB/2018/MDS/No.502) SRM Dental College, Chennai, India. This study followed a prospective controlled clinical trial (CCT) design based on a cohort of consecutive patients with an allocation ratio of 1:1. Patients were recruited from the out- patient clinics of the Department of Periodontology, SRM Dental College. Written in- formed consent was obtained from all participants after a thorough explanation of the aims and objectives of the study. All interventions were in accordance with the ethical standards of the revised Helsinki Declaration for Biomedical Research involving human subjects. This clinical trial was registered at Clinicaltrials.gov (ID:CTRI/2019/09/021168). The present study was reported based on the CONSORT statement [18], and followed the EQUATOR guidelines. 2.2. Sample Size Calculation A sample size calculation was done based on results from an earlier study by Pozzi et al. [19], with 5% alpha error and 80% power based on MBL measurements, with ten implants per group for a total of 20 implants. 2.3. Inclusion and Exclusion Criteria Inclusion criteria were: (i) age between 19–50 years; (ii) good oral hygiene and stable periodontal status; (iii) single edentulous sites with healthy teeth on both sides; (iv) mini- mum bone height ≥11 mm and bone width ≥ 6 mm during baseline CBCT evaluation; (v) willingness to participate in the study and comply with the necessary study requirements, including follow-up for one year. Exclusion criteria included (i) patients with a habit of chronic intake of analgesics; (ii) patients under treatment with bisphosphonates and corticosteroids; (iii) current smokers (>10 cigarettes per day); (iv) loss of any bony wall during the extraction or augmentation; (v) extraction sites associated with failed endodontic treatment; (vi) trauma associated fracture and sub-gingivally extending fracture lines that cannot be endodontically re- stored; (vii) tooth with poor prognosis; (viii) residual root stumps; (ix) pregnant and lac- tating female patients; (x) untreated periodontitis; (xi) presence of parafunctional habits; (xii) immunocompromised patients; (xiii) active infection or severe inflammation at the site of implant placement, evaluated by the presence of purulent secretion. 2.4. Blinding The operator and primary outcome assessors were blinded regarding the recruitment and the sites included in the study (both groups). The patients were not blinded to the intervention. 2.5. Implants A total of twenty dental implants (n = 20), tapered hybrid sandblasted and acid- etched (HSA, Dio-Navi , Busan, Korea), were placed in patients with single edentulous sites which had previously been subjected to tooth extraction. The sites were clinically divided according to whether they received bioactive glass bone graft (Calcium Phospho- silicate [CPS] morsels (NovaBone Morsels, Alachua, FL, USA) (test group, n = 10) or fol- lowed the natural healing process (i.e., non-grafted sites) (control group, n = 10). The study protocol flow chart is illustrated in Figure 1. Biomimetics 2022, 7, 43 4 of 12 Figure 1. Schematic representation of the study protocol. 2.6. Interventions A single experienced surgeon (P.S.G.) performed the surgical procedures. The clini- cal and radiographic parameters were recorded individually by two different investiga- tors (J.C., A.K.) who were blinded to the recruitment and procedures. The sites chosen for Biomimetics 2022, 7, 43 5 of 12 implantation received previously bioactive glass bone grafts or followed natural healing after extraction. After six months, the patients underwent implant placement following a specific protocol. After administering local anesthesia (2% lidocaine with 1:80000 adrenaline), the pa- tient was asked to rinse the mouth with 0.12% chlorhexidine solution for 30 s. The surgical guide was placed in position and stabilized over the patient’s teeth. The guide had been prepared earlier using a three-dimensional guided navigation software (CBCT). The GIS kit was used to prepare the osteotomy sites for implant placement. The pilot drill was initially driven through the sleeve present in the surgical guide following the manufac- turer’s instructions. Subsequent