Implant Periapical Lesion: Clinical and Histological Analysis of Two Case Reports Carried Out with Two Different Approaches.

Periapical implantitis (IPL) is an increasingly frequent complication of dental implants. The causes of this condition are not yet entirely clear, although a bacterial component is certainly part of the etiology. In this case series study, two approaches will be described: because of persistent IPL symptoms, a patient had the implant removed and underwent histological analysis after week 6 from implantation. The histomorphometric examination revealed a 35% bone-implant contact area involving the coronal two-thirds of the implant. The apical portion of the fixture on the other hand was affected by an inflammatory process detectable on radiography as a radiolucent area. The presence of a probable root fragment, detectable as an imprecise radiopaque mass in the zone where the implant was later placed, confirms the probable bacterial etiology of this case of IPL. On the other hand, in case number 2, the presence of IPL around the fixture was solved by surgically removing the implant apical third as well as the adjacent tooth apex. It may be concluded from our histological examination that removal of the apical portion of the fixture should be considered an effective treatment for IPL since the remaining implant segment remains optimally osseointegrated and capable of continuing its function as a prosthetic abutment. Careful attention, however, is required at the implantation planning stage to identify in advance any sources of infection in the edentulous area of interest which might compromise the final outcome.

Immediate fixed rehabilitation supported by pterygoid implants for participants with severe maxillary atrophy: 1-Year postloading results from a prospective cohort study.

STATEMENT OF PROBLEM: Few investigations concerning the use of pterygoid implants have reported reproducible and consistent data, making survival data controversial. PURPOSE: The purpose of this clinical study was to investigate the 1-year survival and success rates of pterygoid implants and prostheses in participants affected by severe atrophy of the posterior maxilla requiring a complete-arch immediate fixed prosthesis. MATERIAL AND METHODS: Fifteen participants, either completely edentulous or with failing dentition in the maxillary arch and with severe atrophy of the posterior maxilla, were enrolled in the study. All participants underwent prosthodontic rehabilitation after implant placement in both the anterior maxilla areas and the pterygoid regions. The survival data of the implants were evaluated at the time of abutment connection by means of a mobility test for each implant. After placement of the prostheses, survival was assessed by means of marginal bone maintenance as assessed by panoramic radiographs and the absence of pain or symptoms of infection. The t test was used for evaluating the difference in age between men and women (α=.05). Correlations between categorical variables (Fisher exact test) were used to evaluate the possible association between the number of implants and both the age and presence of comorbidities (α=.05). RESULTS: During the 1-year follow-up, high prosthesis stability and no implant loss were observed for all participants. In addition, participants did not report any pain or paresthesia. No peri-implant radiolucency was detected in the panoramic radiographs. Survival and success rates in the follow-up period were 100%. CONCLUSIONS: The present study supports the conclusion that pterygoid implants have a high success rate with minimal or no complications.

Immediate fixed rehabilitation of severe maxillary atrophies using trans-sinus tilted implants with or without sinus bone grafting: One-year results from a randomised controlled trial.

BACKGROUND: To compare the clinical outcomes between tilted trans-sinus implants inserted without simultaneous bone grafting versus sinus elevation procedures with bone grafting to support immediately loaded prostheses for the rehabilitation of the atrophic maxilla. MATERIALS AND METHODS: Thirty-two subjects were selected to receive an immediately loaded fixed restoration supported by four or six implants and randomised to receive at least one trans-sinus implant without simultaneous bone grafting (group 1, n = 16) or at least one trans-sinus implant with sinus elevation procedures and bone grafting (group 2, n = 16). Primary outcomes were prosthesis and implant failures. Secondary outcomes were complications and peri-implant marginal bone level changes. RESULTS: Forty-one trans-sinus implants (23 trans-sinus implants without simultaneous bone-grafting and 18 trans-sinus implants with sinus elevation procedures), 23 conventional tilted implants and 84 axial implants were inserted. No drop-outs occurred. At 1 year after loading no prosthesis was lost. One patient treated with sinus graft lost one implant (0.0% vs. 6.3%, difference 6.3%; 95% CI: -4.7 to 17.3; P = 0.99). There were no statistically significant differences in implant failures between the two groups. Complications occurred in eight patients in the group without bone grafting and in nine patients in the group with sinus elevation and bone augmentation. No statistically significant differences were found in complications (50.0% vs. 56.3%, difference 6.3%; 95% CI: -12.7 to 25.3; P = 0.99), and in peri-implant marginal bone level changes (difference 0.05 mm; 95% CI: -0.24 to 0.34; P = 0.604). CONCLUSIONS: In this study, no statistically significant differences were observed between subjects treated with tilted trans-sinus implants without simultaneous bone-grafting or with sinus elevation procedures supporting cross-arch immediately loaded fixed prostheses in atrophic maxillae. Longer follow-ups are needed and alternative procedures such us short implants or crestal sinus elevation procedures should be compared since they could be less invasive.