Clinical Outcomes of Dental Implant Fractures: A Case Series and Analysis of Influencing Factors.

OBJECTIVE: To observe and analyse patients with dental implant fracture and explore the factors influencing the fracture with the aim of providing reference for physicians' clinical work. METHODS: The clinical data of 19 patients with dental implant fracture who visited the Department of Implantology of our hospital between 2007 and 2019 were retrospectively observed and analysed, and the fracture's influencing factors (e.g. the fracted implant site, implant diameter and connection mode, upper prosthetic method and fracture site) were analysed and investigated. RESULTS: The fractured implants comprised 12 Straumann implants (5 fractured at the smooth dental neck and 7 atop the central screws), 5 Bego implants (4 fractured at the smooth dental neck and 1 atop the central screw), 3 Lifecore implants fractured atop the central screws and 1 Anthogyr implant fractured atop the central screw. Of the 19 patients, 6 had anterior dental implant fracture, and 13 had posterior dental implant fracture (21 fractured implants in total). Maxillary anterior dental implant fracture was observed in 6 patients (8 implants), maxillary posterior implant fracture was observed in 3 patients (3 implants), and mandibular posterior dental implant fracture was observed in 10 patients (10 implants). CONCLUSIONS: A good implant system design, appropriate implant diameter and reasonable upper prosthetic method are key to maintaining long-term stability of a dental implant.

Homogenized finite element simulations can predict the primary stability of dental implants in human jawbone.

Adequate primary stability is a pre-requisite for the osseointegration and long-term success of dental implants. Primary stability depends essentially on the bone mechanical integrity at the implantation site. Clinically, a qualitative evaluation can be made on medical images, but finite element (FE) simulations can assess the primary stability of a bone-implant construct quantitatively based on high-resolution CT images. However, FE models lack experimental validation on clinically relevant bone anatomy. The aim of this study is to validate such an FE model on human jawbones. Forty-seven bone biopsies were extracted from human cadaveric jawbones. Dental implants of two sizes (Ø3.5 mm and Ø4.0 mm) were inserted and the constructs were subjected to a quasi-static bending-compression loading protocol. Those mechanical tests were replicated with sample-specific non-linear homogenized FE models. Bone was modeled with an elastoplastic constitutive law that included damage. Density-based material properties were mapped based on µCT images of the bone samples. The experimental ultimate load was better predicted by FE (R2 = 0.83) than by peri-implant bone density (R2 = 0.54). Unlike bone density, the simulations were also able to capture the effect of implant diameter. The primary stability of a dental implant in human jawbones can be predicted quantitatively with FE simulations. This method may be used for improving the design and insertion protocols of dental implants.

Evaluating the Impact of Rotary Instrument Lubricants on Dental Implant Osseointegration: An Experimental Rabbit Tibia Study.

Purpose: The osseointegration in dental implants is greatly affected by various surface properties, such as chemistry, texture, and overall cleanliness. This study aimed to investigate the impact of mineral oil lubricants used in rotary instruments on osseointegration within rabbit tibiae, with a specific focus on potential contamination from dental handpices. Materials and Methods: Twelve New Zealand rabbits were included in this study, each receiving two implants in each tibia, resulting in a total of 48 implants across the study. Groups were organized based on the time until euthanasia and the degree of implant contamination. Three contamination levels were defined: the first group received implants without any lubricant in the handpiece (control group); the second group received implants with handpices managed as recommended; the third group had implants placed using fixtures pre-soaked in lubricant. These groups were further subdivided based on euthanization periods of two and four weeks. We measured and analyzed both the removal torque and the bone-implant contact. Results: We observed a non-significant inverse correlation between the severity of fixture contamination and removal torque. However, there was a significant reduction in bone-implant contact associated with higher contamination levels, particularly after four weeks. Conclusions: Even brief exposure to lubricants from handpieces can jeopardize the osseointegration of implants in bone. Therefore, it is imperative to implement thorough procedures for lubricant removal post-application and to employ precise cleaning and suction during implant drilling and placement to minimize residual oil on the implant surface.

Persistent Idiopathic Dentoalveolar Pain in a Patient With Implant Placement: A Case Report.

