A Rare Case of Front Mandible Orthokeratinized Odontogenic Cyst - Surgical Management with Preventive Rigid Osteosynthesis.

PURPOSE: Cysts and other intrabony lesions can grow asymptomatic until being diagnosed by occasionally done radiologic examination. Missing tooth and malposition of adjacent teeth should induce clinicians to perform X-Ray diagnostic. METHODS: A 37-year-old, male patient was admitted with a hopeless tooth 36, to be extracted and replaced with an implant. Clinical examination revealed also missing one of lower incisors and malposition of remaining lower incisors. Cone-beam computed tomography revealed horizontally impacted lower incisor surrounded by bone defect -15 × 20 × 8 mm with the bone thickness remaining only 3.5 mm in the narrowest area. The basis on strong masticatory muscles and low thickness of bone after surgical removal of tooth and lesion, prophylactic osteosynthesis was planned. To explain the surgery to the patient model of the mandible was 3D printed. RESULTS: Two treatment plans were presented to the patient: 1. custom plate production according to the bone defect and the shape of remaining bone and 2. choosing a standard plate and adjusting it on the 3D printed model. Costs of the material were 10 times higher in a custom solution. Plan 2 was then accepted. 1.2 mm straight plate was prebend on the model and sterilized. Lesion and impacted tooth were removed in local anesthesia. Prepared plates were fixed. CONCLUSIONS: In the presented case custom 3D printed osteosynthesis plate was about 10 times more expensive compared to the standard osteosynthesis plate used. 3D printing of bone model may be helpful for prebending chosen standard plate and planning the surgery.

Radiologic comparative analysis between saline and platelet-rich fibrin filling after hydraulic transcrestal sinus lifting without adjunctive bone graft: A randomized controlled trial.

OBJECTIVES: To evaluate implant survival rate, any complications, and changes in residual alveolar bone height (RABH) using saline or platelet-rich fibrin (PRF) filling after hydraulic transcrestal sinus lifting. METHODS: Dental implants were placed after hydraulic transcrestal sinus lifting and the filling of saline (20 patients) or PRF (20 patients). Outcome measurements were implant survival, any complications, and RABH changes. Cone-beam computed tomography (CBCT) scans were taken and compared preoperatively (T0), immediately postoperatively (T1), at 3 months (T2), 6 months (T3), and 12 months postoperatively (T4), respectively. RESULTS: In a total of 40 patients, 45 implants with a mean length of 10.4 ± 0.8 mm were placed in posterior maxilla of a mean RABH of 6.8 ± 1.1 mm. The increase in RABH peaked at T1, and continuous drooping of the sinus membrane was observed but stabilized at T3. Meanwhile, the gradual increase in the radiopacities was found below the lifted sinus membrane. The PRF filling induced the radiographic intrasinus bone gain of 2.6 ± 1.1 mm, which was significantly more than 1.7 ± 1.0 mm of saline filling at T4 (p < .05). All the implants were in function with no significant complications over the one-year follow-up period. CONCLUSIONS: In this randomized case-control study, the feasibility of hydraulic transcrestal sinus lifting without bone graft was confirmed and PRF might be a better filler to support the elevated sinus membrane. However, adjunctive bone grafting should still be indicated for cases requiring more than 2-3 mm of intrasinus bone gain.

Covalently-Linked Hyaluronan versus Acid Etched Titanium Dental Implants: A Crossover RCT in Humans.

Biochemical modification of titanium surfaces (BMTiS) entails immobilization of biomolecules to implant surfaces in order to induce specific host responses. This crossover randomized clinical trial assesses clinical success and marginal bone resorption of dental implants bearing a surface molecular layer of covalently-linked hyaluronan in comparison with control implants up to 36 months after loading. Patients requiring bilateral implant rehabilitation received hyaluronan covered implants in one side of the mouth and traditional implants in the other side. Two months after the first surgery, a second surgery was undergone to uncover the screw and to place a healing abutment. After two weeks, the operator proceeded with prosthetic procedures. Implants were evaluated by periapical radiographs and the crestal bone level was recorded at mesial and distal sites-at baseline and up to 36 months. One hundred and six implants were positioned, 52 HY-coated, and 48 controls were followed up. No differences were observed in terms of insertion and stability, wound healing, implant success, and crestal bone resorption at any time considered. All interventions had an optimal healing, and no adverse events were recorded. This trial shows, for the first time, a successful use in humans of biochemical-modified implants in routine clinical practice and in healthy patients and tissues with satisfactory outcomes.

