Risk indicators of long-term outcome of implant therapy in patients with a history of severe periodontitis or no history of periodontitis: A retrospective cohort study.

OBJECTIVE: The aim of this retrospective cohort study was to assess factors associated with peri-implant disease in partially edentulous patients with a history of severe periodontitis or no history of periodontitis. METHODS: Partially edentulous patients with a history of severe periodontitis/without history of periodontitis who received implant surgery within the past 6 to 8 years were recalled. Clinical and radiographic examinations were recorded. Periodontal probing depth, marginal bone loss (MBL) and peri-implantitis were considered as the primary outcome and peri-implant bleeding on probing (BOP) was considered as the secondary outcome. The following criteria were considered as the predictors, as well: history of severe periodontitis, gender, age, smoking, brushing frequency, recall interval, full-mouth plaque score, full-mouth bleeding score, splinted prosthesis, open/tight interproximal contact, width of keratinized mucosa, mucosal thickness, implants placed in the grafted bone and implant type. Univariate and multivariate regression analyses were utilized. RESULTS: A total of 88 patients (186 implants) fulfilled the study. Forty-seven patients (108 implants) had a history of severe periodontitis and 41 patients (78 implants) had no history of periodontitis. There was a higher chance of peri-implantitis in patients with a history of severe periodontitis (OR = 11.13; p = 0.045), implants with lack of peri-implant KM (<2 mm) and implants placed in the grafted bone (OR = 14.94, p < 0.001; OR = 4.93, p = 0.047). The risk of peri-implant MBL ≥3 mm was higher in patients with greater FMBS (OR = 1.20; p < 0.001). The chance of peri-implant BOP was independently higher in patients who brushed their teeth at most once per day (OR = 3.20; p = 0.04), higher FMBS (OR = 1.16; p < 0.001) and irregular recall visits (OR = 15.34; p = 0.001). CONCLUSIONS: Partially edentulous patients with the history of severe periodontitis, lack of peri-implant KM and implants placed in bone-grafted sites expressed higher probability of peri-implantitis. In addition, inadequate frequency of brushing (at most once daily) and irregular recall visits were associated with greater chance of peri-implant BOP.

Fracture analysis of one/two-piece clinically failed zirconia dental implants.

OBJECTIVES: Analyzing factors that may have led to fracture of zirconia implants by macro/micro-fractography. METHODS: Six one-piece and ten two-piece full-ceramic zirconia implants from two manufacturers, Z-Systems and CeraRoot, were retrieved after clinical failure. The time-to-failure ranged from 3 to 49 months. Optical and scanning electron microscopy (SEM) were used to analyze the fracture planes at the macro- and microscopic level. Treatment planning, surgical protocol, fracture-origin location and characteristic fracture features were assessed. RESULTS: The fracture of all implants seemed to have been primarily due to overload in bending mode, while the fracture-initiation sites varied for the one- and two-piece implants. The fracture of all one-piece implants originated in the constriction region between two threads in the endosseous implant part. For two-piece implants, the abutment neck, internal abutment-implant connections and inner threads were found to be the main fracture-initiation sites. Surface defects at the root area for one-piece implants and damages at the abutment surface for two-piece implants were connected to the fracture origins. Importantly, the clinical failures of implants were often found to result from combined effects related to patient aspects, treatment planning/protocols, a high bending moment at the weakest link, implant-surface conditions and specific implant designs. SIGNIFICANCE: This study provided information to be considered for future optimization of treatment planning and the surgical protocol for zirconia implants. Optimization of the surface conditions and the zirconia-starting powder were also suggested.

The migration of the bovine-derived xenograft particles: A case series.

The long-term safety of xenografts and their potential association with disease are valid concerns. Bovine bone substitutes which are by far the most commonly used xenografts in dentistry are not biodegradable. The aim of the present report was to raise awareness on the long-term risks of the bovine-derived xenografts. Patients who experienced clinical complications after xenografting are reported. Patients' demographic, significant medical, and dental findings are reported. Complications included migration/encapsulation/displacement of the graft material, chronic inflammation, and soft-tissue disturbances/fenestrations. Albeit some xenograft complications are not significant enough to compromise the initial outcomes achieved, the xenografted particles seemed to be left intact favoring conditions for migration. The authors observed the inability of the human host to biodegrade the xenograft particles. The intact/migrated bovine bone particles present a risk to patients and may contribute to long-term clinical complications in implant dentistry.