Persistent idiopathic dentoalveolar pain (PIDAP) is a type of disease that, despite affecting thousands of people globally, negatively impacts patients' quality of life because of its unknown cause. Notably, the disease has a high prevalence rate and is primarily prone to middle-aged and senior individuals. Efforts have been made to gain the understanding needed for the accurate diagnosis and prompt treatment of PIDAP cases. This case report discusses the challenges faced in diagnosing and managing PIDAP after dental implants. The present study involved the case of a 62-year-old male patient, previously operated on for an implant at position #11, who suffered from chronic pain but no specific cause could be identified. We used an evaluation strategy to gain insights into the patient's illness, including antibiotic treatment, crown replacement, and continued pain. We prescribed nortriptyline 10 mg, and there was an improvement. This finding suggests that nortriptyline 10 mg QHS eliminates chronic pain.

Effect of L-PRF and autogenous bone grafts for immediate implant placement in post tooth extract socket.

The clinical outcomes of bone augmentation substances in immediate dental implant (IDI) placement are of interest to dentists. Hence, we evaluated and compared the effectiveness of L-PRF and autogenous bone grafts in immediate implant placement in tooth extract socket. Hence, assessment of periimplantis pocket depth, assessment of tissue biotype, implant stability and marginal bone loss at one month, three months, and six months follow up was completed. The tissue biotype values at one month, 3 month and 6 month follow up revealed that tissue biotype increased in each category as the time increased in all categories. We found that all three techniques were found to have good clinical outcomes regarding immediate implant placement in fresh tooth extraction socket, however the outcomes were better in the case L-PRF.

Evaluation of alveolar bone width alterations around dental implants.

Teeth that are lost can be replaced with dental implants. A sufficient width of bone surrounding the implant is beneficial to its success. Therefore, it is of interest to examine alterations in width of alveolar bone surrounding dental implants at natural and rebuilt bone locations [alveolar ridge preservation (ARP) /Guided Bone Regeneration (GBR)] using CTBT. A CBCT examination of the implant recipient site was performed on sixty patients (both male and female), who had undergone dental implants. All conventional surgical procedures were followed for inserting dental implants. All participants had their horizontal alveolar bone widths around implants assessed at 3 positions: subcrestal width 1 mm (CW1 (crestal level-CW1), subcrestal width 4 mm (CW4), and subcrestal width 7 mm (CW7). There were 32 male patients and 28 female patients out of 60 totals. The mean bone width was 7.02 mm at CW1 prior to surgery and 6.91 mm afterward; it was 8.52 mm at CW4 and 8.13 mm afterward; and it was 10.21 mm at CW7 prior to surgery and 10.08 mm afterward. There was a substantial difference (P<0.05). At CW1, the bone width was 0.38 mm at local bone and -0.02 mm at ARP/GBR; at CW4, the bone width was 0.46 mm at local bone and 0.23 mm at ARP/GBR; and at CW7, the bone width was 0.22 mm at local bone and 0.02 mm at ARP/GBR. There was no discernible difference (P>0.05). Resorption of the alveolar bone width was only noticeable at the middle third of the sites. Long-term alterations in the alveolar bone width surrounding dental implants at local and rebuilt bone sites can be observed using CBCT images.

Clinical outcomes of single implant supported crowns utilising the titanium base abutment: a 7.5-year prospective cohort study.

OBJECTIVE: To assess radiographic, clinical and patient-reported outcomes of single zirconia implant-supported crowns on titanium base abutments (TBA) over a 7.5-year period. METHODS: Twenty-four patients received bone-level titanium implants and screw-retained zirconia implant crowns utilising TBA. Marginal bone level (MBL), clinical parameters (probing depth-PD, bleeding on probing-BoP, plaque control record-PCR), technical complications (USPHS criteria) and patient satisfaction were assessed at crown delivery (baseline), 1 year (FU-1) and at 7.5 years (FU-7.5) of follow-up. RESULTS: Eighteen patients were available for re-examination at 7.5 years. The mean MBL at FU-7.5 (0.35 ± 0.20mm) did not significantly change compared to baseline (0.54 ± 0.39, p=.352) and to FU-1 (0.54 ± 0.45mm, p=0.524). From baseline to 7.5 years, the mean PD increased significantly, from 3.0 ± 0.6mm to 3.7 ± 0.8mm (p=0.005). However, BoP and PCR did not significantly change; (BOP: from 27.1 ± 20.7% to 25.0 ± 20.0%, p=0.498; PCR: from 11.1 ± 21.2% to 25.0 ± 25.1%, p=0.100). Nine patients presented with more than one bleeding site. This denoted a peri-implant mucositis prevalence of 50%, whilst none of the implants presented peri-implantitis. One incidence of minor and major ceramic chipping were reported on 2 out of the 18 crowns, resulting in a prosthetic survival rate of 94.4%. Seventeen patients were highly satisfied with their result. CONCLUSION: Single implant-supported zirconia crowns on TBA displayed: (i) minor number of technical complications, (ii) high prosthetic survival rate, (iii) stable marginal bone level and (iv) high patient satisfaction at 7.5 years. CLINICAL IMPLICATIONS: Titanium base abutments despite their high use in clinical practice, lack medium- and long-term studies. The presented findings highlight their clinical performance at 7.5 years as they display satisfying radiographic, clinical and patient-related outcomes. TBA appear to be a suitable abutment choice for medium-term implant-supported restorations.

