Deformation of Implant Abutments After Framework Connection Using Strain Gauges

When a cylinder is connected to an abutment it is expected that abutment and cylinder will be subjected to compression forces throughout their periphery because of the clamping force exerted by the screw. The deformation resultant of this compression should be measurable and uniform along the periphery of the abutment. Considering that multiple retainers connected to each other can affect the fit of a framework, as well as the use of different alloys, it is expected that the abutments will present different levels of deformation as a result of framework connection. The aim of this study was to evaluate the deformation of implant abutments after frameworks, cast either in cobalt-chromium (CoCr) or silver-palladium (AgPd) alloys, were connected. Samples (n = 5) simulating a typical mandibular cantilevered implant-supported prosthesis framework were fabricated in cobalt-chromium and silver-palladium alloys and screwed onto standard abutments positioned on a master-cast containing 5 implant replicas. Two linear strain gauges were fixed on the mesial and distal aspects of each abutment to capture deformation as the retention screws were tightened. A combination of compressive and tensile forces was observed on the abutments for both CoCr and AgPd frameworks. There was no evidence of significant differences in median abutment deformation levels for 9 of the 10 abutment aspects. Visually well-fit frameworks do not necessarily transmit load uniformly to abutments. The use of CoCr alloy for implant-supported prostheses frameworks may be as clinically acceptable as AgPd alloy.

TOMOGRAPHIC ANALYSIS OF ANATOMICAL PARAMETERS OF THE AXIS IN CHILDREN

Objective: To carry out an anatomical study of the axis with the use of computed tomography (CT) in children aged from two to ten years, measuring the lamina angle, lamina and pedicle length and thickness, and lateral mass length. Methods: Sixty-four CTs were studied from patients aged 24 to 120 months old, of both sexes and without any cervical anomaly. The measurements obtained were correlated with the data on age and sex of the patients. Statistical analysis was performed using the Students "t" tests. Results: We found that within the age range 24-48 months, 5.5% of the lamina and 8.3% of the pedicles had thicknesses of less than 3.5mm, which is the minimum thickness needed for insertion of the screw. Between 49 and 120 months, there were no lamina thicknesses of less than 3.5mm, and 1.2% of the pedicle thicknesses were less than 3.5mm values. Neither of the age groups had any lamina and pedicle lengths of less than 12mm, or lateral mass lengths greater than 12mm. Conclusion: The analysis of the data obtained demonstrates that most of the time, is possible to use a 3.5mm pedicle screw in the laminas and pedicles of the axis in children. Level of Evidence: II, Development of diagnostic criteria in consecutive patients.

In vitro analysis of the influence of surface treatment of dental implants on primary stability

Surface treatment interferes with the primary stability of dental implants because it promotes a chemical and micromorphological change on the surface and thus stimulates osseointegration. This study aimed to evaluate the effects of different surface treatments on primary stability by analyzing insertion torque (IT) and pullout force (PF). Eight samples of implants with different surface treatments (TS - external hexagon with acid surface treatment; and MS - external hexagon, machined surface), all 3.75 mm in diameter x 11.5 mm in length, were inserted into segments of artificial bones. The IT of each sample was measured by an electronic torquemeter, and then the pullout test was done with a universal testing machine. The results were subjected to ANOVA (p < 0.05), followed by Tukey's test (p < 0.05). The IT results showed no statistically significant difference, since the sizes of the implants used were very similar, and the bone used was not highly resistant. The PF values (N) were, respectively, TS = 403.75 +/- 189.80 and MS = 276.38 +/- 110.05. The implants were shown to be different in terms of the variables of maximum force (F = 4.401, p = 0.0120), elasticity in maximum flexion (F = 3.672, p = 0.024), and relative stiffness (F = 4.60, p = 0.01). In this study, external hexagonal implants with acid surface treatment showed the highest values of pullout strength and better stability, which provide greater indication for their use.

