Soft-Tissue Phenotype as a Risk Indicator of Peri-Implantitis and Peri-Implant Soft-Tissue Dehiscence-A Cross-Sectional Study.

AIM: To investigate the association, as well as to characterize the associated panel of pro- and anti-inflammatory markers, between the different components of the peri-implant phenotype and the presence of peri-implantitis/peri-implant soft-tissue dehiscence (PISTD). MATERIALS AND METHODS: A total of 324 implants in 112 patients were included. The following components of the peri-implant phenotype were clinically measured through the use of a manual periodontal probe or a digital calliper: keratinized mucosa width (PIKM-W), mucosal thickness (MT), attached mucosa (AM) and vestibulum depth (VD). The presence of peri-implantitis and PISTD was assessed through clinical and radiographic examination. Mixed-models logistic regression analyses were performed to analyse the association between peri-implant phenotype and the presence of peri-implantitis or PISTD, adjusting for relevant confounders. Multiplex immunoassays were employed to evaluate the peri-implant crevicular fluid levels of a panel of pro- and anti-inflammatory markers. RESULTS: Peri-implant health, peri-implant mucositis and peri-implantitis were diagnosed in 36.6%, 21.4% and 42% of the patients (classified according to their worst implant) and 35.2%, 34.3%, and 30.5% of the implants, respectively. In the multi-level multiple regression model, the absence of PIKM-W (odds ratio [OR] = 9.24; 95% CI: 2.73-31.28), the absence of attached mucosa (OR = 19.58; 95% CI: 6.12-62.56) and a reduced (<4 mm) vestibulum depth (OR = 2.61; 95% CI: 1.05-6.48) were associated with peri-implantitis. Similarly, the absence of PIKM-W (OR = 6.32; 95% CI: 1.67-23.83), a thin (<2 mm) mucosa (OR = 157.75; 95% CI: 14.06-1769.9) and a reduced vestibulum depth (OR = 3.32; 95% CI: 1.02-10.84) were associated with the presence of PISTD. Implants with PIKM-W = 0 mm showed statistically significantly higher levels of interferon-γ in both regular (≥2 maintenance/year) and irregular (<2 maintenance/year) compliers (p = 0.046 and p = 0.012). In irregular compliers, the absence of PIKM-W was also associated with statistically significantly higher levels of interleukin (IL)-1ß and IL-21 (p = 0.016, p = 0.046). These associations were independent of the effect of relevant confounders (e.g., plaque, compliance with maintenance, etc.). CONCLUSIONS: Within their limits, the present findings indicate that (a) peri-implant soft-tissue phenotype appears to be associated with the presence of peri-implantitis and PISTD, and (b) in the absence of PIKM-W, the inflammatory response seems to be dysregulated and the soft-tissue remodelling up-regulated.

Cooling Efficiency of Sleeveless 3D-Printed Surgical Guides with Different Cylinder Designs.

Background and Objectives: Surgical guides might impede the flow of coolant to the implant drills during the preparation of the implant bed, potentially contributing to increased temperatures during bone drilling. The objective of this experimental study was to assess the cooling efficiency of various guiding cylinder designs for sleeveless surgical guides used in guided surgery. Materials and Methods: In this experimental study, surgical guides with three different guiding cylinder designs were printed. One group had solid cylinders (control) and two test groups (cylinders with pores and cylinders with windows). Forty customized polyurethane blocks with type III bone characteristics were fitted into the guide and fixed in a vise, and implant bed preparations were completed using a simplified drilling protocol with and without irrigation. An infrared thermographic camera was used to record the temperature changes during drilling at the coronal, middle, and apical areas. ANOVA test and Games-Howell post hoc test were used to determine significant thermal differences among groups. Results: A significant thermal increase was observed at the coronal area in the group without irrigation (39.69 ± 8.82) (p < 0.05). The lowest thermal increase was recorded at the surgical guides with windows (21.451 ± 0.703 °C) compared to solid (25.005 ± 0.586 °C) and porous surgical guides (25.630 ± 1.004) (p < 0.05). In the middle and apical areas, there were no differences between solid and porous cylinders (p > 0.05). Conclusions: 3D-printed sleeveless surgical guides with window openings at the guiding cylinders reduce the temperature elevation at the cortical bone in guided implant surgery.

Impact of two different patient decision aids in prosthodontic consultations: a prospective randomized controlled study.

