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1.
Artículo en Inglés | MEDLINE | ID: mdl-34076631

RESUMEN

This case control study measured early crestal bone changes around subcrestally placed platform-switched implants surrounded by thin soft tissue and compared them with regular, matching-platform implants placed in a supracrestal position and surrounded by thick soft tissue. Sixty-six patients received two-piece internal hex dental implants. Control group patients (n = 33) received implants that had a horizontally matching implant-abutment connection and were placed approximately 0.5 to 1 mm supracrestally. Test group patients (n = 33) received platform-switched implants that were placed about 1.5 mm subcrestally. Clinical examinations were conducted, intraoral radiographs were taken, and statistical analysis was performed. After 2 months, the mean bone loss was 0.2 mm (SD: 0.22 mm; range: 0.1 to 1.2 mm) in the control group and -0.69 mm (SD: 0.65 mm; range: 0 to 2.6 mm) in the test group; this difference was found to be statistically significant (P < .05). After 1 year, mean bone loss was 0.28 mm (SD: 0.36 mm; range: 0.1 to 1.63 mm) in the control group and -0.6 mm (SD: 0.55 mm; range: 0.05 to 1.8 mm) in the test group. Platform-switched implants placed in a subcrestal position in vertically thin soft tissues showed statistically significantly more bone loss than non-platform-switched implants placed supracrestally with vertically thick tissues.


Asunto(s)
Pérdida de Hueso Alveolar , Implantes Dentales , Pérdida de Hueso Alveolar/diagnóstico por imagen , Pérdida de Hueso Alveolar/etiología , Huesos , Estudios de Casos y Controles , Implantación Dental Endoósea , Humanos
2.
Int J Oral Maxillofac Implants ; 36(3): 574-580, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34115074

RESUMEN

PURPOSE: To evaluate marginal bone level changes over 3 years around platform-shifting implants with internal conical connections, and to identify the factors relating to bone level changes. MATERIALS AND METHODS: Systemically healthy patients who lost one tooth or two consecutive teeth were enrolled in the study. The subjects received one or two implants with platform-shifting and internal conical connections in healed bone in a submerged manner. Digital standardized periapical radiographs were obtained at the time of implant placement, at prosthesis delivery, at 1 year, and at 3 years after the definitive restorations. Marginal bone level changes were measured at the mesial and distal aspects of each implant. Spearman correlation coefficients were calculated to examine the correlation between marginal bone level changes and clinical factors (age, vertical mucosal thickness, implant length and diameter, insertion torque value, and vertical implant position). RESULTS: Twenty-five patients with 30 implants (8 men and 17 women, mean age: 61.24 ± 13.18 years) were followed up to 3 years after the definitive restorations. The implant survival rate was 100%, and no remarkable complications were found. Mean peri-implant marginal bone level changes were -0.41 ± 0.61 mm (from placement to prosthesis delivery: C1); -0.08 ± 0.54 mm (from prosthesis delivery to 1 year: C2); -0.04 ± 0.95 mm (from prosthesis delivery to 3 years: C3); and 0.04 ± 0.60 mm (from 1 year to 3 years: C4), respectively. Statistically significant differences in bone level changes were observed between C1 and C3, and C1 and C4. Significant correlations of marginal bone level changes with implant diameter in C1 and with vertical implant position in C2 and C3 were observed. CONCLUSION: Within the limitations of this study, platform-shifting implants with internal conical connections appeared to prevent marginal bone resorption, especially after delivery of definitive prostheses, although marginal bone resorption attributed to the reestablishment of biologic width following subcrestal placement might be unavoidable.


Asunto(s)
Pérdida de Hueso Alveolar , Implantes Dentales , Anciano , Pérdida de Hueso Alveolar/diagnóstico por imagen , Pérdida de Hueso Alveolar/etiología , Implantes Dentales/efectos adversos , Diseño de Prótesis Dental , Prótesis Dental de Soporte Implantado , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Torque
3.
Bull Tokyo Dent Coll ; 62(2): 127-134, 2021 Jun 04.
Artículo en Inglés | MEDLINE | ID: mdl-33994424

RESUMEN

We report a case of generalized chronic periodontitis requiring periodontal regenerative therapy. The patient was a 53-year-old woman who presented with the chief complaint of gingival swelling. An initial examination revealed 31.5% of sites with a probing depth of ≥4 mm and 46.3% with bleeding on probing. Radiographic examination showed vertical bone resorption in tooth #33. Horizontal adsorption was also observed in other areas. Based on a clinical diagnosis of severe generalized chronic periodontitis, initial periodontal therapy consisting of plaque control, scaling and root planing, occlusal adjustment, caries treatment, and splint placement was performed. After re-evaluation, surgical periodontal treatment was performed at selected sites. Periodontal regeneration therapy with recombinant human fibroblast growth factor (rhFGF)-2 was performed at #33. Two other sites (#14, 15), which had residual periodontal pockets, were treated by open-flap debridement. After re-evaluation, the patient was placed on a maintenance program. Periodontal regenerative therapy with rhFGF-2 resulted in an improvement in angular bone resorption, which has been properly maintained for 2 years. Continued care is needed to maintain stable periodontal conditions.