Hard and soft tissue changes around implants activated using plasma of argon: A histomorphometric study in dog.

OBJECTIVE: To histologically assess the hard and soft tissue changes after insertion of cleaned and activated titanium implants using plasma of argon. MATERIALS AND METHODS: Eight dogs were included in this study. The mandibular premolars and first molars were extracted. For each hemi-mandible, four implants, 7 mm long and 3.3 mm of diameter, with a ZirTi surface were used. The surface of two implants was randomly treated with argon plasma (test), while the other two implants were left untreated (control). After 1 month, the same procedure was performed in the contralateral hemi-mandible. The amount of old bone, new bone, overall value of old bone plus new bone, and soft tissue was histologically evaluated. RESULTS: After 1 month of healing, high percentages of new bone in close contact with the implant surface were found at both the treated (60.1% ± 15.6%; 95% CI 56.5%-78.0%) and untreated (57.2% ± 13.1%; 95% CI 49.3%-67.5%) implants. Low percentages of old bone were found at this stage of healing, at both the treated (4.4% ± 3.0%; 95% CI 1.2%-5.4%) and untreated (3.4% ± 3.1%; 95% CI 0.6%-4.9%) implants. Not statistically significant differences were found between groups (p > .05). After 2 months of healing, treated implants presented a significantly higher (p = .012) new bone formation (72.5% ± 12.4%; 95% CI 69.6%-86.8%) compared to untreated sites (64.7% ± 17.3%; 95% CI 59.4%-83.3%). Controversially, no difference (p = .270) in terms of old bone was present between treated (3.1% ± 1.7%, 95% CI 1.8%-4.2%) and untreated implants (3.8% ± 1.9%, 95% CI 3.2%-5.8%). Significant differences (p = .018) in terms of total mineralized bone were found between treated (75.6% ± 13.0%, 95% CI 73.3%-91.3%) and untreated implants (68.4% ± 16.8%; 95% CI 64.2%-87.6%). CONCLUSIONS: Implants treated using plasma of argon was demonstrated to reach a higher bone-to-implant contact when compared to untreated implants.

Definitive Abutments Placed at Implant Insertion and Never Removed: Is It an Effective Approach? A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

PURPOSE: To assess whether repeated abutment disconnections and reconnections have any impact on peri-implant bone resorption and soft tissue healing. MATERIALS AND METHODS: Electronic and manual searches were conducted for English-language articles published up to March 2017 that identified a relation between repeated disconnections of implant abutments (PA group) and prosthetic or implant failures, complications, marginal bone loss (MBL), soft tissue healing, and esthetic evaluation (pink esthetic score [PES]) after at least 1 year of function compared with implants receiving a final abutment at the time of implant placement (DA group). RESULTS: Fourteen articles (535 patients with 994 implants) were selected for qualitative analysis. Six of these were included in the meta-analysis. Five prostheses failed in the PA group and 1 failed in the DA group (P = .1047). Seven biologic complications occurred in the PA group and 6 occurred in the DA group (P = .8121). MBL was significantly less in the DA group (difference, 0.279 mm; P = .000). Greater buccal recession occurred in the PA group (difference, 0.198 mm; P = .0004). The PES evaluation showed no differences between groups (P = .289). CONCLUSIONS: Repeated abutment disconnections and reconnections considerably increased MBL and buccal recession. Further studies are needed to confirm these results.

Retrospective Study of 1087 Anodized Implants Placed in Private Practice: Risk Indicators Associated With Implant Failure and Relationship Between Bone Levels and Soft Tissue Health.

INTRODUCTION: To evaluate risk indicators associated with implant failure and relationship between bone levels and soft-tissue health of anodized implants placed in private practice. MATERIAL AND METHODS: Partially or completely edentulous patients who received an anodized implant between 2003 and 2013 were included. Univariate and multivariate analysis was used to identify the relationship between study variables and implant failure. Mean marginal bone level changes (MBLΔ) were assessed using periapical radiographs. Periimplant soft tissue was evaluated using a modified bleeding index (implant mucosal index, IMI). RESULTS: A total of 1087 implants placed in 414 patients were followed for 3.9 ± 2.7 years. The cumulative implant survival rate after 10 years of function was 97.0%. Shorter (P = 0.0068) and maxillary implants (P = 0.0314) were associated with lower implant survival rate. Mean MBL decreased from -0.16 ± 0.43 mm at baseline to -0.53 ± 0.53 mm 8 to 10 years later. Implants with healthier mucosa were associated with less bone loss. CONCLUSIONS: Implants with an anodized surface showed a high long-term survival rate in a daily practice. Longer implants and implants placed in the mandible were associated with greater survival. Immediate loading and tapered design did not affect implant survival. Profuse multipoint bleeding and suppuration on recall were associated with greater bone loss.

