A hybrid unsupervised clustering method for predicting the risk of dental implant loss.

OBJECTIVES: The aim of this study was to predict the risk of dental implant loss by clustering features associated with implant survival rates. MATERIALS AND METHODS: Multiple clinical features from 8513 patients who underwent single implant placement were retrospectively analysed. A hybrid method integrating unsupervised learning algorithms with survival analysis was employed for data mining. Two-step cluster, univariate Cox regression, and Kaplan‒Meier survival analyses were performed to identify the clustering features associated with implant survival rates. To predict the risk of dental implant loss, nomograms were constructed on the basis of time-stratified multivariate Cox regression. RESULTS: Six clusters with distinct features and prognoses were identified using two-step cluster analysis and Kaplan‒Meier survival analysis. Compared with the other clusters, only one cluster presented significantly lower implant survival rates, and six specific clustering features within this cluster were identified as high-risk factors, including age, smoking history, implant diameter, implant length, implant position, and surgical procedure. Nomograms were created to assess the impact of the six high-risk factors on implant loss for three periods: 1) 0-120 days, 2) 120-310 days, and 3) more than 310 days after implant placement. The concordance indices of the models were 0.642, 0.781, and 0.715, respectively. CONCLUSIONS: The hybrid unsupervised clustering method, which clusters and identifies high-risk clinical features associated with implant loss without relying on predefined labels or target variables, represents an effective approach for developing a visual model for predicting implant prognosis. However, further validation with a multimodal, multicentre, prospective cohort is needed. CLINICAL SIGNIFICANCE: Visual prognosis prediction utilizing this nomogram that predicts the risk of implant loss on the basis of clustering features can assist dentists in preoperative assessments and clinical decision-making, potentially improving dental implant prognosis.

Clinical outcomes of implants placed with transcrestal maxillary sinus elevation: a systematic review and meta-analysis.

This systematic review and meta-analysis assesses the clinical outcomes of implants inserted during or following transcrestal sinus lifts. The study protocol was prospectively registered on PROSPERO (CRD42024504513). PubMed, Web of Science, Embase, and Scopus databases were searched up to 21 February 2024, and randomised clinical trials utilising transcrestal sinus lifts were included. Qualitative and quantitative syntheses were conducted. A random effects model was used to pool the survival rate of implants placed with transcrestal sinus lifts using hand osteotomes without grafting, along with meta-regression and subgroup analyses. Funnel plots and Egger's linear regression were used to explore possible publication bias. Probabilities of less than 0.05 were considered significant. A total of 1807 records were identified after the initial search. Seventeen studies were included with 10 of them considered for meta-analysis. Studies used hand osteotomes, a combination of piezoelectric and hand osteotomes, drills, and smart lifts for sinus elevation. Only studies that used hand osteotomes reported subsequent vertigo and dizziness in patients. The meta-analysis showed a 100% (95% CI: 99% to 100%) survival rate for both grafted and non-grafted transcrestal sinus lifts using hand osteotomes. Meta-regression showed that follow-up time did not significantly affect the implants' survival. Subgroup analyses showed no significant difference between bone-level and tissue-level implants and one-stage or two-stage implants. On considering the limitations of this study it can be concluded that closed maxillary sinus elevation can be considered a relatively safe technique that is associated with a high survival rate. However, caution should be taken when using hand osteotomes because of a higher rate of sinus lining perforation and reported patient vertigo.

Association of Peri-Implant Mucosa Dimensions With Emergence Profile Angles of the Implant Prosthesis.

