Patient-, implant- and prosthetic-related factors on peri-implant mucositis and bone loss.

Peri-implant diseases, including peri-implant mucositis (PIM) and peri-implantitis, are a chronic inflammatory disorder triggered by bacterial biofilm in susceptible hosts. Potential risk factors for peri-implant diseases include smoking, dental plaque accumulation, poor oral hygiene, genetics, and absence of peri-implant keratinized mucosa. This cohort study aimed to evaluate the influence of patient-, implant-, and prosthetic-related factors on PIM and peri-implant bone loss (PBL) around dental implants after 1 year of loading. A total of 54 subjects (22 males and 32 females) were included in the study. Peri-implant clinical parameters were assessed and standardized periapical radiographs of each dental implant were obtained 15 days after the definitive prosthesis installation (baseline) and at 3, 6, and 12 months of follow-up. A total of 173 implants were evaluated. PIM affected 44.8% of the implants and no significant association was found between the investigated parameters and PIM incidence, except for type of implant connection. A significantly higher incidence of PIM (80.0%) was observed for implants with internal hexagon connection type after 1 year of follow-up (p = 0.015). Moreover, a mean PBL of 0.35 ± 1.89 mm was observed and no dental implant was affected by peri-implantitis after 1 year of function. No specific influence of patient, implant, or prosthetic factors on PBL was observed. No association was found between the occurrence of PIM/PBL and the patient-, implant-, and prosthetic-related factors investigated in this cohort study, except for the type of dental-implant connection.

The Effectiveness of L-PRF in the Treatment of Schneiderian Membrane Large Perforations: Long-Term Follow-Up of a Case Series.

The perforation of the Schneiderian membrane (SM) is a common surgical complication during the sinus floor augmentation (SFA) procedure. Different approaches have been proposed to completely closer the SM perforation and to avoid graft contamination or migration and postoperative sinus infection. In this context, the leukocyte and platelet-rich fibrin (L-PRF) membranes have been proposed for SM perforation treatment because of their natural adhesive property and resistance. Thus, this case series aims to evaluate the effectiveness of L-PRF in the treatment of SM large perforations during SFA. A total of 9 SM perforations were treated in this case series. The L-PRF membranes were interposed on the perforated SM until the rupture could not be visualized. The maxillary sinus cavities were filled with deproteinized bovine mineral bone (Bio-oss, Geistlich, Switzerland), and a collagen membrane was positioned to cover the lateral access window. After 8 months, 13 implants were placed, achieving satisfactory primary stability. The osseointegration of all implants and absence of infection signs/mucus in the maxillary sinus were observed in cone beam computed tomography or panoramic radiography qualitative analysis after 3-5 years of follow-up. It can be concluded that the use of L-PRF can be considered a viable alternative for the repair of large SM perforations.

Use of alveolar distraction osteogenesis for anterior maxillary defect reconstruction.

Alveolar osteogenic distraction (AOD) is a biological process through which new bone formation occurs between bone segments that are gradually separated by incremental traction. This case report described the oral rehabilitation with dental implants of a patient with a vertical bone defect in the maxillary anterior region using the AOD technique. The patient presented with absence of the teeth 22, 21, 11, and 12 associated with a vertical bone defect. The AOD was performed using a supported osteodistractor device surgically installed with subsequent daily activations. After 21 days, the ideal positioning of bone fragment was confirmed and activation was ceased. Five months after the initial surgery, two dental implants were installed in the region of teeth 12 and 22. An FP3 metal-ceramic prosthesis was installed offering satisfactory esthetic results. In conclusion, the use of AOD to increase the alveolar ridge was effective and ensured rehabilitation with dental implants.

Successful Use of Leukocyte Platelet-Rich Fibrin in the Healing of Sinus Membrane Perforation: A Case Report.

PURPOSE: The aim of this case report was to demonstrate the repair of a large sinus membrane perforation related to a sinus floor augmentation procedure, using leukocyte platelet-rich fibrin (L-PRF), for subsequent rehabilitation of a partially edentulous patient. MATERIALS AND METHODS: The patient presented the absence of teeth numbers 18, 17, and 16, associated with insufficient bone height because of the maxillary sinus pneumatization. A maxillary inlay bone graft was proposed, however, during the sinus floor augmentation procedure, a large portion of the sinus membrane was ruptured. To avoid interruption of the surgical procedure, membrane mending was proposed using L-PRF and collagen membranes. RESULTS: After 8 months, 2 external hexagon connection dental implants were placed in the 16 and 17 teeth regions, and a screw-retained implant-supported prosthesis was installed. CONCLUSION: The use of L-PRF associated with collagen membrane was efficient for the sealing of the sinus membrane perforation and enabled bone formation for subsequent implant installation.

