Stefano Mummolo

Background and Objectives: The use of biomaterials in dentistry is extremely common. From a commercial perspective, different types of osteoconductive and osteoinductive biomaterials are available to clinicians. In the field of osteoconductive materials, clinicians have biomaterials made of heterologous bones at their disposal, including biomaterials of bovine, porcine, and equine origins, and biomaterials of natural origin, such as corals and hydroxyapatites. In recent years, it has become possible to synthesize nano-Ha and produce scaffolds using digital information. Although a large variety of biomaterials has been produced, there is no scientific evidence that proves their absolute indispensability in terms of the preservation of postextraction sites or in the execution of guided bone regeneration. While there is no scientific evidence showing that one material is better than another, there is evidence suggesting that several products have better in situ permanence. This article describes a preliminary study to evaluate the histological results, ISQ values, and prevalence of nano-HA. Materials and Methods: In this study, we planned to use a new biomaterial based on nanohydroxyapatite for implantation at one postextraction site; the nano-HA in this study was NuvaBONE (Overmed, Buccinasco, Milano, Italy). This is a synthetic bone graft substitute that is based on nanostructured biomimetic hydroxyapatite for application in oral–maxillofacial surgery, orthopedics, traumatology, spine surgery, and neurosurgery. In our pilot case, a patient with a hopeless tooth underwent extraction, and the large defect remaining after the removal of the tooth was filled with nano-HA to restore the volume. Twelve months later, the patient was booked for implant surgery to replace the missing tooth. At the time of the surgery, a biopsy of the regenerated tissue was taken using a trephine of 4 mm in the inner side and 8 mm deep. Results: The histological results of the biopsy showed abundant bone formation, high values of ISQ increasing from the insertion to the prosthetic phase, and a good reorganization of hydroxyapatite granules during resorption. The implant is in good function, and the replaced tooth shows good esthetics. Conclusions: The good results of this pilot case indicate starting the next Multicentric study to have more and clearer information about this nanohydroxyapatite (NH) compared with control sites.

In this manuscript, the authors propose a new technique for inserting implants immediately into the sockets corresponding to the lower first molars and, in any case, in the sockets in which the alveolar septum is still present. Immediate post-extraction implants are a widely discussed topic in the literature. Most authors currently consider the insertion of implants immediately after extraction less useful in terms of the procedure’s questionable benefits in maintaining the height of the alveolar bone and more useful in terms of lessening patients’ discomfort. Due to the anatomy of the post-extraction socket and its traditionally cylindrical geometry, this procedure is not always possible.: Next-generation REX-type blade implants were used via their insertion into the septum accompanied by a cortical lamina for periosteal inhibition without filling any of the alveoli.: In the 20 patients treated, the REX implant proved to be stable and surrounded by newly formed bone at the 18-month follow-up. This simple, easily employable technique allows an implant to be inserted immediately after extraction and in the same surgical session, with good patient compliance and good preservation of the alveolus due to the facilitation of periosteal inhibition. The excellent clinical results obtained with the use of a blade implant in the posterior sectors suggest that it is possible to reduce surgical sessions even in conditions of post-extraction sockets whose septum alone can ensure the primary stability essential for osseointegration. The use of a larger number of patients will also provide us with significant statistical results in support of this preliminary clinical work. New clinical studies are needed to understand the true potential of this method for application in daily clinical practice.