Asunto(s)
Pérdida de Hueso Alveolar , Periodontitis Crónica , Proteínas del Esmalte Dental , Pérdida de Hueso Alveolar/diagnóstico por imagen , Pérdida de Hueso Alveolar/cirugía , Periodontitis Crónica/tratamiento farmacológico , Periodontitis Crónica/cirugía , Raspado Dental , Femenino , Factor 2 de Crecimiento de Fibroblastos/uso terapéutico , Estudios de Seguimiento , Regeneración Tisular Guiada Periodontal , Humanos , Persona de Mediana Edad , Pérdida de la Inserción Periodontal , Resultado del Tratamiento
4.
Quintessence Int ; 52(7): 584-595, 2021 Jun 09.
Artículo en Inglés | MEDLINE | ID: mdl-33880907

RESUMEN

OBJECTIVES: The retrospective study was undertaken to assess the peri-implant tissue stability in premolar and molar sites clinically and radiographically for implants 7 years after loading. METHOD AND MATERIALS: 408 implants placed in 275 patients from 2012 to 2020 and following a regular recall protocol were assessed for Modified Plaque Index (MPI), Sulcus Bleeding Index (SBI), pocket probing depth (PPD), and the peri-implant soft tissue dehiscence (PSTD) clinically and mesial bone loss (MBL) and distal bone loss (DBL) radiographically. RESULTS: Significant differences were found in MPI, SBI, and PPD amongst both men and women in the premolar and molar regions. The mean MBL and DBL were substantially greater in women than in men and marginally more in the maxilla than in the mandible. Maximum mean bone loss on either aspect of the premolar and molar implants was 2.80 ± 1.54 mm and 2.97 ± 0.96 mm for women. Implant success of 96.82% at 7 years was achieved and the patient satisfaction levels of 94.55% and 95.50% in the mandibular and maxillary arches, respectively, implied that patients were satisfied with the treatment. CONCLUSION: Women exhibited greater marginal bone loss on the mesial and distal aspects than men, with premolar implant sites demonstrating greater propensity for marginal bone loss than molar implant sites.


Asunto(s)
Pérdida de Hueso Alveolar , Implantes Dentales , Pérdida de Hueso Alveolar/diagnóstico por imagen , Diente Premolar/diagnóstico por imagen , Prótesis Dental de Soporte Implantado , Femenino , Estudios de Seguimiento , Humanos , Masculino , Mandíbula/diagnóstico por imagen , Diente Molar/diagnóstico por imagen , Diente Molar/cirugía , Estudios Retrospectivos , Resultado del Tratamiento
5.
BMC Oral Health ; 21(1): 214, 2021 04 27.
Artículo en Inglés | MEDLINE | ID: mdl-33906655

RESUMEN

BACKGROUND: The influence of different hypoglycemic agents on peri-implant variables among type 2 diabetes mellitus patients is still unclear. Therefore, the aim of this study was to assess the radiographic marginal bone loss and clinical parameters around implants in patients using different hypoglycemic agents. METHODS: In this retrospective cohort study, the dental implant records of type 2 diabetes mellitus patients who met the inclusion criteria were collected. The patients using only single medication as follows: insulin, metformin, or glucagon-like peptide-1 (GLP-1) drugs, were grouped according to their medication. These patients received implant placement with the same initial status, and all the prosthesis restorations were cement-retained ceramic crowns. The peri-implant marginal bone levels were evaluated by periapical radiographs immediately after implant placement and at 1 and 2-year follow-up visits. The baseline characteristics were compared among groups. The peri-implant radiographic marginal bone loss and clinical parameters were preliminarily compared using the Kruskal-Wallis test, and then the covariates were controlled by covariance analysis. Bonferroni post hoc adjustment test was performed for the multiple comparisons. RESULTS: After a review of more than 7000 medical records, a total of 150 patients with 308 implants at 1-year follow-up were assessed. The peri-implant marginal bone loss in the GLP-1 drug group was significantly smaller than the insulin group and metformin group (P < 0.01). The radiographic bone loss in the metformin group was higher than the insulin group (P < 0.05). Some of these included patients were lost to follow-up. Only 74 patients with 129 implants completed the 2-year follow-up. The radiographic bone loss in the metformin group was still higher than the insulin group (P < 0.05) and GLP-1 group (P < 0.01). There was no significant difference in the BOP (+) and the mean PD among groups (P > 0.05). CONCLUSIONS: The radiographic variables were not exactly the same among the patients with different hypoglycemic agents at both the 1 and 2-year follow-ups. After ensuring consistency in baseline characteristics, the positive effect of GLP-1 drugs on peri-implant bone remodeling may be no less than insulin or metformin. More studies are needed to verify the direct effect of these drugs on peri-implant bone. Clinical trial registration number ChiCTR2000034211 (retrospectively registered).


Asunto(s)
Pérdida de Hueso Alveolar , Implantes Dentales , Diabetes Mellitus Tipo 2 , Pérdida de Hueso Alveolar/diagnóstico por imagen , Pérdida de Hueso Alveolar/etiología , Coronas , Implantación Dental Endoósea , Prótesis Dental de Soporte Implantado , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Estudios de Seguimiento , Humanos , Hipoglucemiantes/uso terapéutico , Estudios Retrospectivos , Resultado del Tratamiento
6.
Biomed Res Int ; 2021: 6685991, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33791377