Mandibular Unilateral Paresthesia Following Implant Placement and Clinical Management: Clinical Case Report.

Dental implantology has been considered the mainstay in the rehabilitation of partial or complete edentulism. Nevertheless, complications and failures are occasionally encountered, and the most significant is the neurosensory disturbance. It not only causes persistent discomfort to the patient but frequently degrades the patient's oral health-related quality of life, even leading to a negative psychological impact. This paper presents a case report of a 65-year-old male patient who underwent the replacement of his missing tooth in the right mandibular region (46) with an implant-supported prosthesis two years ago. Since then, he has been experiencing numbness in the right side of the lip and occasional drooling of saliva from the right corner of the mouth. Clinical examination revealed the presence of a prosthetic crown supported by an implant in relation to 46 with inflamed and enlarged gingiva in the region with paresthesia of the right lower lip region. Radiological examination with orthopantomogram (OPG) and cone beam computed tomography (CBCT) revealed that the implant apex rested on the inferior alveolar nerve canal. Careful surgical retrieval of the well-osseointegrated implant was performed under local anesthesia in about seven days. The patient gradually experienced neurosensory improvement, and the paraesthesia was completely resolved in a six-week period. After complete recovery, as evaluated with an objective and subjective assessment, the edentulous site was successfully restored with a provisional fixed partial denture.

Evaluation of the accuracy of cone beam computed tomography (CBCT) in the detection of peri-implant fenestration.

BACKGROUND: Accurate assessment of the bone supporting the implant is crucial. Early detection of bone defects around the implant can prevent the loss of bone support that ultimately leads to the loss of the implant. Therefore, the purpose of this study is to check the accuracy of CBCT in detecting peri-implant fenestrations around the implant. MATERIALS & METHODS: In this laboratory study, healthy beef ribs were used. The ribs were divided into three groups of 12 (control group, 1-2 mm fenestration group, and 2-3 mm fenestration group). The blocks were cut to a length of 20 mm and 36 osteotomies with dimensions of 4 × 12 mm were made by the periodontist in order to place the implant in these bone blocks. Then the titanium implant was placed in the holes and the initial scan was performed with CBCT. In the second group, fenestration-like lesions were created on the same buccal side at a distance of 10 mm from the crest with a diameter of 1-2 mm and in the third group with a diameter of 2-3 mm, and the CBCT scan was performed again with the same parameters. Two radiologists evaluated the images twice for the presence and absence of fenestration. RESULTS: There was no statistically significant difference between direct measurements and CBCT in the fenestration group of 1-2 mm (p < 0.05), but there was a significant difference between direct measurements and CBCT in the fenestration group of 2-3 mm and underestimation was observed in CBCT measurements. CONCLUSION: The findings of this study showed that CBCT radiography has a higher accuracy in measuring the fenestration around the implant with a smaller diameter and has an acceptable diagnostic value in detecting bone loss around the implant.

The Role of Bone Tacks in Sinus Floor Lift Surgery: A Single-Center Experience.