Multidisciplinary approach to oral rehabilitation with dental implants after gunshot injury: A clinical report.

This clinical report describes a multidisciplinary approach to treat a patient with edentulism and a severe anatomic defect in the mandible caused by a gunshot injury by using an implant-fixed complete dental prosthesis. An immediate loading interim implant-fixed complete dental prosthesis in the mandible associated with a maxillary removable complete denture prosthesis was initially provided to restore the intermaxillary relation. Nasal floor elevation and maxillary sinus augmentation were subsequently performed to increase the maxillary bone volume. Definitive implant-fixed complete dental prostheses were placed in both arches in order to rehabilitate this initially compromised anatomic condition, which ensured patient satisfaction and improvement in masticatory function and esthetics.

Survival/Success of Dental Implants with Acid-Etched Surfaces: A Retrospective Evaluation After 8 to 10 Years

Abstract The aim of this study was to conduct a retrospective evaluation of the survival and success rates of dental implants with acid-etched surfaces after 8-10 years of function. Forty-four patients who received 183 implants 8-10 years ago were evaluated. Clinical examinations were performed around the implants and natural teeth. The following parameters were measured: visible plaque index (VPI), marginal bleeding index (MBI), probing depth (PD), bleeding on probing (BOP) and clinical attachment level (CAL). To considerer an implant as a success case, the following criteria were considered: absence of peri-implant infection and suppuration, absence of implant mobility, absence of persistent pain and dysesthesia and absence of radiolucency around the implant. Overall, 178 implants were categorized as surviving (97.3%), 155 were categorized as successful (84.7%), 5 implants (2.7%) were lost (1 in the maxilla and 4 in the mandible), and 3 implants were not under functional load (2.0 %). 20 implants were diagnosed with peri-implantitis. Thus, the survival rate was 97% and the success rate was 85%. In conclusion, implants with acid-etched surfaces showed high survival and success rates after a period of 8 to 10 years of function.

Resumo O objetivo deste estudo foi avaliar retrospectivamente a taxa de sobrevivência e sucesso de implantes com superfície tratada por ataque ácido após 8-10 anos de função. Um total de 44 pacientes que receberam 183 implantes há 8-10 anos foram avaliados. Foi realizado exame clínico de todos os dentes e implantes presentes na cavidade bucal. Os seguintes parâmetros foram avaliados: índice de placa visível (IPV), índice de sangramento gengival (ISG), profundidade de sondagem (PS), sangramento à sondagem (SS), nível clínico de inserção (NCI). Para a classificação de sucesso dos implantes foram considerados os seguintes critérios: ausência de infecção peri-implantar com supuração, ausência de mobilidade, ausência de dor persistente ou disestesia e ausência de radiolucência contínua ao redor do implante. Após avaliação, 178 (97.3%) implantes foram classificados como sobreviventes, 155 (84.7%) aderiram aos critérios de sucesso, 5 implantes (2.7%) foram perdidos (1 na maxila e 4 na mandíbula) e 3 implantes (2.0%) não estavam em função. 20 (11%) implantes foram diagnosticados com peri-implantite. Dessa forma, a taxa de sobrevivência foi de 97% e a taxa de sucesso de 85%. Pode-se concluir que os implantes com superfície tratada por ataque ácido apresentaram altas taxas de sobrevivência e sucesso após 8-10 em função.

Free Gingival Graft to Increase Keratinized Mucosa after Placing of Mandibular Fixed Implant-Supported Prosthesis.

Insufficiently keratinized tissue can be increased surgically by free gingival grafting. The presence or reconstruction of keratinized mucosa around the implant can facilitate restorative procedure and allow the maintenance of an oral hygiene routine without irritation or discomfort to the patient. The aim of this clinical case report is to describe an oral rehabilitation procedure of an edentulous patient with absence of keratinized mucosa in the interforaminal area, using a free gingival graft associated with a mandibular fixed implant-supported prosthesis. The treatment included the manufacturing of a maxillary complete denture and a mandibular fixed implant-supported prosthesis followed by a free gingival graft to increase the width of the mandibular keratinized mucosa. Free gingival graft was obtained from the palate and grafted on the buccal side of interforaminal area. The follow-up of 02 and 12 months after mucogingival surgery showed that the free gingival graft promoted peri-implant health, hygiene, and patient comfort. Clinical Significance. The free gingival graft is an effective treatment in increasing the width of mandibular keratinized mucosa on the buccal side of the interforaminal area and provided an improvement in maintaining the health of peri-implant tissues which allows for better oral hygiene.

