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OBJECTIVE: To evaluate the influence of patient and implant-related factors on the changes of marginal bone levels (MBL) at implants with a follow-up ≥5 years. MATERIALS AND METHODS: At baseline (within 6 months from prosthetic insertion) and long-term (≥5 years after implant placement) visits, interproximal (mesial and distal) MBL were radiographically evaluated. To analyze factors predicting MBL change, the site (either mesial or distal) showing the highest MBL change (hChMBL site) was identified for each implant. Multilevel regression models were built to explain MBL change as well as the probability for a bone loss ≥2 mm at long-term. RESULTS: 942 implants in 312 patients with a mean follow-up of 8.02 ± 2.5 years were analyzed. MBL change was significantly predicted by baseline MBL, oral bisphosphonate (BP) intake, history of periodontitis, diabetes, and super-hydrophilic implant surface. Higher risk for a bone loss ≥2 mm was observed in patients with history of periodontitis (OR = 9.52, 95% CI 0.72-3.79) and taking BP (OR = 6.84, 95% CI 0.21-3.63). Mandibular implants had higher odds for bone loss ≥2 mm compared to maxillary implants (OR = 3, 95% CI 0.39-1.87). CONCLUSIONS: The findings of the present study contribute to the identification of specific clinical scenarios at higher risk for implant-supporting bone loss that need to be strictly monitored during maintenance.
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OBJECTIVES: The aim of the present study was to evaluate the influence of crestal and subcrestal implant position on development of peri-implant diseases. MATERIALS AND METHODS: The study was designed as a retrospective clinical and radiographic analysis. Implant-supported fixed dental prostheses were allocated in two groups: with the shoulder (i) placed in sub-crestal level and (ii) placed at bone level. For each patient, the following clinical variables were assessed: FMPS, FMBS, PlI, BOP, and PD. After prothesis delivery, an intraoral radiograph was obtained; this exam was performed also at 5 years of observation period. RESULTS: No statistically significant difference was found in terms of FMPS and FMBS at baseline and after 5 years follow-up (P < 0.05). A statistically significant difference was assessed between PD of control group and test group (P = 0.042). Patient-based analysis showed a 25.6% of peri-implant mucositis and 32.6% of peri-implantitis for implants placed with the shoulder in crestal position, while for implants inserted in sub-crestal position the percentage of peri-implant-mucositis and peri-implantitis were 19%; no statistically significant difference was found between groups after 5 years (P < 0.05). CONCLUSIONS: Within the limitation of the present study, the clinical and radiographic outcomes showed that the percentage of peri-implant mucositis and peri-implantitis was not statistically significant for both groups after 5 years follow-up. CLINICAL RELEVANCE: The outcomes of present study clinically demonstrated that a deep position of implant shoulder did not provide any benefits. On the contrary, it may be considered a possible risk indicator for implant diseases.
Assuntos
Perda do Osso Alveolar , Implantes Dentários , Mucosite , Peri-Implantite , Humanos , Peri-Implantite/diagnóstico por imagem , Estudos Retrospectivos , Perda do Osso Alveolar/diagnóstico por imagemRESUMO
Arterial hypertension (AH) and periodontitis are among the most common non-communicable chronic diseases worldwide. Besides sharing common risk factors, an increasing body of evidence supports an independent association between the two conditions, with low-grade systemic inflammation acting as the plausible biological link with increased cardiovascular risk. In 2021, the Italian Society of Arterial Hypertension (SIIA) and the Italian Society of Periodontology and Implantology (SIdP) have joined forces and published a joint report on the relationships between AH and periodontitis, reviewing the existing scientific evidence and underlining the need to increase awareness of the strong connection between the two conditions and promote treatment strategies for the control of gums inflammation in patients with AH. The current document extends the previous joint report, providing clinical practical guidelines aimed to support clinicians in the management of patients who suffer from or are at risk of being affected by both conditions. These recommendations are based on careful consideration of the available evidence as well as of the current guidelines on the management of periodontitis and AH and are supported by SIIA and SIdP.