Comparative study of bone repair in mandibular body osteotomy between metallic and absorbable 2.0 mm internal fixation systems. Histological and histometric analysis in dogs: a pilot study

The objective of this study was to compare the bone repair along a mandibular body osteotomy stabilized with 2.0 mm absorbable and metallic systems. 12 male, adult mongrel dogs were divided into two groups (metallic and absorbable) and subjected to unilateral osteotomy between the mandibular third and fourth premolars, which was stabilized by applying two 4-hole plates. At 2 and 18 weeks, three dogs from each group were killed and the osteotomy sites were removed and divided equally into three parts: the upper part was labelled the tension third (TT), the lower part the compression third (CT), and the part between the TT and CT the intermediary third (IT). Regardless of the treatment system, union between the fragments was observed at 18 weeks and the CT showed more advanced stages of bone repair than the TT. Histometric analysis did not reveal any significant differences among the 3 parts or systems in the distance between bone fragments at 2 weeks. Although at 18 weeks the proportions of newly formed bone did not differ among TT, IT and CT, significantly enhanced bone formation was observed in all sections for the metallic group. The patterns of repair were distinct between treatments.

Mini-implant insertion based on tooth crown references: a guide-free technique

Mini-implant insertion requires accurate surgical technique. This study shows an insertion technique using only tooth crown references; its scientific basis is evaluated radiographically. The sample consisted of 213 inter-radicular septa, evaluated in 53 bitewing radiographs. The proximal contour of adjacent tooth crowns was used to define septum width. The midpoint of the septum width was linked to the interdental contact point to determine septum midline. The distances from septum midline to "mesial and distal teeth were measured to evaluate the septum midline centralization degree in two different septum heights. The difference between mesial and distal distances represented the septum midline deviation degree. The mesial and distal distances were compared by t-tests, and the septum midline deviation was correlated with septum height using Pearson's correlation test. The mesial and distal distances were not statistically different in the midpoint of the septum height, but they were different at the apical septum height. There was a moderate correlation (r = 0.45) between septum midline deviation and septum height. The tooth crown references evaluated on interproximal radiographs determine a high centralization degree of the septum midline on which the insertion site could be defined. The greater centralization degree was observed at the coronal septum area.

Tomographic, Histological, and Immunohistochemical Evidences on the Use of N-Butyl-2-Cyanoacrilate for Onlay Graft Fixation in Rabbits

Background: The bone tissue responses to Cyanoacrylate have been described in the literature, but none used N-butyl-2-cyanoacrilate (NB-Cn) for bone graft fixation. Purpose: The aims of the study were: (a) to analyze the bone grafts volume maintenance fixed either with NB-Cn or titanium screw; (b) to assess the incorporation of onlay grafts on perforated recipient bed; and (c) the differences of expression level of tartrate-resistant acid phosphatase (TRAP) protein involved in bone resorption. Materials and Methods: Eighteen New Zealand White rabbits were submitted to calvaria onlay grafting on both sides of the mandible. On one side, the graft was fixed with NB-Cn, while on the other hand the bone graft was secured with an osteosynthesis screw. The computed tomography (CT) was performed just after surgery and at animals sacrifice, after 1 (n = 9) and 6 weeks (n = 9), in order to estimate the bone grafts volume along the experiments. Histological sections of the grafted areas were prepared to evaluate the healing of bone grafts and to assess the expression of TRAP protein. Results: The CT scan showed better volume maintenance of bone grafts fixed with NB-Cn (p = 0.05) compared with those fixed with screws, in both experimental times (analysis of variance). The immunohistochemical evaluation showed that the TRAP expression in a 6-week period was significantly higher compared with the 1-week period, without showing significant difference between the groups (Wilcoxon and MannWhitney). Histological analysis revealed that the NB-Cn caused periosteum damage, but provided bone graft stabilization and incorporation similar to the control group. Conclusion: The perforation provided by screw insertion into the graft during fixation may have triggered early revascularization and remodeling to render increased volume loss compared with the experimental group. These results indicate that the NB-Cn possesses equivalent properties to titanium screw to be used as bone fixation material in osteosynthesis.

Influence of miniscrew dental root proximity on its degree of late stability

Purpose of this study was to evaluate the influence of miniscrew dental root proximity on its late stability degree. 40 miniscrews were inserted between maxillary second premolars and first molars for anterior retraction. Post-surgical radiographs were used to measure the septum width in the insertion site, insertion height, distal and mesial distance from miniscrew to dental root, and the smallest distance between miniscrew and dental root. The miniscrews were divided in two groups according to septum width: ?3 mm (20 miniscrews) and >3 mm (20 miniscrews). The soft tissue in the insertion site, sensitivity during load, plaque around the miniscrew, and evaluation period were also considered. The results showed no significant difference in miniscrew mobility degree and success rate between groups. Miniscrew dental root proximity did not influence the stability and success rate when the distance between the miniscrew and dental root indicated no periodontal ligament invasion. The overall success rate was 90% and no variable was associated with miniscrew failure. Nevertheless, patient sensitivity was frequently associated with some degree of mini-implant mobility. The septum width did not influence the stability and success rate of this anchorage system, but the extreme root proximity did.