Background: Maxillar atrophy is a prevalent condition associated with diminished bone volume, which precludes the conventional placement of dental implants. Sinus floor lift is a surgical procedure that aims to address this atrophy through the insertion of a graft within the sinus cavity. A multitude of techniques have been documented in the international literature for the management of the sinus bone window, though each approach has its own set of advantages and disadvantages. Methods: The present study is a retrospective analysis of traditional sinus floor lift surgery, comparing the outcomes of two surgical approaches: placement of a collagen membrane over the maxillary lateral bone window with or without bone tacks. The study enrolled a total of 48 consecutive patients. Twenty-four patients underwent sinus floor lift surgery, with the placement of a collagen membrane over the maxillary lateral bone window without bone tacks (control group). The remaining 24 patients underwent the same procedure, but with bone tacks (study group). All patients received an amoxicillin 875 mg + clavulanic acid 125 mg administration for six days and underwent Cone Beam Computed Tomography (CBCT) before the sinus floor lift surgery and six months later before the implant surgery. The parameters measured on the preoperative Cone Beam Computed Tomography (CBCT) scan included residual bone, the preoperative thickness of the lateral bone in the center, and the distance between the lateral wall and the medial wall of the sinus. Only the bone height increment was measured on the postoperative CBCT scan. Postoperative complications and the visual analogue scale (VAS) score were also recorded. A statistical analysis was performed, and the correlation between the parameters was evaluated using Pearson's correlation coefficient. A comparison of the mean of the parameters between the treatment group and the control group was conducted using the t-test. Results and Conclusions: The study group was found to have superior outcomes in terms of bone height increment (p = 0.001) and VAS after 7 days (p = 0.11) compared to the control group. The novel application of bone tacks on the collagen membrane over the bone window following sinus elevation surgery was associated with superior outcomes in terms of bone height and reduced pain at seven days, as measured by the VAS, with no postoperative complications.

Clinical Outcomes of Pterygoid and Maxillary Tuberosity Implants: A Systematic Review.

Background: This study aimed to assess the survival of implants placed in the maxillary tuberosity or in the pterygomaxillary region of the maxilla, based on a systematic review of the literature. Methods: An electronic search was undertaken in three databases. The cumulative survival rate (CSR) was calculated. The log-rank (Mantel-Cox) test was used to compare the survival distributions between some groups. Results: Thirty-eight studies were included, reporting 3446 implants (3053 pterygoid, 393 tuberosity) in 2245 patients, followed up for a mean ± SD of 61.0 ± 36.3 months (min-max, 1-144). A total of 208 pterygoid and 12 tuber implants failed, with a clear concentration of failures in the first year of follow-up and a 10-year CSR of 92.5% and 96.9%, respectively. The survival of pterygoid implants was lower than that of implants in the maxillary tuberosity (p = 0.006; log-rank test), and the survival of implants submitted to early/delayed loading was lower than that of immediately loaded implants (p < 0.001; log-rank test). Non-splinted implants presented higher failure rates. Few cases of intra- or postoperative complications were reported. Conclusions: Implants placed in the pterygoid process/maxillary tuberosity present a high 10-year CSR, although with lower survival for pterygoid in comparison to tuber implants. Pterygoid/tuber implants that are splinted with other implants may present higher survival rates than those that are not splinted.

Clinical efficacy of two vertical soft tissue augmentation techniques for peri-implant crestal bone level stability: A randomized clinical trial.

OBJECTIVES: This study aimed to compare the efficacy of two techniques-acellular dermal matrix (ADM) grafting and tenting technique (TT)-for soft tissue height (STH) augmentation simultaneous to implant placement to minimize peri-implant crestal bone level (CBL) changes. METHODS: Forty patients with a healed single mandibular posterior edentulous site with a thin soft tissue phenotype were enrolled. Twenty patients received simultaneously to implant placement ADM grafting, while the others received submerged healing abutment (TT). Clinical peri-implant soft tissue height and radiographic CBL changes were measured at restoration delivery and 1-year follow-up. RESULTS: Both techniques effectively increased soft tissue thickness, resulting in a final average STH of 3.4 ± 0.5 mm after augmentation. On average, soft tissue increased by 1.6 ± 0.5 mm in group ADM and by 1.8 ± 0.4 mm in group TT after augmentation. In Group ADM, mesial CBL decreased from 0.4 ± 0.3 mm to 0.1 ± 0.2 mm, and distal CBL decreased from 0.5 ± 0.3 mm to 0.2 ± 0.3 mm over 1 year. In Group TT, mesial CBL remained stable at 0.3 ± 0.2 mm, while distal CBL reduced slightly from 0.5 ± 0.5 mm to 0.3 ± 0.2 mm. Both groups showed minimal changes in CBL, indicating great stability (pmesial = 0.003, pdistal = 0.004). TT was particularly effective in preventing mesial bone loss (pmesial = 0.019). The mesial CBL changes significantly differed between groups (p = 0.019), and not significantly at distal sites (p = 0.944). Neither treatment exhibited significant bone remodeling below the implant shoulder. CONCLUSION: This study suggests that both techniques were successful in STH augmentation, and they may effectively reduce peri-implant crestal bone level changes, with TT being slightly superior. TT was more prone to post-surgical complications. This RCT was not registered before participant recruitment and randomization.

