Influence of the Transmucosal Surface of Dental Implants on the Soft Tissue Attachment Level and Marginal Bone Loss in Preclinical Studies: A Systematic Review.

PURPOSE: To determine the characteristics of dental implant transmucosal surfaces that influence soft tissue attachment and marginal bone loss (MBL). MATERIALS AND METHODS: The PubMed, Embase, and Cochrane Library electronic databases were searched based on predefined PICO eligibility criteria. Data from animal studies that compared junctional epithelium and connective tissue attachment and MBL from 4 days to 72 weeks were analyzed. The risk of bias was performed with the Systematic Review Centre for Laboratory Animal Experimentation tool. A rank analysis evaluation of data was performed, and the most frequently appearing materials/surfaces for each tissue compartment were identified. RESULTS: The search identified 3,549 studies, 28 of which were eligible for analysis, with an average risk of bias of 28% ± 10%. Machined, polished, etched, sandblasted, or coated titanium and zirconia materials/surfaces were most frequently examined. Several studies investigated lithium disilicate, polyether ether ketone (PEEK) or polyether ketone ketone (PEKK), aluminum oxide, and gold. Based on ranking and frequency of use at different time points, titanium grade IV (Ti-4) microthreads with a polished neck area most frequently supported natural tooth-like junctional epithelial attachment (≤ 1.5 mm), while machined Ti-4 and machined titanium grade V (Ti-5) most frequently supported connective tissue attachment (≤ 1.25 mm) and led to the least MBL (≤ 0.75 mm). CONCLUSIONS: Analyzed data suggest that Ti-4 microthreads with a polished neck area and machined Ti-4 and Ti-5 were the materials/surfaces of choice for the transmucosal part of implants. However, the extensive heterogeneity in reported studies precludes solid identification of the best materials/surfaces.

Mental and Lingual Nerve Paresthesia Following Infiltration Anesthesia for Dental Implant Placement in a Patient With Guillain-Barré Syndrome.

Guillain-Barré syndrome (GBS) is a rare rapid onset autoimmune peripheral polyneuropathy, most commonly characterized by inflammatory demyelination of peripheral nerves. Patients with GBS are considered higher risk for anesthetic-induced neurotoxicity caused by demyelination. In the present report, a case is described of a 56-year-old man with GBS who experienced mental and lingual nerve paresthesia following infiltration anesthesia for dental implant placement in the posterior mandible. The pareshesia lasted 5 months postoperatively and subsided spontaneously without any intervention. The patient was successfully restored with fixed partial dental prosthesis without any other complication. This is considered the first report of such complication in patient with GBS after local anesthesia in the oral and maxillofacial region. Possible pathogenic mechanism of the complication and clinical implications are discussed.

Risk factors for periodontitis & peri-implantitis.

Risk is part of all health professions and generally indicates the chance of getting some form of illness. For dental practitioners this includes periodontitis or peri-implantitis, the focus of this issue. Many risk factors are involved in the development of disease and most likely interact or overlap. Most patients will probably have multiple risk factors, some of which will be the same for both periodontitis and peri-implantitis. The most recent classification of periodontal disease recognises the importance of risk factors and contemporary dental practice requires that clinicians be aware of and manage them. Broadly speaking risk factors can be patient, environment or practitioner related. Patient risk factors would include socio-economic status, smoking, substance use disorders, diabetes, diet and dietary supplements, mental health disorders, old age, poor home dental care or understanding of the need for good home care and use of medications. Environmental modification of the host response through gene function is an emerging risk factor. Lastly, practitioner-related factors in implant dentistry are now known to affect risk. These would include the use of digital technology, but patient related factors such implant location and the body's reaction to an implant itself add to the risk of developing disease. This edition of Periodontology provides an uptodate review of many of these risk factors and their impact summarising current knowledge.

[Evaluation of the effect of Er:YAG laser combined with guided bone regeneration in the treatment of peri-implantitis with osseous defects].