Effects of Mouthwash on Oral Cytomegalovirus, Epstein-Barr Virus, Herpes Simplex Virus Type-1.

Background: Cytomegalovirus (HCMV), Epstein-Barr virus (EBV), and herpes simplex virus type-1 (HSV-1) are pathogens. Objectives: The goal of the present double-blinded, randomized study was to compare the effect on oral viral load of twice daily use over 60 days of Lumineux MouthwashRvs. de-ionized water. The main composition of the mouthwash was Dead Sea salt. Methods: 30 participants were randomized to test or control. For 60 days, participants rinsed for 60s twice daily with 20ml of their allocated mouthwash, after morning and evening meals. On Day 0 and 60, before eating and oral hygiene and at least 60 minutes after drinking, unstimulated saliva was collected. Samples underwent mRNA analysis. Study endpoints were changes in Log Salivary Viral Load. Result: After adjusting for baseline differences, the reduction in viral load was significantly greater for the test group, all p-values <0.001. Baseline differences did not have an effect on the differences between groups in change over time. Conclusion: After adjusting for baseline differences, the reduction in viral load was significantly greater for the test group, all p-values <0.001. Baseline differences did not have an effect on the differences between groups in change over time.

Comparison of peri-implant clinical outcomes of digitally customized and prefabricated abutments: A systematic review and meta-analysis.

BACKGROUND: Digitally customized abutments are increasingly used in contemporary implant prosthodontics. PURPOSE: This systematic review and meta-analysis aimed at comparing the peri-implant clinical outcomes of digitally customized and prefabricated abutments. MATERIALS AND METHODS: The search strategies included electronic databases (PubMed, Embase, Scopus, and Cochrane clinical trials database) and related journals up to September, 2020. A qualitative and quantitative synthesis was performed on data extracted from the included studies. RESULTS: Three RCTs (number of patients = 120; number of dental implants = 120) and two prospective cohort studies (number of patients = 144; number of dental implants = 144) with one to three-year follow-up periods were included. The quantitative analyses did not demonstrate a significant difference between digitally customized and prefabricated abutments for peri-implant pocket depth (P = 0.62), plaque index (P = 0.67), bleeding on probing (P = 0.43), keratinized mucosa width (P = 0.75), and pink aesthetic score (P = 0.30) at one-year follow-up visit. The qualitative analyses for marginal bone level change, calculus accumulation, implant survival rate, implant success rate, white aesthetic score, and patient-reported outcomes did not demonstrate a significant difference between two groups during 1 to 3-year follow-up visits. CONCLUSION: The current data do not provide evidence of significant differences between two abutment fabrication methods in terms of peri-implant clinical outcomes within short-term period (CRD42020170807).

Riesgos y complicaciones clínicas asociadas con los injertos de origen bovino / The long-term risks and complications of bovine-derived xenografts

La frecuencia de las cirugías relacionadas con implantes dentales que involucran procedimientos de aumento de tejido blando y hueso han aumentado significativamente. Los sustitutos óseos derivados de bovinos han sido, por mucho, los xenoinjertos más utilizados en odontología. Aunque la literatura está repleta de estudios clínicos a favor de los materiales de injerto derivados de bovinos, los estudios que reportan los riesgos y las complicaciones clínicas son escasos. La impresión clínica y la preocupación por la seguridad del paciente llevaron al informe que hemos proporcionado. El objetivo de esta presentación de una serie de casos es crear conciencia sobre los riesgos a largo plazo y las complicaciones clínicas tardías de los materiales de injerto derivados de bovinos. Los pacientes fueron referidos a un consultorio privado debido a complicaciones asociadas con los procedimientos de injerto óseo. Reportamos los datos demográficos, hallazgos médicos y dentales significativos. Las complicaciones incluyeron: sinusitis y patologías del hueso maxilar, desplazamiento de los materiales del injerto, falla del implante, reacción de cuerpo extraño, encapsulación del material, inflamación crónica, fenestraciones de tejidos blandos y quistes asociados. Los materiales de injerto derivados de bovino no fueron biodegradables. La preocupación de los autores es que la morbilidad del paciente puede no reducirse con los xenoinjertos, debido a los riesgos inherentes y a las complicaciones asociadas. La resolución de las lesiones y los síntomas asociados se logró después de la eliminación/ remoción de los materiales del injerto óseo. La extracción quirúrgica de los materiales de xenoinjerto puede requerir habilidades clínicas avanzadas, debido a las diferentes configuraciones que los cirujanos pueden encontrar en las partículas no resorbidas y migradas. Los médicos que buscan proporcionar resultados funcionales y estéticos deben ser conscientes de las complicaciones de los materiales de injerto derivados de bovinos. La seguridad a largo plazo de los xenoinjertos y su posible asociación con la transmisión de enfermedades son preocupaciones válidas (AU)

