Implant survival after surgical treatment of early apical peri-implantitis: An ambispective cohort study covering a 20-year period.

PURPOSE: To describe implant survival at least 1 year after the surgical treatment of early apical peri-implantitis (EAP) and explore potential risk factors of failure of such treatment. MATERIALS AND METHODS: An ambispective cohort study was conducted, involving all patients in whom EAP was detected and surgically treated between 1996 and 2016. Reporting followed the STROBE guidelines. The time from implant placement (IP) to EAP surgery (EAPS), the diagnostic stage and intraoperative variables (location, apical lesion in the tooth being replaced, mesial and distal tooth-implant distance measured at the apex, periapical surgery of the adjacent tooth, guided bone regeneration, implant resection, explantation) were recorded to determine their impact upon treatment outcome. RESULTS: The initial sample consisted of 58 implants in 46 patients. The mean time from IP to EAPS was 21.7 ± 10.1 days. At the time of surgery, eight implants presented mobility and were explanted. The final sample consisted of 50 implants in 39 patients evaluated for implant survival after surgical treatment. A cumulative survival rate of 78.3% was recorded. The mean survival time of the EAP treated implants was 85.4 months (standard deviation [SD] 5.94). The diagnostic stage (P < 0.001) and the existence of a previous periapical lesion in the tooth being replaced (P = 0.022) had a significant influence upon implant survival. CONCLUSIONS: The cumulative survival rate was 78.3%, with a mean survival time of 85.4 months. The diagnostic stage of EAP and the presence of a lesion in the tooth being replaced significantly influenced the survival of implants with EAP subjected to surgical treatment.

Replantation of a maxillary second molar after removal of a third molar with a dentigerous cyst: Case report and 12-month follow-up.

The aim of this study was to describe the replantation of a maxillary second right molar, which had been removed for surgical reasons in order to remove a dentigerous cyst associated with the adjacent third molar, and the case's 12-month follow-up. A 51-year-old man presented swelling in the right maxillary area. Radiographic examination showed a large radiolucency in close proximity to the third molar, suggesting a follicular cyst. The third molar was extracted and the cyst underwent curettage. The second molar had to be extracted to enable complete removal of the cyst and to achieve primary closure of the wound, which would have been impossible without repositioning the molar. With this objective, extraoral endodontic treatment was performed, the root-end was resected and prepared with ultrasonic retrotips, and root-end filling was accomplished with MTA before the molar was replanted. At the 12-month follow-up, the tooth showed no clinical signs or symptoms, probing depth was no greater than 3 mm and radiographic examination showed no evidence of root resorption or periapical lesion. Key words:Replantation, maxillary molar, follicular cyst, dentigerous cyst.

Comparative split-mouth study of the anesthetic efficacy of 4% articaine versus 0.5% bupivacaine in impacted mandibular third molar extraction.

OBJECTIVE: The purpose of this study was to compare the clinical efficacy of articaine at 4% (epinephrine 1:100,000) with bupivacaine at 0.5% (epinephrine 1:200,000) for surgical extraction of impacted mandibular third molars. STUDY DESIGN: This was a randomized, double blind, split-mouth, clinical trial. Thirty-six patients took part and underwent extraction of 72 lower third molars. The variables studied were: anesthetic latency time, intra-operative bleeding, anesthetic quality, hemodynamic changes during the surgical intervention, anesthetic duration in the soft tissues, post-operative analgesia and post-operative pain at 2, 6, 12 and 24 hours using a visual analogue scale, as well as any need for additional rescue medication. RESULTS: Latency time was 2.0 minutes for articaine and 3.1 minutes for bupivacaine, with statistically significant difference (p<0.05). Bleeding was greater when bupivacaine was used (p<0.05) and anesthetic quality was greater with articaine (p<0.05). The duration of soft tissue anesthesia was longer with bupivacaine (p<0.05). Differences in post-operative analgesia, haemodynamic changes, post-operative pain and the quantity of rescue medication consumed were not statistically significant (p>0.05). CONCLUSIONS: Articaine showed greater clinical efficacy than bupivacaine, reducing latency time, bleeding, anesthetic duration in the soft tissues and achieving higher anesthetic quality, requiring less reinforcement during surgery than bupivacaine. Key words:Articaine, bupivacaine, anesthetic efficacy, impacted mandibular third molar.

Management and outcome following extraction of 303 supernumerary teeth in pediatric patients.