RESUMEN

The possibility of platelet-rich plasma (PRP) on the improvement of bone and adjacent tissue recovery has previously been validated. However, there is insufficient data supporting the use of platelet-rich plasma to improve the healing of bone and adjacent tissues around an implant in the oral cavity. The purpose of this randomized controlled trial was to observe the effect of platelet-rich plasma (PRP) concentrate on marginal bone loss and bone density around immediate implant placement using Cone Beam Computerized Tomography (CBCT). This clinical study was conducted over a period of six months on 12 subjects, who were equally categorized into two groups. Group I was the control, whereas the subjects in Group II received PRP therapy at the surgical site. All subjects were given a standard treatment with a single implant system (DIO UFII hybrid sandblasted acid-etched implants). Inserted implants were analyzed through CBCT, and records were registered at baseline, at the 12th week before functional loading and the 26th week after functional loading. The bone loss was calculated at the proximal (mesial and distal) side of the implant and bone density at baseline, 12th week, and 26th week after implant placement. SPSS version 23.0 was used for statistical analysis of data. The changes in bone levels were measured and compared between the two groups using the Mann-Whitney U test, with no significant difference. Bone density was analyzed by an independent sample t-test, p value ≤ 0.05 was considered statistically significant. Again, no significant difference in bone density was observed between both groups at all three instances. Therefore, it can be concluded that local injection of PRP after immediate implant placement did not show any decrease in marginal bone loss or improvement in bone density. This trial is registered with NCT04650763.


Asunto(s)
Pérdida de Hueso Alveolar , Tomografía Computarizada de Haz Cónico , Carga Inmediata del Implante Dental , Plasma Rico en Plaquetas , Alveolo Dental , Cicatrización de Heridas , Adulto , Pérdida de Hueso Alveolar/diagnóstico por imagen , Pérdida de Hueso Alveolar/terapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Alveolo Dental/diagnóstico por imagen , Alveolo Dental/cirugía
7.
BMC Oral Health ; 21(1): 171, 2021 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-33794841

RESUMEN

BACKGROUND: This study assessed retrospectively the clinical outcomes of single implant-supported crowns and implant-supported fixed dental prostheses (FDPs). METHODS: This case series compared biological and technical complications in single implant-supported crowns and implant-supported bridges in a time framed sample of all patients who received dental implants between 2009 and 2016 in Dubai Health Authority. Only 3-unit implant-supported prostheses (FDPs) with one intervening pontic and an implant each end were included for comparison to single crown supported implants. Cantilevered implants, implant-supported dentures and cases involving bone grafts or sinus lifts were excluded. The primary outcome measure was marginal bone loss, measured on digital radiographs taken after prosthesis placement at baseline and one year after implant loading, whilst peri-implantitis and technical complications were secondary outcomes. Mixed regression models adjusted for clustering of implants within patients was used for patient and implant factor associations. RESULTS: A total of 454 patients (152 males; 302 females) had 1673 implants. The mean age of males (53.7 years, SD 14.6) was significantly greater than females (49.3 years, SD 12.9, p < 0.001). Mean mesial bone loss on the FDPs was significantly greater at 1 year (1.14 mm, SD 0.63) compared with the mesial surface of single implant-supported crowns (0.30 mm, SD 0.43, p < 0.001). Mean distal bone loss was also significantly greater at 1 year on the distal surfaces of implants supporting bridgework (1.29 mm, SD 0.71) compared with distal surfaces on single implant-supported crowns (0.36 mm, SD 0.54, p < 0.001). Mean marginal bone loss mesially and distally around implants placed in the lower anterior sextant was significantly greater compared to all other sites (p < 0.001). Bone loss by gender, patient's age and medical condition was not different between the 2 implant groups. Screw loosening was the main technical complication (11.5%) whilst peri-implantitis occurred rarely (0.5%). The 66 cement retained implants had significantly more complications compared to the 1607 screw retained implants (p < 0.001). CONCLUSIONS: Mean marginal bone loss around the supporting implants of FDPs (3-unit fixed bridgework) was greater than on single implant-supported crowns at one year after implant loading. Position in the mouth was associated with bone loss. Biological and technical complications occurred rarely.


Asunto(s)
Pérdida de Hueso Alveolar , Implantes Dentales , Pérdida de Hueso Alveolar/diagnóstico por imagen , Pérdida de Hueso Alveolar/etiología , Coronas , Diseño de Prótesis Dental , Prótesis Dental de Soporte Implantado , Fracaso de la Restauración Dental , Dentadura Parcial Fija , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
8.
Int J Oral Maxillofac Implants ; 36(2): 355-360, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33909727

RESUMEN

PURPOSE: The objective of this study was to report implant survival rates, marginal bone loss, and the impact of prosthesis type among patients with type 2 diabetes mellitus (DMT2), with high hemoglobin A1C (HbA1c) values. MATERIALS AND METHODS: This retrospective study utilized patient medical records from an oral surgeon's office. Patients who had moderately or poorly controlled DMT2 with HbA1c values up to 10% were reviewed. Inclusion criteria were partially or fully edentulous patients diagnosed with DMT2 who were subsequently treated with implant-supported prosthetic restorations. Patients were at least 18 years of age. Exclusion criteria were patients who did not present for annual follow-up visits, patient records with incomplete surgical or restorative data, or nondiagnostic radiographs. All the fixed restorations were cement-retained, and the removable restorations were supported by two to six implants. Marginal bone loss and the consequences of prosthetic type were assessed from the last available radiograph compared with the one taken after the surgical procedure. RESULTS: Data of 357 implants were extracted from the records of 38 patients with HbA1c values (6.9% to 10.0%). The mean follow-up was 7.3 years, with a minimum of 5 years. Six implants failed, yielding a 98.4% overall implant survival rate. The patients were divided into two groups according to the HbA1c values before implant placement. The moderately controlled group included 25 patients with DMT2, with HbA1c values of 6.9% to 8.0%, and the poorly controlled group included 13 patients, with HbA1c values of 8.1% to 10.0%. The overall mean bone loss was 2.02 ± 2.43 mm. In both groups, the maxilla demonstrated more bone loss than the mandible (P < .05). Marginal bone loss in moderately controlled and poorly controlled groups was 1.86 (± 2.21) mm and 2.33 (± 2.85) mm, respectively (P < .05). Removable prostheses also revealed greater bone loss rates compared with fixed prostheses in both groups (P < .05). CONCLUSION: Patients with high HbA1c values (8.1% to 10.0%) had more marginal bone loss than those with lower HbA1c values. Removable dentures should be reconsidered as a standard treatment option in these patients.


