Peri-implant diseases and metabolic syndrome components: a systematic review.

OBJECTIVE: Metabolic syndrome (MetS) is defined as a spectrum of conditions associated with an increased risk of developing CVD and type 2 diabetes. MetS include: hyperglycemia, hypertension, visceral obesity, dyslipidemia with elevated values of triglycerides (TG) and low levels of HDL. The aim of this review is to provide current knowledge of the relationship between MetS, its components and peri-implant diseases. MATERIALS AND METHODS: An electronic literature search was conducted in the English language in several databases. The Newcastle-Ottawa Scale was used for quality assessment of cohort and cross-sectional studies; while systematic reviews were evaluated through AMSTAR; results were reported according to the PRISMA Statement. RESULTS: A total of 272 records were identified through database searching, six studies were included for qualitative analysis. No study directly related to MetS was found, there was inconsistent and controversial evidence regarding association with cardiovascular disease. A higher risk of peri-implantitis was detected in people with hyperglycemia. CONCLUSIONS: Future research should be orientated in assessing the risk of peri-implant diseases, evaluating patient's therapeutic response, analyzing directionality of the relationship between MetS, its components and biologic implant complications.

Histological and immunohistochemical evaluation of mandibular bone tissue regeneration.

The purpose of the study was to perform an immunohistochemical and histological evaluation of samples taken from different bone regeneration procedures in atrophic human mandible. 30 patients (15 men and 15 women, age range of 35-60 years), non-smokers, with good general and oral health were recruited in this study and divided into three groups. The first group included patients who were treated with blood Concentration Growth Factors (bCGF), the second group included patients who were treated with a mixture of bCGF and autologous bone, while the third group of patients was treated with bCGF and tricalcium phosphate/hydroxyapatite (TCP-HA). Six months after the regenerative procedures, all patients undergone implant surgery, and a bone biopsy was carried out in the site of implant insertion. Each sample was histologically and immunohistochemically examined. Histological evaluation showed a complete bone formation for group II, partial ossification for group I, and moderate ossification for group III. Immunohistochemical analysis demonstrated a statistically significant difference between the three groups, and the best clinical result was obtained with a mixture of bCGF and autologous bone.

Implant survival and success rates in patients with risk factors: results from a long-term retrospective study with a 10 to 18 years follow-up.

OBJECTIVE: Risk factors for implant therapy are represented by all general and local conditions that through various mechanisms can increase either short-term and long-term failure risk. The aim of this study is to assess the implant survival and implant success rates with single and multiple risk factors. PATIENTS AND METHODS: To address the research purpose, a retrospective cohort study was designed and implemented, including a sample of 225 patients with a total of 871 implants placed. The following risk factors were considered: smoking, bruxism, bone augmentation procedures and the presence of load risk (implants with crown/implant relation > 0.8; angulation > 25°; presence of cantilever). Follow-up ranged from 10 years to 18 years (average follow-up 13.6 years). Failures were subdivided into short-term failures, before the prosthetic phase, and long-term failures, after definitive prosthesis. The success criteria published by Albrektsson and Zarb were adopted. A Cox proportional hazard regression model was used to calculate hazard ratio, with a statistically significant p-value <0.05. RESULTS: Out of the 871 implants placed, 138 did not meet the success criteria, (success rate 84.16%), sixty (43.47%) were classified as "early failure" and seventy-eight as "late failure" (56.53%). A total of 70 dental implants were removed, with a survival rate of 91.96%. CONCLUSIONS: The presence of a single risk factor does not imply a marked increase of failure risk. Among the analyzed factors, the one that proved to be the most dangerous was bruxism, even when presented as the only risk factor. Bruxism with load risk proved to be the most dangerous association (success rate 69.23%) and could be included among the absolute contraindications for implant treatment.

Corrosion behavior of dental implants immersed into human saliva: preliminary results of an in vitro study.

OBJECTIVE: Over the years, different implant surfaces have been used to try to maximize bone to implant contact. The aim of this study was to compare levels of metallic ions and particles dissolution collected from two different dental implants surfaces immersed into human saliva. PATIENTS AND METHODS: A total of 60 dental implants were tested. Group A: sanded with aluminium oxide medium grade particles and acid-etched; Group B: micro-sanded with calcium phosphate powders and acid-etched. Forty implants were immersed in 20 ml of human saliva, twenty, as a control, in sterile saline solution. ICP-MS was performed to detect any metallic ions released from dental implants at T0, on day 1 (T1), on day 3 (T2), after one week (T3), on day 14 (T4), after 3 months (T5) and after 6 months (T6). RESULTS: Dissolution of metallic particles of titanium and nickel, absent in human saliva (T0), were found after one week (T3) for Group B and after 3 months (T5) for Group A. Vanadium was already detected in small concentrations in either group after 1 day, with an exponential growth for Group B. CONCLUSIONS: Preliminary results reported significant values of Ti, Ni and V released by Group B, showing for the first time statistically significant values of vanadium.

A randomized clinical trial about presence of pathogenic microflora and risk of peri-implantitis: comparison of two different types of implant-abutment connections.