OBJECTIVES: The primary aim of this cross-sectional study was to investigate the association between prosthesis design and peri-implant mucosa dimensions and morphology. The secondary aim was to investigate associations between mucosal dimensions and the presence of mucositis. MATERIALS AND METHODS: Forty-seven patients with 103 posterior bone level implants underwent clinical and radiographic examination, including cone beam computer tomography and intraoral optical scanning. Three-dimensional models for each implant and peri-implant mucosa were constructed. Vertical mucosa height (TH), horizontal mucosa width at implant platform (TW), and 1.5 mm coronal of the platform (TW1.5), as well as mucosal emergence angle (MEA), deep angle (DA), and total contour angle (TA) were measured at six sites for each implant. RESULTS: There was a consistent correlation between peri-implant mucosa width and height (ß = 0.217, p < 0.001), with the width consistently surpassing height by a factor of 1.4-2.1. All three angles (MEA, DA, TA) were negatively associated with mucosa height (p < 0.001), while DA was negatively associated with mucosa width (TW1.5) (p < 0.001, ß = -0.02, 95% CI: -0.03, -0.01). There was a significant negative association between bleeding on probing (BoP) and mucosa width at platform (OR 0.903, 95% CI: 0.818-0.997, p = 0.043) and 1.5 coronal (OR 0.877, 95% CI: 0.778-0.989, p = 0.033). Implants with less than half sites positive for BoP (0-2/6) had significantly higher mucosa height (OR 3.51, 95% CI: 1.72-7.14, p = 0.001). CONCLUSIONS: Prosthesis design can influence the dimensions of the peri-implant mucosa, with wider emergence profile angles associated with reduced peri-implant mucosa height. In particular, a wider deep angle is associated with reduced mucosa width in posterior sites. Reduced peri-implant mucosa height and width are associated with more signs of inflammation. TRIAL REGISTRATION: Registered in Thai Clinical Trials Registry: http://www.thaiclinicaltrials.org/show/TCTR20220204002.

Impact of peri-implant keratinized mucosa width on the long-term reconstructive outcomes of peri-implantitis: A retrospective analysis with a follow-up up to 10 years.

PURPOSE: To investigate the effect of mid-buccal peri-implant keratinized mucosa width (KMW) ≥2 mm or peri-implant KMW >0 mm and <2 mm on the long-term outcomes of peri-implantitis reconstructive treatment. MATERIALS AND METHODS: Twenty-nine patients (40 implants; mean follow-up: 9.2 ± 1.4 years) with at least one implant affected by peri-implantitis and surgically treated through a reconstructive procedure followed by a submerged healing were included. Patients were categorized according to their initial KMW: Group 1 (KMW ≥2 mm) and Group 2 (KMW >0 mm and <2 mm). Peri-implant clinical and radiographic parameters and a dedicated composite outcome were assessed at different follow-up visits during supportive peri-implant therapy for up to 10 years. Regression analyses were utilized to identify possible risk/predictive indicators for probing pocket depth (PPD) change and treatment success at the latest follow-up. RESULTS: The mean PPD did not exhibit any statistical difference from the baseline to the latest follow-up between the groups at both patient and implant levels. Long-term treatment success was 46.6% (Group 1) and 42.6% (Group 2) at patient level, it was 42.8% (Group 1) and 33.3% (Group 2), respectively, at implant level (p > 0.05). Group 1 demonstrated significantly higher vertical defect depth reduction than Group 2 (p = 0.018). Presence of buccal bony wall and mean PPD at the baseline were found to be associated with mean PPD change, while KMW at 6 months following surgery was identified as the only significant indicator for treatment success (p < 0.05). CONCLUSION: Implants with KMW ≥2 mm did not present significantly better long-term clinical outcomes following reconstructive therapy than those exhibiting KMW >0 mm and <2 mm. However, KMW values at the end of healing phase following a submerged approach had a significant impact on long-term treatment success.

Maxillary sinus opacification after surgery in asymptomatic patients: Transient swelling of the sinus mucosa or graft dispersion into the maxillary sinus. A radiographic report of three cases after a follow-up period of at least 5 years.