3D surface defect map for assessing buccolingual profile of single tooth gaps following alveolar ridge preservation.

AIM: A new, non-invasive approach suggests using single intraoral optical scanning to analyze the ridge profile of single-tooth gaps following alveolar ridge preservation in the absence of a baseline scan. This method involves creating a three-dimensional (3D) surface map to identify and assess contour changes and ridge profiles based on the adjacent teeth. MATERIALS AND METHODS: The present study was designed as a cross-sectional pilot analysis on a convenience sample of patients undergoing alveolar ridge preservation. Intraoral optical scans were taken on 23 patients, capturing data from 30 edentulous sites. The digital models were then imported into an image analysis software for a 3D surface defect map analysis performed by one examiner. This analysis characterized the buccolingual profile of the single tooth gap relative to the adjacent teeth. 10 linear divergence points, spaced 0.5 mm apart in a corona-apical direction, were identified at the midfacial aspect of the sites. Based on these points the sites were plotted and grouped in three different buccolingual profiles (linear, concave, and convex). Clinical parameters including Keratinized mucosa Width (KMW), and soft tissue phenotype with Colorvue biotype probes were also recorded. RESULTS: Three different buccolingual patterns (linear, convex, and concave) were identified. Seven sites exhibited a linear profile, 10 sites displayed a concave shape, and 13 showed a convex profile. The linear profile had surface discrepancies similar to the neighboring teeth. In contrast, the convex profile revealed mid-buccal discrepancy localized only at the crestal aspect, while the concave had an extended divergence ranging from 1 to 5 mm below the soft tissue margin. Univariate and multiple logistic regression analyses did not reveal any statistically significant variables influencing profilometric analysis; however, when combining phenotype and KMW, thick phenotypes demonstrated a higher proportion of concavity (OR = 4.83) compared to thin ones, suggesting a significant trend. With every 1 mm of increase in KMW, the probability of showing a concavity decreased (p = 0.057). CONCLUSION: A 3D surface defect map represents a useful tool for objectively quantifying ridge defects and profiles by assessing profilometric and surface differences compared to adjacent dentition using a single intraoral scan. This method also indicates that KMW may play a critical role in preventing concavity defects. The 3D defect map can guide decision-making during soft tissue augmentation procedures by emphasizing the specific location of the defect and providing more detailed insights into its localization. These parameters can enable the tailoring of flap management and soft tissue grafting strategies to address the patient's individual needs.

Laminin 332 functionalized surface improve implant roughness and oral keratinocyte bioactivity.

Objective: The biological seal (BS) at the implant-tissue interface is essential for the success of dental implants (DIs), and the absence of a proper BS can lead to peri-implantitis. The basement membrane (BM) and junctional epithelium are critical for sealing the peri-implant mucosa, and laminin 332 is an important protein in binding the epithelium to the implant surface. The aim of this study was to evaluate the response of oral keratinocytes to titanium dental implant surfaces biofunctionalized with laminin 332. Design: The dental implant surface was treated with a piranha solution to create hydroxyl (OH) groups, facilitating biofunctionalization with laminin 332. The modified surface underwent scanning electron microscopy, surface roughness evaluation, and chemical composition analysis. Human keratinocytes from the Cal-27 line were then cultured on the modified implants for 24 and 48 h to assess viability, morphology, cytokine secretion, and mRNA expression of tissue repair-associated genes. Results: The results showed that laminin 332 biofunctionalization of the implant surface resulted in lower values of Ra, Rq and positive surface roughness parameters Rsk, Rku and Rv. The elemental composition showed an increase in nitrogen and carbon content corresponding to protein binding. The biofunctionalized surfaces did not affect cell viability and promoted cytokine secretion (IL-1a and IL-8) and a significant increase (p < 0.05) in MCP-1, EGF, FGF, TGF and VEGF gene expression compared to the control. Conclusion: In conclusion, laminin 332 coating Ti implants was shown to be effective in promoting keratinocyte adhesion, spreading, and viability. This approach could be an alternative way to improve biocompatibility.