The frequency of dental implant related surgeries that involve soft and bone augmentation procedures has increased significantly. Bovinederived substitutes have been by far the most commonly used xenografts in dentistry. Albeit literature is replete with clinical studies in favor of bovine-derived graft materials, bibliographical data reporting on risks and clinical complications is scarce. Clinical impression and concern for patients' safety led to the report we have provided. The aim of the present case series was to raise awareness on the long-term risks and late clinical complications of bovine-derived graft materials. Patients were referred to a private practice due to bone augmentation complications. Demographics, significant medical and dental findings are reported. The present report was conceived with the safety of patients in mind. Complications included sinus and maxillary bone pathoses, displacement of the graft materials, oro-antral and oro-nasal communications, paresthesia, implant failure, foreign body reactions, encapsulation, chronic inflammation, soft tissue fenestrations and associated cyst. Bovine-derived graft materials were not biodegradable. Resolution of the associated lesions and symptoms was achieved after the removal of the bone graft materials. Clinicians seeking to provide functional and esthetic outcomes should be aware of the complications of the bovine-derived graft materials. The long-term safety of xenografts and their potential association with disease are valid concerns (AU)

Influence of artificial aging on mechanical properties of commercially and non-commercially available zirconia dental implants.

OBJECTIVE: To evaluate the effect of artificial aging on the mechanical resistance and micromechanical properties of commercially and noncommercially available zirconia dental implants. METHODS: Scanning electron microscopy (SEM) and X-ray computed tomography (X-CT) were performed on implant systems including: Z-systems®, Straumann®, Zibone® and commercially and non-commercially available TAV dental® with varying grain sizes. Accelerated aging was performed at 134 °C and 2-bar pressure for 30 hours. Before and after aging, the mechanical load to failure was investigated and the bending moments were calculated. Nanoindentation responses of the representative Zibone implant before and after aging were performed to evaluate the effects of aging on hardness (H) and Young's modulus (E). A two-sample t-test statistical analysis was used to determine significant differences of bending moments within groups. RESULTS: All implants presented with compact and homogenous core structures without porosities. The bending moment was significantly increased after aging for all groups (P ≤ 0.05) except for Z-systems (significant decrease (P = 0.022)) and TAV group 3 (no significant increase (P = 0.181)). The increase in bending moment was less pronounced with increasing grain size in TAV groups (group 1: P = 0.036, group 2: P = 0.05, group 3: P = 0.18). E and H were reduced approximately 32% and 18% respectively following aging within the transformed, microcracked zone of the presentative Zibone implant. CONCLUSIONS: Aging led to both increase and decrease of the mechanical properties of the implant systems analyzed. The apparent contrast amongst groups can be explained based on differences in grain sizes and surface features. Aging decreased micromechanical properties of one implant system which warrants further investigation.

The long-term risks and complications of bovine-derived xenografts: A case series.

The frequency of dental implant related surgeries that involve soft tissue and bone augmentation procedures has increased significantly. Bovine-derived substitutes have been by far the most commonly used xenografts in dentistry. Albeit literature is replete with clinical studies in favor of bovine-derived graft materials, bibliographical data reporting on risks and clinical complications is scarce. Clinical impression and concern for patient safety led to the report we have provided. The aim of the present case series was to raise awareness on the long-term risks and late clinical complications of bovine-derived graft materials. Patients were referred to a private practice due to bone augmentation complications. Demographics, significant medical and dental findings are reported. Complications included sinus and maxillary bone pathoses, displacement of the graft materials, oroantral communications, implant failure, foreign body reactions, encapsulation, chronic inflammation, soft tissue fenestrations and associated cysts. Bovine-derived graft materials were not biodegradable. Resolution of the associated lesions and symptoms was achieved after the removal of the bone graft materials. The surgical removal of the xenograft materials may require advanced clinical skills because of the different configurations clinicians might encounter of the non-resorbed and migrated particles. The authors' concern is that patient morbidity may not be reduced with xenografts, due to the inherent risks and associated complications. Clinicians seeking to provide functional and esthetic outcomes should be aware of the complications of the bovine-derived graft materials. The long-term safety of xenografts and their potential association with disease are valid concerns.