Maxillary sinus grafting is a predictable regenerative technique to facilitate maxillary posterior implant placement when there is insufficient vertical bone height inferior to the maxillary sinuses to allow placement of implants of adequate dimensions. It enables an increase in vertical bone height, which makes implant placement easier. Maxillary sinus mucosal membrane perforation is one of the most common intraoperative complications during maxillary sinus grafting and may result in extrusion of graft material into the sinus. When this occurs, the mucociliary function of the maxillary sinus may expel the extruded graft material through its natural ostium, though graft particles may remain in the sinus or possibly occlude the natural ostium. After grafting, transient maxillary sinus mucosal oedema may occur. A postoperative CBCT scan may reveal varying degrees of sinus opacification, namely partial, subtotal or total. Although it is always possible to identify graft material, which may enter the sinus as a result of membrane perforation that might not even be visible to the implantologist during the surgical procedure, it is challenging to assess whether sinus opacification is due to mucosal thickening or mucus accumulation. The aim of the present case series was to offer a pragmatic approach to managing asymptomatic patients whose CBCT scans demonstrated partial, subtotal or total maxillary sinus opacification with bone graft particles that seemed to have been extruded into the sinus.

The safety of maxillary sinus floor elevation and the accuracy of implant placement using dynamic navigation.

OBJECTIVE: To date, it remains a challenge to conduct maxillary sinus floor elevation (MSFE) owing to heterogeneity of anatomical structures and limited operative visibility of the maxillary sinus. The aim of this study is to investigate the safety of MSFE and the accuracy of implant placement using dynamic navigation. METHODS: Forty-two implants were placed in thirty-five patients requiring implantation in posterior maxilla with dynamic navigation. They were assigned to either lateral window sinus floor elevation (LWSFE) group (n = 22) or transcrestal sinus floor elevation (TSFE) group (n = 20) according to the residual alveolar bone height (RBH). Platform deviation, apex deviation and angular deviation between actual and planned implant placement were measured in precision evaluation software. Three deviations of two groups were compared via SPSS 22.0 software. RESULTS: Neither accidental bleeding nor perforation of Schneiderian membrane occurred in any patients. The actual window position of LWSFE was consistent with the preoperative design. There were no significant differences in platform, apex and angular deviations between the two groups (P > 0.05). CONCLUSION: In this study the dynamic navigation harvested clinically acceptable safety of MSFE and accuracy for implant placement in posterior maxillary region. The dynamic navigation would provide the clinician with assistance in achieving precise preoperative planning and reducing complications in surgical procedures. The granular bone grafts used in the LWSFE did not significantly affection on the accuracy of the simultaneous implant placement under the guidance of dynamic navigation.

Local risk factors for one-year dental implant loss and late loss in 287 failed implants caused by peri-implantitis or infection after prosthesis loading: a retrospective study.

The purpose of this paper was to retrospectively assess the local factors that are likely to be associated with the risks for one-year dental implant loss.A retrospective study was designed and implemented. The sample consisted of patients who underwent an implant loss or removal caused by peri-implantitis or infection after prosthesis loading. The chi-squared test and generalised estimating equations (GEE) were used to explore the potential risk factors for one-year implant loss. A total of 279 patients with 287 failed implants were enrolled in this study. Immediate implant placement exhibited a 3.373 (95% CI: 1.652 to 6.886) significantly increased risk to experience one-year implant loss than early and late implant placement (p = 0.001). In addition, implants loaded during a healing period fewer than two months after implant placement were at 18.139 (95% CI: 8.925 to 36.866) significantly higher risk of one-year implant loss when compared with those that loaded within more than two months after implant placement (p < 0.001). Smokers were 1.866 (OR = 1.866,95% CI: 0.993 to 3.510) times as high risk for one-year implant loss as non-smokers, but there were no significant statistical differences (p = 0.053). Immediate implant placement and early implant loading were considered risk factors for one-year implant loss.

Dental implant considerations in patients with systemic diseases: An updated comprehensive review.

BACKGROUND: Various medical conditions and the drugs used to treat them have been shown to impede or complicate dental implant surgery. It is crucial to carefully monitor the medical status and potential post-operative complications of patients with systemic diseases, particularly elderly patients, to minimize the risk of health complications that may arise. AIM: The purpose of this study was to review the existing evidence on the viability of dental implants in patients with systemic diseases and to provide practical recommendations to achieve the best possible results in the corresponding patient population. METHODS: The information for our study was compiled using data from PubMed, Scopus, Web of Science and Google Scholar databases and searched separately for each systemic disease included in our work until October 2023. An additional manual search was also performed to increase the search sensitivity. Only English-language publications were included and assessed according to titles, abstracts and full texts. RESULTS: In total, 6784 studies were found. After checking for duplicates and full-text availability, screening for the inclusion criteria and manually searching reference lists, 570 articles remained to be considered in this study. CONCLUSION: In treating patients with systemic conditions, the cost-benefit analysis should consider the patient's quality of life and expected lifespan. The success of dental implants depends heavily on ensuring appropriate maintenance therapy, ideal oral hygiene standards, no smoking and avoiding other risk factors. Indications and contraindications for dental implants in cases of systemic diseases are yet to be more understood; broader and hardcore research needs to be done for a guideline foundation.