Asunto(s)
Pérdida de Hueso Alveolar , Implantes Dentales , Diabetes Mellitus Tipo 2 , Pérdida de Hueso Alveolar/diagnóstico por imagen , Pérdida de Hueso Alveolar/etiología , Implantación Dental Endoósea/efectos adversos , Implantes Dentales/efectos adversos , Diseño de Prótesis Dental , Prótesis Dental de Soporte Implantado , Fracaso de la Restauración Dental , Diabetes Mellitus Tipo 2/complicaciones , Estudios de Seguimiento , Hemoglobina A Glucada , Humanos , Estudios Retrospectivos
9.
Int J Oral Maxillofac Implants ; 36(2): 371-378, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33909730

RESUMEN

PURPOSE: The aim of this study was to evaluate the survival and success rates of oral rehabilitations in a shortened maxillary dental arch and expanded maxillary sinus with 4-mm extrashort implants splinted to longer ones. MATERIALS AND METHODS: One 10-mm and one/two extrashort 4-mm titanium-zirconium SLActive tissue-level dental implants were inserted into 11 patients with limited vertical bone availability due to an expanded maxillary sinus antrum. Immediately and 6 months after insertion, implant stability resonance frequency analysis (RFA) values were assessed with an Osstell device. Splinted crowns combining 4- and 10-mm implants were supplied to all 11 cases. RESULTS: In 10 cases, the bone quality was type III, and in one case, type IV. Among 17 4-mm and 11 10-mm implants, the median RFA values were 61 (interquartile ranges [IQR]: 59 to 64) and 66 (IQR: 64 to 72). One 4-mm implant failed to osseointegrate and was removed. After 6 months of healing, secondary-stability measurements of 16 of the remaining 4-mm implants increased to 68 (IQR: 62 to 72) and of 10-mm implants to 78 (IQR: 77 to 80). After 1 year, all (11/11) oral rehabilitations supported by 10-mm (11/11) and 4-mm (16/16) implants were functional. The medians and IQRs of the probing depths (median: 2.8 mm, IQR: 2.3 to 3.1 mm vs median: 2.9 mm, IQR: 2.4 to 3.1 mm) and the crestal bone loss (median: 0.75 mm, IQR: 0 to 0.9 mm vs median: 0.22 mm, IQR: 0 to 0.4 mm) for the 10-mm and 4-mm implants, respectively, were similar. CONCLUSION: Rehabilitations with splinted crowns combining 4- and 10-mm implants demonstrated a favorable 1-year performance in a shortened maxillary dental arch.


Asunto(s)
Pérdida de Hueso Alveolar , Implantes Dentales , Pérdida de Hueso Alveolar/diagnóstico por imagen , Pérdida de Hueso Alveolar/cirugía , Implantación Dental Endoósea , Diseño de Prótesis Dental , Prótesis Dental de Soporte Implantado , Fracaso de la Restauración Dental , Humanos , Maxilar/diagnóstico por imagen , Maxilar/cirugía , Estudios Prospectivos
10.
Int J Oral Maxillofac Implants ; 36(2): 379-387, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33909731

RESUMEN

PURPOSE: The aim of this study was to clinically and radiographically evaluate mandibular overdentures supported by four short implants combined with two different doses of photobiomodulation (PBM). MATERIALS AND METHODS: A split-mouth design was applied; six completely edentulous male subjects received four short implants in the canine and second premolar area. Short implants were inserted via a digital fully guided approach with a stereolithographic surgical guide. All patients received five PBM sessions immediately after surgery and every 48 hours. Group A (n = 6) implants on the right side received a dose of 3.75 J/cm2, and group B (n = 6) implants on the left side received a dose of 7.5 J/cm2. Evaluation of peri-implant probing depth (PIPD), modified Gingival Index (MGI), and vertical bone loss was performed at the time of prosthetic loading and 6 and 12 months later. The implant stability quotient (ISQ) was also assessed 6 and 12 months after loading. RESULTS: There was no significant difference between both groups regarding PIPD values. However, a minor but significant increase from the baseline (P < .001) was observed in PIPD values in both groups after 12 months. The MGI scores at the different time intervals were very low for both groups. The mean vertical bone loss after 12 months was minimal for both groups but statistically significant from the baseline (P < .001). ISQ values for both groups after 12 months revealed a significant increase from the baseline, and group B values were significantly higher than those of group A. CONCLUSION: Within the limitations of this study, a mandibular overdenture supported by four short implants is a valid treatment modality for atrophic mandibles, and a PBM dose of 7.5 J/cm2 has a potential positive influence on implant healing and osseointegration.