Ten-year hard and soft tissue results of a pilot double-blinded randomized controlled trial on immediately loaded post-extractive implants using platform-switching concept.

AIM: To evaluate the 10-year post-loading radiological and esthetic outcomes of implants inserted in post-extraction sites and restored with or without platform-switching protocol. MATERIAL AND METHODS: Twenty-two patients were scheduled for maxillary post-extractive implant, using a 13 mm in length and 5.5 mm in diameter implant (Global, Sweden & Martina, Padua, Italy). They randomly received definitive restorations using platform-switching concept (abutment 3.8 mm in diameter: test group) or standard restoration (abutment 5.5 mm in diameter: control group). Outcome measures were survival rates of implants and prostheses, peri-implant marginal bone loss and periodontal indices 10 years after prosthetic loading. Moreover, esthetic parameters including soft tissue buccal peri-implant mucosal levels (REC) and mesial and distal papilla height (PH) were taken at definitive restoration, 2 and 10 years thereafter. RESULTS: Nineteen implants were analyzed after 10 years of follow-up. No implants nor prostheses failed. The postoperative radiographs demonstrated an overall mean bone loss of 0.18 ± 0.14 mm in the test group and of 0.80 ± 0.40 mm in the control group (P = 0.00108). Test group showed 0.23 ± 0.51 mm of REC gain and PH was of 0.21 ± 0.33 mm on average. On the other side, the control group presented a REC = -0.59 ± 0.80 mm with PH = -1.12 ± 0.55 mm, demonstrating a slight continuous soft tissue shrinkage during the entire follow-up. The mean values were statistically significant different between test and control group for both REC gain (P = 0.01174) and PH (P = 0.0009). CONCLUSIONS: With the limitations of this study, immediate single implant restorations rehabilitated with platform-switching protocol may provide peri-implant alveolar bone-level stability and avoid continuous soft tissue shrinkage after 10 years of prosthetic loading compared to a platform-matching restoration. Further studies involving larger sample sizes are required to confirm these preliminary results.

Influence of plasma cleaning procedure on the interaction between soft tissue and abutments: a randomized controlled histologic study.

INTRODUCTION: Plasma application can lead to an improved adhesion between soft tissue and abutments and promotes cell spreading. OBJECTIVE: A triple-blinded randomized controlled clinical trial was performed to in vivo test the effect of cleaning abutment titanium surfaces with plasma of argon on cell adhesion and collagen fiber orientation at an early healing time. MATERIAL AND METHODS: Thirty healthy patients with 30 submerged implants, at the second surgery, randomly received either a specially designed abutment with no additional treatment (as they come from industry; control group, G1) or cleaned by plasma of argon (test group, G2). Two weeks thereafter, a small biopsy including abutment and soft tissues around the abutment was performed. Abutments were analyzed using scanning electron microscopy to assess cell adhesion to the abutment surface. Outcome measures were the following: percentage of area occupied by cells, the presence or absence of cells, aspect of adhered cells, and the presence of contaminants. At the same time, the soft tissue histological analysis evaluated density and orientation of collagen fibers. Statistical analysis was performed using the Kolmogorov-Smirnov normality test and Levene variance homogeneity test. Data were analyzed using a nonparametric ranking test. The associations between the different qualitative variables were studied using Pearson's chi-squared test. The Mann-Whitney U-test (for two independent samples) was applied for quantitative variables. RESULTS: Mean percentages of area occupied by cells were 15.14% (range 2.91-44.27) and 33.75% (range 2.37-68.4) for G1 and G2, respectively. Differences were close to significance (P = 0.089). The proportion of samples presenting adhered cells was homogeneous between the two groups (P = 0.142). In all cases, cells presented a flattened aspect, but not in three cases in the G2; in 17 cases, cells were efficiently adhered, and in 11 cases, cells presented filopodia with no statistical differences between groups (P > 0.05). No case from G2 showed contamination with cocobacteria with statistical differences between groups (P = 0.006). Collagen fiber density was higher in the basal, medial, and coronal area of G2 compared to G1 with a statistical difference in the internal area (P < 0.05). The orientation of the fibers varied according to the coordinate area with oblique fibers predominant in G2 than in G1. CONCLUSION: Plasma of argon may promote cell adhesion and positively influence collagen fiber orientation. A greater sample is necessary to confirm these preliminary results.