PURPOSE: To evaluate the clinical benefits of Er:YAG laser combined with guided bone regeneration (GBR) in the treatment of peri-implantitis-assocaited osseous defects. METHODS: Twenty-six patients (34 implants in total) who underwent implant restoration in Dental Disease Prevention and Treatment Institute, Jiading District, from 2017 to 2019 and were diagnosed with peri-implantitis with osseous defects, and randomly divided into the experimental group and control group. The two groups of patients received open flap surgery, debridement and GBR treatment. The only difference in the experimental group was the use of Er: YAG laser to modulate and remove inflammatory tissue as well as to decontaminate the implant surface, instead of traditional mechanical treatment in the control group. The probing depth (PD), bleeding on probing (BOP), and plaque index (PI), the height of the bone defect around the implant (reduce of marginal bone level, RBL) were recorded and compared. SPSS 20.0 software package was used to analyze the data. RESULTS: The PD, BOP, PI and RBL of the two groups of patients were significantly improved after treatment with different methods. There was no significant difference in the improvement of PD, BOP and PI between the two groups 6, 12 and 24 months after treatment, while the improvement of RBL in the experimental group was significantly better than that of the control group 12 and 24 months after treatment. CONCLUSIONS: In the treatment of GBR with peri-implantitis and osseous defects, Er: YAG laser therapy is more effective than traditional mechanical methods, and is more conducive to the regeneration of new bone.

Is titanium alloy Ti-6Al-4 V cytotoxic to gingival fibroblasts-A systematic review.

OBJECTIVES: Grade V titanium alloy (Ti-6Al-4 V) is a well-recognized metallic biomaterial for medical implants. There has been some controversy regarding the use of this alloy in medical devices in relation to the toxicity of vanadium. In Dentistry, Ti-6Al-4 V remains prevalent. This systematic review aims to evaluate the effects of Ti-6Al-4 V on cells relevant to oral environments such as gingival fibroblasts. MATERIALS AND METHODS: A literature search was undertaken for relevant English language publications in the following databases: Dental and Oral Science, Medline and Web of Science. The electronic search was supplemented with a search of references. RESULTS: After application of inclusion and exclusion criteria. A total of eight papers are included in this review. These papers were all in vitro studies and were categorized into whole implant, discs, or implant particles based on the type of test materials used in the studies. CONCLUSION: Based on the analyses of the eight included studies in this review, if Ti-6Al-4 V as a material is unchallenged, i.e., as a whole implant in pH neutral environments, there appears to be little effect on fibroblasts. If Ti-6Al-4 V is challenged through corrosion or wear (particle release), the subsequent release of vanadium and aluminium particles has an increased cytotoxic effect in vitro in comparison to commercially pure titanium, hence concerns should be raised in the clinical setting.

Effect of Acupuncture on Post-implant Paresthesia.

Paresthesia is defined as an alteration in local sensibility, associated with numbness, tingling, or unpleasant sensations caused by nerve lesions or irritation. It can be temporary or permanent. The treatment protocol for facial paresthesia is primarily based on the use of drugs and implant removal, which may not be completely effective or may require other risk exposure when there is no spontaneous regression. However, other therapeutic modalities such as acupuncture can be used. The aim of this study is to report a case of a patient with paresthesia of the inferior alveolar nerve and pain caused by an implant surgery performed 2 years earlier. The patient received acupuncture treatment during 4 months of weekly sessions. Six points were used: Large Intestine (LI4), Large Intestine (LI11), Stomach (ST36), Liver (LR3), Extra Head and Neck (E-HN-18), and Stomach (ST5). The visual analog scale was used before and after each session for the analysis of paresthesia and pain, together with assessment of the paresthesia by delimitation of the desensitized region of the skin and presented discomfort. Pain remission and reduction in the size of the paresthesia area occurred after four sessions.