Retrospective assessment of patients' risk for peri-implant diseases using the implant disease risk assessment (IDRA) tool: A cohort study.

INTRODUCTION: The implant disease risk assessment (IDRA) tool was designed to assess an individual's risk of developing peri-implant diseases by evaluating and integrating multiple risk factors. This study aimed to evaluate the IDRA tool to determine the risk of developing peri-implant disease in patients rehabilitated with dental implants. METHODS: A retrospective observational cross-sectional study was conducted, collecting data from 92 patients with 92 selected dental implants. Data included the history of periodontitis, sites with bleeding on probing (BoP), teeth and/or implants with probing depths (PDs) ≥ 5 mm, alveolar bone loss relative to the patient's age, susceptibility to periodontitis, the frequency of supportive periodontal therapy (SPT), the distance from the restorative margin (RM) of the implant-supported prosthesis to the marginal bone crest (MBC), and factors related to the prosthesis itself. Additionally, the validated instrument periodontal risk assessment (PRA) was employed for comparison. Statistical analyses utilized Chi-square, Mann-Whitney, and ROC curve. RESULTS: Outcomes indicated that 62 implants (67.4%) were classified as high-risk. Among the IDRA parameters, history of periodontitis was the primary factor contributing to an increased risk (p < 0.001). IDRA revealed high sensitivity (100%) and low specificity (63%) (AUC = 0.685; 95% CI: 0.554-0.816; p = 0.047), and there was a low agreement between the IDRA and PRA tools (Kappa = 0.123; p = 0.014). The peri-implant disease developed in 16 implants with 5.44 (±2.50) years of follow-up, however, no significant association was observed between the high- and low-medium risk groups and the occurrence of peri-implant diseases. CONCLUSION: Most of the evaluated implants presented high IDRA risk. The IDRA tool exhibited high sensitivity and low specificity; no significant association was observed between the risk profile and the development of peri-implant diseases.

A hybrid unsupervised clustering method for predicting the risk of dental implant loss.

OBJECTIVES: The aim of this study was to predict the risk of dental implant loss by clustering features associated with implant survival rates. MATERIALS AND METHODS: Multiple clinical features from 8513 patients who underwent single implant placement were retrospectively analysed. A hybrid method integrating unsupervised learning algorithms with survival analysis was employed for data mining. Two-step cluster, univariate Cox regression, and Kaplan‒Meier survival analyses were performed to identify the clustering features associated with implant survival rates. To predict the risk of dental implant loss, nomograms were constructed on the basis of time-stratified multivariate Cox regression. RESULTS: Six clusters with distinct features and prognoses were identified using two-step cluster analysis and Kaplan‒Meier survival analysis. Compared with the other clusters, only one cluster presented significantly lower implant survival rates, and six specific clustering features within this cluster were identified as high-risk factors, including age, smoking history, implant diameter, implant length, implant position, and surgical procedure. Nomograms were created to assess the impact of the six high-risk factors on implant loss for three periods: 1) 0-120 days, 2) 120-310 days, and 3) more than 310 days after implant placement. The concordance indices of the models were 0.642, 0.781, and 0.715, respectively. CONCLUSIONS: The hybrid unsupervised clustering method, which clusters and identifies high-risk clinical features associated with implant loss without relying on predefined labels or target variables, represents an effective approach for developing a visual model for predicting implant prognosis. However, further validation with a multimodal, multicentre, prospective cohort is needed. CLINICAL SIGNIFICANCE: Visual prognosis prediction utilizing this nomogram that predicts the risk of implant loss on the basis of clustering features can assist dentists in preoperative assessments and clinical decision-making, potentially improving dental implant prognosis.

Epidemiology of Odontogenic Sinusitis.

Odontogenic sinusitis (ODS) is more common than historically thought, representing 25% to 40% of all maxillary sinusitis. Due to a lack of widely accepted diagnostic criteria and a specific international diagnostic code, a true overall prevalence is unknown. ODS may be caused by either a multitude of infectious dental pathologies or complications after dental procedures. The most common dental etiologies causing ODS are apical periodontitis (endodontic) and oroantral communication or fistula after dental extraction. Less commonly, ODS can evolve after dental implant or maxillary sinus bone grafting surgeries, infection of odontogenic cysts, or advanced periodontitis.