osteotomies were carried out using the drilling protocol provided by the manufacturer. Once the final osteotomy was carried out, implant inser- tion was done through the sleeve in the surgical guide with an insertion torque greater than 35 N.cm using an implant driver. All the implants were placed equi-crestally. The stability was measured after remov- ing the surgical guide, followed by the placement of a prosthetic abutment, and was re- stored functionally (Figure 2). The same surgical protocol was observed for both the con- trol and test groups. All patients received postoperative instructions. Patients were in- structed to rinse with 0.2% chlorhexidine digluconate twice daily for two weeks. Analge- sic medications (Ibuprofen, 500 mg) were prescribed a day thrice for three days. Figure 2. (a) Superimposition of CBCT for surgical guide preparation; (b) Stabilization of the surgi- cal guide; (c) Osteotomy site preparation through the surgical guide using an initial pilot drill; (d) Subsequent osteotomies in the sequence of the drilling protocol; (e) Implant insertion; (f) Implant equi-crestally placed; (g) Abutment placed; (h) Provisional restoration. 2.7. Clinical and Radiographic Outcomes Clinical parameters evaluated were full-mouth plaque scores (F-MPS) [20], full- mouth bleeding scores (F-MBS) [21], site-specific plaque scores (S-SPS), site-specific bleed- ing scores (S-SBS), peri-implant sulcus depth (P-ISD) (using a plastic probe, Hu-Friedy [PCV11KIT12], with a probing force of 0.2 N to 0.3 N), along with peri-implant abutment attachment level (P-IAL) and position of relative gingival margin (PGM) [22]. A radiographic assessment of mean marginal bone loss (MBL) was performed with radiovisiography [23]. A standardization of the radiographs was performed using a cus- tomized silicon bite block to index the dentitions that are fixed with the metal bar of the holding device. Radiographs were obtained using a standardized long cone parallel tech- nique. The digital images obtained were superimposed using SOPRO Imaging (v. 2.40). The dimensions obtained measured the marginal bone loss (MBL) at the mesial and distal aspects. Biomimetics 2022, 7, 43 6 of 12 2.8. Follow-Up Clinical parameters of S-SPS, S-SBS, P-ISD, P-IAL, and PGM were evaluated at six months and 1-year post-functional loading. The MBL and implant survival rate (ISR) were assessed at 1-year post-functional loading (Figures 3a–e and 4a–d). Figure 3. (a) Evaluation of site-specific plaque score using a disclosing agent; (b) Evaluation of the site-specific bleeding score; (c) Measurement of peri-implant sulcus depth; (d) Measurement of peri- implant abutment attachment level; (e) Measurement of the position of the relative gingival margin. Biomimetics 2022, 7, 43 7 of 12 Figure 4. Measurement of marginal bone loss (MBL). (a) Immediately post-functional loading (Con- trol); (b) 1-year post-functional loading (Control); (c) Immediately post-functional loading (test); (d) 1-year post-functional loading (Test). 2.9. Statistical Analysis Data management and analysis were performed using Statistical Package for Social Science (SPSS, v.17, for Microsoft Windows). An independent t-test was applied for the intergroup comparison of F-MPI, F-MBI, P-ISD, PGM, MBL, and ISR. Mann–Whitney test U was applied for an intergroup comparison of S-SPS, and S-SBS. A comparison of all the clinical and radiographic parameters within the groups was analyzed through paired t- test and Wilcoxon signed-rank test. Pearson’s correlation coefficient test correlated the clinical and radiographic parameters of both the control and test groups. In all the statis- tical tests, a p-value ≤ 0.05 was considered to be significant. 