Comparison of Zirconia Implant Surface Modifications for Optimal Osseointegration.

Zirconia ceramic implants are commercially available from a rapidly growing number of manufacturers. Macroscopic and microscopic surface design and characteristics are considered to be key determining factors in the success of the osseointegration process. It is, therefore, crucial to assess which surface modification promotes the most favorable biological response. The purpose of this study was to conduct a comparison of modern surface modifications that are featured in the most common commercially available zirconia ceramic implant systems. A review of the currently available literature on zirconia implant surface topography and the associated bio-physical factors was conducted, with a focus on the osseointegration of zirconia surfaces. After a review of the selected articles for this study, commercially available zirconia implant surfaces were all modified using subtractive protocols. Commercially available ceramic implant surfaces were modified or enhanced using sandblasting, acid etching, laser etching, or combinations of the aforementioned. From our literature review, laser-modified surfaces emerged as the ones with the highest surface roughness and bone-implant contact (BIC). It was also found that surface roughness could be controlled to achieve optimal roughness by modifying the laser output power during manufacturing. Furthermore, laser surface modification induced a very low amount of preload microcracks in the zirconia. Osteopontin (OPN), an early-late osteogenic differentiation marker, was significantly upregulated in laser-treated surfaces. Moreover, surface wettability was highest in laser-treated surfaces, indicating favorable hydrophilicity and thus promoting early bone forming, cell adhesion, and subsequent maturation. Sandblasting followed by laser modification and sandblasting followed by acid etching and post-milling heat treatment (SE-H) surfaces featured comparable results, with favorable biological responses around zirconia implants.

Clinical Dilemmas in the Differential Diagnosis of Peri-implantitis: Case Presentation and Literature Review.

Advancements in the field of implantology have made dental implants a mainstay treatment for both fully and partially edentulous patients. As a result, practitioners need to be able to identify clinical signs of peri-implant disease in its early stages and provide patients with reliable treatment options. The objective of this article is to provide a differential diagnosis of peri-implant lesions, outlining the clinical, radiographic, and histopathologic features of similar benign and malignant conditions. Additionally, two case studies are presented that showcase lesions that mimic peri-implantitis, providing practitioners with practical examples of how to apply the discussed features in a clinical setting. Lesions described in the differential diagnosis include physiologic bone loss, implant fracture, loosened abutments, pyogenic granuloma, peripheral giant cell granuloma, peripheral ossifying fibroma, squamous cell carcinoma, and metastasis extending to the oral cavity.

Esthetic Considerations In Minimally Invasive Orthognathic Surgery.

The success of dental implants has long been considered to be dependent primarily on the quality and quantity of alveolar bone. Bone grafting allows patients with insufficient bone volume to obtain implant-supported prosthetic solutions for treatment of edentulism. While extensive bone grafting procedures have been commonly used to rehabilitate severely atrophic arches, they can be associated with long treatment times, unpredictability, and donor site morbidity. Nongrafting solutions have more recently been employed that maximally utilize the residual highly atrophic alveolar or extra-alveolar bone for implant therapy. With the use of modern diagnostic imaging and 3D printing technology, clinicians are able to provide individualized, subperiosteal implants that fully adapt to the patient's remaining alveolar bone. Other "graftless" implants, including zygomatic implants, utilize the patient's extraoral facial bone outside the alveolar process and have been shown to provide predictable results. This article discusses the rationale for graftless solutions in implant therapy and the data supporting the use of various graftless protocols as alternatives to grafting and conventional dental implant therapy.

Graftless Implantology as a Forward-Looking Clinical Concept for Highly Atrophic Maxillary Arches.

For many decades the success of dental implants has been considered to be dependent predominantly on the quality and quantity of the patient's alveolar bone. Building on the high success rates of implants, bone grafting eventually was implemented, allowing patients with insufficient bone volume to obtain implant-supported prosthetic solutions for treatment of partial or complete edentulism. Extensive bone grafting procedures have been commonly used to rehabilitate severely atrophic arches but are associated with long treatment times, unpredictability, and donor site morbidity. More recently, nongrafting solutions that maximally utilize the residual highly atrophic alveolar or extra-alveolar bone for implant therapy have been reported to have success. The emergence of diagnostic imaging and 3D printing technology has allowed clinicians to provide individualized, subperiosteal implants that can adapt precisely to the patient's remaining alveolar bone. Furthermore, paranasal, pterygoid, and zygomatic implants that utilize the patient's extraoral facial bone outside the alveolar process can provide predictable and optimal results with no or minimal bone grafting with less treatment time. This article considers and evaluates the rationale for graftless solutions in implant therapy as well as the data supporting the use of various graftless protocols as alternatives to grafting and conventional dental implant therapy.

