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BACKGROUND: Peri-implantitis poses significant challenges in clinical practice, necessitating effective therapeutic strategies. This case report presents a comprehensive treatment approach for managing peri-implantitis, focusing on resective surgery, including implantoplasty and long-term maintenance. METHODS: We describe the case of a 50-year-old female patient with peri-implantitis affecting a maxillary full-arch implant-supported rehabilitation. The treatment strategy involved resective surgery with implantoplasty, a new maxillary overdenture, and a regular maintenance care schedule of three to four visits per year. Clinical and radiographic assessments were performed over a 10-year follow-up period. RESULTS: Post-treatment, all maxillary implants demonstrated no probing depths exceeding 4 mm, absence of bleeding on probing or suppuration, minimal plaque accumulation, and no further bone loss. Resective surgery with implantoplasty seems to have effectively provided submucosal decontamination and created a supra-mucosal implant surface conducive to oral hygiene. Despite regular maintenance, some mandibular implants exhibited bone loss during the follow-up period and were managed using the same approach as for the maxillary implants. CONCLUSIONS: The comprehensive treatment approach yielded favorable long-term clinical and radiographic outcomes, underscoring the effectiveness of the combined strategies in managing peri-implantitis. Nevertheless, the potential for recurrence or the development of peri-implantitis in new implants, even after a decade of successful treatment and strict maintenance, highlights the importance of ongoing, diligent care and regular evaluations to promptly diagnose and address these issues. KEY POINTS: Why is this case new information? The long-term effectiveness of peri-implantitis treatments, particularly involving implantoplasty, remains under-documented. This case provides insights from a 10-year follow-up on the efficacy of a comprehensive approach for managing peri-implantitis. Furthermore, these findings illustrate the potential for new peri-implantitis to develop, regardless of sustained peri-implant health and rigorous maintenance. This finding highlights the critical role of continuous monitoring for the early diagnosis and treatment of new implants exhibiting peri-implantitis. What are the keys to the successful management of this case? The success of this case hinged on a comprehensive treatment approach that combines surgical intervention associated with implantoplasty to remove implant threads, thereby creating smoother surfaces, less retentive for plaque accumulation. A critical aspect of this approach was also the redesign of prosthetic components to improve hygiene accessibility, continuous monitoring, and consistent maintenance care. What are the primary limitations to success in this case? The primary challenge in achieving success in this case was the prevention of new implants with peri-implantitis, despite the patient's consistent adherence to the maintenance program. Moreover, a critical evaluation of implant characteristics, particularly their susceptibility to mechanical failures, is paramount when performing implantoplasty. Furthermore, aligning patient expectations with the realistic esthetic and functional outcomes of the treatment is often challenging. PLAIN LANGUAGE SUMMARY: Peri-implantitis, an inflammatory disease affecting dental implants, is quite challenging to treat. This case report describes how a 50-year-old woman with this condition was successfully treated and maintained over 10 years. The approach included a surgical method called resective surgery, which involved reshaping the bone defect (osteoplasty) and smoothing the implant surface (implantoplasty). Additionally, she was fitted with a new upper denture and had regular follow-up visits three to four times a year. After ten years, her upper implants were stable with no signs of infection or further bone loss, and they were easy to keep clean. Some of her lower implants did experience inflammation with progressive bone loss during this time, but they were managed using the same surgical procedure as for her upper implants. This 10-year case report highlights positive and stable clinical results after resective surgery for treating peri-implantitis and the importance of an interdisciplinary approach and regular check-ups for maintenance, early diagnosis, and management of peri-implantitis over the long term.
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OBJECTIVE: To digitally evaluate the three-dimensional (3D) remodelling of FGG used to treat RT2 gingival recessions and lack of keratinized tissue on mandibular incisor teeth. METHODS: Data from 45 patients included in a previous multicentric RCT were analyzed. Silicone impressions were taken before (baseline) and 3, 6 and 12 months after standardized FGG placement. Casts were scanned and images were superimposed, using digital software, to obtain measurements of estimated soft tissue thickness (eTT; 1, 3, and 5 mm apical to baseline gingival margin). In addition, soft tissue volume (STV) and creeping attachment (CA) were assessed. RESULTS: All patients exhibited postoperative eTT and STV increases, at all time points. The greatest mean thickness gain was observed at eTT3 (1.0 ± 0.4 mm) at 12 months. At 12 months, STV was 52.3 ± 21.1 mm3, without relevant changes compared to the 3- and 6-month follow-up. CA, which was observed as early as six months postoperatively, was evident in â¼85 % of teeth at 12 months. CONCLUSIONS: Application of FGG was an effective phenotype modification therapy, as shown by the significantly increased tissue thickness postoperatively. Despite the use of FGG technique not aiming for root coverage, digital 3D assessment documented the early and frequent postoperative occurrence of CA, which helped improve recession treatment outcomes. CLINICAL SIGNIFICANCE: The use of 3D assessment methodology allows precise identification of the tissue gain obtained with FGG, which, regardless of technique, results in predictable phenotype modification and frequent occurrence of creeping attachment.