Dental implants treatment outcomes in patient under active therapy with alendronate: 3-year follow-up results of a multicenter prospective observational study.

OBJECTIVE: To evaluate the 3-year clinical and radiographic data of fixed implant-supported dental prosthesis delivered to patients having taken alendronate 35-70 mg weekly for at least 3 years before implant placement. MATERIALS AND METHODS: Forty consecutive patients treated with oral bisphosphonates and requiring an implant-supported restoration were recruited in two private centers between January 2008 and December 2011. Implants were inserted through minimally invasive approach under antibacterial and antibiotic treatment, 6 months after alendronate administration stopping. After 4 months of submerged healing, implants underwent prosthetic loading. Hygiene maintenance and clinical assessments were scheduled every 4 months for 3 years. Outcome measures were the following: implant and prosthetic success, survival rates, any observed clinical complications, marginal bone remodeling, probing pocket depth and bleeding-on-probing. RESULTS: At the end of the study, eight patients dropped out. The final sample size resulted in 32 consecutive partially or fully edentulous patients (32 females; mean age 64.6 years) with 98 submerged implants. In only one patient, maxillary implant failed during healing period. No prosthesis failed during the entire follow-up, and no major complications were recorded. Implant and prostheses success resulted in an overall survival rate of 98, 98% and 100%, respectively. Three-year mean marginal bone loss was 1.35 ± 0.21 (CI 95% 1.24-1.38). Successful soft tissue parameters were found around all implants. CONCLUSIONS: Oral bisphosphonate therapy did not appear to significantly affect implant survival and success in case of accurate treatment time selection, minimally invasive surgical approach and constant follow-up. Further prospective studies involving larger sample sizes and longer durations of follow-up are required to confirm these results.

Distinguishing predictive profiles for patient-based risk assessment and diagnostics of plaque induced, surgically and prosthetically triggered peri-implantitis.

OBJECTIVE: To investigate whether specific predictive profiles for patient-based risk assessment/diagnostics can be applied in different subtypes of peri-implantitis. MATERIALS AND METHODS: This study included patients with at least two implants (one or more presenting signs of peri-implantitis). Anamnestic, clinical, and implant-related parameters were collected and scored into a single database. Dental implant was chosen as the unit of analysis, and a complete screening protocol was established. The implants affected by peri-implantitis were then clustered into three subtypes in relation to the identified triggering factor: purely plaque-induced or prosthetically or surgically triggered peri-implantitis. Statistical analyses were performed to compare the characteristics and risk factors between peri-implantitis and healthy implants, as well as to compare clinical parameters and distribution of risk factors between plaque, prosthetically and surgically triggered peri-implantitis. The predictive profiles for subtypes of peri-implantitis were estimated using data mining tools including regression methods and C4.5 decision trees. RESULTS: A total of 926 patients previously treated with 2812 dental implants were screened for eligibility. Fifty-six patients (6.04%) with 332 implants (4.44%) met the study criteria. Data from 125 peri-implantitis and 207 healthy implants were therefore analyzed and included in the statistical analysis. Within peri-implantitis group, 51 were classified as surgically triggered (40.8%), 38 as prosthetically triggered (30.4%), and 36 as plaque-induced (28.8%) peri-implantitis. For peri-implantitis, 51 were associated with surgical risk factor (40.8%), 38 with prosthetic risk factor (30.4%), 36 with purely plaque-induced risk factor (28.8%). The variables identified as predictors of peri-implantitis were female sex (OR = 1.60), malpositioning (OR = 48.2), overloading (OR = 18.70), and bone reconstruction (OR = 2.35). The predictive model showed 82.35% of accuracy and identified distinguishing predictive profiles for plaque, prosthetically and surgically triggered peri-implantitis. The model was in accordance with the results of risk analysis being the external validation for model accuracy. CONCLUSIONS: It can be concluded that plaque induced and prosthetically and surgically triggered peri-implantitis are different entities associated with distinguishing predictive profiles; hence, the appropriate causal treatment approach remains necessary. The advanced data mining model developed in this study seems to be a promising tool for diagnostics of peri-implantitis subtypes.