OsteoMacs and Their Role in Early Implant Failure and Osseointegration.

Dental implant failure cannot always be explained by clinical risk factors. Recent literature suggests that immune cells are pivotal players in the integration of biomaterials and have a co-relationship within a set of osteal macrophages known as "OsteoMacs." These cells have been known to polarize quickly between a M1 pro-inflammatory and a M2 wound healing state during implant osseointegration. OsteoMacs play a critical immune surveillance role in the osseointegration of dental implant healing and bone homeostasis. This review is intended to provide an overview of the current understanding of OsteoMacs and their role in early implant failure and osseointegration.

A Clinical Approach to Treatment of Retrograde Peri-Implantitis.

Retrograde peri-implantitis (RPI) is a primary microbial inflammatory condition that affects only the apical portion of an osseointegrated implant, which retains normal bone-to-implant contact in its coronal portion. Currently, no uniformly accepted definition or classification exists for RPI. This article reviews the etiopathological mechanisms, diagnostic pattern, and current treatment modalities for this type of periapical implant bone loss. The prevalence of RPI is reported to be relatively low, and along with a lack of an accepted classification system there is no widely accepted treatment algorithm. Therapeutic options include antibiotics, open-flap implant debridement, and apical resection eventually including apicoectomy of endodontically affected adjacent teeth, with or without bone grafting or removal of the affected implant. Implants with RPI usually remain osseointegrated. A diagnostic approach is proposed.

Are Cannabis and Electronic Cigarettes Risks for Early Sinus Lift Failures?

To achieve restorative success for esthetic cases a process is needed that can be reproduced repeatedly. As with any process there are critical steps that must be followed to ensure accurate and precise results. This article outlines a verification process of provisional restorations in order to obtain appropriate esthetics, phonetics, and function. Additionally, the article discusses how newly created contours can be transferred intraorally to the laboratory benchtop and then to the final restorations. Through the process of verification, the clinician can establish restorative predictability to enhance the restorative success of any esthetic case.

A Clinical Approach to Treatment of Retrograde Peri-Implantitis.

Retrograde peri-implantitis (RPI) is a primary microbial inflammatory condition that affects only the apical portion of an osseointegrated implant, which retains normal bone-to-implant contact in its coronal portion. Currently, no uniformly accepted definition or classification exists for RPI. This article reviews the etiopathological mechanisms, diagnostic pattern, and current treatment modalities for this type of periapical implant bone loss. The prevalence of RPI is reported to be relatively low, and along with a lack of an accepted classification system there is no widely accepted treatment algorithm. Therapeutic options include antibiotics, open-flap implant debridement, and apical resection eventually including apicoectomy of endodontically affected adjacent teeth, with or without bone grafting or removal of the affected implant. Implants with RPI usually remain osseointegrated. A diagnostic approach is proposed to establish the staging of the lesion and determine the best treatment option accordingly. When there is no loss of implant stability the most adequate treatment in the acute and chronic stage is apical resection of the implant with regeneration of the bone defect. If there is implant mobility, extraction of the implant is necessary.

An Algorithmic Approach to Evaluation of an Ailing Implant.

With the incidence of failed and ailing dental implants increasing, the authors conducted research to evaluate and characterize all known criteria used in the assessment of implant health in the clinical setting. A review of articles found in electronic databases was performed. Once all parameters for implant assessment as supported by current literature were selected, implant assessment documents were created: a data acquisition form and a quantitative comprehensive evaluation. These documents provide the clinician an algorithm that yields a prognosis of survival for each implant. Diagnostic criteria were organized to offer a comprehensive assessment of risk factors related to implant health. Data acquisition prior to establishing the prognosis is necessary in accordance with the staging system developed. Parameters for diagnosis and staging include a thorough medical/social history of the patient, implant history, and clinical evaluation. The authors concluded that the establishment of parameters for comprehensive implant evaluation in the clinical setting is feasible. This assessment process enables an effective clinical approach to evaluate and treat ailing implants while facilitating a clinical diagnostic algorithm.