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Hipertensão , Periodontite , Humanos , Periodontite/diagnóstico , Periodontite/epidemiologia , Periodontite/terapia , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia , Itália , Fatores de Risco , InflamaçãoRESUMO
An accumulating body of evidence supports an independent association between high blood pressure (BP) and periodontitis, possibly mediated by low-grade inflammation. This joint report by the Italian Society of Hypertension (SIIA) and the Italian Society of Periodontology and Implantology (SIdP) working group on Hypertension and Periodontitis (Hy-Per Group) provides a review of the evidence on this topic encompassing epidemiology, biological plausibility, relevance, magnitude, and treatment management. Consensus recommendations are provided for health professionals on how to manage BP in individuals showing signs of poor oral health. In summary, (1) large epidemiological studies highlight that individuals with periodontal diseases have increased risk for high/uncontrolled BP independent of confounders; (2) mechanistically, low-grade inflammation might have a causal role in the association; (3) BP profile and control might benefit from periodontal treatment in pre-hypertensive and hypertensive individuals; (4) oral health status should be evaluated as a potential risk factor for high/uncontrolled BP, and effective oral care should be included as an adjunct lifestyle measure during hypertension management. Further research is needed to optimize BP management in individuals with poor oral health.
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Hipertensão , Doenças Periodontais , Periodontite , Humanos , Hipertensão/epidemiologia , Hipertensão/etiologia , Hipertensão/terapia , Periodontite/complicações , Periodontite/epidemiologia , Periodontite/terapia , Inflamação , Fatores de RiscoRESUMO
OBJECTIVE: The aim of this study was to assess the impact of lockdown due to the coronavirus COVID-19 pandemic on the periodontal status of patients with periodontitis in supportive periodontal therapy. METHOD AND MATERIALS: A retrospective analysis of patients affected by periodontitis stage III-IV-grade A, B, and C, who had their supportive periodontal therapy to September 2020, after a period of 6 months from the planned maintenance recall (March 2020) was performed. Clinical parameters full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS), and probing depth (PD) were evaluated. Patients were assigned to three groups: A (nonsmokers); B (< 10 cigarettes/day); and C (> 10 cigarettes/day). Statistical analysis was used to compare intra-group and inter-group differences. RESULTS: In total, 55 subjects with the mean age of 47.7 ± 7.0 years were enrolled. The number of participants in group A and group B decreased, respectively, from 25 (45.5%) to 20 (36.4%) and from 17 (30.9%) to 13 (23.6%). The C group increased from 13 (23.6%) to 22 (40.0%). A statistically significant increase in mean FMPS was recorded in group A (from 22.5 ± 3.5 to 30.0 ± 28.3; P < .0001); group B (from 22.5 ± 12.7 to 42.5 ± 3.5; P < .0001); and group C (from 22.5 ± 25.5 to 42.5 ± 10.6; P < .0001). A statistically significant increase in mean FMBS was recorded in group A (from 15.0 ± 7.1 to 25.0 ± 21.2; P < .0001); group B (from 15.0 ± 0.0 to 37.5 ± 3.5; P < .001); and group C (from 12.5 ± 3.5 to 30.0 ± 7.1; P < .0001). A statistically significant increase in mean PD was recorded in group A (from 4.48 ± 0.5 to 5.25 ± 1.2; P < .001); in group B (from 4.71 ± 0.7 to 5.38 ± 1.31; P < .0001); and group C (from 6.00 ± 0.0 to 7.09 ± 1.1; P < .0001). CONCLUSIONS: Within the limitations of this study the results showed that the pandemic period resulted in an increase in probing depth for the patients in regular SPT, possibly due to increased tobacco consumption.
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COVID-19 , Periodontite , Adulto , Controle de Doenças Transmissíveis , Humanos , Pessoa de Meia-Idade , Pandemias , Perda da Inserção Periodontal , Estudos Retrospectivos , SARS-CoV-2RESUMO
An accumulating body of evidence supports an independent association between high blood pressure (BP) and periodontitis, possibly mediated by low-grade inflammation. This joint report by the Italian Society of Hypertension (SIIA) and the Italian Society of Periodontology and Implantology (SIdP) working group on Hypertension and Periodontitis (Hy-Per Group) provides a review of the evidence on this topic encompassing epidemiology, biological plausibility, relevance, magnitude, and treatment management. Consensus recommendations are provided for health professionals on how to manage BP in individuals showing signs of poor oral health. In summary, (1) large epidemiological studies highlight that individuals with periodontal diseases have increased risk for high/uncontrolled BP independent of confounders; (2) mechanistically, low-grade inflammation might have a causal role in the association; (3) BP profile and control might benefit from periodontal treatment in pre-hypertensive and hypertensive individuals; (4) oral health status should be evaluated as a potential risk factor for high/uncontrolled BP, and effective oral care should be included as an adjunct lifestyle measure during hypertension management. Further research is needed to optimize BP management in individuals with poor oral health.