Survival/Success of Dental Implants with Acid-Etched Surfaces: A Retrospective Evaluation After 8 to 10 Years.

The aim of this study was to conduct a retrospective evaluation of the survival and success rates of dental implants with acid-etched surfaces after 8-10 years of function. Forty-four patients who received 183 implants 8-10 years ago were evaluated. Clinical examinations were performed around the implants and natural teeth. The following parameters were measured: visible plaque index (VPI), marginal bleeding index (MBI), probing depth (PD), bleeding on probing (BOP) and clinical attachment level (CAL). To considerer an implant as a success case, the following criteria were considered: absence of peri-implant infection and suppuration, absence of implant mobility, absence of persistent pain and dysesthesia and absence of radiolucency around the implant. Overall, 178 implants were categorized as surviving (97.3%), 155 were categorized as successful (84.7%), 5 implants (2.7%) were lost (1 in the maxilla and 4 in the mandible), and 3 implants were not under functional load (2.0 %). 20 implants were diagnosed with peri-implantitis. Thus, the survival rate was 97% and the success rate was 85%. In conclusion, implants with acid-etched surfaces showed high survival and success rates after a period of 8 to 10 years of function.

Surgical Treatment of Implants Affected by Periimplantitis After 15 Years of Loading: A Case Report.

PURPOSE: The aim of this case report is to describe the surgical treatment of 2 implants affected by periimplantitis after 15 years of loading. MATERIALS AND METHODS: The treatment included mechanical and chemical decontamination with topical application of tetracycline associated with a regenerative approach. Both defects were filled with particulate autogenous bone from tuber and covered with resorbable collagen membrane. RESULTS: The follow-up of 30 and 13 months of the implants 24 and 14, respectively, showed an absence of clinical signs of periimplant inflammation and near-complete bone regeneration. CONCLUSIONS: The therapy approach was effective in eliminating periimplant inflammation and promoting bone gain around the implants.

Use of a palatal pedicle flap for closure of an oroantral fistula / Fechamento de fístula bucossinusal com retalho palatino pediculado

Sinus lifting has become a routine procedure in modern implant dentistry. Despite its predictability, this type of surgery may eventually lead to serious complications and sequelae. Most of the time, such complications are due to technical failures, such as perforation of the sinus membrane during surgery, which may eventually lead to graft loss due to infection within the sinus, which finds its drainage path into the mouth and leads to an oroantral communication (OAC). Epithelization of such a draining duct characterizes an oroantral fistula (OAF). This report presents the use of a palatal pedicle flap to successfully close an OAF in a patient who had previously undergone a sinus lifting procedure. Several surgical techniques may be used in the closure of an OAF, and the choice of a particular technique is subject to the characteristics and location of the communication as well as to the preference of the surgeon. The palatal pedicle flap was successfully chosen in the present case report. The palatal pedicle flap was considered an adequate option for closure of an OAF in a single-stage surgical procedure, with no loss of either keratinized mucosa or buccal sulcus depth in the area of the fistula.

A cirurgia de elevação da mucosa do seio maxilar para enxerto ósseo e posterior colocação de implantes osseointegráveis vem se tornando um procedimento de rotina na implantodontia moderna. Embora previsível, em alguns casos, tal procedimento, pode levar a complicações e sequelas consideráveis. Na maioria das vezes, essas complicações são ocasionadas por falhas técnicas, como a perfuração da membrana sinusal no momento transcirúrgico, o que pode acarretar perda do enxerto devido a um processo infeccioso no interior do seio maxilar, cuja via de drenagem acaba provocando a comunicação com a cavidade oral. A fístula bucossinusal é caracterizada pela persistência e epitelização desse pertuito. Neste relato é apresentado um caso de fechamento de fístula bucossinusal com o uso de um retalho palatino pediculado, em um paciente que havia desenvolvido um processo infeccioso, após ter sido submetido à realização de uma cirurgia para a elevação do seio maxilar. A cirurgia para o fechamento das comunicações bucossinusais apresenta técnicas variadas, que podem ser eleitas de acordo com as preferências do operador, além da localização e características da comunicação. Para o presente relato de caso, a técnica do retalho palatino pediculado foi eleita para o tratamento cirúrgico, proporcionando a cura do paciente. A técnica do retalho palatino pediculado mostrou-se uma opção adequada para o fechamento da fístula bucossinusal em um único ato cirúrgico, sem perda de mucosa ceratinizada ou diminuição do sulco vestibular na região da fístula.