Impacted teeth: Closed flap surgery.

OBJECTIVE: The present pilot study evaluated the impact of closed flap surgical technique on periodontal tissues and the esthetic outcome. MATERIALS AND METHODS: Twenty-four consecutively treated patients with a mean age of 15 (range 12-30) underwent closed flap surgery for the exposure of impacted teeth. The study evaluated periodontal probing depths, bone level, zone of keratinized tissue, and esthetic appearance after the completion of orthodontic treatment. RESULTS: Tooth impaction was more frequent in females (No. 14) than males (No. 10) in this study. Palatal and buccal impactions were 77% and 23%, respectively. Post-orthodontic treatment, periodontal probing depth averaged 2.2 mm and zone of keratinized gingiva averaged 3.6 mm. No discernible radiographic bone loss or root resorption was noticed. Overall, gingival margins provided an esthetic appearance in all cases. CONCLUSION: Closed flap surgical technique was associated with periodontal health and esthetic outcomes for an average of 10 years post-orthodontic treatment. CLINICAL SIGNIFICANCE: The evolution of teeth and maxillary/mandibular bones has distinctively differed in origins and development contributing to tooth impaction and overcrowding. This study demonstrated that closed flap surgery is a reliable procedure for the treatment of impacted teeth that provides periodontal health and esthetic appearance post-orthodontic treatment.

Zirconia dental implants: A clinical and radiographic evaluation.

OBJECTIVE: Limited clinical evidence has been reported in dental literature regarding zirconia dental implants. The aim of the present retrospective consecutive case series was to evaluate the clinical outcome of zirconia dental implants with 1 to 5 years of follow-up. CLINICAL CONSIDERATIONS: The clinical outcome of 24 implants in 12 consecutive patients (male 5, female 7) with a mean age of 55 years (range 27-86) is reported. Radiographic crestal bone level was assessed by the use of "ImageJ" software program. Gingival and plaque indices were recorded at baseline and latest follow-up. CONCLUSION: The overall success rate of zirconia implants was 92%. Within the limitations of the present clinical evaluation, zirconia implants provided excellent clinical results and esthetic outcomes. A mean periimplant bone loss of 0.3 mm was measured in 33.3% of the implants and 66.7% were not affected by radiographic detectable periimplant bone loss. Two implants in two patients failed. Low gingival and plaque indices were predominant values for both interim and final restorations. The apparent less affinity to plaque accumulation may favor soft tissue health around zirconia dental implants and decrease the risk of inflammation or infection. Zirconia dental implant merits further investigation. CLINICAL SIGNIFICANCE: Zirconia dental implants are emerging as an option in clinical practice of implant dentistry providing stable clinical results and esthetic outcomes.

The Impact of In Vitro Accelerated Aging, Approximating 30 and 60 Years In Vivo, on Commercially Available Zirconia Dental Implants.

BACKGROUND: Despite increased popularity of Zirconia dental implants, concerns have been raised regarding low temperature degradation (LTD) and its effect on micro-structural integrity. PURPOSE: This study evaluated the effect of LTD on four types of Zirconia dental implants at 0, 30, and 60 years of artificial aging. The impact of aging on t-m transformation and micro crack formation was measured. MATERIALS AND METHODS: Accelerated aging at 15 and 30 hours, approximating 30 and 60 years in vivo, aged 36 Zirconia dental implants: Z systems® (A), Straumann® (B), Ceraroot® (C), and Zeramex® (D). Focused ion beam-scanning electron microscopic analysis determined the micro structural features, phase transformation, and the formation of micro cracks. RESULTS: At 15 hours, type A implant presented with micro cracks and t-m transformation of 0.9 µm and 3.1 µm, respectively. At 30 hours, micro cracks remained shallow (1 µm). At 15 hours, type B implant presented micro cracks (0.7 µm) and grain transformation (1.2 µm). At 30 hours, these features remained superficial at 0.6 and 1.5 µm, respectively. Type C implant presented surface micro cracks of 0.3 µm at 15 hours. The depth of t-m transformation slightly increased to 1.4 µm. At 30 hours, number of micro cracks increased at the surface to an average depth of 1.5 µm. Depth of t-m transformation increased to an average of 2.5 µm. At 15 hours, micro cracks remained superficial (0.8 µm) for type D implant and depth of t-m transformation increased to 2.3 µm. At 30 hours, the depth of micro cracks increased to an average of 1.3 µm followed by increased t-m transformation to a depth of 4.1 µm. CONCLUSION: Depth of grain transformation remained within 1-4 µm from the surface. The effect of aging was minimal for all Zirconia implants.