Análise tomográfica dos parâmetros anatômicos do áxis de crianças

OBJETIVO: Estudo anatômico do áxis através de tomografia computadorizada (TC) em crianças de dois a dez anos de idade, mensurando a angulação das lâminas, espessura e comprimento de lâminas e pedículos e espessura da massa lateral. MÉTODOS: Estudou-se 64 TCs da coluna cervical de indivíduos com idades entre 24 e 120 meses, de ambos os sexos e sem deformidades cervicais. Correlacionaram-se as variáveis estudadas com os grupos etários e sexo dos pacientes. A análise estatística foi realizada por meio do teste t. RESULTADOS: Verificou-se que na faixa etária entre 24-48 meses, 5,5% das lâminas e 8,3% dos pedículos possuem espessura menores do que 3,5mm, espessura necessária para colocação de um parafuso. Entre 49-120 meses não há lâminas com espessuras menores do que 3,5mm e 1,2% dos pedículos possuem espessura menor do que 3,5mm. Em ambos os grupos etários não há comprimento de lâminas e pedículos menores do que 12 mm e massas laterais maiores do que 12 mm. CONCLUSÃO: A análise das dimensões obtidas no estudo permite, na maioria dos casos, a colocação de parafusos de 3,5mm nas lâminas e pedículos do áxis de crianças. Nível de Evidência II, Desenvolvimento de critérios diagnósticos em pacientes consecutivos.

Influência do preparo do orifício piloto na ancoragem dos parafusos pediculares

OBJETIVO: Avaliamos a influência do diâmetro e do modo de preparação do orifício piloto na resistência ao arrancamento e no torque de inserção dos parafusos pediculares com diâmetro interno cônico. MÉTODOS: Ensaios mecânicos foram realizados com parafusos pediculares com alma cônica e diâmetro de 4,2mm e 5,2mm inseridos nos pedículos vertebrais lombares de suínos. O orifício piloto foi confeccionado com de broca e sondas (pontiaguda e cortante) com diferentes diâmetros. RESULTADOS: Testando o parafuso de 4,2mm a perfuração com orifício igual ou inferior ao menor diâmetro interno do parafuso, aumentou o torque e a resistência ao arrancamento. Perfurações com diferentes instrumentos apresentaram comportamento semelhante. Perfurações com sondas permitiram que orifícios confeccionados com dimensões superiores ao menor diâmetro interno do parafuso apresentassem resistência semelhante a das perfurações com dimensões iguais ao menor diâmetro interno do implante, realizadas com sondas e brocas. CONCLUSÕES: Nos de 4,2 mm o diâmetro e o modo de preparação do orifício influenciam o torque e a resistência, nos de 5,2 mm apenas o torque de inserção. Não há correlação entre força de arrancamento e torque de inserção. Nível de evidência II, Estudos terapêuticos - Investigação dos Resultados do Tratamento.

Parafusos pediculares: estruturas anatômicas em risco no tratamento da escoliose idiopática

OBJETIVO: Avaliar a posição das estruturas anatômicas em risco durante a inserção de parafusos pediculares na coluna torácica e sua relação com a variação do ângulo de Cobb. MÉTODOS: Os parâmetros estudados foram: a medida do ângulo de Cobb nas radiografias e a posição da medula espinhal, da cavidade pleural e aorta na ressonância nuclear magnética em relação a uma linha de 40mm criada para simular o parafuso pedicular nas cinco vértebras apicais. RESULTADOS: A distância da aorta ao corpo vertebral e o ângulo de segurança do lado convexo apresentaram diferença estatística quando relacionados com a variação do ângulo de Cobb medido. CONCLUSÃO: Os resultados apresentados sugerem maior risco de lesão da artéria aorta com o aumento do ângulo de Cobb e aumento do risco na inserção de parafusos pediculares no lado convexo da curvatura, quando se considera o ângulo de segurança.