Asunto(s)
Pérdida de Hueso Alveolar , Implantes Dentales , Terapia por Luz de Baja Intensidad , Pérdida de Hueso Alveolar/diagnóstico por imagen , Prótesis Dental de Soporte Implantado , Prótesis de Recubrimiento , Estudios de Seguimiento , Humanos , Masculino , Mandíbula/diagnóstico por imagen , Mandíbula/cirugía , Resultado del Tratamiento
11.
Clin Oral Implants Res ; 32(5): 651-656, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33686723

RESUMEN

OBJECTIVES: To analyse whether there is a difference in marginal bone levels (MBL) and the respective changes between cemented and screw-retained reconstructions at 3 and 5 years of loading. METHODS: Radiographic data from 14 prospective multicentre clinical trials following implant loading with fixed cemented (CEM) or screw-retained (SCREW) reconstructions with a 3- to 5-year follow-up were retrieved from a database. MBL and MBL changes were assessed at initiation of implant loading (BL), at 3 (FU-3) and 5 years (FU-5) thereafter. The presence of peri-implantitis was also determined. RESULTS: Data from 1,672 implants at BL, 1,565 implants at FU-3 and 1,109 implants at FU-5 were available. The mean MBL amounted to 0.57 mm (SD 0.87) at BL, 0.55 mm (SD 0.86) at FU-3 and 0.65 mm (SD 1.18) at FU-5. At FU-3, the mean MBL was 0.44 mm (SD 0.65) in group CEM and 0.63 mm (SD 0.99) in group SCREW showing a significant difference between the groups (intergroup <0.05). At FU-5, the mean MBL was 0.42 mm (SD 0.77) in CEM and 0.80 mm (SD 1.37) in SCREW, again with significant differences between both groups (p < .05). MBL changes between BL and FU-3 amounted to 0.11 mm (SD 1.02) (bone loss) in SCREW and -0.17 mm (SD 1.03) (bone gain) in CEM. Similarly, mean MBL changes from BL to FU-5 amounted to 0.23 mm (SD 1.31) (bone loss) in SCREW and -0.26 mm (SD 1.27) (bone gain) in CEM. The prevalence of peri-implantitis amounted to 6.9% in CEM and 5.6% in group SCREW (intergroup p = .29063) at FU-3. At FU-5, peri-implantitis amounted to 4.6% in CEM and 6.2% in group SCREW (intergroup p = .28242). CONCLUSION: Cemented implant reconstructions compared with screw-retained reconstructions revealed higher marginal bone levels and similar rates of peri-implantitis during 5 years. The difference in MBL and the respective changes between the two groups, however, appear to be clinically negligible.


Asunto(s)
Pérdida de Hueso Alveolar , Implantes Dentales , Periimplantitis , Pérdida de Hueso Alveolar/diagnóstico por imagen , Pérdida de Hueso Alveolar/etiología , Tornillos Óseos , Implantes Dentales/efectos adversos , Prótesis Dental de Soporte Implantado , Humanos , Periimplantitis/etiología , Estudios Prospectivos
12.
Clin Oral Investig ; 25(5): 2461-2478, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33609186

RESUMEN

OBJECTIVES: This study aims to compare the treatment outcomes of periodontal intrabony defects by using platelet-rich fibrin (PRF) with other commonly utilized modalities. MATERIALS AND METHODS: The eligibility criteria comprised randomized controlled trials (RCTs) comparing the clinical outcomes of PRF with that of other modalities. Studies were classified into 10 categories as follows: (1) open flap debridement (OFD) alone versus OFD/PRF; (2) OFD/bone graft (OFD/BG) versus OFD/PRF; (3) OFD/BG versus OFD/BG/PRF; (4-6) OFD/barrier membrane (BM), OFD/PRP, or OFD/enamel matrix derivative (EMD) versus OFD/PRF; (7) OFD/EMD versus OFD/EMD/PRF; (8-10) OFD/PRF versus OFD/PRF/metformin, OFD/PRF/bisphosphonates, or OFD/PRF/statins. Weighted means and forest plots were calculated for probing depth (PD), clinical attachment level (CAL), and radiographic bone fill (RBF). RESULTS: From 551 articles identified, 27 RCTs were included. The use of OFD/PRF statistically significantly reduced PD and improved CAL and RBF when compared to OFD. No clinically significant differences were reported when OFD/BG was compared to OFD/PRF. The addition of PRF to OFD/BG led to significant improvements in CAL and RBF. No differences were reported between any of the following groups (OFD/BM, OFD/PRP, and OFD/EMD) when compared to OFD/PRF. No improvements were also reported when PRF was added to OFD/EMD. The addition of all three of the following biomolecules (metformin, bisphosphonates, and statins) to OFD/PRF led to statistically significant improvements of PD, CAL, and RBF. CONCLUSIONS: The use of PRF significantly improved clinical outcomes in intrabony defects when compared to OFD alone with similar levels being observed between OFD/BG and OFD/PRF. Future research geared toward better understanding potential ways to enhance the regenerative properties of PRF with various small biomolecules may prove valuable for future clinical applications. Future research investigating PRF at histological level is also needed. CLINICAL RELEVANCE: The use of PRF in conjunction with OFD statistically significantly improved PD, CAL, and RBF values, yielding to comparable outcomes to OFD/BG. The combination of PRF with bone grafts or small biomolecules may offer certain clinical advantages, thus warranting further investigations.