Abordaje reconstructivo para un defecto de periimplantitis / Reconstructive approach for a peri-implantitis defect

Si bien el conocimiento científico para el tratamiento de la periimplantitis ha avanzado significativamente en los últimos años, sigue en discusión qué tipo de abordaje quirúrgico genera los mejores resultados clínicos y si el uso de biomateriales da mejoras significativas en dicho tratamiento. Este reporte de caso describe un abordaje quirúrgico reconstructivo de un defecto intraóseo por periimplantitis en una paciente que refería dolor y un intenso sangrado en sus implantes dentales, empleando un sustituto óseo anorgánico mineral bovino, sin el uso de una membrana o barrera, y con un protocolo de descontaminación de la superficie del implante mecánico y químico. Posteriormente, a las 20 semanas de realizado el procedimiento, se hizo la evaluación del defecto, obteniendo profundidades al sondeo menores a 5 mm, ausencia de sangrado al sondeo en todos los sitios y un llenado óseo radiográfico de aproximadamente 90%; cumpliendo con los criterios de éxito de la terapia periimplantaria. Lo anterior muestra que la terapia reconstructiva para los defectos por periimplantitis puede ser posible mediante el uso de un sustituto óseo xenogénico únicamente y con una correcta descontaminación de la superficie del implante (AU)

Although scientific knowledge for the treatment of peri-implantitis have advanced significantly in recent years, the type of surgical approach that generates the best clinical results is still under discussion and whether the use of biomaterials gives significant improvements in said treatment. This case report describes a reconstructive surgical approach for a periimplantitis intrabony defect using an anorganic bovine bone substitute, without the use of a membrane or barrier, and with a mechanical and chemical implant surface decontamination protocol. Twenty weeks after the procedure, the defect was reassessed, obtaining probing depths of less than 5 mm, no bleeding on probing in all sites, and radiographic bone filling of approximately 90%; meeting the success criteria for the peri-implant therapy. This shows that reconstructive therapy for periimplantitis defects may be possible using a xenogeneic bone substitute only and proper decontamination of the implant surface (AU)

The effect of one-time abutment placement on clinical and radiographic outcomes: A 5-year randomized clinical trial.

OBJECTIVE: The aim of this study was to evaluate the long-term (5 years) clinical efficacy of the one-abutment one-time protocol (test) versus the standard of care by placing the definitive abutment on the day of the prosthetic delivery (control). MATERIALS AND METHODS: In this study, 39 subjects with 60 implants were randomly allocated to either the test or the control group. Changes in the radiographic interproximal bone levels (DIB), modified sulcus bleeding index, probing depth, modified plaque index, papilla fill (Jemt score), incidence of peri-implantitis and peri-implant mucositis as well as patient-reported outcomes measures (PROMs) were collected and compared at 1, 3 and 5 years. RESULTS: At 5 years, the control group showed a greater, although not statistically significant, change in mean DIB values (0.97 mm vs. 0.53 mm). Regarding the other clinical parameters evaluated, no statistically significant differences were observed between groups at any time point. At 5 years, 51% of the implants presented peri-implant mucositis (25.5% in the control and 23.5% in the test), and only one implant in the test group developed peri-implantitis. CONCLUSIONS: The connection and disconnection of healing abutments during the healing period was not associated with higher long-term bone loss. Clinical outcomes and PROMs were similar between groups.

Radiographic bone loss around dental implants: a large-cohort, long-term follow-up revealing prevalence and predictive factors.