Avaliação in vitro e in vivo de superfícies de titânio revestidas com vidro bioativo / In vitro and in vivo evaluation of a bioactive titanium surface modified by bioglass coating

Objetivo: Esse estudo experimental in vitro e in vivo testou a capacidade de osseoindução de uma nova superfície de titânio nanoestruturada revestida com vidro bioativo contendo fosfato de cálcio. Metodologia: A rugosidade superficial foi avaliada por microscopia de força atômica utilizando 9 corpos de prova dos três diferentes grupos: titânio microtexturizado (Ticp) e revestidos com vidro bioativo e secos nas temperaturas de 370 C (BGTi37) ou 6000 C (BGTi600). Células osteoblásticas primárias obtidas das calvárias de ratos neonatos foram cultivadas in vitro em meio α-MEM suplementado em contato ou não (controle) com discos de titânio microtexturizado (Ticp) e revestidos (BGTi37 e BGTi600). A viabilidade celular e produção de fosfatase alcalina foram avaliadas após 7 dias de cultura e a mineralização após 14 dias de cultura. Os dados foram submetidos a análise de variância (ANOVA) seguido pelo teste de Tukey, com nível de significância de 5%. A morfologia dos osteoblastos em contato com as três superfícies foi avaliado por microscopia eletrônica de varredura após 7 e 14 dias. Quatorze parafusos de titânio microtexturizados (Ticp -controle) e quatorze parafusos experimentais revestidos com vidro bioativo e secos à 370 C (BGTi37) foram instalados aleatoriamente nas tíbias de 14 ratos Wistar. Os animais foram eutanasiados após 14 e 28 dias e suas tíbias preparadas e analisadas por microtomografia computadorizada. Resultados: O grupo Ticp apresentou a maior rugosidade média(129,6 nm), seguido do grupo BGTi600 (91,85 nm), que foram estatisticamente semelhantes. O grupo BGTi37 apresentou a menor rugosidade(74,51 nm), sendo significativamente menor do que os outros dois grupos. A proporção de células viáveis, a produção de fosfatase alcalina e a mineralização do grupo BGTi600 foi significativamente menor do que as do grupo controle e do Ticp. Para os demais grupos (BGTi37, Ticp e controle),a proporção de células viáveis, produção de fosfatase alcalina e mineralização foram semelhantes. O número de osteoblastos em contato com todas as superfícies foi maior no período de 14 dias comparado ao período de 7 dias. A maior quantidade de osteoblastos foi observada em contato com a superfície de Ticp e a menor quantidade em contato com a superfície de BGTi600. Os osteoblastos em contato com a superfície Ticp apresentaram-se com morfologia poligonal e maiores do que os dos grupos BGTi37 e BGTi600, que apresentam-se com morfologia mais alongada, mais notadamente no grupo BGTi600. A quantidade de prolongamentos citoplasmáticos, junções intercelulares e vesículas observadas nos espécimes do grupo BGTi600 foi notadamente menor do que nos grupos Ticp e BGTi37. Os parâmetros avaliados por microtomografia computadorizada da cortical e da medular ósseas em torno dos parafusos experimentais (BGTi37) e controles (Ticp) foram estatisticamente semelhantes. Conclusões: A superfície BGTi37 apresentou comportamento biológico semelhante à uma superfície de titânio microtexturizada (Ticp), com ótimos resultados de longo prazo já consolidados na literatura. Fato bastante promissor, considerando as possibilidades de aprimoramento dessa superfície experimental em futuros estudos.