PURPOSE: The purpose of this study was to describe the treatment of permanent teeth impacted by supernumerary teeth and their outcome following extraction. METHODS: The study population comprised 200 2- to 14-year-olds. RESULTS: A total of 303 supernumerary teeth were removed from the 200 patients. Surgery was performed on: 129 teeth (~43%) from the vestibular and palatine/lingual (mixed) side; 110 teeth (~36%) from the palatine/lingual side; and 64 teeth (~21%) from the vestibular side. Regarding the shape of the supernumerary teeth, the distribution was: 118 conoid teeth; 92 supplementary teeth; 66 tuberculate teeth; and 27 teeth of varied shapes. In approximately 61% of the permanent teeth (159 teeth), the supernumerary teeth caused impaction of the former, while no case of impaction was recorded in the case of the primary dentition. The impacted permanent teeth evolved favorably in 100% of the orthodontic tractions, in 80% of the relocations, and in approximately 65% of the conductive alveolectomies. CONCLUSIONS: The highest percentage success rate in treating permanent teeth impacted by supernumerary teeth corresponded to those cases in which surgery could be combined with orthodontic treatment. There were no displacements of neighboring buds during removal of the supernumerary teeth in the primary dentition.

Peripheral giant cell granuloma associated with dental implants: clinical case and literature review.

Peripheral giant cell granuloma (PGCG) associated to dental implants is a very infrequent peri-implant soft-tissue complication, with only 11 cases recorded in the literature to date. The present study describes a 54-year-old woman presenting a swelling of the alveolar margin in the fourth quadrant in relation to a fixed prosthesis cemented over implants. Treatment consisted of complete resection of the lesion with implantoplasty of the exposed implant threads. The diagnosis of PGCG was confirmed by histological study, and no relapse has been recorded after 12 months of follow-up.

Bone necrosis around dental implants: A patient treated with oral bisphosphonates, drug holiday and no risk according to serum CTX.

Osteonecrosis of the jaw (ONJ) may appear following certain oral surgery procedures in patients treated with oral bisphosphonates (OB). Guidelines for the treatment of these patients were set out in the American Association of Oral and Maxillofacial Surgeons (AAOMS) Position Paper on Bisphosphonate-Related Osteonecrosis of The Jaws (Position Paper) and Approved by the Board of Trustees in September 2006. For the AAOMS the placement of implants in these patients is not contraindicated. In addition, the serum C-terminal telopeptide bone suppressor marker (CTX) test is available to determine the risk of ONJ. A case is presented of ONJ in a patient with 6 months of OB discontinuation ("drug holiday") before dental implant placement (following the guidelines of the AAOMS) and with no risk of osteonecrosis according to the serum CTX value (340 pg/ml). The wound healed favorably with complete healing at 7 months. In this case, the serum CTX test must be questioned as to its predictive value of ONJ, and more reliable markers of this risk are needed. Key words:Bisphosphonates, dental implants, bone necrosis, serum CTX.

Risk factors associated with early failure of dentalimplants. A literature review

The aim of the study was to examine articles published on risk factors associated with early failure of dental implants.We conducted a search on PubMed for articles published between January 2000 and December 2009 usingthe keywords ‘dental implants’ and ‘early failure’. Seven studies that specified the number of early failed implantsand studied the associated risk factors were included.Early failures are caused by the inability of tissue to establish osseointegration prior to prosthetic restoration;however the causal factors and mechanisms are unclear. In the reviewed literature there was a higher percentageof early than late failures; nevertheless, few articles were found that analyzed risk factors associated with early implantfailure. In the majority of studies, statistically significant factors associated with early implant failure weresmoking, quantity and quality of bone, and posterior implant location. The low number of studies in the literaturedoes not allow definitive conclusions to be drawn (AU)

Interleukins IL-6, IL-8, IL-10, IL-12 and periimplant disease. An update

Introduction: A study is made of the usefulness of cytokines (such as interleukin-6 (IL-6), interleukin-8 (IL-8),interleukin-10 (IL-10) and interleukin-12 (IL-12)) as markers of periimplant disease (mucositis and periimplantitis).An increase in the levels of these cytokines in dental implant crevicular fluid may give rise to a lack of osteointegration,bone loss or implant failure.Objective: To review the literature relating IL-6, IL-8, IL-10 and IL-12 levels to dental implant surgery and periimplantitis.Material and Method: A PubMed literature search was made of articles in English and Spanish, using the keywords “cytokine and dental implants”, cytokine and periimplantitis”, “IL-6, IL-8, IL-10, IL-12 and dental implants”,“IL-6, IL-8, IL-10, IL-12 and periimplantitis”. Fourteen articles were found and classified into two groupsrelating interleukin levels to: a) periimplant disease; and b) their influence upon dental implant osteointegrationwithout periimplant disease.Conclusions: An increase in interleukin levels is observed in patients with periimplant disease, though there iscontroversy over the effect of interleukins in crevicular fluid and periimplantitis in relation to implant failure orthe development of periimplant disease (AU)