Asunto(s)
Pérdida de Hueso Alveolar , Fibrina Rica en Plaquetas , Pérdida de Hueso Alveolar/diagnóstico por imagen , Pérdida de Hueso Alveolar/tratamiento farmacológico , Pérdida de Hueso Alveolar/cirugía , Trasplante Óseo , Regeneración Tisular Guiada Periodontal , Humanos , Pérdida de la Inserción Periodontal , Colgajos Quirúrgicos/cirugía
13.
Artículo en Inglés | MEDLINE | ID: mdl-33572988

RESUMEN

Background: Implant dentistry has evolved over time, resulting in better treatment outcomes for both patients and clinicians. The aim of this trial was to test whether the immediate loading of implants with a platform-switching design influences the marginal bone level, compared to four-week loading, after one year of follow-up. Moreover, a comparison of clinical data regarding implant survival, implant stability, and patient-reported outcome measures (PROMs) was conducted. Methods: Klockner® VEGA® implants with a ContacTi® surface were placed in partially edentulous patients in the posterior areas. Group A received an immediately loaded prosthesis (one week) and Group B received an early-loaded prosthesis (four weeks). All abutments were placed at the time of surgery. Radiographic and clinical data were recorded. Results: Twenty-one patients were treated (35 implants). No implants were lost during the study. The final marginal bone level did not show differences between groups. The bone loss at 12 months at the implant level was 0.00 mm for both groups (median). The final implant quotient stability (ISQ) values did not differ between groups (median 73 and 70.25), nor did the other clinical parameters or PROMs. Conclusions: The results suggest that neither of the loading protocols with the implants used influenced the marginal bone level-not the osseointegration rate, clinical conditions, or PROMs.


Asunto(s)
Pérdida de Hueso Alveolar , Pérdida de Hueso Alveolar/diagnóstico por imagen , Fracaso de la Restauración Dental , Dentadura Parcial Fija , Estudios de Seguimiento , Humanos , Oseointegración , Prótesis e Implantes , Resultado del Tratamiento
14.
J Periodontal Res ; 56(3): 547-557, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-33522612

RESUMEN

BACKGROUND: An increasing number of patients with chronic periodontitis (CP) have received implant restoration. However, very few studies have evaluated the probable risk indicators of implant loss in patients with CP. OBJECTIVE: The aim of this study is to evaluate implant long-term survival rates in patients with CP. The results are analyzed to discern potential risk indicators of implant loss. METHODS: A total of 1549 implants were inserted in 827 non-smokers and systemically healthy CP patients between March 2011 and March 2019. Clinical variables (age; sex; implant location; implant diameter; implant length; implant type; bone quality; bone graft, periodontal disease status, and insertion torque) were recorded. Kaplan-Meier survival curves illustrated the cumulative survival rate. The relationship between variables and implant loss was discerned by univariate analysis. Further multivariate Cox proportional hazard regression analysis was carried out for the variables with P < 0.2. RESULTS: The cumulative survival rates were 98.8% after 3 months, 97.9% after 6 months, 97.7% after 1 year, and 97.4% after 2 to 9 years. After adjusting possible confounders, the multivariable Cox regression model revealed statistically significant influences of implant location, history of bone graft, and insertion torque on implant loss. Implants with history of bone graft were more likely to loss. Implants inserted in the anterior area had a higher implant loss risk; insertion torque of <15 Newton-centimeter (Ncm) showed a relatively high risk of being lost. CONCLUSIONS: The study represented public hospital insight into long-term implant results of patients with CP. Under the premise of strict periodontal control, patients with the history of CP exhibited relatively high implant survival rate. Anterior implant location, history of bone graft, and insertion torque <15 Ncm are associated with a lower implant survival rate and could be considered at a higher risk of implant failure in patients with CP.


Asunto(s)
Pérdida de Hueso Alveolar , Implantes Dentales , Pérdida de Hueso Alveolar/diagnóstico por imagen , Pérdida de Hueso Alveolar/epidemiología , Implantes Dentales/efectos adversos , Fracaso de la Restauración Dental , Estudios de Seguimiento , Humanos , No Fumadores , Estudios Retrospectivos , Tasa de Supervivencia
15.
Clin Oral Implants Res ; 32(5): 539-548, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33565656

RESUMEN

OBJECTIVE: The objective of this randomized controlled trial was to evaluate the radiographic changes and histologic healing following alveolar ridge preservation (ARP) using autogenous whole tooth (AWTG), test group, versus autogenous demineralized dentin graft (ADDG), control group. MATERIAL AND METHODS: Twenty non-molar teeth indicated for extraction were randomized into two groups (n = 10/group). Extracted teeth were prepared into AWTG or ADDG (0.6N HCl; 30 min), inserted into extraction sockets and covered by collagen membranes. Cone-beam computed tomography (CBCT) scans at baseline and six months were compared to assess ridge-dimensional changes. At six months, bone biopsies of engrafted sites were harvested and analyzed histomorphometrically. RESULTS: All sites healed uneventfully. Reduction was 0.85 ± 0.38 mm and 1.02 ± 0.45 mm in ridge width, 0.61 ± 0.20 mm and 0.72 ± 0.27 mm in buccal and 0.66 ± 0.31 mm and 0.56 ± 0.24 mm in lingual ridge height for the AWTG and ADDG group, respectively (p > .05). Histologically, no inflammatory reactions were noticeable and all samples showed new bone formation. Qualitatively, graft-bone amalgamations were more pronounced in ADDG samples. Histomorphometrically, new bone, graft remnants and soft tissue occupied 37.55% ± 8.94%, 17.05% ± 5.58% and 45.4% ± 4.06% of the areas in the AWTG group and 48.4% ± 11.56%, 11.45% ± 4.13% and 40.15% ± 7.73% in the ADDG group of the examined areas, respectively (p > .05). CONCLUSIONS: AWTG and ADDG are similarly effective in ARP. Yet, histologically ADDG seems to demonstrate better graft remodeling, integration and osteoinductive properties.


