Relationship Between Long-Term Marginal Bone Loss and Bone Quality, Implant Width, and Surface.

PURPOSE: Short- or long-term implant survival and success are related to peri-implant marginal bone loss (MBL), among other key factors. The purpose of this study was to analyze the role of clinical and implant-related variables in MBL over a long-term follow-up. MATERIALS AND METHODS: A retrospective study of 558 implants in 172 patients was conducted, analyzing the relationship between MBL and clinical, implant-related, and prosthetic design-related variables. MBL was measured on digital radiographs with specific software, using implant threads as reference. RESULTS: Linear mixed analysis revealed the following significant effects: a lower mean MBL for type IV bone (0.047 mm/year, 95% CI [-0.019, 0.119]) than for type III bone (0.086 mm/year, 95% CI [0.038, 0.138]), type II bone (0.112 mm/year, 95% CI [0.070, 0.167]), or type I bone (0.138 mm/year, 95% CI [0.052, 0.23]); an increased MBL of 0.033 mm/year for each increment of 1 mm in diameter (95% CI [0.002, 0.065]); a lower mean MBL in smooth implants (0.103 mm/year, 95% CI [0.090, 0.117]) vs rough implants (0.122 mm/year, 95% CI [0.102, 0.142]). The mean MBL was > 0 mm/year for all prostheses except for fixed complete dental prostheses. CONCLUSION: Within the limits of a retrospective follow-up study, a lower mean peri-implant MBL was associated with type IV bone, a smaller diameter, a smooth surface, and a fixed complete dental prosthesis.

Multivariate study of factors influencing primary dental implant stability.

OBJECTIVES: The purpose was to determine by multivariate analysis in a large series of dental implants the variables associated with primary endosseous dental implant stability (DIS). MATERIAL AND METHODS: A 10-year retrospective study was conducted of 1084 Brånemark implants placed in 316 patients. Clinical variables (age, gender, smoking habit, and periodontal status), implant diameter, implant length, and Periotest values (PTVs) were analyzed in bivariate and multivariate studies in order to determine their influence on DIS, using a cut-off PTV value of -2. RESULTS: The site of implant insertion showed the strongest association with primary DIS failure among the study variables. Implants in the anterior mandible had a 6.43-fold lower risk of primary DIS risk vs. those at other sites [95% confidence interval (CI) 3.28-12.61], and implants in the maxillary had a 2.70-fold higher risk of primary DIS failure vs. those in the mandible (95% CI 1.82-4). Among other variables, females had a 1.54-fold higher risk of primary DIS failure vs. males (95% CI 1.88-2.22) and implants <15 mm in length had a 1.49-fold higher risk of failure vs. longer implants (95% CI 1.09-2.04). CONCLUSION: According to these findings, primary DIS failure is more likely in females, at sites other than the anterior mandible, and with dental implants shorter than 15 mm, at least when non-threaded titanium implants are used. These data may be of value in the identification of patients at a high risk of primary DIS failure with immediate implant loading.

Early implant failure. Prognostic capacity of Periotest: retrospective study of a large sample.

OBJECTIVES: The objectives of this study were to determine the accuracy of Periotest to monitor primary implant stability at first-stage surgery, to identify by multivariate analysis the variables associated with early implant failure and to compare Periotest with radiographic study in the diagnosis of implant stability at second-stage surgery (during osseointegration period). MATERIAL AND METHODS: A 10-year retrospective study was conducted on 1084 Brånemark implants placed in 316 patients. Clinical variables, implant diameter and length, Periotest values (PTVs) and radiological variables were analyzed in bivariate and multivariate studies in order to determine their influence on early implant failure. RESULTS: After examination of the sensitivity and specificity values obtained for different PTV cutoff points, a cutoff PTV of -2 was selected (84% sensitivity and 39% specificity). In the bivariate analysis, early failure was significantly related to smoking habits, implant location, bone type, implant features and PTVs (-2 and >or=-2). In the final multiple logistic model, only age (odds ratio (OR)=4.53; 95% confidence interval (CI), 1.34-15.27), smoking habits (OR=2.5; 95% CI, 1.3-4.79), bone type (OR=1.93; 95% CI, 1.01-3.7) and PTV at first surgery (OR=3.01; 95% CI, 1.5-6.02) were independently related to early failure. CONCLUSIONS: The Periotest (with -2 cutoff) at first surgery offers high sensitivity in the prognosis of early implant loss and shows a greater capacity to evaluate stability during the osseointegration period compared with radiographic study.

Consensus document on the use of antibiotic prophylaxis in dental surgery and procedures.

The goal of antibiotic prophylaxis in Odontology is to prevent the onset of infections through the entranceway provided by the therapeutic action, therefore it is indicated providing there is a considerable risk of infection, either because of the characteristics of the operation itself or the patient s local or general condition. Nonetheless, clinical trials with antibiotics in dental pathologies have had scant regard for the required methodological criteria and, in addition, are not sufficiently numerous. This text presents the results of an expert conference comprising the Presidents of the most representative Scientific Societies in Spain who have analyzed the existing literature and have drawn on their valuable professional experience. It describes the technical circumstances, analyzes the biological and pharmacological foundations and their application to the most representative medical situations. It is concluded that antibiotic prophylaxis in Odontology has certain well-founded, precise indications and offers the international scientific community a practical protocol for action.