OBJECTIVE: This retrospective study analyzed radiographic bone levels of 10,871 dental implants in a cohort of 4,247 patients over a 22-year period. The objectives of the study were to assess and explore risk factors associated with the radiographic bone level of dental implants. METHOD AND MATERIALS: A longitudinal observational cohort study based on data collected from 1995 to 2019 was conducted on implants placed by a single periodontist. Inclusion criteria included both partially and fully edentulous sites. Exclusion criteria were patients who were considered ASA 3 or greater. Information on medical and dental status prior to implant placement such as diabetes and smoking were included in the analysis. Implant factors such as the implant characteristics (length and diameter) and surgical site were recorded. The outcome assessed was the prevalence of bone loss around implants and any associative factors related to the bone loss. RESULTS: Overall, dental implants lost an average of 0.05 ± 0.38 mm of bone 2 to 3 years after placement and 0.21 ± 0.64 mm 8 years after placement. The soft tissue condition was evaluated using the Implant Mucosal Index (IMI), and bone loss around dental implants was significantly higher when bleeding on probing was multi-point and moderate, multi-point and profuse, and when infection with suppuration was recorded. The mean difference in bone level between smokers and nonsmokers was 0.26 mm (P < .01) over a 4-year period. A mean difference of 0.10 mm (P = .04) in bone loss over 4 years was found between those with an autoimmune disease compared to those without. The diameter of the implant and immediate loading of the dental implant did not influence the radiographic bone levels over time. CONCLUSIONS: This large dataset of dental implants highlights predictive risk factors for bone loss around dental implants and the impact these risk factors have on the implant bone level. Consideration of these risk factors by both the dental team and the patient prior to dental implant placement will promote success of the treatment.

Impact of keratinized mucosa on implant-health related parameters: A 10-year prospective re-analysis study.

AIM: To investigate whether the lack of keratinized mucosa (KM) affects peri-implant health after 10 years of loading. MATERIALS AND METHODS: Data from 74 patients with 148 implants from two randomized controlled studies comparing different implant systems were included and analyzed. Clinical parameters including bleeding on probing (BOP), probing depth (PD), plaque index, marginal bone loss (MBL), and KM width (KMW) at buccal sites were collected at baseline (time of the final prosthesis insertion), 5-year and 10 years postloading. Multivariable logistic and linear regression models by means of a generalized estimated equation (GEE) were used to evaluate the influence of buccal KM on peri-implant clinical parameters; BOP, MBL, PD, and adjusted for implant type (one-piece or two-piece) and compliance. RESULTS: A total of 35 (24.8%) implants were healthy, 67 (47.5%) had mucositis and 39 (27.6%) were affected by peri-implantitis. In absence of buccal KM (KM = 0 mm), 75% of the implants exhibited mucositis, while in the presence of KM (KMW >0 mm) 41.2% exhibited mucositis. Regarding peri-implantitis, the corresponding percentages were 20% (KM = 0 mm) and 26.7% (KM >0 mm). Unadjusted logistic regression showed that the presence of buccal KM tended to reduce the odds of showing BOP at buccal sites (OR: 0.28 [95% CI, 0.07 to 1.09], p = 0.06). The adjusted logistic regression model revealed that having buccal KM (OR: 0.21 [95% CI, 0.05 to 0.85], p = 0.02) and using two-piece implants (OR: 0.34 [95% CI, 0.15 to 0.75], p = 0.008) significantly reduced the odds of showing BOP. Adjusted linear regression by means of GEE showed that KM and two-piece implants were associated with reduced MBL and MBL changes (p < 0.05). CONCLUSION: The lack of buccal KM appears to be linked with peri-implant parameters such as BOP and MBL, but the association is weak. The design of one-piece implants may account for their increased odds of exhibiting BOP.

Peri-implant epidermoid cyst: A case report and literature analysis.