OBJECTIVES: Different approaches to prosthodontic consultation, all involving a strong focus on shared decision-making, were analyzed from the perspective of patients by inter-group comparisons. No patient decision aid (PDA) was used in the control group, a paper-based PDA in test group 1, and a software-based PDA in test group 2. MATERIALS AND METHODS: Seventy-five patients were prospectively randomized to the control group or a test group. All patients then rated the consultation on a questionnaire, six key items of which were analyzed, along with the time spent on each consultation. RESULTS: Overall satisfaction was highest in test group 2, with a significant difference from the control group (p = 0.015). Test group 2 showed the most favorable ratings for all six questionnaire items, which invariably was significant compared to the control group (p = 0.032). Test group 1 significantly differed from test group 2 based on two items (consultation was adequately intelligible: p = 0.011; consultation was adequately comprehensive: p = 0.034) but not from the control group based on any item (p = 0.070). CONCLUSIONS: Within the limitations of this study, the use of a software-based PDA, in particular, can be recommended based on patient satisfaction and was associated with the shortest sessions for consultation. CLINICAL RELEVANCE: Patients are routinely faced with a wealth of information in dental offices and may be overwhelmed especially by prosthetic treatment options and decision requirements. Our findings shed some light on the nature of aids that may truly be helpful in the process of shared decision-making. TRIAL REGISTRATION: ClinicalTrials.gov.Identifier: ISRCTN11472465.

Assisted removal of metal housings from overdentures with a 445-nm diode laser: A dental technique.

A straightforward, laser-assisted method of extracting the metal housings from an overdenture by using the visible (blue) light of a high-power dental diode laser is presented. This approach produced localized softening of the acrylic resin, allowing the metal housing to be dislodged without damage. This technique minimizes damage to the metal housings during removal, is rapid and conservative, and may help reduce patient costs.

Neurological Risks During Implant Placement in the Anterior Maxilla and Mandible: A Literature Review.

The placement of implants in the anterior maxillary and mandibular region requires esthetic proficiency and surgical finesse. It is important to consider the esthetic outcome while avoiding any type of nerve injury for the patient. In this literature review, anatomical structures of the anterior jaw were reviewed from a gross anatomical and radiographic interpretation. A discussion on the frequency of neurosensory complications for patients as a result of nerve damage in this region was evaluated. The purpose of this literature review was to educate the dental surgeon to consider the anterior jaw's neurological structures when performing procedures like implant surgery. The mandibular incisive canal (MIC) presents as an extension of the inferior alveolar canal that runs between the mental foramina. The MIC is a structure that is easily depicted in cone-beam computed tomography (CBCT) imaging and is present in most subjects in gross anatomical studies. The anterior loop of the mental nerve is another structure that is discussed in this paper. Although its structure is accurately depicted in CBCT images, its anatomical variations in patients can make implant treatment planning difficult. The maxilla contains 2 neurovascular structures that were discussed. First, the nasopalatine canal and its relation and impact on implant placement is evaluated. Case reports are reviewed that outline a prophylactic enucleation and bone grafting of the canal prior to implant placement. Second, the canalis sinuosus, which houses the anterior superior alveolar nerve, is of concern during implant placement in the lateral incisor region. Case reports involving nerve damage with follow-up are discussed.

Thermal Effects of 445-nm Diode Laser Irradiation on Titanium and Ceramic Implants.

This study aimed to evaluate temperature changes in titanium and ceramic implants after using a 445-nm diode laser under different in vitro conditions. Titanium (Ti) and ceramic (Zr) dental implants were placed into a bone analog, and an intrabony defect was created at each implant. A 445-nm diode laser was used to irradiate the defects for 30 seconds, noncontact, at 2 W in continuous wave (c.w.) and pulsed mode. The experiment was done at room temperature (21.0 ± 1°C) and in a water bath (37.0 ± 1°C). Two thermocouple probes were used to record real-time temperature changes (°C) at the coronal part of the implant (Tc) and the apex (Ta). The temperature was recorded at time 0 (To) and after 30 seconds of irradiation (Tf). The average temperature change was calculated, and a descriptive analysis was conducted (P < .05). The Ti implant resulted in the highest ΔT values coronally (29.6°C) and apically (6.7°C) using continuous wave at 21°C. The Zr implant increased to 26.4°C coronally and 5.2°C apically. In the water bath, the coronal portion of the Ti and Zr implants rose to 14.2°C and 14.01°C, respectively, using continuous waves. The ΔT values for Ti were 11.9°C coronally and 1.7°C apically when placed in a water bath using pulsed mode. The lowest ΔT occurred on the Zr implant with ΔTc and ΔTa of 4.8°C and 0.78°C, respectively. Under in vitro conditions, the 445-nm diode laser in pulsed mode seems to be safe for use on ceramic implants and should be used with caution on titanium implants.

