Management of apical bone loss around a mandibular implant: a case report.

Various terms, etiologies, and treatment strategies have been suggested in conjunction with bone loss limited only to the apical portion of an implant that remains otherwise well osseointegrated. Proposed etiologic factors include bone overheating, microbial involvement of adjacent teeth, pre-existing bone infection, and overload. However, the mandible and maxilla seem to have different predispositions in response to these causative agents. Treatment protocols for peri-implant infection have included minimally invasive approaches such as granulation tissue removal and detoxification of the implant surface, as well as more aggressive measures. This case report demonstrates the achievement of osseous healing and reosseointegration in a patient who presented with presented apical bone loss and signs of infection around a mandibular implant. Reosseointegration was achieved following an intraoral apicoectomy-like approach, ie, removal of the infected nonintegrated portion of the implant, and meticulous debridement of the granulation tissue. A literature review of 13 relevant published studies was conducted. The current understandings regarding the etiology and treatment strategies for management of apical bone loss around dental implants are summarized and presented.

Management of a patient with a failed transmandibular implant.

UNLABELLED: The Transmandibular Implant System (TMI) had been developed in order to provide a patient with a severely resorbed mandible with a stable and retensive implant-supported overdenture. Failure of the transmucosal posts may necessitate removal of the transmandibular implant in total and treatment with an implant-supported prosthesis. The purpose of this paper is to describe overcoming failure of a transmandibular implant without removal and synchronous placement of endosseous dental implants in the interforaminal region, providing an implant-retained overdenture to the patient. CLINICAL RELEVANCE: Transmandibular implants are rarely used nowadays and management of a failed transmandibular implant is reported even less often. Where bone height is adequate, dental implants may be placed in the anterior mandible, even when the failed transmandibular implant is not completely removed.

Assessment of surgical skills in implant dentistry.

PURPOSE: This study aimed to (1) compare 2 scales in the assessment of first-stage implant surgery, (2) assess the interrater reliability of these scales, and (3) compare self-assessment with observer assessment. MATERIALS AND METHODS: Twenty-three patients underwent first-stage implant surgery. One assessor, an experienced dental surgeon, assisted and supervised the operator, while the second, a postgraduate trained in assessment, observed the procedure closely. The assessment scales consisted of a checklist and a global rating scale. RESULTS: A significant correlation was found between the checklist and the global rating scale scores (r = 0.47, P = .002). The British Standards Reproducibility Coefficients were 2.5 (checklist) and 7.4 (global rating scale) for interrater reproducibility and 7.0 (checklist) and 12.6 (global rating scale) for self-assessment versus assessor reproducibility. Finally, analysis of the intraclass correlation coefficients between the assessors (0.74 and 0.64 for the checklist and the global rating scale, respectively) and between the surgeons' and trainers' scores (0.09 for the checklist and 0.18 for the global rating scale) showed a much weaker agreement for the latter. DISCUSSION: There was good correlation between scores using the 2 different methods of assessment. The interrater reliability was substantial for both scales. However, training of assessors to ensure higher levels of interrater reliability may be necessary. These results also demonstrated the inability of some surgeons to assess their performance accurately. CONCLUSION: Both the checklist and the global rating scales provided useful assessment data, and both were considered of value by the assessors and surgeons in providing feedback. The development of assessment and self-assessment skills in implant surgery is necessary if we are to establish a culture of commitment to lifelong learning.