Path planning for image based visual servoing

This thesis deals with Visual Servoing and its strictly connected disciplines like projective geometry, image processing, robotics and non-linear control. More specifically the work addresses the problem to control a robotic manipulator through one of the largely used Visual Servoing techniques: the Image Based Visual Servoing (IBVS). In Image Based Visual Servoing the robot is driven by on-line performing a feedback control loop that is closed directly in the 2D space of the camera sensor. The work considers the case of a monocular system with the only camera mounted on the robot end effector (eye in hand configuration). Through IBVS the system can be positioned with respect to a 3D fixed target by minimizing the differences between its initial view and its goal view, corresponding respectively to the initial and the goal system configurations: the robot Cartesian Motion is thus generated only by means of visual informations. However, the execution of a positioning control task by IBVS is not straightforward because singularity problems may occur and local minima may be reached where the reached image is very close to the target one but the 3D positioning task is far from being fulfilled: this happens in particular for large camera displacements, when the the initial and the goal target views are noticeably different. To overcame singularity and local minima drawbacks, maintaining the good properties of IBVS robustness with respect to modeling and camera calibration errors, an opportune image path planning can be exploited. This work deals with the problem of generating opportune image plane trajectories for tracked points of the servoing control scheme (a trajectory is made of a path plus a time law). The generated image plane paths must be feasible i.e. they must be compliant with rigid body motion of the camera with respect to the object so as to avoid image jacobian singularities and local minima problems. In addition, the image planned trajectories must generate camera velocity screws which are smooth and within the allowed bounds of the robot. We will show that a scaled 3D motion planning algorithm can be devised in order to generate feasible image plane trajectories. Since the paths in the image are off-line generated it is also possible to tune the planning parameters so as to maintain the target inside the camera field of view even if, in some unfortunate cases, the feature target points would leave the camera images due to 3D robot motions. To test the validity of the proposed approach some both experiments and simulations results have been reported taking also into account the influence of noise in the path planning strategy. The experiments have been realized with a 6DOF anthropomorphic manipulator with a fire-wire camera installed on its end effector: the results demonstrate the good performances and the feasibility of the proposed approach.

Riabilitazione protesica ed implanto-protesica di pazienti in età evolutiva affetti da Displasia Ectodermica

