Stress and inflammation as a detrimental combination for peri-implant bone loss.

The causes of peri-implant bone loss continue to be controversial. To determine the impact of biomechanical stress and inflammation, we investigated a total of 80 interforaminal implants in situ for more than 10 years. Two stress groups, with 14 patients each, were established: a low-stress situation with single-standing implants, and an increased-stress situation with splinted implants. To categorize inflammation, we introduced a Composite Inflammation Score using 4 inflammatory parameters. Peri-implant bone loss was calculated from digital panoramic radiographs. To differentiate between the effects of stress and inflammation, we compared bone loss in both stress groups at equivalent levels of inflammation. With greater Composite Inflammation Score values, a clear discrepancy between single-standing and splinted implants was evident (p = 0.117/0.000, regression analysis; p = 0.135/0.000, analysis of variance; p = 0.002, t tests). While stress and inflammation alone may not necessarily be detrimental factors, the presence of stress heightens peri-implant bone loss significantly as inflammation increases.

[Life threatening oral hemorrhage after implantation into the distal right mandible]. / Biochirurgische Wund-konditionierung mittels Madentherapie und Vakuum-verbänden nach Teilnekrose eines Haut-Muskel-Transplantats im bestrahlten Kopf-Hals-Bereich.

In dental practice, surgical implant procedures are frequently conducted for pre-prosthetic surgery. Intra-operative complications are rare and can mostly be prevented effectively with adequate preparatory measures. However, not all risks can be anticipated a priori. Anatomical variation, such as variation in the path of blood vessels, is often unpredictable. This paper describes a life-threatening hemorrhage that occurred in a 60-year-old male during the insertion of an implant in the distal right mandible. It was impossible to stop the bleeding using local measures. Only extraoral ligation of the facial artery proved effective in suppressing the hemorrhage. The submentalis artery, a branch of the facial artery, had an atypical path directly below the caudal ridge of the mandible. The possibility of similar complications should make us re-evaluate preoperative preventive measures, and places greater demands on intra-operative complication prophylaxis. The international literature on this topic is discussed.