The Risk of Prion Infection through Bovine Grafting Materials.

BACKGROUND: Bovine-derived grafting materials are frequently used in a variety of bone augmentation techniques. The aim of this paper is to assess the unique safety issue of bovine-derived grafting materials that is rarely addressed in dental literature: risk of bovine spongiform encephalopathy (BSE). METHODS: The validity of the current BSE diagnostic methods, surveillance and epidemiological trends in affected countries, and BSE infectivity in bovine bone before and after manufacturing processing were reviewed and analyzed. RESULTS: Prion screening has significant limits. Humans are not safe from the infection of prion disease of other species. Prions can and do break the species barrier. There is evidence there may be tens of thousands of infectious carriers in the western countries alone. This raises concern about the potential for perpetuation of infection via medical procedures. CONCLUSION: The limited ability to screen prions within the animal genome, along with a long latency period to manifestation of the disease (1 to over 50 years) in infected patients, provides a framework for discussing posible long-term risks of the xenografts that are used so extensively in dentistry. We suggest abolishing the use of bovine bone.

The Endo Blog

This blog contains information on clinical practice in Endodontics. It is intended to be an educational tool and a discussion forum for endodontists professionals. You can discuss and exchange views on the treatments, innovations, clinical cases and research related to endodontics.

Prospective, 1-year observational study of double-threaded tapered body dental implants with immediate loading.

STATEMENT OF PROBLEM: Unlike conventional loading protocols, the immediate loading of single implants has not been fully investigated. PURPOSE: The purpose of this study was to assess the prosthetic and esthetic periimplant mucosal outcomes of immediately restored dental implants during a 1-year follow-up. MATERIAL AND METHODS: Twenty participants meeting the established inclusion criteria received double-threaded, tapered body dental implants (SuperLine; Dentium). Implants were placed and stabilized at a minimum of 35 Ncm of torque and restored immediately after the surgery with interim restorations. These were replaced with definitive restorations 6 months after implant placement. Clinical measurements at each visit included resonance frequency analysis, the evaluation of the participants' oral health (gingival and plaque indices), and the esthetic outcome of the interim or definitive restoration. RESULTS: Implants placed in this clinical study had a 100% success rate. The oral health and esthetic outcomes were favorable for all participants. CONCLUSIONS: Double-threaded, tapered body dental implants that were placed and immediately restored with fixed interim prostheses and with definitive prostheses after 6 months remained stable and functional after 1 year.

Isolation and Assessment of Mesenchymal Stem Cells Derived From Bone Marrow: Histologic and Histomorphometric Study in a Canine Periodontal Defect.

The aim of the present study was to investigate an isolation procedure to culture mesenchymal stem cells derived from bone marrow and evaluate their potential in periodontal regeneration. Potential stem cells from bone marrow, aspirated from the iliac crest of nine mongrel canines 1 to 2 years of age, were cultivated. After the examination of surface epitopes of the isolated cells, the total RNA from osteogenic, adipogenic, and chondrogenic cell cultures were analyzed by reverse transcription polymerase chain reaction (RT-PCR) to confirm stem cell gene expressions. 2 × 10(7) mL of the stem cells were loaded on 0.2 mL of anorganic bovine bone mineral (ABBM) granules. In each animal, bilateral acute/chronic intrabony periodontal defects were created surgically and by placement of ligatures around the cervical aspect of the teeth. At week 5, after flap debridement, the bilateral defects were randomly assigned to 2 treatment groups: the control group received ABBM, and the test group received BMSCs-loaded ABBM. Eight weeks after transplantation, regenerative parameters were analyzed histologically and histometrically. The RNA expressions confirmed the cultivation of mesenchymal stem cell. More new cementum and periodontal ligament (PDL) were measured in the test group (cementum: 3.33 ± 0.94 vs 2.03 ± 1.30, P = 0.027; PDL: 2.69 ± 0.73 vs 1.53 ± 1.21, P = 0.026). New bone formation was similar in both groups (2.70 ± 0.86 vs 1.99 ± 1.31; P = 0.193). Mesenchymal stem cells derived from bone marrow should be considered a promising technique for use in patients with periodontal attachment loss and merits further investigations.