3. Results Twenty-four edentulous sites requiring implant placement in the anterior or pre-mo- lar sites were selected between February 2019 and April 2019. After phase I therapy, pa- tients willing to participate in the whole study period and fill out the inclusion criteria were categorized into two groups. However, two patients in each group declined the par- ticipation, thus resulting in a total of 20 patients, with 10 in each group. The parameters were evaluated at three intervals (baseline, after six months, and after 1-year post func- tional loading). Uniform sample distribution was evident in both groups based on age and gender distribution, as no statistically significant difference was observed (p > 0.05). Clinical parameters, such as S-SPS and S-SBS in the control and test groups, did not show any statistical differences between time points, indicating a healthy peri-implant tissue during loading and a proper peri-implant maintenance post-loading (p > 0.05). In the control group, PISD decreased at one year (3.23 mm ± 0.26 mm) from baseline (3.44 mm ± 0.29 mm), and from 6 months (3.40 mm ± 0.24 mm). Similarly, the relative position of the gingival margin showed statistically significant gains at one year (2.50 mm ± 0.52 Biomimetics 2022, 7, 43 8 of 12 mm) compared to the baseline (3.20 mm ± 0.63 mm), and at six months (2.90 mm ± 0.56 mm). It indicates a significant coronal creeping of the peri-implant mucosa at the one year period in the control group (p < 0.05) (Table 1). Table 1. Intragroup comparison of clinical parameters between baseline, 6 months, and 1 year in control and test group. Clinical Parameter Timeline Control Test Between baseline to 6 months 0.31 0.00 Site-Specific Plaque Score Between baseline to 1 year 0.15 −1.41 (S-SPS) (%) Between 6 months to 1 year 0.31 −1.00 Between baseline to 6 months 0.31 0.00 Site-Specific Bleeding Score Between baseline to 1 year 0.15 −1.41 (S-SBS) (%) Between 6 months to 1 year 0.31 −1.00 Between baseline to 6 months 0.12 0.16 Peri-Implant Sulcus Depth Between baseline to 1 year 0.01 * 0.003 * (PISD) (mm) Between 6 months to 1 year 0.01 * 0.003 * Between baseline to 6 months 0.08 0.03 * Relative Position of Gingival Margin Between baseline to 1 year 0.01 * 0.01 * (PGM) (mm) Between 6 months to 1 year 0.03 * 0.08 * p < 0.05 was considered as statistically significant. In the test group, P-ISD significantly decreased at one year (3.27 mm ± 0.34 mm) post- loading and was considerably lower compared to the baseline (3.45 mm ± 0.35) and at six months (3.42 mm ± 0.39 mm). The relative position of the gingival margin (PGM) showed a significant gain at six months and one year compared to the baseline (3.40 mm ± 0.51 mm). It indicates a coronal creeping of the peri-implant mucosa during the one-year fol- low-up (p < 0.05) (Table 1). The intergroup comparison of the clinical parameters such as S-SPS, S-SBS, P-ISD, and PGM at baseline, six months, and one year revealed no significant differences (p > 0.05). These data suggest that patients from both groups had good oral hygiene habits and maintained plaque control measures. There was decreased plaque accumulation and the subjects were free from active peri-implant diseases, leading to an improved soft tissue attachment level (Table 2). Table 2. Intergroup comparison of clinical parameters at 6 months and 1 year. Parameter Timeline Control Test p-Value 6 months 15.00 ± 12.91 12.50 ± 13.17 0.66 S-SPS 1 year 17.50 ± 12.07 17.50 ± 12.07 1.00 6 months 15.00 ± 12.91 12.50 ± 13.17 0.66 S-SBS 1 year 17.50 ± 12.07 17.50 ± 12.07 1.00 6 months 3.40 ± 0.24 3.42 ± 0.39 0.11 PISD 1 year 3.23 ± 0.26 3.27 ± 0.34 0.52 6 months 2.90 ± 0.56 3.00 ± 0.66 0.85 PGM 1 year 2.50 ± 0.52 2.70 ± 0.48 0.20 Marginal bone loss (MBL) was compared between groups at one-year post-loading. Both the groups showed similar MBL at the mesial and distal aspects at 1-year post-load- ing, i.e., 0.31 mm in the mesial aspect and 0.28 mm in the distal aspect of the control group; and 0.35 mm in the mesial and 0.33 mm in the distal part of the test group, without any statistical significance (p > 0.05). This indicates that the bone levels had shifted apically with a minimal and comparable amount of MBL in both groups (Table 3). Biomimetics 2022, 7, 43 9 of 12 Table 3. Comparison of mean marginal bone loss (MBL) changes between control and test group after one year. Period Parameter Group Mean ± Sd F-Value p-Value (Year) Mesial mean MBL Control 0.31 ± 0.11 1 0.01 0.89 (M-MBL) (mm) Test 0.35 ± 0.11 Distal mean MBL Control 0.28 ± 0.09 1 1.90 0.18 (D-MBL) (mm) Test 0.33 ± 0.13 MBL = Marginal bone loss. When correlating the clinical with radiographic parameters, the