The Effect of Proton Pump Inhibitors on Early Implant Failure A Retrospective Cohort Study.

Background and Objectives: Maintenance of a firm and long-term stable osseointegration is the primary goal of implant dentistry. Time is used to define implant failure characteristics. Early implant failure (EIF) occurs up to one year after loading. Recent studies indicated an association between proton pump inhibitors (PPI) therapy and failure of osseointegration. The present study assessed whether the use of PPIs is a risk factor to EIF. Materials and methods: A retrospective cohort study including 687 patients and 2971 dental implants. The study group (PPIs users) comprised 17.3% (119) individuals and 18.7% (555) implants. The remaining cohort (82.7% (568) individuals and 81.3% (2416) implants) served as control. The information was taken from the patients' files. The following information was collected: age, gender, physical status, systemic diseases, HbA1C values before and after implant-supported prosthesis delivery in cases of diabetes mellitus, smoking, implant location, number of implants per individual, bone augmentation, implant brand, length and width, and EIF. EIF was defined as implant removal within a period of up to 12 months from loading. Results: EIF in PPIs vs. non-PPIs users was 19.3% vs. 14.3% (p = 0.16) at patient level and 5.4% vs. 3.5% at implant level (p = 0.03). Univariate analysis yielded factors significantly associated with PPIs use, including older age, physical status of the American Society of Anesthesiology (ASA) 3, hypertension, hyperlipidemia, diabetes mellitus, osteoporosis, cardiovascular accident (CVA), location (anterior mandible), shorter and narrower implants, and higher number of implants per individual. Multivariate analysis yielded statistically significant OR of 1.91; p = 0.01 for EIF following PPIs use and 2.3; p < 0.001 for location in anterior mandible. Conclusions: Patients and their healthcare providers are advised to carefully consider the potential risks of taking PPIs prior to dental implant surgery. Further research is needed to confirm these risks and elucidate systemic and local factors that may be involved in such outcomes.

Immediate Maxillary Full-Arch Rehabilitation of Periodontal Patients with Terminal Dentition Using Tilted Implants and Bone Augmentation: A 5-Year Retrospective Cohort Study.

BACKGROUND: All-on-four protocols with tilted implants in the maxilla are used to rehabilitate the terminal dentition of the severe generalized periodontitis patients. Data on long-term biological complications are scarce. METHODS: Eighty-four axial and forty-six tilted immediate implants have been placed in the extraction sockets of 23 patients according to a four-six implants protocol combined with ridge augmentation. Within 72 h, a provisional prosthesis was cemented to the implants; after 6 months, a cemented ceramic-metallic prosthesis was delivered. The patients were followed for up to 5 years. RESULTS: The 5-year survival rate of the straight and tilted implants was 100% and 97.8, and the prosthetic one was 100%. Marginal bone loss (MBL) of the straight implants was 0.42 ± 0.67 and 0.59 ±1.01 mm on the mesial and distal sides; for the tilted, it was 0.37 ± 0.68 and 0.34 ±0.62 mm, and the differences were not statistically significant. Implant position, smoking, keratinized mucosal width, and cantilever did not affect MBL. Peri-implant mucositis involved 29.4% and 22.2% of the straight and tilted implants, respectively; peri-implantitis involved 5.8% and 4.4% of the straight and tilted implants, respectively, without statistical significance. CONCLUSIONS: This immediate loading protocol's 5-year survival and success rates were high. No difference between the straight and tilted implants was found regarding survival, success rates, and MBL.

Histologic and Histomorphometric Evaluation of a Connective Tissue Graft Retrieved with a Novel Deepithelialization Procedure: A Case Series.

Various free connective tissue graft (CTG) harvesting techniques have been reported. The lining epithelium of the palatal graft may be retrieved either intra- or extraorally. This report presents a series of root coverage cases where deepithelialization was intraorally performed before harvesting the graft with a round diamond bur mounted on a low-speed handpiece. Ten single-tooth gingival recession defects in five patients were treated, applying a surgical procedure based on a coronally advanced flap combined with a free CTG that was deepithelialized in situ by the same method. Recession and probing depths and keratinized tissue and recession widths were recorded at baseline and the follow-up evaluations. Follow-up was between 7 and 21 months (mean: 12.1 ± 5.04 months). Clinical, esthetic, and histologic evaluations were performed. Mean root coverage was 89% ± 24.86% (range: 25% to 100%), and complete root coverage was observed in 80% of cases; the esthetic score range was 6 to 9 (mean: 7.44 ± 1.01). Epithelial remnants, although different in proportions, were evident in all samples (range of prevalence: 4.57% to 29.12%). Within the limitations of the small number of clinical cases, the presented in situ deepithelialization technique for CTG seems to be valuable and may accordingly be routinely applied.

Effect of root surface conditioning on gingival recession coverage with a connective tissue graft. A retrospective comparative study of three different agents.

OBJECTIVE: Different root modifiers have been proposed in the literature with an attempt to improve the healing process and the success rate of root coverage procedures. The aim of the present retrospective study was to evaluate the effect of three different types of root surface conditioning, namely, tetracycline (TTC), ethylene-di-amino-tetra-acetic acid (EDTA) and saline, on the outcome of root coverage procedures applying the same surgical technique. MATERIALS AND METHODS: Twenty-nine patients with 60 Classes I, II, or III recession defects were treated using connective tissue with a partial-thickness double-pedicle graft. In 21 recession defects root surface was treated with TTC and, in other 21, with EDTA, while in the remaining, saline solution was applied. Statistical analysis consisted of descriptive statistics and Kruskal-Wallis, Mann-Whitney, and chi-square tests. RESULTS: Differences between pre- and postoperative values were statistically significant only within but not between groups. Mean root coverage was 73.25%, 69.19%, and 82.17% in the TTC, the EDTA, and the saline groups, respectively. The study revealed no statistically significant differences for all evaluated parameters between groups. CONCLUSION: Within the limits of this study, root conditioning, prior to root coverage procedures, does not significantly affect their outcome. CLINICAL SIGNIFICANCE: Clinical outcome of root coverage procedures is not related to the type of root surface conditioning.

Thermal Changes at the One-Piece Implant Surface During the Setting of Two Autopolymerized Acrylic Resins.

PURPOSE: To compare the temperature changes during the setting process of two provisional crown materials, polymethyl methacrylate (PMMA)-based acrylic resin (Ac) and bis-acryl composite resin (Co), at the first thread surface of one-piece implants. MATERIALS AND METHODS: Twenty-two 3.3-mm-diameter one-piece implants were divided into two groups according to the provisional restoration material. Implants were mounted on a Plexiglas apparatus. A K-type thermocouple was fixed at the most coronal thread. Baseline (Bl Temp) and maximal (Max Temp) temperatures of both groups were recorded during the curing process. Total heat flux (THF) at the implant surface and thermal amplitude (Temp-Amp) were calculated. Differences between groups were compared using a t test for unpaired observations. RESULTS: Upon curing, a statistically significant increase in the Max Temp from the Bl Temp was detected in both groups, with a greater increase in the Ac compared with the Co group. The Temp-Amp and the THF were two times greater in the Ac group than the Co group. CONCLUSION: Significant heat is produced during the polymerization of PMMA-based resin and bis-acryl composite resin provisional crowns in one-piece implants. To decrease the risk of thermal challenge at the implant cervical aspect associated with restoration of immediately loaded implants, bis-acryl composite resin should be used.