Accuracy of torque controllers on healing abutments in implant dentistry-an in vitro study.

PURPOSE: To evaluate the accuracy of three torque-control devices used on healing abutments in implant prosthodontics. MATERIALS AND METHODS: In this in vitro experiment, three torque controllers, Ankylos friction-based, Straumann spring-based, and Anthogyr pre-calibrated torque control devices were used to tighten the healing abutments of Ankylos and Straumann dental implants to a pre-determined value of 15 Ncm. A digital torque meter (DT), Cedar DID-4A, was used to assess removal torque as a surrogate for the accuracy of the torque controllers to apply a tightening force of 15 Ncm on healing abutments.  One-way analysis of variance (ANOVA) was used to identify differences between each torque controller and the digital torquemeter, a p < 0.05 was considered significant. RESULTS: The torque required to remove the healing abutments was 16.05 ± 0.66 Ncm for the Ankylos ratchet, 12.61 ± 0.90 Ncm for the Straumann ratchet, and 14.37 ± 1.08 Ncm for the Anthogyr torque-control device. Significant statistical differences were observed between Ankylos and the control digital torquemeter (p = 1.84E-8 ; F = 50.3); Anthogyr and control digital torquemeter (p = 0.01; F = 6.79); and Straumann and control digital torquemeter (p = 0.01; F = 141.15). CONCLUSION: Friction-based (Ankylos), spring-based (Straumann), and pre-calibrated (Anthogyr) torque control devices present over-torque and under-torque values when used over healing abutments of Ankylos and Straumann implant systems.

Biological mechanisms underlying complications related to implant site preparation.

Implant site preparation is a critical stage of implant surgery that may underpin various complications related to implant surgery. This review discusses the latest available scientific information on risk factors related to implant site preparation. The role of the drilling process in relation to the density of the available alveolar bone, the effects of insertion torque on peri-implant osseous healing, and implant-related variables such as macrodesign and implant-abutment connection are all factors that can influence implant success. Novel information that links osteotomy characteristics (including methods to improve implant initial stability, the impact of drilling speed, and increase of the implant insertion torque modifying the bone-implant interface) with the appropriate instrumentation techniques will be discussed, as well as interactions at the bone-biomaterial interface that may lead to biologic complications mediated by implant dissolution products.

Drug-associated bone resorption with potential dental and implant implications.

Every year more and more innovative pharmacological agents are introduced medicine, to treat systemic diseases. Due to these rapid and recent advancements, many patients are receiving treatment with a high variety of drugs, such as selective serotonin reuptake inhibitors, bisphosphonates, tumor necrosis factor (TNF)-α inhibitors, cyclosporine, and steroids. Since implant and osseous surgery are common treatment modalities used, within dentistry, it is of critical important to acknowledge and discuss the potential effects of selective serotonin reuptake inhibitors, bisphosphonates, TNF-α inhibitors, cyclosporine, and steroids, on bone healing. The present paper discusses the possible detrimental ramifications and risks these drug classes may have on bone healing.

Reducing errors in guided implant surgery to optimize treatment outcomes.

Clinical considerations and treatment criteria in implant placement are constantly evolving. Prosthetically driven implant surgery has become the standard of care to improve short and long-term functional and esthetic outcomes. Therefore, implant position and angulation are planned according to the available bone, anatomical structures, and the requirements of the future prosthetic superstructure. In parallel with these developments, significant progress has been made in data imaging and different software technologies to allow the integration of data within a digital file format. Digitalization in implant surgery enables optimal planning of implant position, as well as the ability to transfer this planning to the surgical field-a process defined as "computer-supported implant planning and guided surgery." The aims of the present review are as follows: (a) to critically appraise the indications and potential "added value" of guided implant surgery, elaborating the main differences between dynamic and static guidance; and (b) to discuss the most important clinical considerations relevant for the different steps of the workflow that might influence the surgical outcome and to offer recommendations on how to avoid or reduce process errors in order to optimize treatment outcomes.