OBJECTIVE: To establish consensus-driven guidelines that could support the clinical decision-making process for implant-supported rehabilitation of the posterior atrophic maxilla and ultimately improve long-term treatment outcomes and patient satisfaction.
METHODS: A total of 33 participants were enrolled (18 active members of the Italian Academy of Osseointegration and 15 international experts). Based on the available evidence, the development group discussed and proposed an initial list of 20 statements, which were later evalu-ated by all participants. After the forms were completed, the responses were sent for blinded ana-lysis. In most cases, when a consensus was not reached, the statements were rephrased and sent to the participants for another round of evaluation. Three rounds were planned.
RESULTS: After the first round of voting, participants came close to reaching a consensus on six statements, but no consensus was achieved for the other fourteen. Following this, nineteen statements were rephrased and sent to participants again for the second round of voting, after which a consensus was reached for six statements and almost reached for three statements, but no consensus was achieved for the other ten. All 13 statements upon which no consensus was reached were rephrased and included in the third round. After this round, a consensus was achieved for an additional nine statements and almost achieved for three statements, but no consensus was reached for the remaining statement.
CONCLUSIONS: This Delphi consensus highlights the importance of accurate preoperative planning, taking into consideration the maxillomandibular relationship to meet the functional and aesthetic requirements of the final restoration. Emphasis is placed on the role played by the sinus bony walls and floor in providing essential elements for bone formation, and on evaluation of bucco-palatal sinus width for choosing between lateral and transcrestal sinus floor elevation. Tilted and trans-sinus implants are considered viable options, whereas caution is advised when placing pterygoid implants. Zygomatic implants are seen as a potential option in specific cases, such as for completely edentulous elderly or oncological patients, for whom conventional alternatives are unsuitable.

In the past decades, personalized regenerative medicine has gained increased attention. Autologous platelet concentrates (APCs) such as PRP, PRGF, and L-PRF, all serving as a source of a large variety of cells and growth factors that participate in hard and soft tissue healing and regeneration, could play a significant role in regenerative periodontal procedures. This narrative review evaluated the relative impact of APCs in alveolar ridge preservation, sinus floor augmentation, and the regeneration of bony craters around teeth, both as a single substitute or in combination with a xenograft. L-PRF has a significant beneficial effect on alveolar ridge preservation (bone quality). The data for PRGF are less convincing, and PRP is controversial. L-PRF can successfully be used as a single substitute during transcrestal (≥3.5 mm bone gain) as well as 1-stage lateral window sinus floor elevation (>5 mm bone gain). For PRGF and especially PRP the data are very scarce. In the treatment of bony craters around teeth, during open flap debridement, L-PRF as a single substitute showed significant adjunctive benefits (e.g., >PPD reduction, >CAL gain, >crater depth reduction). The data for PRP and PRGF were non-conclusive. Adding PRP or L-PRF to a xenograft during OFD resulted in additional improvements (>PPD reduction, >CAL gain, >bone fill), for PRGF no data were found. Autologous platelet concentrates demonstrated to enhance bone and soft tissue healing in periodontal regenerative procedures. The data for L-PRF were most convincing. L-PRF also has the advantage of a greater simplicity of production, and its 100% autologous character.

OBJECTIVE: Piezoelectric bone surgery was introduced into clinical practice almost 20 years ago as an alternative method for cutting bone in dental surgical procedures, in an attempt to reduce the disadvantages of using conventional rotary instruments. The aim of this Consensus Conference was to evaluate the current evidence concerning the use of piezoelectric surgery in oral surgery and implantology.
METHODS: Three working groups conducted three meta-analyses with trial sequential analysis, focusing on the use of piezoelectric surgery in impacted mandibular third molar extraction, lateral sinus floor elevation and implant site preparation. The method of preparation of the systematic reviews, based on comprehensive search strategies and following preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, was discussed and standardised.
RESULTS: Moderate/low evidence suggests that piezoelectric surgery is significantly associated with a more favourable postoperative course (less pain, less trismus) after impacted mandibular third molar extraction than conventional rotary instruments. Moderate evidence suggests that implants inserted with piezoelectric surgery showed improved secondary stability during the early phases of healing compared with those inserted using a drilling technique. Strong/moderate evidence suggests that piezoelectric surgery prolongs the duration of surgery in impacted mandibular third molar extraction, sinus floor elevation and implant site preparation, but it is unclear whether the slight differences in duration of surgery, even if statistically significant, represent a real clinical advantage for either operator or patient. Weak evidence or insufficient data are present to draw definitive conclusions on the other investigated outcomes.
CONCLUSIONS: Further well-designed trials are needed to fully evaluate the effects of piezoelectric surgery, especially in implant site preparation and sinus floor elevation.

OBJECTIVE: To compare the clinical and patient-reported outcomes of ≤6-mm implants with those of ≥10-mm implants placed after both lateral and transcrestal sinus floor elevation.
METHODS: Using PubMed (MEDLINE), EMBASE, and Cochrane, a literature search for randomized controlled trials was performed. All the outcome variables were evaluated through a quantitative meta-analysis, and the influence of other clinical covariates were determined with a metaregression. For the survival outcomes, trial sequential analysis (TSA) was performed to adjust results for type I and II errors and to analyze the power of the available evidence.
RESULTS: After full-text reading, 12 studies were included in the analyses. No statistically significant difference was found after 3 years between the 2 study groups (P = 0.36). Short implants displayed fewer biological complications (P = 0.05), less marginal bone loss (MBL) from implant placement (P < 0.01), and reduced surgical time and treatment cost. However, long implants showed a statistically significant smaller number of prosthetic complications (P = 0.03). TSA confirmed the results of the meta-analysis, revealing that additional studies are needed due to low statistical power of the available evidence.
CONCLUSIONS: The placement of short implants is a predictable option in treating patients with maxillary atrophy up to a 3-year follow-up. Studies with a longer observational period are needed to study the long-term performance of these implants.