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Encía , Recesión Gingival , Imagenología Tridimensional , Incisivo , Humanos , Recesión Gingival/cirugía , Imagenología Tridimensional/métodos , Encía/patología , Femenino , Masculino , Adulto , Persona de Mediana Edad , Adulto Joven , Procesamiento de Imagen Asistido por Computador/métodos , Resultado del Tratamiento , Estudios de Seguimiento , Mandíbula/cirugía , Mandíbula/diagnóstico por imagen , Gingivoplastia/métodos , Modelos DentalesRESUMEN
Soft tissue deficiency in a tooth extraction site in the aesthetic area is a common and challenging clinical situation. This case report demonstrates the successful treatment of extensive gingival recession and buccal bone dehiscence associated with a hopeless tooth. Initially, a connective tissue graft was used to cover the root and thicken the soft tissue. After 2 months, the tooth was extracted, an implant was immediately placed, and a temporary restoration was installed. After 3 months, the soft tissue exhibited a natural and harmonious architecture. A custom zirconia abutment and crown were then fabricated and placed. At the 4-year follow-up, the peri-implant tissue displayed satisfactory aesthetics, with a well-structured buccal bone plate and healthy peri-implant indicators. This two-stage approach, addressing gingival recession first and proceeding with immediate implant placement after soft tissue healing, proved to be a safe and effective method with stable long-term results.
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Estética Dental , Recesión Gingival , Humanos , Recesión Gingival/cirugía , Recesión Gingival/etiología , Femenino , Estudios de Seguimiento , Coronas , Carga Inmediata del Implante Dental/métodos , Extracción Dental , Masculino , Implantes Dentales de Diente Único , Adulto , Tejido Conectivo/trasplante , Resultado del Tratamiento , Persona de Mediana EdadRESUMEN
The purpose of this study was to compare the outcomes of a modified gingival graft technique, in which the released flap is positioned and sutured over the graft, with the conventional free gingival graft (FGG) procedure, when both are used for gingival augmentation. A 12-month, multicenter parallel randomized controlled trial was conducted. Subjects with buccal RT2 gingival recessions and keratinized tissue width (KTW) < 2 mm in at least one mandibular incisor were randomized to control group (n = 20; conventional FGG) or test group (n = 20; modified FGG; flap sutured over FGG using sling sutures). The primary outcome (KTW) was measured at baseline and after 3, 6 and 12 months, as was keratinized tissue thickness (KTT). Postoperative pain (POP) and analgesic intake were also recorded. Both techniques promoted a significant increase in KTW and KTT when compared to baseline (p < 0.05) with no significant differences between groups (KTW change of 6.1±1.5 mm and 5.4±1.6 mm, for control and test, respectively; p=0.16). However, test group patients reported less POP after 7 days and used less analgesic medication than control group patients (p < 0.05). We concluded that the modified FGG was comparable to conventional FGG in augmenting keratinized tissue width and thickness at mandibular incisors, but resulted in less patient morbidity.
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Encía , Recesión Gingival , Humanos , Resultado del Tratamiento , Encía/trasplante , Recesión Gingival/cirugía , Colgajos Quirúrgicos/cirugía , Atención OdontológicaRESUMEN
Abstract The purpose of this study was to compare the outcomes of a modified gingival graft technique, in which the released flap is positioned and sutured over the graft, with the conventional free gingival graft (FGG) procedure, when both are used for gingival augmentation. A 12-month, multicenter parallel randomized controlled trial was conducted. Subjects with buccal RT2 gingival recessions and keratinized tissue width (KTW) < 2 mm in at least one mandibular incisor were randomized to control group (n = 20; conventional FGG) or test group (n = 20; modified FGG; flap sutured over FGG using sling sutures). The primary outcome (KTW) was measured at baseline and after 3, 6 and 12 months, as was keratinized tissue thickness (KTT). Postoperative pain (POP) and analgesic intake were also recorded. Both techniques promoted a significant increase in KTW and KTT when compared to baseline (p < 0.05) with no significant differences between groups (KTW change of 6.1±1.5 mm and 5.4±1.6 mm, for control and test, respectively; p=0.16). However, test group patients reported less POP after 7 days and used less analgesic medication than control group patients (p < 0.05). We concluded that the modified FGG was comparable to conventional FGG in augmenting keratinized tissue width and thickness at mandibular incisors, but resulted in less patient morbidity.