BACKGROUND: A peri-implant cystic lesion is a rare finding, and to date most investigators have considered that its pathogenesis is caused by trauma and infection related to dental implantation. However, the pathogenesis of these cysts remains unclear and is recognized to have multifactorial origins. CASE PRESENTATION: In February 2021, a 75-year-old male patient underwent implant restoration due to mobility of the left maxillary central incisor. The implant achieved good osseointegration and was successfully restored. However, in March 2023, the patient sought treatment due to mobility of the dental implant. Clinical examination showed that the implant had loosened in three directions (vertical, mesial-distal, and labial-lingual), and the peri-implant mucosa was slightly red and swollen. Radiographic examination (cone beam computed tomography) showed a large radiolucent area with clear boundaries involving the cervical and middle portions of the dental implant, and white bone lines were observed at the edge of the low-density shadow. Intraoperatively, we removed the patient's implant, performed a complete debridement, and conducted bone augmentation surgery in the area of bone defect. Postoperatively, the patient recovered well. The final histopathological result confirmed an epidermoid cyst. CONCLUSIONS: Peri-implant epidermoid cyst is a rare complication that affects the long-term outcome of implant therapy. This case serves as a warning to clinicians to avoid involving epithelial tissue in the implant site during implant surgery, in order to prevent the potential occurrence of a peri-implant epidermoid cyst, thereby creating better conditions for the patient's recovery and the long-term efficacy of the implant.

Clinical outcomes and risk factor analysis of dental implants inserted with lateral maxillary sinus floor augmentation: A 3- to 8-year retrospective study.

AIM: To evaluate the 3- to 8-year outcomes of dental implants placed with lateral sinus floor augmentation (LSFA) and to identify factors affecting implant survival. MATERIALS AND METHODS: This retrospective study was performed by screening all implants placed with LSFA procedures, which were conducted between January 2012 and December 2016. Subantral bone gain (SABG) and apical bone height (ABH) were assessed using panoramic radiographs. The cumulative survival rate of implants was analysed using life-table analysis and Kaplan-Meier survival curves. The influential risk factors affecting survival were assessed using univariate log-rank tests and multivariable mixture cure rate model. Implant complications were recorded. RESULTS: Based on the established criteria, a total of 449 patients (760 implants) were included in this study. In the 3- to 8-year follow-up (mean ± SD, 5.81 ± 1.33 years), 15 implants in 14 patients failed, with a CRS of 96.81% on an implant basis and 95.07% on a patient basis. A history of periodontitis and poor compliance with supportive periodontal treatment was associated with a significantly higher risk of implant failure at both implant and patient levels. Significant decreases in ABH occurred during each yearly interval except for 3 years. A similar trend has been observed for SABG at 1, 2, 6 and 8 years. The total complication rate was 31.84% on implant basis, with peri-implant mucositis (21.58%) being the most frequent biologic complication and porcelain cracking (5.00%) being the most common technical complication. CONCLUSIONS: Implant with LSFA is a reliable treatment option in atrophic maxilla. A history of periodontitis without regular supportive periodontal treatment was identified as a predictor for implant failure. Slight but significant shrinkage of vertically augmented bone can be observed after implant placement.

Management of bleeding during dental implant surgery using a novel implant with an abbreviated drilling protocol: A clinical report.

Coagulopathy is a well-recognized complication in dental surgery in patients who use oral anticoagulants or some dietary supplements. Proper pre-operative diagnosis, medical consultation, timely management, and conservative treatment can decrease the incidence of such complications. Management of bleeding during dental implant surgery commonly involves conventional methods such as discontinuation of anticoagulant use, compression, styptics, and local anesthetic administration containing vasoconstrictors. This clinical report describes the successful management of a patient with a history of coagulopathy who was rehabilitated with complete arch fixed implant-supported prostheses with immediate loading. A novel implant design with a significantly abbreviated single drill protocol for osteotomy preparation was used in an outpatient setting. The novel protocol successfully decreased the overall bleeding and significantly reduced the intraoperative time for the surgical procedure. Additional considerations related to the novel implant design and osteotomy protocol, supplementary applications, and advantages of the protocol are presented in this article.

Correlation between intraosseous thermal change and drilling impulse data during osteotomy within autonomous dental implant robotic system: An in vitro study.

