ABSTRACT
@#Alveolar bone is an important anatomic basis for implant-supported denture restoration, and its different degrees of defects determine the choices of bone augmentation surgeries. Therefore, the reconstruction of alveolar bone defects is an important technology in the clinical practice of implant restoration. However, the final reconstructive effect of bone quality, bone quantity and bone morphology is affected by many factors. Clinicians need to master the standardized diagnosis and treatment principles and methods to improve the treatment effect and achieve the goal of both aesthetic and functional reconstruction of both jaws. Based on the current clinical experience of domestic experts and the relevant academic guidelines of foreign counterparts, this expert consensus systematically and comprehensively summarized the augmentation strategies of alveolar bone defects from two aspects: the classification of alveolar bone defects and the appropriate selection of bone augmentation surgeries. The following consensus are reached: alveolar bone defects can be divided into five types (Ⅰ-0, Ⅰ-Ⅰ, Ⅱ-0, Ⅱ-Ⅰ and Ⅱ-Ⅱ) according to the relationship between alveolar bone defects and the expected position of dental implants. A typeⅠ-0 bone defect is a bone defect on one side of the alveolar bone that does not exceed 50% of the expected implant length, and there is no obvious defect on the other side; guided bone regeneration with simultaneous implant implantation is preferred. Type Ⅰ-Ⅰ bone defects refer to bone defects on both sides of alveolar bone those do not exceed 50% of the expected implant length; the first choice is autologous bone block onlay grafting for bone increments with staged implant placement or transcrestal sinus floor elevation with simultaneous implant implantation. Type Ⅱ-0 bone defects show that the bone defect on one side of alveolar bone exceeds 50% of the expected implant length, and there’s no obvious defect on the other side; autologous bone block onlay grafting (thickness ≤ 4 mm) or alveolar ridge splitting (thickness > 4 mm) is preferred for bone augmentation with staged implant placement. Type Ⅱ-Ⅰ bone defects indicate that the bone plate defect on one side exceeds 50% of the expected implant length and the bone defect on the other side does not exceed 50% of the expected implant length; autologous bone block onlay grafting or tenting techniques is preferred for bone increments with staged implant implantation. Type Ⅱ-Ⅱ bone defects are bone plates on both sides of alveolar bone those exceed 50% of the expected implant length; guided bone regeneration with rigid mesh or maxillary sinus floor elevation or cortical autologous bone tenting is preferred for bone increments with staged implant implantation. This consensus will provide clinical physicians with appropriate augmentation strategies for alveolar bone defects.
ABSTRACT
@#Patients with type 2 diabetes mellitus (T2DM) have a large demand for dental implants, but the pathologic state of T2DM patients could compromise the efficacy of implant treatment. Glycemic control can improve the success rate of implants in the T2DM population, but the early osseointegration of individuals still needs to be improved. Strengthening early osseointegration in patients with T2DM is one of the urgent problems for clinicians. The pharmacological mechanisms of hypoglycemic drugs on the market for bone metabolism are different and may require different interventions on the bone around the implant, but there is a lack of direct clinical evidence of the protective effect of hypoglycemic drugs. This review integrated the bone metabolic effect of drugs in clinical medical research and dental implant research. The aim was to provide medication guidance for T2DM patients who require implant surgery, and it is recommended to avoid the use of drugs with negative effects on bone as far as possible without violating the clinical medication guidelines, including SGLT-2 inhibitors and thiazolidinediones. Instead, they should choose glucose-lowering drugs that are beneficial to bone metabolism, such as insulin, metformin and GLP-1 receptor agonists. However, the comparative clinical effects of these drugs on periimplant bone need to be further elucidated. The researcher should select appropriate drugs (incretin drugs) to enhance the early osseointegration of implants in patients with T2DM.
ABSTRACT
@#Through a review of the literature on surface treatment of superhydrophilic implants and its clinical application, this paper discusses the shortening of load time, the improvement of the planting success rate and its long-term effect. Additionally, attention should be paid to the nonindication of superhydrophilic implants and issues requiring attention. The literature review showed that healthy patients could carry out an early load 21 days after implantation of superhydrophilic implants, and the load could be completed as soon as 6 weeks after implantation with superhydrophilic short implants when the residual alveolar bone height of the posterior dental area was repaired. Even if the residual alveolar bone density of the patient is low, the application of superhydrophilic implants can shorten the healing period to 8 weeks. Notably, some studies have reported that superhydrophilic implants have no significant effect on patients with a history of radiotherapy and the use of anticoagulants. Because the adhesion of the superhydrophilic implant to the bacteria is also improved to some extent, it is very important to prevent the use of antibiotics when using the superhydrophilic implant. Finally, this paper discusses and anticipates the future research direction of superhydrophilic implants: longer periodic follow-up and more in-depth molecular mechanism studies.
ABSTRACT
@#In 2017, there were 451 million people (ages 18 to 99) with diabetes worldwide, and this number is expected to grow to 592 million by 2035. A series of complications in diabetic patients often leads to oral vascular and bone lesions. Therefore, dental implant doctors urgently need to understand the clinical characteristics of diabetes mellitus patients to provide the best treatment. For dental implant doctors, the following problems still exist in the treatment of diabetic patients with poor blood sugar control: ① alveolar fossa healing in diabetic patients is slow after extraction, and bone regeneration is often needed, which prolongs the treatment cycle and increases the pain of patients; ② the rate of new bone formation in diabetic patients after alveolar bone grafting is slow; ③ it takes a long time for the body to achieve effective bone bonding after dental implantation in diabetic patients, and the outcomes are poor; ④ the health of the tissue around dental implants is affected by blood sugar level, which is difficult to maintain in diabetic patients. Current studies suggest that the long-term success rate of implants is predictable in diabetic patients when blood sugar levels are well controlled (HbA1c < 6%). This article will review the current research status of dental implantation therapy for diabetic patients to provide a reference for clinical practice.
ABSTRACT
In order to understand the mechanisms of poor osseointegration following dental implants in type 2 diabetics, it is important to study the biological properties of alveolar bone osteoblasts isolated from these patients. We collected alveolar bone chips under aseptic conditions and cultured them in vitro using the tissue explants adherent method. The biological properties of these cells were characterized using the following methods: alkaline phosphatase (ALP) chemical staining for cell viability, Alizarin red staining for osteogenic characteristics, MTT test for cell proliferation, enzyme dynamics for ALP contents, radio-immunoassay for bone gla protein (BGP) concentration, and ELISA for the concentration of type I collagen (COL-I) in the supernatant. Furthermore, we detected the adhesion ability of two types of cells from titanium slices using non-specific immunofluorescence staining and cell count. The two cell forms showed no significant difference in morphology under the same culture conditions. However, the alveolar bone osteoblasts received from type 2 diabetic patients had slower growth, lower cell activity and calcium nodule formation than the normal ones. The concentration of ALP, BGP and COL-I was lower in the supernatant of alveolar bone osteoblasts received from type 2 diabetic patients than in that received from normal subjects (P < 0.05). The alveolar bone osteoblasts obtained from type 2 diabetic patients can be successfully cultured in vitro with the same morphology and biological characteristics as those from normal patients, but with slower growth and lower concentration of specific secretion and lower combining ability with titanium than normal ones.