Objectives: This experimental in vitro and in vivo study tested the osteoinduction ability of a new nanostructured titanium surface coated with bioglass with calcium phosphate. Methods: Surface roughness was evaluated by atomic force microscopy using 9 specimens of three groups: sandblasting and acid etching commercially pure titanium (cpTi) and bioglass coated dried at temperatures of 370 C (BGTi37) or 6000 C (BGTi600). Rat calvarial osteogenic cells were cultured in supplemented α-MEM medium in contact or not (control) with sandblasting and acid etching (SLA) commercially pure titanium discs (cpTi) and bioglass coated (BGTi37 and BGTi600). Cell viability and alkaline phosphatase (ALP) activity were measured after 7 days of culture. The mineralization was assessed after 14 days of culture. The data were compared by analysis of variance (ANOVA) complemented by Tukey test. The level of significance was 5%. Scanning electron microscopy after 7 and 14 days assessed osteoblasts morphology in contact with the three surfaces. Fourteen SLA commercially pure titanium screws (cpTi -control) and fourteen experimental screws bioglass coated dried at temperatures of 370 C (BGTi37) were randomly placed into 14 male Wistar rats' tibiae. The animals were sacrificed after 14 and 28 days and their tibias processed for micro-CT analysis. Results: The cpTi group (129.6 nm) showed the highest average roughness, followed by BGTi600 group (91.85 nm), which were statistically similar. The BGTi37 group (74.51 nm) showed the lowest surface roughness compared to the other two groups. Cell viability, ALP activity and mineralization of BGTi600 group were significantly lower than the control and cpTi groups. BGTi37, cpTi and control groups showed no significant differences in cell viability, ALP activity and mineralization. The number of cells in contact with all surfaces was higher in 14 days compared to 7 days. Higher amount of osteoblasts was observed in contact with the cpTi surface and the smaller amount in contact with the BGTi600 surface. Osteoblasts in contact to cpTi surface showed a flat polygonal shape and were larger than the BGTi37 and BGTi600 groups, which presented with a sharper morphology, most notably in the BGTi600 group. The number of cytoplasmic processes, intercellular junctions and vesicles observed in specimens of BGTi600 group was markedly lower than in cpTi and BGTi37 groups. The micro-CT parameters of the cortical and trabecular bone around the experimental (BGTi37) and controls (Ticp) screws presented no statistical differences. Conclusions: The BGTi37 surface showed biological behavior similar to a SLA titanium surface (cpTi), with excellent long-term results already established in the literature. A very promising fact, considering the improvement possibilities of this experimental surface in future studies

Into the Paradigm of Local Factors as Contributors for Peri-implant Disease: Short Communication.

Although some systemic conditions have been associated with peri-implant disease, local contributing factors largely remain to be determined. This study aimed at evaluating, based on clinical photographs obtained from peri-implantitis treatment publications, the possible local contributing factors involved in its development based upon a survey obtained from three experienced clinicians (> 20 years of expertise). Cohen's kappa index was used to test the interexaminer reliability. "Too-buccal implant position" was the only parameter to reach almost perfect interexaminer agreement (κ = 0.81). "Thin-tissue biotype" and "minimal presence of keratinized mucosa" demonstrated moderate agreement (κ = 0.43 and κ = 0.58, respectively). The rest of the parameters studied based on clinical photographs were fair or poor. Therefore, based on this clinicians' survey, implants too buccally placed, minimal or a lack of keratinized mucosa, and thin-tissue biotype might contribute to a higher susceptibility of developing peri-implantitis. These factors must be the focus of attention in future cross-sectional studies on the incidence of peri-implant diseases.

Hard and soft tissue responses to three different implant materials in a dog model.

The aim of this study was to assess hard and soft tissue responses using three dental implants made of different materials. Implants made of titanium (Ti), yttria-stabilized tetragonal zirconia polycrystals (Y-TZP) and ceria partially stabilized zirconia/alumina nanocomposite (Ce-TZP/Al2O3) were used in a dog model. Five male beagles were sacrificed at three months after implantation, and harvested mandible were observed and analyzed. Histological observations were similar in all groups. There were no significant differences in any histomorphometric parameters. Our results suggested the possibility of Ce-TZP/Al2O3 as a dental implant material, similar to Ti and Y-TZP.

The influence of low-frequency variable magnetic fields in reducing pain experience after dental implant treatment.

UNLABELLED: The paper presents the evaluation of analgesic effect or magnetostimulation and magnetoledtherapy after implantation treatment. The study was conducted on 3 groups (Z applicator, IR applicator and conventional drug therapy) of 10 patients each of whom underwent a single implantation. Magnetostimulation was carried out using Viofor JPS Delux equipment. The patients were exposed to magnetic field for approx. 15 minutes before the treatment and during the visit after 6 hours after the implantation procedure. Pain perception of patients was recorded on the Visual Analogue Scale (VAS). RESULTS: the most intense pain was reported in the control group. The least intense pain appeared in the group with Z applicator. Patients using Z and IR applicators took analgesics less frequently and used much weaker analgesics than the control group. Pain perceived in the first group was between 0 and 2, while in the second group - between 2 and 3, and in the control group - between 3 and 5 in VAS scale. Magnetostimulation reduces patient's demand for analgesics after implantation procedures and yielded better effects in reduction of pain in comparison with magnetostimulation with LED therapy.