OBJECTIVES: This study aims at examining the correlation of intraosseous temperature change with drilling impulse data during osteotomy and establishing real-time temperature prediction models. MATERIALS AND METHODS: A combination of in vitro bovine rib model and Autonomous Dental Implant Robotic System (ADIR) was set up, in which intraosseous temperature and drilling impulse data were measured using an infrared camera and a six-axis force/torque sensor respectively. A total of 800 drills with different parameters (e.g., drill diameter, drill wear, drilling speed, and thickness of cortical bone) were experimented, along with an independent test set of 200 drills. Pearson correlation analysis was done for linear relationship. Four machining learning (ML) algorithms (e.g., support vector regression [SVR], ridge regression [RR], extreme gradient boosting [XGboost], and artificial neural network [ANN]) were run for building prediction models. RESULTS: By incorporating different parameters, it was found that lower drilling speed, smaller drill diameter, more severe wear, and thicker cortical bone were associated with higher intraosseous temperature changes and longer time exposure and were accompanied with alterations in drilling impulse data. Pearson correlation analysis further identified highly linear correlation between drilling impulse data and thermal changes. Finally, four ML prediction models were established, among which XGboost model showed the best performance with the minimum error measurements in test set. CONCLUSION: The proof-of-concept study highlighted close correlation of drilling impulse data with intraosseous temperature change during osteotomy. The ML prediction models may inspire future improvement on prevention of thermal bone injury and intelligent design of robot-assisted implant surgery.

Immediate repair of bony defects in the posterior mandibular region following removal of a fractured implant: a feasible treatment?

The aim of this study was to assess whether immediate bone reconstruction after removal of a fractured dental implant in the posterior mandible provides a sound base for implant replacement, with a favourable treatment outcome and high patient satisfaction. Eight consecutive patients with a fractured implant neck were included. The implant was removed via osteotomy, following which the site was immediately repaired with a mixture of autogenous bone and bone substitute. After a 4-month healing period, sufficient bone and favourable soft tissue conditions were present, allowing implant placement with adequate primary stability. After a further 3 months, the implants were restored with an all-ceramic restoration. Patient satisfaction, the aesthetic outcome, complications, and postoperative morbidity were assessed using standardized clinical and radiographic examinations up to 5 years after crown placement. No implant failures were observed during the follow-up. Plaque accumulation, the presence of calculus, bleeding tendency, and peri-implant inflammation indices were low, indicating healthy peri-implant conditions. The mean marginal bone level change at the 5-year follow-up was - 0.17 ± 0.46 mm. All patients reported a high level of satisfaction (mean overall score 9.3 ± 0.5). In conclusion, immediate reconstruction of the hard tissue after removal of a fractured dental implant is a viable treatment option. This approach facilitates rehabilitation, reduces morbidity, and leads to favourable aesthetic outcomes.

Risk factors associated with early implant failure: A retrospective review.

PURPOSE: The purpose of this study was to investigate the association between possible risk factors and early implant failure. PATIENTS AND METHODS: This retrospective cohort study included consecutive patients receiving dental implant treatment in a four-year timeframe. Patient-related variables (age, sex, smoking, and systemic disease), local factors (area, reason for tooth extraction, and bone quality), surgical variables (bone augmentation, time of implant placement, staging, and antibiotic prophylaxis), and implant-related factors (brand, length, and diameter) were analyzed. Bivariate analyses and multivariate logistic regression model were used to determine the variables associated with early implant failure. RESULTS: The study group comprised 1323 implants in 738 patients with a mean of 1.8 implants/patient of which, 53 failed in 52 patients in the early stage (before final prosthetic loading). According to the multivariate model, smoking (Odds Ratio=1.836, P=0.031), posterior maxillary region (OR=2.958, P=0.006), implantation in place of teeth extracted due to periodontal problems (OR=2.531, P=0.004), bone type IV (OR=2.881, P=0.008), implant in previously augmented site (OR=2.239, P=0.014), and immediate provisional prosthesis (OR=3.418, P=0.019) were associated with a significantly higher risk of early implant failure. Narrow implants showed a significantly higher risk of early failure in bivariate analyses (P=0.012). However, the effect was no longer significant in the multivariate model (OR=2.322, P=0.068). CONCLUSION: Early implant failure would be more expected in smokers, posterior maxilla, history of periodontal problems, type IV bone, augmented bone, and immediately loaded cases.