Attitudes of Oral Surgeons and Periodontists towards Immediate Dental Implant Placement.

Objectives: This cross-sectional study aimed to evaluate the factors that determine the choice of oral surgeons and periodontists to perform immediate dental implant placement. Material and Methods: An anonymous survey was carried out from January 6, 2024 to February 29, 2024. The questionnaire was distributed online to Lithuanian specialists - oral surgeons and periodontists, who perform implantation procedures. A total of 186 professionals were included in this survey. Chi-square test, its degrees of freedom was used for the analysis of variables. Results: The main reason for refusing immediate implant placement is a periapical lesion greater than 5 mm, reported by 91.7% of oral surgeons and 96.9% of periodontists. Good aesthetics and preservation of anatomical structures are identified as an advantage by 99.2% of oral surgeons and 92.3% of periodontists. In the aesthetic zone, for periodontists, the main criterion for choosing a method is the quantitative and qualitative indicators of the soft tissue of the extraction socket 96.9%, and for oral surgeons - the morphology of the bone walls of the socket 87.6%. Only 43.1% of periodontists and 33.9% of oral surgeons are familiar with and use extraction socket morphology assessment classifications for immediate dental implant placement. Conclusions: Taking into account study's results, it is recommended to adjust the teaching programs at Universities and to increase the knowledge of specialists performing dental implantation procedures, by carrying out continuous educational programs.

Effectiveness of Low-Level Laser Therapy in reducing postoperative pain after dental implant surgery: A randomized clinical trial.

BACKGROUND: A clinical trial was conducted to measure the effectiveness of a combined wavelength of 660 nm and 808 nm Low-Level Laser Therapy (LLLT) in reducing postoperative pain in partially and totally edentulous patients who underwent dental implant surgery. MATERIALS AND METHODS: The study included 20 blinded individuals divided in a randomized split-mouth fashion; the experimental group in one hemiarch and the control group in the other hemiarch. The experimental group received a total of 22.5 Joules (J) of LLLT divided into 5 points per implant immediately after surgery. The control group received a placebo treatment. At 24 h, 72 h, and 7 days, a blinded surveyor administered a pain questionnaire using a Numerical Rating Scale (NRS) combined with a Verbal Rating Scale (VRS) to assess pain onset after surgery, duration of the first pain episode, and pain evolution. Group data were analyzed with an ANOVA test for repeated measures and a paired t-test at defined time intervals. RESULTS: The experimental group showed a significant decrease in postoperative pain at 24 h and at 72 h for fully edentulous patients. There was a non-significant difference in the duration of the first pain episode. The mean pain levels decreased over time for both the experimental and control treatments, but only statistically significantly for the experimental group in the 24-72 h and 24 h to 7 days intervals. The same was true for the control group when comparing 24 and 72 h and between 24 h and 1 week. The time range between 72 h and 1 week showed no statistically significant differences. CONCLUSION: Within the limitations of this study, a single dose of 22.5 J LLLT per implant helps to decrease postoperative pain in dental implant surgery at 24 h for partially edentulous patients and at 24 and 72 h for fully edentulous patients.

The mechanical complications and behavior of angulated dental implant abutment systems versus conventional abutments, a narrative review.

Background: Angulated screw channel (ASC) abutment allows off-axis dental implants to be used in dental restorations without the need for cementation. As this is a relatively new system, research on its clinical performance is limited. Objectives: To summarize the available in-vitro and in-vivo studies on the mechanical and technical issues associated with the ASC system and compare its clinical performance with that of conventional implant-supported abutments. Methods: A comprehensive literature search in PubMed, Web of Science, and ScienceDirect databases was performed, focusing on articles about angulated (angled) screw channel (ASC) systems published in English between January 2015 and November 2023. Only in-vitro and in-vivo studies were included. Results: After analyzing the recorded articles, 26 studies (11 in vivo and 15 in vitro) were included in the final discussion and review. Conclusion: Although the ASC system is still relatively new, and is presently outperformed by conventional abutment systems in terms of technical and mechanical properties, in short- and medium-term in-vivo studies, it was shown reliable for retaining single or multiple-unit implant restorations in both posterior and anterior zones. Still, further long-term clinical research is needed to fully elucidate the risk factors associated with ASC failures.