results were nega- tively correlated with S-SPS, S-SBS, and P-ISD with MBL. The results showed a positive correlation between the relative position of the gingival margin and MBL. However, none of these comparisons approached statistical significance (p > 0.05) (Table 4). Table 4. Pearson’s correlation of clinical and radiographic parameters at one year in the control and test group. Radiographic Parameter Mesial Mean Distal Mean Clinical Parameters Crestal Bone Level Crestal Bone (M-MCBL) Level (D-MCBL) R-value −0.19 −0.11 Site-specific Plaque CONTROL p-value 0.59 0.74 score R-value 0.08 −0.003 (S-SPS) TEST p-value 0.80 0.99 R-value −0.19 −0.11 Site-specific Bleeding CONTROL p-value 0.59 0.74 Score R-value 0.08 −0.003 (S-SBS) TEST p-value 0.80 0.99 R-value −0.56 −0.51 Peri Implant Sulcus CONTROL p-value 0.09 0.12 Depth R-value 0.15 0.11 (PISD) TEST p-value 0.67 0.74 R-value 0.14 0.21 Relative Position of CONTROL p-value 0.69 0.54 Gingival Margin R-value 0.04 0.27 (PGM) TEST p-value 0.89 0.44 4. Discussion Dental implants serve to provide predictable long-term restorative solutions for missing teeth. Minimizing damage to the underlying alveolar bone can serve to enhance the success and survival rate of dental implants. Several strategies are used to prevent alveolar bone resorption, including atraumatic flapless tooth extraction [24], bone grafts, membranes, and additional surgical procedures [25]. This study assessed the implant sur- vival rate (ISR) and marginal bone loss (MBL) in mesial and distal sites of dental implants placed with guided implant surgical protocol (GIS) in sockets with bioactive glass grafts compared to non-grafted sites after one year of functional loading. Our findings showed that both groups had similar marginal bone loss in the mesial and distal aspects. Pozziet al. (2014) [19] observed an MBL of 0.80mm in the conventional group and 0.71mm in the computer-guided group after one year of loading, which depicted less bone loss for the computer-guided group. Similarly, Tallaricoet al. (2018) [17] found that computer-guided Biomimetics 2022, 7, 43 10 of 12 implant placement reduced the marginal bone loss compared to the free-hand placement over a five-year follow-up after implant placement. The computer-guided group had sig- nificantly lower MBL, with a difference of 0.2mm at 1-year and 0.4mm at 5-year post- loading. These findings broadly support our result that GIS may help limit marginal bone loss. The type of surgical procedure may play a large role in bone remodeling. Maintain- ing the architecture of the tissues (soft and hard) around the dental implant and respecting the dynamism of the bone in the healing/remodeling process are critical drivers for suc- cess [26]. Using GIS may help to overcome possible drawbacks of the conventional im- plant placement by avoiding flap elevation, enabling proper angulation, and the accurate positioning of the implants. This is conducive to immediate functional loading, allowing a better remodeling of the underlying local tissues. This can minimize bone loss and help in long-term stability. Another variable examined was the implant survival rate (ISR). The recent literature reveals that dental implants have a high implant survival rate (96.4%) at ten years post- placement [27]. In this study, we assessed ISR after one year of post-functional loading. The ISR was similar for both groups, with a 100% survival rate. Tallarico et al. [17] and Pozzi et al. [19] demonstrated similar results, highlighting 100% ISR for the computer- guided group. Bone remodeling directly affects the primary implant stability. Stability is deter- mined by the quality and quantity of bone, the type of implant (geometry, diameter, length, and surface characteristics), and surgical techniques [28,29]. The biomaterial used in grafting may influence secondary stability. Bone graft materials are involved in peri- implant bone remodeling and osteoconduction [30,31], leading to new bone formation at the implant surface [32]. The dental implant used in this study was the tapered hybrid, sandblasted and acid-etched (HSA). Sandblasting and acid-etching techniques improved the bone-to-implant contact (BIC), positively affecting implant stability and reducing bone loss. A study based on the sandblasting technique demonstrated that it accentuated and stimulated osteoblasts to adhere to the implant surface, thereby increasing the rates of bone formation [33]. Similarly, acid-etched implants have also shown high survival rates up to 92.9% in long-term follow-up studies with 17 years of observation [33]. The regenerative material used in the present study was bioactive glass morsels. It has osteoconductive activity and serves as a scaffold. Bioactive glass has a brittle structure and has been termed a supercooled liquid. When bioactive glass morsels contact body fluids, they undergo ionic dissolution and glass degradation. The consequent rise in pH of the local microenvironment favors bone regeneration causing enhanced osteoid for- mation and mineralization [10]. Our findings may be partly due to the high quality of the implant characteristic, regenerative material used, and GIS protocol. The well-preserved extraction socket underwent natural and favorable healing, offering the best environment for plentiful osteoblasts to help in bone formation. The amount of bone healing was com- parable in both groups, indicating that bioactive glass is a promising scaffold material. Jung et al. [34] and Ten Heggeler et al. [35] reported that bone substitutes could limit the alveolar resorption after tooth extraction, but not prevent the alveolar bone's physiological resorption, especially in molar areas. Our findings suggest that either grafted and non-grafted groups had a reduced S-SPS and S-SBS, ensuring the presence of suitable connective tissue attachment, providing a low level of gingival inflammation. The progressive reduction of P-ISD and positive cor- onal shift in the PGM of both groups was evident, establishing a soft tissue barrier with the transmucosal component of the implant. Thus, it enhanced the resistance to probing, showed a better mucosal barrier, maintained a reduced P-ISD, and gained in the relative gingival margin position, leading to a reduced peri-implant attachment loss in both groups. The limitation of this study was that the sample size was relatively small at 20 sites. GIS is technique-sensitive. Beginners or less experienced clinicians could show operator bias. Future studies with greater sample sizes should analyze the clinical and radiological Biomimetics 2022, 7, 43 11 of 12 parameters over a long period to provide a fuller picture of the benefits of the GIS protocol in grafted sockets. Different implant designs and surfaces should also be examined to con- firm and validate these findings. 5. Conclusions Within the limitations of this study, the guided implant surgical (GIS) protocol ap- pears to be promising, and provides reliable, predictable treatment results, with a reduc- tion in marginal bone loss and improved implant survival rate. The GIS protocol avoided raising flaps and provided a better position to place implants, preserving the marginal bone around implants. The bioactive glass used for grafting permitted adequate bone for- mation and is a promising scaffolding material. Future research on GIS can serve to vali- date these findings and provide optimized, customized treatment plans for patients, lim- iting human error, and improving treatment outcomes. Author Contributions: Conceptualization, P.B., P.S.G.P., D.A.; methodology, M.H.M., M.S.; soft- ware, S.S., M.H.D.A.W.; validation, H.D., A.P.; formal analysis, T.M.B., S.V.; investigation A.H.; re- sources, G.V.O.F.; data curation, S.P.; writing—original draft preparation, P.B.,P.S.G.P., D.A., S.S., M.H.D.A.W., H.D., Z.H.A. and A.P.; writing—review and editing, T.M.B., S.V.,A.H., G.V.O.F., S.P.; visualization, P.B.; supervision, S.P.; project administration, P.S.G.P. All authors have read and agreed to the published version of the manuscript. Funding: This research received no external funding. Institutional Review Board Statement: The study was conducted in accordance with the ethical standards of the revised Helsinki Declaration for Biomedical Research involving human subjects and approved by the Institutional Review Board of SRM Dental