Prevalence and Possible Risk Factors of Peri-implantitis: A Concept Review.

AIM: The purpose of this review is to estimate the prevalence of peri-implantitis, as well as to determine possible risk factors associated with its development in patients treated with oral implants. BACKGROUND: Although implant therapy has been identified as a successful and predictable treatment for partially and fully edentulous patients, complications and failures can occur. Peri-implantitis is considered a biologic complication that results in bone loss around implants and may lead to implant treatment failure. RESULTS: A great variation has been observed in the literature regarding the prevalence of peri-implantitis according to the diagnostic criteria used to define peri-implantitis. The prevalence ranges from 4.7 to 43% at implant level, and from 8.9 to > 56% at patient level. Many risk factors that may lead to the establishment and progression of peri-implantitis have been suggested. There is strong evidence that presence and history of periodontitis are potential risk factors for peri-implantitis. Cigarette smoking has not yet been conclusively established as a risk factor for peri-implantitis, although extra care should be taken with dental implant in smokers. Other risk factors, such as diabetes, genetic traits, implant surface roughness and presence of keratinized mucosa still require further investigation. CONCLUSION: Peri-implantitis is not an uncommon complication following implant therapy. A higher prevalence of peri-implantitis has been identified for patients with presence or history of periodontal disease and for smokers. Until now, a true risk factor for peri-implantitis has not been established. Supportive maintenance program is essential for the long-term success of treatments with oral implants. CLINICAL SIGNIFICANCE: The knowledge of the real impact of peri-implantitis on the outcome of treatments with oral implants as well as the identification of risk factors associated to this inflammatory condition are essential for the development of supportive maintenance programs and the establishment of prevention protocols.

Sobrevivência e sucesso de implantes osseointegrados com superfície tratada por ataque ácido: avaliação retrospectiva de 8 a 10 anos / Survival and success of dental implants with surface treated with acid attack: retrospective evaluation of 8 to 10 years

Implantes dentários com superfície tratada por ataque ácido representam uma opção clínica para a reabilitação de regiões edêntulas. No entanto, trabalhos prévios mostram que uma variedade de fatores de risco pode comprometer a longevidade do implante. O objetivo deste estudo foi avaliar retrospectivamente a taxa de sobrevivência e sucesso de implantes com superfície tratada por ataque ácido. A amostra constituiu-se de 183 implantes instalados em 44 pacientes que foram submetidos à reabilitação protética no período de 2003 a 2005. A idade média dos pacientes no momento da instalação dos implantes foi de 50 anos, sendo 18 pacientes do gênero masculino e 26 do gênero feminino. Após exames clínico e radiográfico, foi verificado que apenas 5 implantes (2,7%) foram perdidos em 4 pacientes, 1 na maxila e 4 na mandíbula, e 3 implantes (2,0%) não estavam em função. Dos implantes presentes, 155 (87%) aderiram aos critérios de sucesso e 20 (11%) apresentavam peri-implantite. Os pacientes foram reabilitados com próteses múltiplas e unitárias do tipo parafusadas ou cimentadas. Dentre as reabilitações protéticas, implantes com próteses múltiplas parafusadas apresentaram uma maior porcentagem de peri-implantite (15,3%). Baseado nestes resultados, implantes com superfície tratada com ataque ácido apresentaram uma taxa de sobrevivência de 97% e uma taxa de sucesso de 85% após um período de 8 a 10 anos em função.

Rough-surface dental implants are a viable clinical alternative for rehabilitation of edentulous areas. However, previous studies have suggested that a vast array of risk factors may compromise the long-term success rate of dental implants. This retrospective study aimed to evaluate the survival and the success rates of dental implants with an acid-etched surface. 183 implants were performed in 44 patients who received subsequent implant-supported prosthetic treatment between the years of 2003 and 2005. Patient mean-age at the time of implant placement was 50 years. 18 patients were male and 26 female. Clinical and radiographic examination showed that only 5 implants (2,7%) were lost among 4 patients, 1 in the maxilla and 4 in the mandible and that 3 implants (2,0%) were not in function. 155 (87%) of the functioning implants fell under the success criteria employed whereas 20 (11%) of them presented peri-implantitis. Rehabilitation included screw-retained or cemented single crowns and bridges. A higher prevalence of peri-implantitis (15.3%) was noted for screw-retained bridges. Results showed a survival rate of 97,3% and a success rate of 87% for dental implants with an acid-etched surface after 8 to 10 years of loading