Hemodynamic and ventilatory changes during implant surgerywith intravenous conscious sedation

Purpose: This study was conducted to determine the hemodynamic and ventilatory changes during implant surgerywith intravenous conscious sedation, and whether preoperative anxiety, gender or age influence these parameters.Patients and Methods: A prospective study carried out between May 2004 and February 2007, on 102 patientstreated with dental implants under local anesthesia and conscious intravenous sedation. Patients completed aquestionnaire prior to surgery to evaluate preoperative dental anxiety using Corah’s scale. The hemodynamic andventilatory changes were evaluated by monitoring systolic pressure (SP), diastolic pressure (DP), heart rate (HR)and oxygen saturation (SaO2). These values were collected at 5 points during surgery; before commencing theoperation (baseline value), during local anesthetic injection, at the moment of incision and raising of a mucoperiostealflap, during implant placement, and finally at suturing. Intravenous conscious sedation was administeredbetween baseline value and injection of the local anesthetic.Results: The highest SP and DP were recorded at baseline and at suturing. The highest HR was recorded at themoment of incision and raising of the mucoperiosteal flap; the lowest SaO2 was recorded at local anesthetic injection.There was no relationship between hemodynamic and ventilatory values and preoperative anxiety or gender.A greater age was associated with higher SP and lower SaO2, these differences being statistically significant.Conclusions: Most of the cardiovascular and ventilatory changes induced by the implant surgery with intravenousconscious sedation were within normal ranges. The results indicate that midazolam with fentanyl do not produceimportant hemodynamic and ventilatory changes, being a good association for intravenous conscious sedation indental implant surgery (AU)

Clinical characteristics, treatment, and evolution in 14 cases of pediatric orofacial lymphangioma.

PURPOSE: To present the largest series of orofacial lymphangioma in children published to date, analyzing the clinical characteristics and evolution of, and the treatment used for, these lesions. MATERIALS AND METHODS: The clinical data from patients diagnosed with orofacial lymphangioma, who were treated from 1998 to 2008 at the Oral and Maxillofacial Surgery Unit, Children's Hospital La Fe of Valencia (age 0 to 14 years), were reviewed. All patients with a clinical, radiographic, or, in surgical cases, histopathologic, diagnosis of orofacial lymphangioma were included. RESULTS: A total of 14 patients (8 boys and 6 girls; mean age 4.6 years) were included in the present study. Of the 14 cases, 9 had been diagnosed before the patients were 2 years old and 2 of which were congenital; 8 cases were located on the dorsum of the tongue. The lesion diameter was 1 to 2 cm in 9 patients, with 1 less than 1 cm, and was larger than 2 cm in 5. For treatment, 4 lymphangiomas were monitored periodically and resolved spontaneously, 1 was treated with sclerotherapy, and 9 with surgical extirpation. After surgery, 2 patients developed a recurrence within 13 months. CONCLUSIONS: Most of the lymphangiomas diagnosed in children occurred before 2 years of age, were on the dorsum of the tongue, and had a mean size of 1 to 2 cm. Of those treated with surgical extirpation, 2 recurred.

Interleukins IL-6, IL-8, IL-10, IL-12 and periimplant disease. An update.

INTRODUCTION: A study is made of the usefulness of cytokines (such as interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10) and interleukin-12 (IL-12)) as markers of periimplant disease (mucositis and periimplantitis). An increase in the levels of these cytokines in dental implant crevicular fluid may give rise to a lack of osteointegration, bone loss or implant failure. OBJECTIVE: To review the literature relating IL-6, IL-8, IL-10 and IL-12 levels to dental implant surgery and periimplantitis. MATERIAL AND METHOD: A PubMed literature search was made of articles in English and Spanish, using the key words "cytokine and dental implants", cytokine and periimplantitis", "IL-6, IL-8, IL-10, IL-12 and dental implants", "IL-6, IL-8, IL-10, IL-12 and periimplantitis". Fourteen articles were found and classified into two groups relating interleukin levels to: a) periimplant disease; and b) their influence upon dental implant osteointegration without periimplant disease. CONCLUSIONS: An increase in interleukin levels is observed in patients with periimplant disease, though there is controversy over the effect of interleukins in crevicular fluid and periimplantitis in relation to implant failure or the development of periimplant disease.