college, Chennai, India (SRMDC/IRB/2018/MDS/No.502) Informed Consent Statement: Informed consent was obtained from all subjects involved in the study and writted informed consent was taken from all patients. Data Availability Statement: Not applicable. Acknowledgments: The authors thank the radiographic parameter assessor (A. Kannan, MDS) from the Department of Oral Medicine and Radiology, SRM Dental College, Ramapuram, Chennai, for his valuable support and help during the clinical trial. Conflicts of Interest: The authors declare no conflict of interest. References 1. Pietrokovski, J.; Massler, M. Alveolar ridge resorption following tooth extraction. J. Prosthet. Dent. 1967, 17, 21–27. 2. Johnson, K. A study of the dimensional changes occurring in the maxilla following tooth extraction. Aust. Dent. J. 1969, 14, 241– 3. Iasella, J.M.; Greenwell, H.; Miller, R.L.; Hill, M.; Drisko, C.; Bohra, A.A.; Scheetz, J.P. Ridge preservation with freeze-dried bone allograft and a collagen membrane compared to extraction alone for implant site development: A clinical and histologic study in humans. J. Periodontol. 2003, 74, 990–999. 4. Avila-Ortiz, G.; Chambrone, L.; Vignoletti, F. Effect of alveolar ridge preservation interventions following tooth extraction: A systematic review and meta-analysis. J. Clin. Periodontol. 2019, 46 (Suppl. 2), 195–223. https://doi.org/10.1111/jcpe.13057. 5. Mahato, A.; Kundu, B.; Mukherjee, P.; Nandi, S.K. Applications of Different Bioactive Glass and Glass-Ceramic Materials for Osteoconductivity and Osteoinductivity. Trans. Indian Ceram. Soc. 2017, 76, 149–158. https://doi.org/10.1080/0371750X.2017.1360799. 6. Cannillo, V.; Salvatori, R.; Bergamini, S.; Bellucci, D.; Bertoldi, C. Bioactive Glasses in Periodontal Regeneration: Existing Strategies and Future Prospects—A Literature Review. Materials. 2022, 15, 2194. 7. Hench, L.L. The story of Bioglass®. J Mater Sci Mater Med. 2006, 17, 967–978. 8. Jones, J.R. Review of bioactive glass: from Hench to hybrids. Acta Biomater. 2013, 9, 4457–4486. 9. Bodhare, G.H; Kolte, A.P; Kolte, R.A. and Shirke, P.Y. Clinical and radiographic evaluation and comparison of bioactive bone alloplast morsels when used alone and in combination with platelet-rich fibrin in the treatment of periodontal intrabony defects—A randomized controlled trial. J Periodontol. 2019, 90, 584–594. 10. Skallevold, H.E.; Rokaya, D.; Khurshid, Z.; Zafar, M.S. Bioactive Glass Applications in Dentistry. Int J Mol Sci. 2019, 20, 5960. doi: 10.3390/ijms20235960. Biomimetics 2022, 7, 43 12 of 12 11. Fiorellini, J.P.; Nevins, M.L. Localized ridge augmentation/preservation. A systematic review. Ann. Periodontol. 2003, 8, 321–327. 12. Urban, I.A.; Jovanovic, S.A.; Lozada, J.L. Vertical ridge augmentation using guided bone regeneration (GBR) in three clinical scenarios prior to implant placement: A retrospective study of 35 patients 12 to 72 months after loading. Int. J. Oral Maxillofac. Implant. 2009, 24, 502–510. 13. Barone, A.; Orlando, B.; Cingano, L.; Marconcini, S.; Derchi, G.; Covani, U. A randomized clinical trial to evaluate and compare implants placed in augmented versus non-augmented extraction sockets: 3-year results. J. Periodontol. 2012, 83, 836–846. 14. Simion, M.; Jovanovic, S.A.; Tinti, C.; Benfenati, S.P. Long-term evaluation of osseointegrated implants inserted at the time or after vertical ridge augmentation: A retrospective study on 123 implants with 1-5 year follow-up. Clin. Oral Implant. Res. 2001, 12, 35–45. 15. Pisoni, L.; Ordesi, P.; Siervo, P.; Bianchi, A.E.; Persia, M.; Siervo, S. Flapless versus traditional dental implant surgery: Long- term evaluation of crestal bone resorption. J. Oral Maxillofac. Surg. 2016, 74, 1354–1359. 16. Bover-Ramos, F.; Viña-Almunia, J.; Cervera-Ballester, J.; Peñarrocha-Diago, M.; García-Mira, B. Accuracy of Implant Placement with Computer-Guided Surgery: A Systematic Review and Meta-Analysis Comparing Cadaver, Clinical, and In Vitro Studies. Int. J. Oral Maxillofac. Implant. 2018, 33, 101–115. 17. Tallarico, M.; Esposito, M.; Xhanari, E.; Caneva, M.; Meloni, S.M. Computer-guided vs freehand placement of immediately loaded dental implants: 5-year postloading results of a randomised controlled trial. Eur. J. Oral Implant. 