Correlates of Early Dental Implant Failure: A Retrospective Study.

PURPOSE: To examine whether patient-level disease diagnoses, drug treatments, and dental clinical factors are correlates of early implant failure. MATERIALS AND METHODS: This historical, nested case-control study used electronic medical records to retrieve patient-level data on individuals with implant failure occurring up to 6 months after implantation, including demographics, clinical information (number, location, and complicated status of implants), underlying diseases (osteoporosis, diabetes, hypertension, inflammatory bowel disease [IBD], myocardial infarction [MI]), and drug purchases (chemotherapy, bisphosphonates, selective serotonin inhibitors, antihypertensive medications, proton pump inhibitors [PPIs], disease-modifying antirheumatic drugs, corticosteroids, and nonsteroidal anti-inflammatory drugs) among adult members of a large, state-mandated health provider in Israel between 2015 and 2020. Individuals with implant extraction occurring up to 6 months after implantation were matched 1:1 to controls. Univariate and adjusted multivariate conditional logistic regression models were used to examine the odds ratios (ORs) of all dental implant risk factors among the patients. RESULTS: A total of 585 individuals with implant failure (mean age, 53 years [42,62], 51.3% females and 49.7% males) were identified among 29,378 eligible patients. Compared to controls, patients who experienced implant failure (ie, cases) were more likely to have smoked in their lifetime (18% vs 11.5%, P = .009), experienced IBD (1.5% vs 0.02%, P = .059), and consumed PPIs within 6 months of the implant surgery (40.0% vs 32.5%, P = .028). Clinical factors, including the number of implants per person (individuals with two implants, OR = 1.53; individuals with at least four implants, OR = 3.33; P < .01), location of implant (maxilla; OR = 1.59; 95% CI: 1.2-2.04), and smoking (OR = 1.57; 95% CI: 1.09-2.26) were significant correlates of early implant failure among the included cases. Crohn's disease, MI, and osteoporosis were found to be borderline significant correlates of early dental implant failure. CONCLUSIONS: Among the factors examined, the number of implants, the location of implants, and smoking history were significant correlates of early implant failure, while Crohn's disease, MI, and osteoporosis were found to not be significant. Larger patient-level studies are needed to examine the individual and combined effects of diseases, medications, and clinical factors on early implant failure.

Clinical and Radiographic Outcomes of a New Fully Tapered Implant with the One-Abutment One-Time Approach: In-Line Clinical Case Series with a 1-Year Follow-up.

PURPOSE: To evaluate the bone level changes in a new implant design (fully tapered with platform switching) with the one-abutment one-time protocol after 1 year of loading. MATERIALS AND METHODS: Thirty patients received 1 or 2 implants (6-, 8-, or 10-mm length and 3.5-, 3.75-, or 4.5-mm diameter, bone-level design) to replace one or multiple edentulous sites. Only the mesial implant was assessed. Radiographic, clinical, and esthetic results and the survival and success rates were evaluated 1 year after final loading. RESULTS: At 1 year, no peri-implant bone loss was seen in any of the cases. Mean marginal crestal bone loss between surgery and crown placement was 0.19 ± 0.17 mm (P < .0001). Between surgery and the 1-year follow-up, the mean marginal crestal bone loss was 0.25 ± 0.24 mm (P < .0001). The difference in the modified Plaque Index between 1 year of follow-up and crown placement was significant for in the mesial (0.33 ± 0.54 mm; P = .003) and distal surfaces (0.5 ± 0.73 mm; P = .001). The probing pocket depth was statistically significantly deeper at 1 year than at crown placement at the mesial and distal aspects (average depth = 0.75 mm; P < .0005). No statistically significant differences were found for any other clinical or esthetic parameters. The overall survival and success rates after 1 year were 100%. CONCLUSIONS: The fully tapered, deep-thread, platform-switched implant design placed with the one-abutment one-time protocol demonstrated minimal marginal crestal bone loss and crestal bone stability at 1 year of follow-up.