Bone augmentation procedures to enable dental implant placement are frequently performed. The remit of this working group was to evaluate the current evidence on the efficacy of regenerative measures for the reconstruction of alveolar ridge defects.
The discussions were based on four systematic reviews focusing on lateral bone augmentation with implant placement at a later stage, vertical bone augmentation, reconstructive treatment of peri-implantitis associated defects, and long-term results of lateral window sinus augmentation procedures.
A substantial body of evidence supports lateral bone augmentation prior to implant placement as a predictable procedure in order to gain sufficient ridge width for implant placement. Also, vertical ridge augmentation procedures were in many studies shown to be effective in treating deficient alveolar ridges to allow for dental implant placement. However, for both procedures the rate of associated complications was high. The adjunctive benefit of reconstructive measures for the treatment of peri-implantitis-related bone defects has only been assessed in a few RCTs. Meta-analyses demonstrated a benefit with regard to radiographic bone gain but not for clinical outcomes. Lateral window sinus floor augmentation was shown to be a reliable procedure in the long term for the partially and fully edentulous maxilla.
The evaluated bone augmentation procedures were proven to be effective for the reconstruction of alveolar ridge defects. However, some procedures are demanding and bear a higher risk for post-operative complications.

OBJECTIVE: The task of this working group was to update the knowledge about the use of drugs and biologicals affecting healing of soft tissue and bone during implant treatment or procedures associated with it. Moreover, the impact of titanium particles and biocorrosion on complications and implant survival has been analysed.
METHODS: The literature in the areas of interest (platelet concentrates, antiresorptive drugs as well as implant-host interaction) was screened using systematic reviews for the former two areas, whereas a narrative critical review was performed for the latter topic. Two manuscripts on platelet concentrates, one manuscript on antiresorptive drugs and one manuscript on the effects of biocorrosion, were presented for group analysis with subsequent discussion in the plenum and final consensus approval.
RESULTS: Results and conclusions of the individual reviews of the three topics are presented in the respective papers. Conclusions of the group on strengths and weaknesses of available evidence as well as consensus statements and directions for further research are provided in this study. The following papers were subject to group discussions and formed the basis for the consensus statements: Stähli A, Strauss FJ, Gruber R. () The use of platelet-rich-plasma to enhance the outcomes of implant-related therapies: a systematic review Strauss FJ, Stähli A, Gruber R. (2018) The use of platelet-rich-fibrin to enhance the outcomes of implant-related therapies: a systematic review Mombelli A, Hashim D, Cionca N. () What is the impact of titanium particles and bio-corrosion on implant survival and complications? A critical review Stavropoulos A, Bertl K, Pietschmann P, Pandis N, Morten Schiødt, Klinge B. () The effect of antiresorptive drugs on implant therapy: a systematic review.

Regenerative therapies with platelets have been widely used in medicine over the past two decades as a means to speed revascularization to damaged/defective tissues. Within the oral cavity, the sinus is one of the least vascularized areas with healing times typically increased to augment lost or missing bone. As a result, attempts have been proposed to combine platelet concentrates with various biomaterials to accelerate new blood flow to these tissues and ultimately facilitate new bone regeneration. While platelet-rich plasma (PRP) was introduced as a first-generation platelet concentrate, more recently platelet-rich fibrin (PRF) has been developed with anticoagulant removal from centrifugation protocols. Unlike PRP, PRF forms a fibrin clot that may further be utilized as a 3-dimensional scaffold containing a concentrated pool of autologous growth factors for tissue regeneration. Over the past decade, PRF has been used both as a sole grafting material and in combination with a bone graft for sinus augmentation procedures. This article highlights the biological and clinical advantages of using PRF with or without a bone grafting material for sinus augmentation procedures and provides guidelines detailing when, where, and why to use PRF alone versus in combination with a bone graft. Furthermore, the use of PRF for the repair of Schneiderian membrane perforations and as a barrier membrane for lateral window closure is discussed.

OBJECTIVE: Maxillary sinus grafting is a predictable and reliable procedure that has been routinely performed for more than 30 years. The complication rate is low, but some cases may require additional surgery, and the outcome of oral rehabilitation may be affected. The purpose of the present study was to evaluate the early and late complications after sinus lift procedures performed in the authors\' center, with special attention to risk factors and their connection to the principles of prevention and treatment.
METHODS: A retrospective analysis of 127 patients was performed. During an 8-year period, patients underwent preprosthetic surgery with implants and a maxillary sinus lift procedure because of maxillary atrophy. In total, 202 sinus lift procedures were performed and 364 implants were placed (117 simultaneously and 247 delayed). Clinical data, local or systemic disease, risk factors, type of surgery, intraoperative and postoperative complications, and the evolution of the implant zone were recorded.
RESULTS: The most common intraoperative complication was damage to the Schneiderian membrane (25.7%), which did not show any connection to postoperative complications. Thirty patients (14.9%) developed postoperative complications, including wound infection, abscess, or dehiscence with drainage (9 cases), maxillary sinusitis of the operated area (6 cases), partial exposure of the simultaneous onlay graft (6 cases), and loss of the graft (2 cases).
CONCLUSIONS: Sinus lift surgery is a proven and reliable technique because of the low observed rate of postoperative complications and the success rate of implants placed into the grafted area. To minimize risk, care must be taken with all technical details and risk factors that can lead to fatality.