2018, 11, 203–213. 18. Schulz, K.F.; Altman, D.G.; Moher, D. CONSORT 2010 statement: Updated guidelines for reporting parallel group randomised trials. Trials 2010, 11, 1–8. 19. Pozzi, A.; Tallarico, M.; Marchetti, M.; Scarfò, B.; Esposito, M. Computer-guided versus free-hand placement of immediately loaded dental implants: 1-year post-loading results of a multicentre randomised controlled trial. Eur. J. Oral Implant. 2014, 7, 229–242. 20. O’Leary, T.J.; Drake, R.B.; Naylor, J.E. The plaque control record. J. Periodontol. 1972, 43, 38. 21. Ainamo, J.; Bay, I. Problems and proposals for recording gingivitis and plaque. Int. Dent. J. 1975, 25, 229–235. 22. Sathya Ramanathan, B.D.S.; Prakash, M.P.; Appukuttan, M.D.; Sangeetha Subramanian, B.D.S.; Victor, D.J. Microbial Assessment of Two Different Abutment Designs in Peri-implant Sulcus and Implant Abutment Interface: A Case Control Postloading Study. Int. J. Periodontics Restor. Dent. 2020, 40, e119-26. 23. Fernández, A.F.; Mahmud, A.-A.F.J.; Carrió, C.P.; Oltra, D.P.; Conejero, J.; Diago, M.P. Radiological assessment of peri-implant bone loss: A 12-month retrospective study. J. Clin. Exp. Dent. 2011, 5, e430-4. 24. Fickl, S.; Zuhr, O.; Wachtel, H.; Bolz, W.; Huerzeler, M. Tissue alterations after tooth extraction with and without surgical trauma: A volumetric study in the beagle dog. J. Clin. Periodontol. 2008, 35, 356–363. https://doi.org/10.1111/j.1600-051X.2008.01209.x. 25. Kotsakis, G.; Chrepa, V.; Marcou, N.; Prasad, H.; Hinrichs, J. Flapless alveolar ridge preservation utilizing the “socket-plug” technique: Clinical technique and review of the literature. J. Oral Implant. 2014, 40, 690–698. https://doi.org/10.1563/AAID-JOI- D-12-00028. 26. Borges, H.; Correia, A.R.M.; Castilho, R.M.; Fernandes, G.V.O. Zirconia Implants and Marginal Bone Loss: A Systematic Review and Meta-Analysis of Clinical Studies. Int. J. Oral Maxillofac. Implant. 2020, 35, 707–720. https://doi.org/10.11607/jomi.8097. 27. Strnad, J.; Urban, K.; Povysil, C.; Strnad, Z. Secondary stability assessment of titanium implants with an alkali-etched surface: A resonance frequency analysis study in beagle dogs. Int. J. Oral Maxillofac. Implant. 2008, 23, 502–512. 28. Topcuoglu, T.; Bicakci, A.A.; Avunduk, M.C.; Sahin Inan, Z.D. Evaluation of the effects of different surface configurations on stability of miniscrews. Sci. World J. 2013, 2013, 396091. 29. Davies, J.E. Mechanisms of endosseous integration. Int. J. Prosthodont. 1998, 11, 39–401. 30. Raghavendra, S.; Wood, M.C.; Taylor, T.D. Early wound healing around endosseous implants: Review of the literature. Int. J. Oral Maxillofac. Implant. 2005, 20, 425–431. 31. Coelho, P.G.; Jimbo, R. Osseointegration of metallic devices: Current trends based on implant hardware design. Arch. Biochem. Biophys. 2014, 561, 99–108. 32. Velasco-Ortega, E.; Alfonso-Rodríguez, C.A.; Monsalve-Guil, L.; España-López, A.; Jiménez-Guerra, A.; Garzón, I.; Alaminos, M.; Gil, F.J. Relevant aspects in the surface properties in titanium dental implants for the cellular viability. Mater. Sci. Eng. C 2016, 64, 1–10. https://doi.org/10.1016/j.msec.2016.03.049. 33. Velasco-Ortega, E.; Jimenez-Guerra, A.; Monsalve-Guil, L.; Ortiz-Garcia, I.; Nicolas-Silvente, A.I.; Segura-Egea, J.J.; Lopez- Lopez, J. Long-Term Clinical Outcomes of Treatment with Dental Implants with Acid Etched Surface. Materials 2020, 13, 1553. https://doi.org/10.3390/ma13071553. 34. Jung, R.E.; Siegenthaler, D.W.; Hammerle, C.H. Postextraction tissue management: A soft tissue punch technique. Int. J. Periodontics Restor. Dent. 2004, 24, 545–553. 35. Ten Heggeler, J.M.; Slot, D.E.; Van der Weijden, G.A. Effect of socket preservation therapies following tooth extraction in non- molar regions in humans: A systematic review. Clin. Oral Implant. Res. 2010, 22, 779–788.

Journal

BiomimeticsMultidisciplinary Digital Publishing Institute

Published: Apr 13, 2022

Keywords: bioactive glass; CBCT; dental implants; flapless technique guided implant surgery; implant planning; minimally invasive surgical technique; surgical guides

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