OBJECTIVE: The aim of this in vivo study was to evaluate two different types of implant-abutment connections: screwed connection and cemented connection, analyzing peri-implant bacteria microflora as well as other clinical parameters. PATIENTS AND METHODS: Twenty implants were selected, inserted in 20 patients, 10 with a screwed implant-abutment connection (Group 1) and 10 with a cemented implant-abutment connection (Group 2). The peri-implant microflora was collected, after at least 360 days from the prosthetic rehabilitation, using paper points inserted in peri-implant sulcus for 30 s. Polymerase chain reaction (PCR) Real-time analyzed the presence of 9 bacteria periodontal-pathogens and Candida albicans. RESULTS: Our findings showed that bacteria colonized all Groups analyzed, the average bacterial count was 3.7 E +08 (±1.19) in Group 1, compared to 2.1 E +08 (±0.16) in Group 2; no statistically significant differences were observed (p>0.0.5). In Group 1, however, bacterial colonization of peri-implant sulci was over the pathogenic threshold for 5 bacteria, indicating a high-risk of peri-implantitis. Also in Group 2, results showed a microflora composed by all bacteria analyzed but, in this case, bacterial colonization of peri-implant sulci was over the pathogenic threshold for only 1 bacterium, indicating a lower risk of peri-implantitis. Moreover, clinical parameters (PPD > 3 mm and m SBI > 0) confirmed a greater risk of peri-implantitis in Group 1 compared to Group 2 (p<0.05). CONCLUSIONS: We concluded that, also after only 360 days, implants with screwed connection showed a higher risk of peri-implantitis that implants with cemented connection.

Monolithic zirconia and digital impression: case report.

AIMS: The aim of this study is to present a clinical case of a full arch prosthetic rehabilitation on natural teeth, combining both digital work-flow and monolithic zirconia. PATIENTS AND METHODS: Digital impression was taken with an intraoral optical scanner (CS3500, Carestream Dental, Atlanta, GA, USA). A prosthetic rehabilitation was realized on natural teeth using monolithic zirconia from 1.6 to 1.4 and from 2.7 to 2.4 frameworks, while in the aesthetic area (from 2.3 to 1.3), technicians left on the structure a 0.8 mm vestibular space for ceramic layering. DISCUSSION: The combination of digital impression technology and the use of the monolithic zirconia had demonstrated the delivery of the final prosthetic device in a quick time without the need to remodel functional or aesthetic areas. The digital work-flow combines intraoral optical impression techniques and CAD/CAM technology, in order to achieve a fully digital and successful way to deliver prosthetic restorations to patients, providing aesthetics and function in shorter intervals of time. The clinical outcome of this study was satisfactory but a long-term evaluation is needed.

El examen mental abreviado (Mini-Mental State Examination) como prueba de selección para el diagnóstico de demencia: estudio poblacional colombiano / The mini-mental state examination as a diagnostic selection test for dementia. A Colombian population study

Introducción. El examen mental abreviado (EMA) o Mini Mental State Examination (MMSE) se emplea masivamente para detectar déficit cognoscitivo. Objetivo. Probar una versión en castellano del EMA en población colombiana con baja escolaridad. Material y métodos. Estudio poblacional puerta a puerta, en muestra aleatoria estratificada de habitantes urbanos y rurales de cinco regiones de Colombia, seguido por evaluación neurológica y neuropsicológica de casos sospechosos (fase 2). Para diagnosticar demencia se emplearon criterios del DSM-IV. Resultados. 1.611 sujetos de 50 o más años respondieron el formato de la OMS para el estudio epidemiológico de enfermedades neurológicas y la versión en castellano del EMA; el 55,2% de ellos tenían tres o menos años de escolaridad; 536 individuos fueron remitidos a la fase 2 y otros 366 fueron evaluados por un neurólogo para descartar otras condiciones neurológicas: se diagnosticaron 12 casos de demencia entre los primeros y uno entre los últimos. La prevalencia ajustada por edad fue de 8,1 por mil sujetos mayores de 50 (IC 95%: 3,7-12,5); y 34,2 por mil mayores de 75 (IC 95%: 12,2-56,2). La sensibilidad y especificidad fueron del 92,3 y 53,7%; 16 de las 19 preguntas de la prueba mostraron diferencias significativas (p< 0,001) según la escolaridad. La diferencia entre los sexos a favor de los hombres es significativa en niveles educativos bajos (p< 0,001) pero no en sujetos con más de cinco años de estudio. Conclusiones. Las puntuaciones del MMSE poseen una alta correlación con el nivel educativo. Su baja especificidad lleva a que una gran cantidad de sujetos de baja escolaridad, no demenciados, requieran posteriores evaluaciones (AU)

Introduction. Folstein’s Mini Mental State Examination (MMSE) is widely used as screening test for cognitive impairment. Objective. To test a Spanish version of the MMSE in a population of high illiteracy rate. Material and methods. Population-based survey of a stratified random sample of urban and rural residents of five regions of Colombia, followed by neurological and neuropsychological evaluation of suspect cases (phase 2). Dementia was diagnosed using DSM-IV criteria. Results. 1,611 subjects age 50 or older filled out both the WHO Protocol for Epidemiologic Studies of Neurological Disorders and a Spanish version of the MMSE; 55.2% of them had three or less years of schooling; 536 individuals with scores below cutoff points were sent to phase 2. Of the population with satisfactory scores in MMSE 366 (34.0%) were evaluated by neurologists to exclude other neurological conditions. Twelve cases of dementia were diagnosed among individuals with scores below cutoff point and one among subjects with high scores. Age-adjusted prevalence was 8.1 per thousand subjects age 50 or over (95% CI: 3.7-12.5); and 34.2 per thousand for ages 75 or over (95% CI: 12.2-56.2). Sensitivity and specificity were 92.3 and 53.7%; 16 of the 19 questions show significant differences (p< 0.001) according to educational level. A gender gap is significant in low educational levels (p< 0.001) but not in subjects with more than five years of schooling. Conclusions. MMSE scores correlated closely with level of education. Low specificity leads to many non-demented subjects with low educational status requiring further investigation (AU)