High volume local anesthesia as a postoperative factor of pain and swelling in dental implants.

OBJECTIVE: To determine whether the administration of high-volume local anesthesia can influence postoperative pain and swelling, and the degree of patient satisfaction, following dental implant placement. MATERIAL AND METHODS: One hundred patients (45 women and 55 men) between 19 and 80 years old were divided into two groups: group A (n = 50, with placement of an implant using an atraumatic approach in each patient, with sub-periosteal injection of a volume of Ultracain(®) ≤0.9 mL [half a carpule]) and group B (n = 50, involving the same surgical procedure but infiltrating a local anesthetic volume of ≥7.2 mL [four carpules]). Visual analog scales were used in all patients to rate intraoperative pain and postoperative pain and swelling. After the first week, the patients completed a questionnaire evaluating satisfaction with treatment. RESULTS: The intraoperative pain scores were similar in both groups (p = 0.363), while the postoperative pain and swelling scores were significantly lower in group A at all time points. Patient rated satisfaction with the surgical treatment was higher in group A. CONCLUSIONS: Excess injected volume of local anesthetic in dental implant surgery has a negative impact upon both postoperative pain and swelling, and on patient rated satisfaction.

The effect of subgingival ozone and/or hydrogen peroxide on the development of peri-implant mucositis: a double-blind randomized controlled trial.

PURPOSE: This double-blind randomized controlled trial assessed the effect of subgingival ozone (O3, gaseous ozone, HealOzone MK II, KaVo) and/or hydrogen peroxide (H2O2) on the development of peri-implant mucositis. MATERIALS AND METHODS: Twenty subjects (mean age, 60 ± 7.7 years) with 80 implants (4 implants each) were recruited. First, a 2-week pretrial phase took place to achieve healthy gingiva. Subsequently, partial gum shields were constructed for the experimental area (around the 4 implants); subjects were asked to refrain from brushing in that area by wearing the gum shield. The following treatments were randomly applied (for 60 seconds) to implant sites on days 0, 7, and 14: (1) air (O2) and saline (0.9% NaCl) (control group), (2) O2 and H2O2 (3%), (3) O3 and saline, and (4) O3 and H2O2. Plaque, gingival, and bleeding indices were recorded on days 0, 7, 14, and 21. RESULTS: Significant differences were seen among the treatments (P < .01) in plaque (F = 16.68), modified gingival (F = 7.86), and bleeding (F = 18.42) indices. O3 + saline and O3 + H2O2 produced optimum gingival health scores and were equally effective and the most effective in controlling bleeding (mean score = 0.05), while O2 + saline was the least effective (mean score = 0.56). CONCLUSION: Ozone showed great potential for management of peri-implant mucositis.

The team approach to managing dental implant complications: the periodontist's point of view.

Implant-related complications are a fact of life among practitioners who place or restore implants. They occur for a variety of reasons with varying consequences. Those classified as minor complications are most easily corrected and may have little impact on the course of treatment, but severe complications can have serious consequence in expense, complexity, and ultimate success. Many severe complications may be irreversible, leaving the patient with less desirable esthetic options, or worse, permanent disability in terms of speech and function. While various members of the dental team may have different points of view, implant complications are a concern to all. Successful results require comprehensive care, collaborative treatment, and knowledge of dental implant complications. Therefore, it is in the best interest of the patient that all involved in treatment be aware of the different types of complications that can be experienced and learn how to work together as a team to achieve successful outcomes.

Thermodynamic effects of laser irradiation of implants placed in bone: an in vitro study.