Introduction. Ectodermal Dysplasias are a heterogeneous group of inherited disorders characterized by dysplasia of tissues of ectodermal origin (hair, nails, teeth, skins and glands). Clinically, it may be divided into two broad categories: the X-linked hypoidrotic form and the hidrotic form. Hypohidrotic Ectodermal Dysplasia (H.E.D) is characterized by the triad oligo-anodontia, hypotricosis, hypo-anhydrosis (Christ-Siemens-Tourane syndrome). The incidence of HED is about 1/100,000. Mutation in the actodysplasin-A (EDA) and ectodysplasin-A receptor (EDAR) genes are responsible for X-linked and autosomal HED. The clinical features include sparse, fine hair, missing or conical-shaped teeth, decreased sweat and mucous glands, hypoplastic skin, and heat intolerance with exercise or increased ambient temperature. Complete or partial anodontia and malformation of teeth are the most frequent dental findings. Incisors and canines are often conical-shaped while primarily second molars, if present, are mostly affected by taurodontism. Treatment is supportive and includes protection from heat exposure, early prosthetic rehabilitation, skin, hair ear, nose and nail care, and genetic counseling for family planning. The diagnosis of HED in the neonatal and early infancy period may be difficult since sparse hair and absent teeth are normal finding at this age. In childhood the diagnosis is more easily made on the basis of history and clinical examination. Dental abnormalities are the most common complaint. Prosthetic rehabilitation has been recommended as an essential part of the management of HED because is important from functional, esthetic, and psychological standpoint. A team approach that includes input from a pediatric dentist, an orthodontist, a prosthodontist, and an oral and maxillofacial surgeon is necessary for a successful outcome. Conventional prosthodontic rehabilitation in young patient is often difficult because of the anatomical abnormalities of existing teeth and alveolar ridges. The conical shaped teeth and “knife-edge” alveolar ridges result in poor retention and instability of dentures. Moreover, denture must permit jaws expansion and a correct pattern of growth. Materials and Methods. Complete removable dentures were provided to allow for normal physiological development and a corrected masticatory function. Initial maxillary and mandibular impressions were made with smallest stock trays and irreversible hydrocolloid and then final impressions ware made with light-bodied polysulfide rubber base impression material. A base of autopolymerizing resin was constructed and a wax rim was added to the base. The patient’s vertical dimension of occlusion was established by assessing phonetic and esthetic criteria. Preliminary occlusal relations were recorded, and the mandibular cast was mounted on the articulator. Acrylic resin teeth specific for children dentures were selected and mounted. The dentures were tried in and, after proper adjustments, were inserted. The patients were monitored clinically every month to fit prostheses. Cephalometric radiographs were taken every 6 month with the prostheses in place in order to evaluate correct pattern of growth. Cephalometric measurements were realized and used to evaluate the effect of rehabilitation on craniofacial growth. Cephalometric measurements of sound patients were compared with ED patients. After two month expander screws (three-way screw in the upper denture and two-way the lower one)were inserted in each denture in order to permit the expansion of the denture and the jaws growth. Where conical teeth were present, composite crown were realized and luted to improve the esthetic and phonesis. In order to improve retention the placement of endosseous implants was carried out. TC 3D Accuitomo was performed and a resin model of mandibular bone of the patient was realized. At the age of 11 years two implants were inserted into anterior mandible in a child with anodontia. Despite a remarkable multi-dimensional atrophy of the mandibular alveolar process, the insertion of two tapered screw implants (SAMO Smiler, diameter 3.8, length 10 mm). After a submerged healing period of two-three month, the implants were exposed. Implants were connected with an expansion guide that permits mandibular growth and prosthetic retention. The amount of mandibular growth was also evaluate dusing the expansion guide. Results. Early oral rehabilitation improve oral function, phonesis and esthetic, reducing social impairment. Treated patients showed normal cephalometric measurement. Early rehabilitation is able to prevent the prognatissm of the mandibula . The number of teeth was significantly related to several changes in craniofacial morphology. Discussion. In the present study the 5,3% of ED patients showed hypodontia, the l’89,4% di oligodontia, and the 5,3% di anodontia. The cephalometric analysis supports that ED patients showed midface hypoplasia. ED groups showed an increased pogonion to nasion measurement than sound patients, indicative of class III tendency. The present study demonstrated that number of teeth was significantly correlated with deviation of cephalometric measurements from normality. Oligoanodontia is responsible for changing of cephalometric measuraments also on sagittal plane with a class III tendency. Maxillary jaw showed a retrused position related to the presence of hypodontia.

Il trattamento delle fratture e lussazioni vertebrali nei piccoli animali

Treatment of spinal fracture and luxation in small animals Traumatic spinal injuries usually result from a mechanic trauma. Spinal facture and luxations generally occur in the junction between and more mobile parts of the spinal column: close to the skull, thorax and pelvis. Fractures may occur alone or in combination with luxation as fracture/luxation. When the fractures are not stable the best solution is the surgical fixation. Internal and external fixation are the surgical methods for the treatment of vertebral fractures and luxations. The authors report the treatment of 12 cases of thoracic and lumbar vertebral fractures and luxations in small animals using the screws/pins and Polymethylmethacrylate technique. The analysis of results is a contribute I the valutation of surgical technique and complications in the post-surgical period.

Minimalinvasive Osteosynthese der distalen extraartikulären Radiusfraktur : XSCREW und DorsalNailPlate im biomechanischen Vergleich