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Hipertensão , Periodontite , Implantação Dentária , Humanos , Hipertensão/epidemiologia , Itália/epidemiologia , Periodontia , Periodontite/epidemiologia , Sociedades Odontológicas , Sociedades MédicasRESUMO
OBJECTIVE: A papilla preservation crown-lengthening procedure (PPCL) was proposed for treatment of the maxillary anterior teeth (canine to canine) and compared to two traditional techniques. METHOD AND MATERIALS: Thirty patients were assigned to three treatment groups: PPCL, the apically positioned flap with buccal approach (APF-B), and the apically positioned flap with buccal and palatal approach (APF-BP). Several clinical parameters were recorded at baseline and 6 months after surgery. RESULTS: Although no statistically significant differences were reported in many of the clinical parameters examined, APF-B and APF-BP showed a significantly higher interproximal clinical attachment loss when compared to PPCL. In the PPCL group, there was a significant increase in esthetic appraisal by the patients. CONCLUSION: Crown lengthening using a papilla-preservation flap approach and osseous recontouring is a viable alternative approach and could be useful in esthetic regions.
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Aumento da Coroa Clínica/métodos , Estética Dentária , Maxila/cirurgia , Adulto , Feminino , Humanos , Masculino , Satisfação do Paciente , Estudos Prospectivos , Retalhos Cirúrgicos , Resultado do TratamentoRESUMO
The purpose of this randomized controlled study is to investigate the clinical results obtained over four years and incidence of complications associated with one- versus two-piece custom made zirconia anchorages, in single tooth implant-supported restorations of the maxillary anterior region. Sixty-five patients, with a total of 74 missing maxillary teeth, were selected in the period from February 2007 to July 2010. Two different ways of custom made zirconia abutment and final prosthetic restoration were evaluated: a standard zirconia abutment associated with a pressed layer of lithium disilicate with an all-ceramic cemented restoration versus one-piece restoration with the facing porcelain fired and pressed straight to the custom made zirconia abutment. In 29 cases, the restoration consisted of an all-ceramic restoration for cementation (two pieces); in 45 cases the restoration was a screw-retained restoration (one piece). Three all-ceramic restorations broke during the observation time. Two one-piece restorations fractured after 26 months. At follow-up examination there were no significant differences between one-piece and two-piece groups regarding the PI, BI, and MBL. Awaiting studies with longer follow-up times, a careful conclusion is that zirconia anchorages for single-implant restorations seem to demonstrate good short-term technical and biological results.
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Implantes Dentários para Um Único Dente/efeitos adversos , Materiais Dentários/efeitos adversos , Maxila/cirurgia , Zircônio/efeitos adversos , Materiais Dentários/uso terapêutico , Porcelana Dentária/efeitos adversos , Porcelana Dentária/uso terapêutico , Falha de Restauração Dentária , Feminino , Humanos , Masculino , Maxila/efeitos dos fármacos , Maxila/patologia , Pessoa de Meia-Idade , Zircônio/uso terapêuticoRESUMO
PURPOSE: Sinus elevation via the lateral approach for implant rehabilitation of atrophic posterior maxillae is considered a safe and predictable therapy. Several xenogeneic biomaterials of different biologic origin have been used as valid and predictable alternatives to autogenous bone. This multicenter randomized controlled double-blind prospective clinical trial aimed to compare histomorphometrically two xenogeneic grafting materials used for sinus elevation with simultaneous implant placement. MATERIALS AND METHODS: Seven private practices in Italy were involved. Patients presenting at least one site with a residual bone crest height between 2 and 4 mm were treated. Control sites were grafted with 100% deproteinated particulated bovine bone (DPBB), while test sites were grafted with prehydrated corticocancellous porcine bone (PCPB). Root-form implants were placed simultaneously. Insertion torque and clinical stability were assessed and recorded. At 6 months, a biopsy specimen was harvested from each site, and histomorphometric analyses were performed. RESULTS: Thirty-seven patients received 42 sinus elevations (24 test and 18 control). Eighty-two implants with adequate primary stability were placed. Fifty-five implants were placed in residual bone crests greater than 2 mm but less than 4 mm (average 2.7 mm) and achieved an average insertion torque of 22.8 ± 11.3 N/cm. Nineteen implants were placed in ridges greater than 3 mm but less than 5 mm, and eight were placed in ridges with more than 5 mm remaining. After 6 months, three implants had failed to integrate, leading to a survival rate of 96.34%. Forty-two specimens were analyzed histomorphometrically. No significant differences in total bone volume (PCPB 37.43%, DPBB 37.52%) or residual grafting material (PCPB 13.55%, DPBB 16.44%) were detected. CONCLUSIONS: In this study, PCPB compared well with DPBB as a grafting material for lateral sinus elevation.