Lasers have been proposed for various applications involving dental implants, including uncovering implants and treating peri-implantitis. However, the effect of laser irradiation on the implant surface temperature is only partially known. The aim of this pilot study was to determine the effect of irradiation with diode, carbon dioxide, and Er:YAG lasers on the surface temperature of dental implants placed in bone, in vitro. For this study, one dental implant was placed in a bovine rib. A trephine bur was used to create a circumferential defect to simulate peri-implantitis, and thermocouples were placed at the coronal and apical aspect of the implant. The implant was irradiated for 60 s using four different lasers independently and change in temperature as well as time to reach a 10 °C increase in temperature were recorded. There was wide variability in results among the lasers and settings. Time for a 10 °C increase ranged from 0.9 to over 60 s for the coronal thermocouple and from 18 to over 60 s for the apical thermocouple. Maximum temperature ranged from 5.9 to 70.9 °C coronally and from 1.4 to 23.4 °C apically. During laser irradiation of dental implants, a surface temperature increase beyond the "critical threshold" of 10 °C can be reached after only 18 s.

Observational study of the use of Symphytum 5CH in the management of pain and swelling after dental implant surgery.

OBJECTIVE: To assess the effect of Symphytum 5CH on the postoperative pain and swelling after placement of a titanium dental implant. MATERIAL AND METHODS: Data on pain and swelling following pure titanium implants were reviewed. Patients were treated postoperatively with ketoprofen only or ketoprofen and Symphytum 5CH, according to the treating dentist's usual practice. Demographics and baseline characteristics were recorded and compared. Pain and swelling were compared between the two treatment groups using the Wilcoxon rank sum test and ordinal logistic regression, estimating odds ratios and confidence intervals. RESULTS: 100 implants in 57 patients (28 males, 29 females) were treated with ketoprofen alone; 100 implants in 60 patients (14 males, 46 females) with ketoprofen and Symphytum. The group treated with ketoprofen and Symphytum appeared to have a better response in terms of both pain and swelling. Ordinal logistic regression: pain 0.23, 95% CI 0.13-0.41; swelling 0.24, 95% CI 0.13-0.44. Correction for demographics and implant characteristics greatly widened the confidence intervals so that the results were no longer statistically significant (pain: OR = 0.15, 95% CI 0.07-34.56; swelling OR = 0.18, 95% CI 0.07-46.78). CONCLUSIONS: Adding Symphytum 5CH to conventional analgesia may reduce pain and swelling after minor dental implant surgery. No firm conclusion can be drawn since the results are confounded by baseline differences, principally gender. Further, randomized, studies should be conducted.

Gene expression of inflammation and bone healing in peri-implant crevicular fluid after placement and loading of dental implants. A kinetic clinical pilot study using quantitative real-time PCR.

PURPOSE: Early detection of healing complications after placement of dental implants is a pressing but elusive goal. This paper proposes a non-invasive diagnostic tool for monitoring healing- and peri-implant disease specific genes, complementary to clinical evaluations. MATERIAL AND METHODS: Eighteen partially edentulous patients were recruited to this pilot study. Three Brånemark TiUnite® implants/patient (Nobel Biocare) were placed in a one-stage procedure. Abutments with smooth or rough (TiUnite®) surface were placed. The test group (n = 9) received fixed bridges (immediate loading), whereas the control group (n = 9) implants were loaded 3 months after surgery. In addition to clinical measurements, crevicular fluid was collected using paper strips at the implant abutments 2, 14, 28, and 90 days postoperative. mRNA was extracted, purified, and converted to cDNA. Quantitative PCR assays for IL-1ß, TNF-α, Osteocalcin (OC), Alkaline Phosphatase (ALP), Cathepsin K, Tartrate Resistant Acid Phosphatase, and 18S ribosomal RNA were designed and validated. Relative gene expression levels were calculated. RESULTS: One implant was lost in the control group and three in the test group. In one test patient, one implant showed lowered stability after 2 to 4 weeks and was unloaded. Later implant stability improved which allowed for loading after 3 to 4 months. TNF-α and ALP most commonly showed correlation with clinical parameters followed by IL-1ß and OC. The strongest correlation was found for TNF-α with clinical complications at 2 and 14 days (p = .01/r = -048, and p = .0004/r = -0.56, respectively; test and control groups together). In some cases, gene expression predicted clinical complications (TNF-α, ALP, CK). CONCLUSION: This study is based on samples from few individuals; still, some genes showed correlation with clinical findings. Further studies are needed to refine and optimize the sampling process, to find the appropriate panel, and to validate gene expression for monitoring implant healing.