Asunto(s)
Pérdida de Hueso Alveolar , Aumento de la Cresta Alveolar , Pérdida de Hueso Alveolar/diagnóstico por imagen , Pérdida de Hueso Alveolar/prevención & control , Proceso Alveolar/diagnóstico por imagen , Proceso Alveolar/cirugía , Dentina , Humanos , Extracción Dental , Alveolo Dental/diagnóstico por imagen , Alveolo Dental/cirugía
16.
Int J Oral Maxillofac Implants ; 36(1): 59-67, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33600524

RESUMEN

PURPOSE: Short dental implants serve as a valuable alternative for patients with limited bone height. Immediate or early provisionalization facilitates a more physiologic environment for the gingival tissues to be modeled. The purpose of this meta-analysis was to systematically review and evaluate the implant survival and marginal bone loss with immediate and early loading protocols of short dental implants (≤ 6 mm). MATERIALS AND METHODS: A literature search (electronic and manual) was conducted to identify studies with a focused PICO question: "In patients with short dental implants, does loading time affect treatment outcomes?" Studies using an immediate or early loading protocol for restoration of short implants with a mean follow-up of at least 1 year, and refraining from the use of advanced surgical procedures (sinus floor elevation, bone augmentation), were included. After evaluating patient selection and outcome reporting biases, a meta-analysis was conducted to assess implant survival and bone loss for studies fulfilling the inclusion criteria. Bone loss differences between immediate and early loading protocols were evaluated by Student t test, and Spearman correlation analysis was used to analyze the trends between crown-to-implant (C/I) ratio and bone loss. RESULTS: A total of 396 studies with patients receiving short implants (≤ 6 mm) with immediate or early prosthetic loading protocols were identified. For the 7 included studies, the pooled implant survival rate for 322 implants with a follow-up ranging from 1 to 10 years (5 years) was 91.63% (95% CI: 88% to 94%), with a mean bone loss effect estimate of 0.52 ± 0.1 mm (z = 3.07, P < .002). The differences observed in the mean bone loss for studies using immediate loading as opposed to early loading were not statistically significant. A moderate but significant positive correlation was observed between the C/I ratio and mean bone loss levels (r = 0.67, P = .02). CONCLUSION: Short implants with immediate or early loading protocols have satisfactory long-term treatment prospects with satisfactory implant survival rates and minimal bone loss.


Asunto(s)
Pérdida de Hueso Alveolar , Implantes Dentales , Carga Inmediata del Implante Dental , Elevación del Piso del Seno Maxilar , Pérdida de Hueso Alveolar/diagnóstico por imagen , Pérdida de Hueso Alveolar/cirugía , Implantación Dental Endoósea , Prótesis Dental de Soporte Implantado , Fracaso de la Restauración Dental , Estudios de Seguimiento , Humanos , Resultado del Tratamiento
17.
Int J Oral Maxillofac Implants ; 36(1): 131-136, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33600534

RESUMEN

PURPOSE: The clinical long-term outcomes of short implants are controversial. The aim of this study was to perform a long-term evaluation of short implants in posterior partially edentulous areas under various conditions. MATERIALS AND METHODS: This retrospective study was conducted with patients who had received 5- to 8-mm short implants to avoid bone grafts and spare anatomical structures between November 2005 and February 2014. Clinical outcomes (primary and secondary stability, marginal bone loss, and success and survival rates) were analyzed according to predictor variables of surgical procedure (submerged vs nonsubmerged), crown/implant ratio (1.5 and 2.0), type of prosthetic (single vs splinted crown), and arch location (maxilla vs mandible). The success rate was evaluated according to Albrektsson's criteria, and 5- and 10-year cumulative survival rates were calculated using Kaplan-Meier survival curves. RESULTS: A total of 148 patients (73 men, 75 women, mean age: 59.2 years) and 225 short implants were analyzed in this study. Over an average period of 6.21 ± 3.09 years, marginal bone loss was 0.43 ± 1.01 mm, and overall success and survival rates were 93.33% ± 25.0% and 97.78% ± 14.77%, respectively. Cumulative 5- and 10-year survival rates were 99.05% ± 0.65% and 96.72% ± 1.62%, respectively. CONCLUSION: Short implants (≤ 8 mm) in posterior edentulous areas showed comparable long-term outcomes of marginal bone loss and success and survival rates with conventional implants regardless of other clinical variables such as surgical procedure, crown/implant ratio, prosthetic type, and arch location.


Asunto(s)
Pérdida de Hueso Alveolar , Implantes Dentales , Pérdida de Hueso Alveolar/diagnóstico por imagen , Implantación Dental Endoósea/efectos adversos , Implantes Dentales/efectos adversos , Diseño de Prótesis Dental , Prótesis Dental de Soporte Implantado , Fracaso de la Restauración Dental , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento
18.
Int J Oral Maxillofac Implants ; 36(1): 165-176, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33600538