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This study aimed to simultaneously assess hard and soft tissues alterations and their proportions after alveolar ridge preservation (ARP). Participants (n = 65) who were previously enrolled in a clinical trial investigating ARP healing were selected. The CBCT DICOM (Digital Imaging and Communications in Medicine) and the cast STL (stereolithographic) files of each subject were imported, segmented, and superimposed. A cross-section view of the superimposed image presented the outlines from each DICOM and STL file. The center of preserved ridge was selected in the superimposed image and used to draw the reference lines to realize the measurements. Horizontal linear measurements determined ridge width (RW) and its respective hard/soft tissue proportion (H:S) at 1, 3, 5, and 7 mm below the buccal bone crest immediately after ARP and at the 4-month follow-up. At 1 mm, the baseline RW was 11.6 mm and reduced to 10 mm after 4 months. The baseline H:S was 65%:35% and was 43%:57% at the 4-month follow-up. Considering only the buccal half of the ridge, baseline H:S was 77%:23%, while after 4 months it shifted to 58%:42%. A similar pattern was observed at 3, 5, and 7 mm but with decreased resorption degree. The present study showed that hard tissue is mostly responsible for RW loss after healing, especially in the first 3 mm below the buccal bone crest. Soft tissue partially compensated for the hard tissue shrinkage, gaining thickness in the analyzed areas.
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Pérdida de Hueso Alveolar , Aumento de la Cresta Alveolar , Sustitutos de Huesos , Pérdida de Hueso Alveolar/diagnóstico por imagen , Pérdida de Hueso Alveolar/prevención & control , Proceso Alveolar/diagnóstico por imagen , Proceso Alveolar/cirugía , Sustitutos de Huesos/uso terapéutico , Humanos , Extracción Dental , Alveolo Dental/diagnóstico por imagen , Alveolo Dental/cirugíaRESUMEN
AIM: To compare tissue changes at implant sites previously treated with two biomaterials for alveolar ridge preservation (ARP) in the aesthetic zone, 1 year after restoration. MATERIALS AND METHODS: Sixty-six participants were treated with ARP using demineralized bovine bone mineral (DBBM) or DBBM +10% of collagen (DBBM-C), both covered with a collagen matrix (CM). Dental implants were placed, and definitive crowns were installed. Silicon impressions were taken before tooth extraction (T0), 2 weeks after crown insertion (T1) and 1 year after restoration (T2). Mid-facial mucosal level change (MLC), soft tissue thickness changes (TT), and marginal bone loss (MBL) were analysed using inter-group comparisons. RESULTS: Fifty-four participants were included in the analysis. The mid-facial level change between T0-T1 and T1-T2 showed no statistical difference between DBBM and DBBM-C. Between T0 and T1 for soft tissue thickness, DBBM performed significantly better at 3 and 5 mm below the mucosal margin. From T1 to T2, no significant differences between groups were found at any level for soft tissue thickness and MBL. CONCLUSION: At the aesthetic zone, advanced recession from tooth extraction to crown placement can be expected at sites treated with ARP regardless of biomaterial used. However, after crown insertion, tissue stability can be predicted.
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Pérdida de Hueso Alveolar , Aumento de la Cresta Alveolar , Pérdida de Hueso Alveolar/prevención & control , Proceso Alveolar/cirugía , Animales , Bovinos , Estética Dental , Estudios de Seguimiento , Humanos , Extracción Dental , Alveolo Dental/cirugíaRESUMEN
BACKGROUND: Outcome discrepancies between protocols and respective publications represent a concerning bias. The purpose of this study was to assess the prevalence of selective outcome reporting (SOR) in root coverage randomized clinical trials (RCTs). METHODS: Published root coverage RCTs (July 2005 to March 2020) were included if a corresponding protocol could be identified in a public registry. Discrepancies between protocol and its correspondent publication(s) were compared regarding primary and secondary outcomes and other study characteristics. Associations between trial characteristics and SOR were evaluated. RESULTS: Forty four studies (54 publications) were included. The majority of studies (77.3%) were retrospectively registered. SOR was frequent (40.9% of trials) and consisted of primary outcome downgrade (22.7%); secondary outcome upgrade (11.4%); new primary outcome introduced in publication (25%); protocol primary outcome omitted from publication (13.6%) and discrepancy in primary outcome timing (18.2%). SOR was unclear in 20.5% of studies and favoured statistical significance in 12 studies (27.3%). SOR was significantly associated with study significance (p < 0.001) and unclear outcome definition in the publication (p < 0.001). Only a third (32.8%) of primary outcomes were completely defined. CONCLUSIONS: The present study identified high prevalence of SOR in root coverage RCTs.