Gegenstand der Arbeit: Die distale Radiusfraktur ist der häufigste Bruch des Menschen. Neben etablierten Verfahren wie der dorsalen und palmaren Plattenosteosynthese gibt es seit Kurzem neuartige minimalinvasive Osteosynthesesysteme. Gegenstand der vorliegenden Arbeit ist die Untersuchung der biomechanischen Stabilität von zwei neuartigen Implantaten für die distale extraartikuläre Radiusfraktur. rnMethodik: Es handelt sich einerseits um das System XSCREW (Zimmer, Freiburg i. Br., Deutschland), eine kanülierte Schraube, die über den Processus styloideus eingeführt wird und mit bis zu neun Bohrdrähten im Knochen fixiert werden kann. Das Vergleichsimplantat DorsalNailPlate (HandInnovations, Miami, Florida, USA) ist ein Hybrid aus einer dorsalen Platte und einem Marknagel. Beide Systeme wurden an 8 paarigen frischen unfixierten Leichenradii unter Axialbelastung bis 100 N und Torsionsbelastung bis 1,5 Nm getestet. Die A3-Fraktur wurde durch eine standardisierte Keilosteotomie simuliert. Das Biomaterial wurde prä- und postinterventionell sowie nach einem Dauerbelastungstest unter 1000 Zyklen in Rotation mit 0,5 Hz untersucht. Ein Versagenstest mit steigendem Drehmoment beendete das Experiment. rnErgebnisse: Die XSCREW erreichte eine Axialsteifigkeit von 136 N/mm und eine Torsionssteifigkeit von 0,16 Nm/°. Die DNP erzielte hingegen axial 70 N/mm und torsional 0,06 Nm/°. Der Unterschied zwischen beiden Verfahren war nur für die Torsion eindeutig statistisch auffällig (p=0,012), jedoch nicht für die Axialsteifigkeit (p=0,054). Die ursprüngliche Axial- und Torsionssteifigkeit wurde durch die XSCREW signifikant besser wiederhergestellt als durch die DNP (p=0,012). Beide Verfahren erzielten nach der Intervention signifikant niedrigere Steifigkeiten als die intakten Knochen (p=0,012). Ein Präparat der DNP-Gruppe und vier Präparate der XSCREW-Gruppe überstanden den Dauerbelastungstest. Das Drehmoment bei Versagen war mit der XSCREW höher als mit der DNP, der Unterschied zwischen den Verfahren war signifikant (p=0,043). Die Schwachstellen beider Systeme lagen vorwiegend in der proximalen Verankerung im Knochen. Kirschner-Drähte bzw. Verriegelungsschrauben führten unter andauernder Belastung zu einer Spaltung der Kortikalis im Schaftbereich. Bedingt durch die Ausrichtung der distalen Verriegelungen können mit beiden Implantaten Schäden an der radiocarpalen bzw. radioulnaren Gelenkfläche entstehen. rnZusammenfassung: Die XSCREW ermöglicht insgesamt eine höhere mechanische Stabilität als die DNP. Beide Verfahren sind jedoch einer winkelstabilen palmaren Plattenosteosynthese insbesondere unter rotatorischer Dauerbelastung unterlegen und erreichen nicht die Stabilität eines anderen neuartigen minimalinvasiven Systems.

Ten-year results of a three-arm prospective cohort study on implants in periodontally compromised patients. Part 1: implant loss and radiographic bone loss

OBJECTIVES: The aim of this study was to compare the long-term outcomes of implants placed in patients treated for periodontitis periodontally compromised patients (PCP) and in periodontally healthy patients (PHP) in relation to adhesion to supportive periodontal therapy (SPT). MATERIAL AND METHODS: One hundred and twelve partially edentulous patients were consecutively enrolled in private specialist practice and divided into three groups according to their initial periodontal condition: PHP, moderate PCP and severe PCP. Perio and implant treatment was carried out as needed. Solid screws (S), hollow screws (HS) and hollow cylinders (HC) were installed to support fixed prostheses, after successful completion of initial periodontal therapy (full-mouth plaque score <25% and full-mouth bleeding score <25%). At the end of treatment, patients were asked to follow an individualized SPT program. At 10 years, clinical measures and radiographic bone changes were recorded by two calibrated operators, blinded to the initial patient classification. RESULTS: Eleven patients were lost to follow-up. During the period of observation, 18 implants were removed because of biological complications. The implant survival rate was 96.6%, 92.8% and 90% for all implants and 98%, 94.2% and 90% for S-implants only, respectively, for PHP, moderate PCP and severe PCP. The mean bone loss was 0.75 (+/- 0.88) mm in PHP, 1.14 (+/- 1.11) mm in moderate PCP and 0.98 (+/- 1.22) mm in severe PCP, without any statistically significant difference. The percentage of sites, with bone loss > or =3 mm, was, respectively, 4.7% for PHP, 11.2% for moderate PCP and 15.1% for severe PCP, with a statistically significant difference between PHP and severe PCP (P<0.05). Lack of adhesion to SPT was correlated with a higher incidence of bone loss and implant loss. CONCLUSION: Patients with a history of periodontitis presented a lower survival rate and a statistically significantly higher number of sites with peri-implant bone loss. Furthermore, PCP, who did not completely adhere to the SPT, were found to present a higher implant failure rate. This underlines the value of the SPT in enhancing the long-term outcomes of implant therapy, particularly in subjects affected by periodontitis, in order to control reinfection and limit biological complications.