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Perda do Osso Alveolar/reabilitação , Materiais Biocompatíveis/uso terapêutico , Substitutos Ósseos/uso terapêutico , Implantação Dentária Endóssea/métodos , Levantamento do Assoalho do Seio Maxilar/métodos , Adulto , Idoso , Perda do Osso Alveolar/patologia , Animais , Bovinos , Implantes Dentários , Falha de Restauração Dentária/estatística & dados numéricos , Método Duplo-Cego , Feminino , Humanos , Masculino , Maxila/cirurgia , Seio Maxilar/cirurgia , Pessoa de Meia-Idade , Estudos Prospectivos , Suínos , TorqueRESUMO
The aim of this report is to demonstrate the outcome of implant rehabilitation in the anterior maxilla. Aesthetics in implantology results from the correct execution of many rehabilitation phases: presurgical planning, surgical and prosthetic phases, and case management. In the presurgical phase, preexisting anatomical conditions and prosthetic evaluations influence the choice of regenerative techniques. Correct presurgical planning, in order to realize surgical and prosthetic procedures, is the most important phase to obtain an aesthetic result. Only a successful anatomical correction of hard and soft tissues is able to assure a satisfying therapeutic achievement involving many operative steps and the rigorous observance of recovery timing. A guided bone regeneration technique with a staged approach was used in conjunction with implant replacement.
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Implantação Dentária Endóssea/métodos , Incisivo/cirurgia , Fraturas dos Dentes/cirurgia , Adulto , Aumento do Rebordo Alveolar/métodos , Estética Dentária , Humanos , Incisivo/diagnóstico por imagem , Incisivo/lesões , Masculino , Radiografia , Fraturas dos Dentes/diagnóstico por imagemRESUMO
OBJECTIVES: The aim of this study was to identify a correct clinical, surgical, and prosthetic management of endosseous implants replacing missing teeth in the anterior maxilla, achieving predictable aesthetic outcomes. Placement of immediate post-extraction implants without incisions or flap elevation is one of the surgical treatment options able to improve the healing and regenerative potentials of the fresh socket. MATERIALS: Fifty-five patients (33 men, 22 women), ranging in age from 19 to 57 years (mean 29), were selected for this study. All the patients were not smokers, no bruxers, presented stable soft tissue conditions, an acceptable occlusion, and the absence of pathologies that would contraindicate bone healing. Patients were treated with implants made by 2 manufacturers: Institute Straumann, Walderburg, Switzerland and Friadent, Mannheim, Germany. A total of 87 implants were placed immediately after each failing tooth had been removed. The temporary restoration was placed 3 months after implant placement, and the final restoration was placed 4 months from the surgical procedure. The patients were evaluated clinically and radiographically at implant placement, and 2, 4, 18, and 24 months post-insertion. RESULTS: At 24 months, only 3 implants were lost (2 in male patients;1 in female patient). All of these failed implants did not achieve osseointegration. The overall success rate was 96.6%, with an implant failure rate of 3.4%, all prior to restoration. CONCLUSIONS: The immediate placement in the anterior maxilla fresh extraction sockets without incisions or flaps elevation is a surgical option that can ensure ideal peri-implant tissues healing, preserving the presurgical gingival and bone aspects. For a predictable aesthetic result, the most important aspect seems to be the height and thickness of the buccal bone wall, which remain after immediate placement of the fixture.