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Ensayos Clínicos Controlados Aleatorios como Asunto , Sesgo , Sistema de RegistrosRESUMEN
The aims of this study were to (i) evaluate the bone alterations following maxillary molar extraction and (ii) identify the factors associated with bone alterations using a tomographic analysis. Cone Beam Computer Tomographies (CBCTs) of 17 subjects with 25 maxillary molars were analyzed, before and, in average, 12 months following extraction. Fifty CBCTs were segmented as 3D models that were used as reference for analysis. Cross-sectional planes were established to measure the dimensional changes in the vertical, horizontal aspects, and the area of the alveolar bone. Associations between root divergence, initial bone location related to the maxillary sinus, and the thickness of buccal and palatal bone at baseline was assessed using mixed-effect models. Overall, the average reduction in vertical bone height was 35.23% (2.61 ± 1.76 mm). The mean reduction of area of alveolar process and horizontal bone width were 18.89% (56.08 ± 44.23 mm2) and 65.10% (8.33 ± 4.51 mm), respectively. There was a marginal significant association between horizontal bone changes and the thickness of palatal bone (p = 0.05). The results of the present study indicated that following maxillary molar extraction, significant dimensional changes occur in both the vertical and horizontal directions. The vertical changes were mainly attributed to remodeling on the coronal aspect of the alveolar ridge and sinus pneumatization was rare.
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Imagenología Tridimensional , Tomografía Computarizada de Haz Cónico Espiral , Proceso Alveolar/diagnóstico por imagen , Tomografía Computarizada de Haz Cónico , Estudios Transversales , Humanos , Maxilar/diagnóstico por imagen , Diente Molar/diagnóstico por imagenRESUMEN
The objective of this study was to determine whether collagen matrix (CM) is an alternative to connective tissue graft technique (CTG) in the treatment of multiple gingival recessions (GR). The indication of CM for the treatment of multiple GR is not yet clear. More studies are needed to better understand this treatment modality, as an alternative to CTG. In this single-blind, split-mouth randomized clinical trial, fifteen patients with multiple Miller class I upper GR were selected and randomly assigned to control group (CTG) or test group (CM). Root coverage (RC) and patient-centered outcomes were evaluated at baseline and after 3, 6, and 12 months. A total of 82 GRs were treated. There was no significant difference regarding GR depth (GRD, primary outcome) between CTG (0.5 ± 0.9 mm) and CM groups (0.6 ± 1.0 mm) (p = 0.225). Percentage of RC was 82.14% in CTG and 77.7% in CM. Both groups demonstrated a gain in keratinized tissue width at 12 months (p < 0.05). Dentine hypersensitivity was effectively reduced in both groups. Postoperative pain was significantly higher in the CTG (p = 0.001). Esthetic satisfaction was high for both groups, with no significant difference (p > 0.05) between groups. After 12 months, both surgical treatments were able to promote RC, and GRD was similar in both CTG and CM groups.
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Colágeno/uso terapéutico , Tejido Conectivo/trasplante , Recesión Gingival/cirugía , Adolescente , Adulto , Sensibilidad de la Dentina/prevención & control , Femenino , Estudios de Seguimiento , Humanos , Modelos Lineales , Masculino , Persona de Mediana Edad , Tempo Operativo , Reproducibilidad de los Resultados , Método Simple Ciego , Estadísticas no Paramétricas , Colgajos Quirúrgicos , Factores de Tiempo , Resultado del Tratamiento , Escala Visual Analógica , Adulto JovenRESUMEN
Root coverage surgery can be performed in patients with gingival recession to cover the exposed root aiming to control hypersensitivity and promotes better aesthetic. Optical magnification has been proposed as a refinement in this surgical technique to increase root coverage. This approach may lead to enhanced soft tissue stability, less post-operative discomfort, better predictability and esthetic appearance. Aim: This systematic review aimed to evaluate the effectiveness of magnification on root coverage surgery when compared to procedures performed without magnification. Methods: Randomized controlled trials with a follow-up of at least 6 months that compared surgeries for root coverage performed under optic magnification versus conventional (macro) root coverage surgery were screened. The primary outcome was mean root coverage (mm) (MRC) and secondary outcomes were percentage of root coverage (PRC) and complete root coverage (CRC). Results: Of 569 papers relevant to this review, seven were included. Meta-analysis showed that the use of magnification may favor greater PRC (7.38%, 95% CI 3.66-11.09). Conclusion: Magnification can increase PRC in root coverage surgeries. More randomized trials with the use of magnification may be necessary to verify if this benefit is clinically relevant, in order to justify the use of this device
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Periodontitis , Recesión Gingival , MicrocirugiaRESUMEN
The aim of this case report is to describe the diagnosis and treatment of a patient with necrotizing ulcerative gingivitis. An 18-year-old man with no systemic problems reported with chief complaints of gingival bleeding during toothbrushing and spontaneous pain. Clinical examination revealed significant plaque accumulation on the surfaces of all teeth as well as papillary necrosis involving mainly the anterior teeth. Treatment included an initial phase of supragingival plaque and calculus removal along with at-home use of 0.12% chlorhexidine gluconate mouthrinse twice a day for 30 days. After the initial phase, subgingival scaling was performed, and regular oral hygiene methods were resumed by the patient. After active therapy was completed, a periodontal maintenance regimen was established, and the patient was recalled for periodontal maintenance therapy. Follow-up occurred weekly throughout treatment, monthly for the first 6 months posttreatment, and 2-3 times a year during the periodontal maintenance therapy. Clinical results after 10 years showed that this approach controlled the acute phase and maintained the patient's periodontal health over time.