Risk factors associated with early failure of dental implants. A literature review.

The aim of the study was to examine articles published on risk factors associated with early failure of dental implants. We conducted a search on PubMed for articles published between January 2000 and December 2009 using the keywords 'dental implants' and 'early failure'. Seven studies that specified the number of early failed implants and studied the associated risk factors were included. Early failures are caused by the inability of tissue to establish osseointegration prior to prosthetic restoration; however the causal factors and mechanisms are unclear. In the reviewed literature there was a higher percentage of early than late failures; nevertheless, few articles were found that analyzed risk factors associated with early implant failure. In the majority of studies, statistically significant factors associated with early implant failure were smoking, quantity and quality of bone, and posterior implant location. The low number of studies in the literature does not allow definitive conclusions to be drawn.

Hemodynamic and ventilatory changes during implant surgery with intravenous conscious sedation.

PURPOSE: This study was conducted to determine the hemodynamic and ventilatory changes during implant surgery with intravenous conscious sedation, and whether preoperative anxiety, gender or age influence these parameters. PATIENTS AND METHODS: A prospective study carried out between May 2004 and February 2007, on 102 patients treated with dental implants under local anesthesia and conscious intravenous sedation. Patients completed a questionnaire prior to surgery to evaluate preoperative dental anxiety using Corah's scale. The hemodynamic and ventilatory changes were evaluated by monitoring systolic pressure (SP), diastolic pressure (DP), heart rate (HR) and oxygen saturation (SaO2). These values were collected at 5 points during surgery; before commencing the operation (baseline value), during local anesthetic injection, at the moment of incision and raising of a mucoperiosteal flap, during implant placement, and finally at suturing. Intravenous conscious sedation was administered between baseline value and injection of the local anesthetic. RESULTS: The highest SP and DP were recorded at baseline and at suturing. The highest HR was recorded at the moment of incision and raising of the mucoperiosteal flap; the lowest SaO2 was recorded at local anesthetic injection. There was no relationship between hemodynamic and ventilatory values and preoperative anxiety or gender. A greater age was associated with higher SP and lower SaO2, these differences being statistically significant. CONCLUSIONS: Most of the cardiovascular and ventilatory changes induced by the implant surgery with intravenous conscious sedation were within normal ranges. The results indicate that midazolam with fentanyl do not produce important hemodynamic and ventilatory changes, being a good association for intravenous conscious sedation in dental implant surgery.

Immediate versus nonimmediate placement of implants for full-arch fixed restorations: a preliminary study.

PURPOSE: To compare the success rates, after 1 year of loading, for implants placed immediately after tooth extraction and in healed sites in patients undergoing extraction of all residual teeth for rehabilitation with a fixed, full-arch, implant-supported prosthesis. MATERIALS AND METHODS: A retrospective case series study was conducted of 38 patients treated from June 2004 to June 2008 by extraction of all remaining teeth and implant placement in both mature bone and at the extraction site in the same procedure. After osteointegration, the implants were restored with fixed full-arch prostheses. The marginal bone loss around the implants was measured after 1 year. The success rate according to Buser criteria was calculated for the immediate and nonimmediate implants. RESULTS: A total of 41 arches were restored in 30 patients, 23 in the maxilla and 18 in the mandible. A total of 292 implants were placed, 173 immediately and 119 in mature bone. Of the 292 implants, 8 failed, 4 in the immediate group and 4 in the nonimmediate group. The mean bone loss was 0.6 mm at 1 year of loading (0.63 ± 0.18 mm at the immediate implant sites and 0.58 ± 0.26 in mature bone). The mean success rate was 96.9% overall, 97.7% for the immediate group, and 96.3% for the nonimmediate group. CONCLUSIONS: Enhanced bone healing and remodeling can take place in fresh extraction socket defects associated with immediately placed implants. The results of the present study have demonstrated that immediate implant osseointegration can be as, or more, successful than nonimmediate implantation during the same healing period.