RESUMEN

PURPOSE: This study sought to define the tissue responses at different implant-abutment interfaces by studying bone and peri-implant mucosal changes using a 5-year prospective randomized clinical trial design study. The conus interface was compared with the flat-to-flat interface and platform-switched implant-abutment systems. MATERIALS AND METHODS: One hundred forty-one subjects were recruited and randomized to the three treatment groups according to defined inclusion and exclusion criteria. Following implant placement and immediate provisionalization in healed alveolar ridges, clinical, photographic, and radiographic parameters were measured at 6 months and annually for 5 years. The calculated changes in marginal bone levels, peri-implant mucosal zenith location, papillae lengths, and peri-implant Plaque Index and bleeding on probing were statistically compared. RESULTS: Forty-eight conus interface implants, 49 flat-to-flat interface implants, and 44 platform-switched implants were placed in 141 subjects. Six platform-switched interface and eight flatto- flat interface implants failed, most of them within 3 months. After 5 years, 33 conical interface, 28 flat-to-flat interface, and 27 platform-switched interface implants remained for evaluation. Calculation of marginal bone level change showed a mean marginal bone loss of -0.16 ± 0.45 (-1.55 to 0.65), -0.92 ± 0.70 (-2.90 to 0.20), and -0.81 ± 1.06 (-3.35 to 1.35) mm for conical interface, flat-to-flat interface, and platform-switched interface implants, respectively (P < .0005). The peri-implant mucosal zenith changes were minimal for all three interface designs (0.10 mm and +0.08 mm, P > .60). Only 16% to 19% of the surfaces had presence of bleeding on probing, with no significant differences (P > .81) between groups. Interproximal tissue changes were positive and similar among the implant interface designs. CONCLUSION: Over 5 years, the immediate provisionalization protocol resulted in stable peri-implant mucosal responses for all three interfaces. Compared with the flat-to-flat and platform-switched interfaces, the conical interface implants demonstrated significantly less early marginal bone loss. The relationship of marginal bone responses and mucosal responses requires further experimental consideration.


Asunto(s)
Pérdida de Hueso Alveolar , Implantes Dentales de Diente Único , Pérdida de Hueso Alveolar/diagnóstico por imagen , Pérdida de Hueso Alveolar/etiología , Coronas , Estética Dental , Humanos , Maxilar/diagnóstico por imagen , Maxilar/cirugía , Estudios Prospectivos
19.
J Clin Periodontol ; 48(6): 805-815, 2021 06.
Artículo en Inglés | MEDLINE | ID: mdl-33527462

RESUMEN

OBJECTIVES: To evaluate radiographic bone level (RxBL) at dental implants and its associated factors in Spain. MATERIAL AND METHODS: This cross-sectional study was performed by a network of sentinel dentists from regions of Spain. RxBL was defined as the distance from the implant shoulder to the first clearly visible contact between the implant surface and the bone. Radiographic measurements were performed by two trained and experienced periodontists. Implant and patient data were also collected. Descriptive, bivariate, discriminative and multivariate analyses were done. RESULTS: A total of 49 sentinel dentists provided data 275 patients. Mean RxBL from 474 implants (5-13 years) was 1.87 mm (range: 0.00-13.17 mm). Statistically significant associations between RxBL and clinical output variables (bleeding on probing, oedema, plaque, probing depth, suppuration, keratinized tissue) were found. In the multiple regression analysis, statistically significant associations for RxBL were found for smoking habit, implant diameter, years of follow-up and type of prosthesis (p < 0.01). CONCLUSIONS: Peri-implant RxBL ranged from 0 to 13.17 mm. It was significantly associated with clinical output variables and with some potentially predictor variables, at patient- (smoking >10 cigarettes/day) and implant- (diameter, years of follow-up, Toronto bridge) levels.


Asunto(s)
Pérdida de Hueso Alveolar , Implantes Dentales , Placa Dental , Periimplantitis , Pérdida de Hueso Alveolar/diagnóstico por imagen , Estudios Transversales , Humanos , España
20.
J Clin Periodontol ; 48(5): 668-678, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-33555608

RESUMEN

AIM: Evaluation of the effectiveness of regenerative treatment of intra-bony defects in combination with consecutive orthodontic tooth movements in stage IV periodontitis. MATERIAL AND METHODS: A total of 526 intra-bony defects in 48 patients were analysed after regenerative therapy using collagen-deproteinized bovine bone mineral with or without collagen membrane or enamel matrix derivative followed by orthodontic tooth movement initiated 3 months after surgery. Changes in radiographic bone levels (BL) and probing pocket depths (PPD) were evaluated after 1 year and up to 4 years. RESULTS: Tooth loss amounted to 0.57%. Mean BL gain was 4.67 mm (±2.5 mm) after 1 year and 4.85 mm (±2.55 mm) after up to 4 years. Mean PPD was significantly reduced from 6.00 mm (±2.09 mm) at baseline to 3.45 mm (±1.2 mm) after 1 year, and to 3.12 mm (±1.36 mm) after 2-4 years. Pocket closure (PPD ≤4 mm) was accomplished in 87% of all defects. Adjunctive antibiotic therapy did not show any statistically significant impact on treatment outcomes. CONCLUSIONS: Within the limits of this retrospective study design, the findings suggest that the combination of regenerative treatment and consecutive orthodontic tooth movements resulted in favourable results up to 4 years.


Asunto(s)
Pérdida de Hueso Alveolar , Periodontitis , Pérdida de Hueso Alveolar/diagnóstico por imagen , Pérdida de Hueso Alveolar/cirugía , Animales , Bovinos , Estudios de Cohortes , Estudios de Seguimiento , Regeneración Tisular Guiada Periodontal , Humanos , Pérdida de la Inserción Periodontal/cirugía , Periodontitis/cirugía , Estudios Retrospectivos , Técnicas de Movimiento Dental , Resultado del Tratamiento
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