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Placa Dental , Gingivitis Ulcerosa Necrotizante , Adolescente , Placa Dental/complicaciones , Índice de Placa Dental , Estudios de Seguimiento , Gingivitis Ulcerosa Necrotizante/etiología , Gingivitis Ulcerosa Necrotizante/terapia , Humanos , Masculino , Antisépticos BucalesRESUMEN
The aim of this study was to evaluate the effect of a lower dose of parathyroid hormone- PTH (1-34) on osteogenic potential of bone healing around titanium implants inserted into the tibia of rats. A blind parallel study was conducted in 45 adult male Wistar rats. Each rat received one titanium implant (4.5 x 2.2 mm) and was randomly assigned to receive subcutaneous injections, three times/week for 30 days, of the following treatments: group 1 - 40 µg/kg of PTH (1-34) (n=15); group 2 - 2 µg/kg of PTH (1-34) (n=15) and; group 3 - only the vehicle required for hormone dissolution (n=15). Thirty days after surgery, the animals were sacrificed and specimens containing the implant and the surrounding bone were removed and processed for non-decalcified sections. The sections were evaluated according to the following histometric parameters: proportion of mineralized tissue (PMT) adjacent to the implant threads (500 µm band); bone filling within the limits of the threads (BF) and; bone-to-implant contact (BIC). For the cortical region, both hormone dosages (groups 1 and 2) promoted better results, for all parameters, when compared to control group (p<0.05). Similar results were observed for the BF parameter in the cancellous region (p=0.0394). Therefore, systemic administration of PTH (1-34) stimulates bone formation around titanium implants, even at low doses.
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Huesos/efectos de los fármacos , Implantes Dentales , Hormona Paratiroidea/administración & dosificación , Animales , Relación Dosis-Respuesta a Droga , Masculino , Modelos Animales , Oseointegración , Ratas , Ratas WistarRESUMEN
AIM: To test the non-inferiority of demineralized bovine bone mineral (DBBM) compared to DBBM with 10% collagen (DBBM-C) for maintenance of bone volume after tooth extraction in the anterior maxilla. MATERIALS AND METHODS: Sixty-six patients were randomly treated with DBBM or DBBM-C, both of which were covered with a collagen matrix for ridge preservation in the anterior maxilla. Cone-beam computed tomographic analysis was performed immediately and 4 months after treatment. The primary outcome, for which non-inferiority of DBBM was tested, was change in the horizontal ridge width 1 mm below the buccal alveolar crest (HW-1) 4 months after extraction. RESULTS: Four months after extraction, HW-1 measured -1.60 mm ± 0.82 mm for DBBM-C, while the DBBM group showed a mean loss of -1.37 mm ± 0.84 mm (p = 0.28, 0.23 [95% CI: -0.19; 0.64]). The horizontal ridge width at 3 mm (HW-3) showed -0.98 mm (±0.67 mm) for DBBM-C and -0.84 mm (±0.62 mm) for DBBM (p = 0.40, 0.12 [95% CI: -0.19; 0.45]), and the horizontal ridge width at 5 mm (HW-5) showed -0.67 mm (±0.47 mm) for DBBM-C and -0.56 mm (±0.48 mm) for DBBM (p = 0.36, 0.11 [95% CI: -0.13; 0.34]). CONCLUSIONS: The present clinical trial demonstrated non-inferiority of DBBM compared to DBBM-C for maintenance of alveolar bone volume 4 months after tooth extraction in the anterior maxilla.