Accidental migration of a dental implant into the ethmoid sinus following a transalveolar sinus elevation procedure.

BACKGROUND: Migration of a dental implant into the paranasal sinuses may be the result of sinus membrane perforation, loss of osseointegration, and lack of initial stability. The majority of displaced implants migrate into the maxillary sinus, which may cause sinusitis. PURPOSE: The purpose of this study is to report an extremely rare ethmoid sinus migration of a dental implant after crestal approach in a resorbed posterior maxilla. MATERIALS AND METHODS: A 60-year old Korean male with a noncontributory medical history was referred from a local clinic to remove the migrated dental implant in the right ethmoid sinus. The patient had symptoms of mild sinusitis. The implant had been placed 6 months earlier through the bone-added transalveolar approach in a severely resorbed maxilla. RESULTS: The displaced implant was removed through the intraoral approach. A lateral window was made and an endoscopic surgery was performed to remove the implant. Healing was uneventful, and sinusitis symptom had ceased. CONCLUSION: The crestal approach for severely resorbed posterior maxillae should be performed when there is a potential for primary stability. If bone quality is poor and initial stability cannot be achieved, lateral window sinus elevation procedure is a better option for successful implant placement. Migrated implant may be removed with antrostomy and endoscopic surgery.

Simultaneous sinus lift and implant installation: prospective study of consecutive two hundred seventeen sinus lift and four hundred sixty-two implants.

PURPOSE: If less than 4 mm of residual bone is remained in posterior maxilla, two-stage operation is recommended for implant installation. However, if primary stability could be obtained using tapered designed implants, one-stage surgery could be performed with reliable success rate in severely resorbed maxilla. The purpose of this prospective study was to evaluate survival and success rates of the implants simultaneously placed into grafted sinus using rough-surfaced implant. MATERIALS AND METHODS: A total of two hundred seventeen consecutive sinus lifting through lateral approach and four hundred sixty-two simultaneous implants were installed from November 2003 for 5.5 years. Xenogenic bone was used solely for bone graft materials. Second surgery was performed around 6 months after operation and porcelain fused metal or gold crown was used for definitive restorations. Cumulative survival and success rates were evaluated according to residual alveolar bone height (RABH), smoking status, and Schneiderian membrane perforation. RESULTS: The mean follow-up was 57.1 ± 15.6 (36-98) months. Of the four hundred sixty-two implants, two hundred sixty-two implants (56.7%: group 1) were installed in posterior maxilla less than 4-mm RABH and two hundred implants (43.3%: group 2) were placed in over 5-mm RABH. The cumulative survival and success rates were 98.91% and 96.54%. There was no statistically significant difference in success rate between group 1 and group 2 (p = .3135). Perforation of the membrane was not related to success (p = .7162), but smoking status is significantly related with implant failure (p = .0003). CONCLUSIONS: Sinus lifting with simultaneous implant placement could be used to treat atrophic maxilla in patients with minimal RABH when initial stability could be obtained by using taper designed implants with surgical techniques. Smoking is a possible factor for implant failure. Membrane perforation did not have an adverse effect on implant success if the membrane was repaired with absorbable membrane and fibrin glue.

Osteonecrosis of the jaw after implant surgery in patients treated with bisphosphonates--a presentation of six consecutive cases.

BACKGROUND: Osteonecrosis of the jaws in patients treated with bisphosphonates is mostly associated with intravenous bisphosphonates while the incidence associated with oral bisphosphonates is not significant. PURPOSE: The purpose of this paper is to describe a series of cases of jaw osteonecrosis that may be associated with dental implant placement in patients who had taken nitrogen containing bisphosphonates via oral and/or intravenous route. PATIENTS: Six female patients were treated for osteonecrosis of the jaw after implant placement. An average age was 71.8 ± 6.5 years old and they had a history of bisphosphonate use. Two patients suffered from cancer and the other patients had osteoporosis. Two osteoporosis patients had taken only oral bisphosphonate and the other patients received intravenous bisphosphonates. RESULTS: Resection of necrotized bone, implant removal, and primary closure were performed in five patients and four patients showed uneventful healing. One patient presented recurrence at the maxilla and underwent further extraction and resection. One patient presented with an exposure of the bone after implant placement was treated with an advanced flap closure, and the implants were preserved. CONCLUSION: Unusual jaw necrosis after dental implant surgery might be related with oral and/or intravenous bisphosphonates. Wide resection of necrotic bone, collagen graft, and primary closure are key factors for successful healing.