Antral retriever and displaced dental implants in the maxillary sinus.

PURPOSE: Removal of antral foreign bodies after implantation is mandatory to avoid infectious processes and may be a troublesome question. Different surgical approaches could be considered, with several limitations and morbidities. METHODS: We present a new tool (Antral Retriever) conceived to remove antral dental implants or any other migrated material through a minimally invasive canine fossa approach, under continuous endoscopic view and local anesthesia. RESULTS AND CONCLUSIONS: Antral Retriever enables the surgeon to successfully remove antral foreign bodies through a canine fossa approach under continuous endoscopic visualization and local anesthesia, with minimal discomfort for the patient

Profiling of patients presenting with posttraumatic neuropathy of the trigeminal nerve.

AIMS: To describe the cause, clinical signs, and symptoms of patients presenting to a tertiary care center with iatrogenic lesions to the mandibular branches of the trigeminal nerve. METHODS: Pain history, pain scores using the visual analog scale, and mechanosensory testing results were recorded from 93 patients with iatrogenic lingual nerve injuries (LNI) and 90 patients with iatrogenic inferior alveolar nerve injuries (IANI). Results were analyzed using the SPSS statistical software. Chi-square tests were applied for nonparametric testing of frequencies, where P ⋜ .05 indicated statistical significance. Appropriate correlations were also carried out between certain data sets. RESULTS: Significantly more females were referred than males (P < .05). Overall, third molar surgery (TMS) caused 73% of LNI, followed by local anesthesia (LA) (17%). More diverse procedures caused IANI, including TMS (60%), LA (19%), implants (18%), and endodontics (8%). Approximately 70% of patients presented with neuropathic pain coincident with anesthesia and÷or paresthesia. Neuropathy was demonstrable in all patients with varying degrees of loss of mechanosensory function, paresthesia, dysesthesia, allodynia, and hyperalgesia. Functionally, IANI and LNI patients mostly had problems with speech and eating, where speech was affected amongst significantly more patients with LNI (P < .001). Sleep, brushing teeth, and drinking were significantly more problematic for IANI patients (P < .05, P < .001, and P < .0001, respectively). CONCLUSION: Neuropathic pain, as well as anesthesia, frequently occurs following iatrogenic trigeminal nerve injury similar to other posttraumatic sensory nerve injuries. This must be acknowledged by clinicians as a relatively common problem and informed consent appropriately formulated for patients at risk of trigeminal nerve injuries in relation to dentistry requires revision.

Surgical and prosthodontic consequences of inadequate treatment planning for fixed implant-supported prosthesis in the edentulous mandible.

Treatment planning for mandibular fixed implant-supported prostheses requires close communication between surgeons and restorative dentists. Improper implant positioning can result in significant difficulty for patient comfort and fabrication of a functional prosthesis. This case report describes the consequences of placing implants with no preoperative planning with regard to the implant position based on the final restorative plan. A 46-year-old male had all of his remaining maxillary and mandibular teeth extracted, and had 5 implants placed immediately in the interforaminal region of the mandible with the intent of providing a fixed prosthesis. Six weeks later, the patient was referred for prosthodontic care. The patient had no prostheses at that time and was in severe pain due to impingement of the lower lip by one of the implants. The implants were deemed to be in unfavorable positions and angulations. Thereafter, the case was treatment-planned systematically, requiring 2 additional surgical procedures---removal of one of the implants and alveoloplasty of posterior mandible for creation of space for prosthetic components. The remaining 4 implants with unfavorable angulations posed a prosthodontic challenge for fabrication of a prosthesis. The situation was eventually managed by fabrication of a screw-retained metal-resin fixed prosthesis over the remaining 4 implants. Although the situation was managed successfully, it resulted in increased time and treatment expenses, additional appointments, and elaborative steps for correction. Prosthodontics-driven treatment planning concepts and guidelines for prevention of such situations are described in this article.