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Pérdida de Hueso Alveolar , Aumento de la Cresta Alveolar , Sustitutos de Huesos , Proceso Alveolar , Animales , Bovinos , Tomografía Computarizada de Haz Cónico , Humanos , Extracción Dental , Alveolo DentalRESUMEN
Abstract The objective of this study was to determine whether collagen matrix (CM) is an alternative to connective tissue graft technique (CTG) in the treatment of multiple gingival recessions (GR). The indication of CM for the treatment of multiple GR is not yet clear. More studies are needed to better understand this treatment modality, as an alternative to CTG. In this single-blind, split-mouth randomized clinical trial, fifteen patients with multiple Miller class I upper GR were selected and randomly assigned to control group (CTG) or test group (CM). Root coverage (RC) and patient-centered outcomes were evaluated at baseline and after 3, 6, and 12 months. A total of 82 GRs were treated. There was no significant difference regarding GR depth (GRD, primary outcome) between CTG (0.5 ± 0.9 mm) and CM groups (0.6 ± 1.0 mm) (p = 0.225). Percentage of RC was 82.14% in CTG and 77.7% in CM. Both groups demonstrated a gain in keratinized tissue width at 12 months (p < 0.05). Dentine hypersensitivity was effectively reduced in both groups. Postoperative pain was significantly higher in the CTG (p = 0.001). Esthetic satisfaction was high for both groups, with no significant difference (p > 0.05) between groups. After 12 months, both surgical treatments were able to promote RC, and GRD was similar in both CTG and CM groups.
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Humanos , Masculino , Femenino , Adolescente , Adulto , Adulto Joven , Colágeno/uso terapéutico , Tejido Conectivo/trasplante , Recesión Gingival/cirugía , Colgajos Quirúrgicos , Factores de Tiempo , Modelos Lineales , Método Simple Ciego , Reproducibilidad de los Resultados , Estudios de Seguimiento , Resultado del Tratamiento , Estadísticas no Paramétricas , Sensibilidad de la Dentina/prevención & control , Tempo Operativo , Escala Visual Analógica , Persona de Mediana EdadRESUMEN
This is a cross-sectional study that aimed to estimate maxillary sinus floor (MSF) pneumatization in single missing tooth of posterior maxilla, by using cone-beam computed tomography (CBCT). CBCT images were analyzed bilaterally and divided into 2 groups: edentulous site (EdS) - edentulous single region of upper second premolar, first or second molars; Tooth site (TS) - contralateral region homologous to the EdS region, with tooth present. Variables evaluated were: sinus height (SH), estimated sinus pneumatization (eSP: ∆ EdS - TS), healed ridge height (HR) and presence of localized sinus pneumatization (LSP) in molars teeth at TS. HR were categorized according to therapeutic option for posterior maxilla. 183 CBCT scans were included and it was observed that EdS presented a higher SH than the TS (p < 0.001) showing an eSP of 0.9 ± 2.93 mm. First molars presented the highest SH for both sides, although significant differences were detected when compared to second molars. First molars were mostly affected by LSP at TS (36 out of 43). Individuals with LSP at TS presented lower HR than the ones without LSP (p < 0.05). 54% of the cases presenting LSP obtained HR < 5 mm, which indicates sinus lift surgery. The present study showed that tooth loss in posterior maxilla favors sinus pneumatization and the identification of LSP at molar roots seems to indicate a greater necessity for sinus lift surgeries.
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Pérdida de Hueso Alveolar/diagnóstico por imagen , Enfermedades Maxilares/diagnóstico por imagen , Seno Maxilar/diagnóstico por imagen , Pérdida de Diente/complicaciones , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Pérdida de Hueso Alveolar/etiología , Pérdida de Hueso Alveolar/patología , Proceso Alveolar/diagnóstico por imagen , Proceso Alveolar/patología , Análisis de Varianza , Tomografía Computarizada de Haz Cónico/métodos , Estudios Transversales , Femenino , Humanos , Masculino , Enfermedades Maxilares/etiología , Enfermedades Maxilares/patología , Seno Maxilar/crecimiento & desarrollo , Seno Maxilar/patología , Persona de Mediana Edad , Cavidad Nasal/diagnóstico por imagen , Cavidad Nasal/patología , Hueso Paladar/diagnóstico por imagen , Hueso Paladar/patología , Valores de Referencia , Estudios Retrospectivos , Estadísticas no Paramétricas , Pérdida de Diente/diagnóstico por imagen , Adulto JovenRESUMEN
OBJECTIVES: The objective of this 3-year split-mouth randomized controlled clinical study was to compare narrow-diameter implants (NDIs) to regular-diameter implants (RDIs) in the posterior region of the jaws (premolars and molars) in regards to (i) the marginal bone level (MBL) and (ii) implant and prosthesis survival and success rates. MATERIAL AND METHODS: A total of 22 patients were included in the study. Each patient received at least one implant of each diameter (Ø3.3 and Ø4.1 mm), placed either in the maxilla or mandible to support single crowns. A total 44 implants (22 NDIs and 22 RDIs) were placed and included in the study. Twenty-one implants were placed in the premolar, whereas 23 were placed in molar areas. Radiographic evaluations to access the MBL were performed immediately after implant placement, 1 and 3 years after implant loading. Peri-implant clinical variables including probing pocket depth (PPD) and bleeding on probing (BoP) were obtained after crown delivery, 1 and 3 years after loading. Furthermore, the survival and success rates of the implants and prosthesis were also evaluated. RESULTS: Twenty patients were able to complete the study. There was no statistically significant difference regarding MBL between groups at implant placement (p = .084), 1-year (p = .794) and 3-year (p = .598) time intervals. The mean peri-implant bone loss at 3-year follow-up was -0.58 ± 0.39 mm (95% CI: -0.751 to -0.409) and -0.53 ± 0.46 mm (95% CI: -0.731 to -0.329) for NDIs and RDIs, respectively. BoP was present at 15% and 10% of NDIs and RDIs, respectively, at 3-year follow-up. PPD >5 mm was observed in 5% and 0% of the implants of NDIs and RDIs, respectively, at 3-year follow-up. At the 3-year examination, the implant success rates were in the NDIs and RDIs sites, respectively, 95% and 100%. The corresponding values for prosthesis success rates were 90% for NDIs and 95% for RDIs. CONCLUSION: The present study demonstrated that NDIs placed to support single crowns in the posterior region did not differ to RDIs in regards to MBL, implant survival, and success rates.
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Coronas , Implantes Dentales de Diente Único , Diseño de Prótesis Dental , Prótesis Dental de Soporte Implantado , Pérdida de Hueso Alveolar , Diente Premolar , Fracaso de la Restauración Dental , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Diente MolarRESUMEN
Abstract This is a cross-sectional study that aimed to estimate maxillary sinus floor (MSF) pneumatization in single missing tooth of posterior maxilla, by using cone-beam computed tomography (CBCT). CBCT images were analyzed bilaterally and divided into 2 groups: edentulous site (EdS) - edentulous single region of upper second premolar, first or second molars; Tooth site (TS) - contralateral region homologous to the EdS region, with tooth present. Variables evaluated were: sinus height (SH), estimated sinus pneumatization (eSP: ∆ EdS - TS), healed ridge height (HR) and presence of localized sinus pneumatization (LSP) in molars teeth at TS. HR were categorized according to therapeutic option for posterior maxilla. 183 CBCT scans were included and it was observed that EdS presented a higher SH than the TS (p < 0.001) showing an eSP of 0.9 ± 2.93 mm. First molars presented the highest SH for both sides, although significant differences were detected when compared to second molars. First molars were mostly affected by LSP at TS (36 out of 43). Individuals with LSP at TS presented lower HR than the ones without LSP (p < 0.05). 54% of the cases presenting LSP obtained HR < 5 mm, which indicates sinus lift surgery. The present study showed that tooth loss in posterior maxilla favors sinus pneumatization and the identification of LSP at molar roots seems to indicate a greater necessity for sinus lift surgeries.
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Humanos , Masculino , Femenino , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Adulto Joven , Enfermedades Maxilares/diagnóstico por imagen , Pérdida de Hueso Alveolar/diagnóstico por imagen , Pérdida de Diente/complicaciones , Seno Maxilar/diagnóstico por imagen , Hueso Paladar/patología , Hueso Paladar/diagnóstico por imagen , Valores de Referencia , Enfermedades Maxilares/etiología , Enfermedades Maxilares/patología , Estudios Transversales , Estudios Retrospectivos , Análisis de Varianza , Pérdida de Hueso Alveolar/etiología , Pérdida de Hueso Alveolar/patología , Pérdida de Diente/diagnóstico por imagen , Estadísticas no Paramétricas , Tomografía Computarizada de Haz Cónico/métodos , Proceso Alveolar/patología , Proceso Alveolar/diagnóstico por imagen , Seno Maxilar/crecimiento & desarrollo , Seno Maxilar/patología , Persona de Mediana Edad , Cavidad Nasal/patología , Cavidad Nasal/diagnóstico por imagenRESUMEN
Abstract The aim of this study was to evaluate histomorphometrically the influence of two techniques of dental implant site preparation on bone healing around titanium implants. Fifteen male Wistar rats (±300 g) were used in the study. Each tibia was randomly assigned to receive the implant site preparation either with a conventional drilling technique (control - DRILL group) or with a piezoelectric device (PIEZO group). The animals were sacrificed after 30 days and then the following histomorphometric parameters were evaluated (percentage) separately for cortical and cancellous regions: proportion of mineralized tissue (PMT) adjacent to implant threads (500 μm adjacent); bone area within the threads (BA) and bone-implant contact (BIC). The results demonstrated that there were no statistically significant differences between both groups for cancellous BIC (p>0.05) and cortical PMT (p>0.05). On the other hand, a higher percentage of BA was observed in the PIEZO group in the cortical (71.50±6.91 and 78.28±4.38 for DRILL and PIEZO groups, respectively; p<0.05) and cancellous regions (9.62±4.06 and 19.94±14.18 for DRILL and PIEZO groups, respectively; p<0.05). The piezosurgery also showed higher PMT values in the cancellous zone (9.35±5.54 and 18.72±13.21 for DRILL and PIEZO groups, respectively; p<0.05). However, the DRILL group presented better results for BIC in cortical region (80.42±10.88 and 70.25±16.93 for DRILL and PIEZO groups, respectively; p<0.05). In conclusion, for the implant site preparation, the piezosurgery was beneficial to bone healing rates in the cancellous bone region, while the drill technique produced better results in the cortical bone.
Resumo O objetivo deste estudo foi avaliar histomorfometricamente a influência de duas técnicas de preparo para implante dentário sobre a reparação óssea ao redor de implantes de titânio. Foram utilizados 15 ratos machos Wistar, com aproximadamente 300 g. Uma tíbia dos animais foi aleatoriamente selecionada para o preparo do leito para instalação de um implante de titânio com um motor rotatório convencional (Grupo ROTATÓRIO) e a outra com ultrassom cirúrgico piezoelétrico (Grupo PIEZO). Após 30 dias, os animais foram sacrificados e foram avaliados os seguintes parâmetros histomorfométricos (em porcentagem), separadamente, para a região cortical e medular: a proporção de tecido mineralizado (PTM) na região adjacente ao implante (500 μm adjacentes); área de tecido mineralizado (AO) dentro dos limites das roscas do implante e a extensão de tecido ósseo em contato direto (CD) com a superfície do implante. Os resultados deste estudo mostraram que não foram observadas diferenças para CD na região medular (p>0,05) e para PTM na região cortical (p>0,05). Por outro lado, um maior preenchimento das roscas foi observado quando utilizou-se ultrassom cirúrgico piezoelétrico tanto na região cortical (71,50±6,91 e 78,28±4,38 para os grupos ROTATÓRIO e PIEZO, respectivamente; p<0,05) quanto na região medular (9,62±4,06 e 19,94±14,18 para os grupos ROTATÓRIO e PIEZO, respectivamente; p<0,05). Resultados semelhantes foram observados para o parâmetro PTM na região medular (9,35±5,54 e 18,72±13,21 para os grupos ROTATÓRIO e PIEZO, respectivamente; p<0,05). No entanto, o grupo ROTATÓRIO foi superior ao grupo PIEZO em relação a CD na região cortical (80,42±10,88 e 70,25±16,93 para os grupos ROTATÓRIO e PIEZO, respectivamente; p<0,05). Pode-se concluir que, para o preparo do leito para implantes, a piezocirurgia favoreceu o reparo ósseo na região medular, enquanto a técnica convencional promoveu melhores resultados no osso cortical.
Asunto(s)
Animales , Masculino , Ratas , Implantes Dentales , Piezocirugía , Titanio , Ratas WistarRESUMEN
BACKGROUND: Synthetic parathyroid hormone [PTH(1-34)] has been investigated for its benefits on bone healing and osteoporosis treatment; however, there is little information regarding bone grafts. This study therefore investigates the effect of PTH(1-34) on autogenous bone graft healing. METHODS: Bone grafts were harvested from the calvarium of rats with a trephine bur (3-mm internal diameter) and placed on the cortex near the mandible angle with a titanium screw. Animals were randomly assigned to group 1 (control): subcutaneous injections of saline solution, three times a week (n = 15); group 2: 2 µg/kg PTH(1-34), three times a week (n = 15); and group 3: 40 µg/kg PTH(1-34), three times a week (n = 15). Thirty days postoperatively, the animals were killed, and specimens (implant + bed + graft) were removed and used for undecalcified sections. The following histometric parameters were evaluated: total bone thickness (TT) (bed + gap + graft), graft thickness (GT) (adjacent to the implant), bone-to-implant contact (BIC), and bone area (BA) (within the limits of the threads). Five additional animals were sacrificed immediately after surgery (zero hour) to register bed and graft sizes before healing. RESULTS: Group 3 showed significantly greater bone gain compared with groups 1 and 2 (TT and GT, P <0.05). In relation to initial thickness (zero hour), groups 1 and 2 showed a total decrease in volume of 15.91% and 20.83%, respectively, whereas group 3 showed a slight bone gain (1.21%). Data analysis revealed a significant difference for group 3 compared with groups 1 and 2 (P <0.01). No differences were observed for BIC and BA (P >0.05). CONCLUSION: Systemic administration of PTH(1-34) augmented bone volume in autogenous grafts.