Mouth opening limitation and influence of age and surgical location for static fully guided dental implant placement: an observational, cross-sectional clinical study.

The influence of age and region of the mouth was assessed in regard to mouth opening in fully guided implant placement. Ninety patients were included in this study, 30 in each of three age groups (20-34, 35-55, and >55 years). Maximum passive mouth opening was recorded in three locations: incisal, canine, and molar. The minimum distance required to allow the bone drilling sequence through a static fully guided approach was analysed for four implant systems: Straumann, MIS Dentsply, Astra Tech Dentsply, and Dentium. The mean ± standard deviation maximum mouth opening (all 90 patients) was 46.34 ± 7.70 mm, 36.82 ± 5.92 mm, and 30.99 ± 5.40 mm in the incisal, premolar, and molar region, respectively. No significant difference in mouth opening at any of the three locations was found between the age groups (all P > 0.05). However, a correlation was found between increasing age and decreasing average mouth opening in all three mouth regions; each additional 1 year resulted in a mean reduction of 0.13 mm, 0.09 mm, and 0.08 mm in the incisal, premolar, and molar region, respectively. The minimum required mouth opening was most likely to be met for implant placement in the incisal region (98.9% of all patients) and least likely to be met for placement in the molar region, particularly for older patients (as low as 30% of patients). Mouth opening remains a major limitation in fully guided implant surgery, especially in posterior areas and in older patients. The use of some implant systems in the posterior area may be limited to only one in three patients.

Short implants (<8mm) versus longer implants (≥8mm) with lateral sinus floor augmentation in posterior atrophic maxilla: A meta-analysis of RCT`s in humans.

BACKGROUND: One of the greatest challenges that dentists face today is to rehabilitate severe atrophied alveolar ridges in partially and completely edentulous patients with implants. Despite the high survival rate of implants placed next to sinus elevation, this technique presents complications that can be avoided by placing short implants, an option that also presents high survival rates. For this reason, the aim of this study is to compare the survival rate, marginal bone loss and complications associated with short implants (<8 mm) versus longer implants (≥8mm) placed with lateral sinus floor elevation in posterior atrophic maxillae. MATERIAL AND METHODS: A literature search was conducted by two independent reviewers in the PubMed/Medline (National Library of Medicine, Washington, DC) electronic database for articles published from January 2007 to July 2018. Seven qualified articles were selected for the meta-analysis. RESULTS: The test for overall effect did not find statistical significance in the survival rates, overall complications, intra-operative complications, post-operative complications and prosthetic complications. However, the test showed statistically significant differences in biological complications in favor of standard implants, and marginal bone loss between control and test groups in favor of short implants (<8mm) was found. CONCLUSIONS: Within the limitations of the present study, prosthetic rehabilitations with short implants (<8mm) in posterior maxilla is a reliable treatment option as an alternative to lateral wall sinus floor augmentation.

Osseoinductive elements around immediate implants for better osteointegration: a pilot study in foxhound dogs.

OBJECTIVE: The aim of this study was to evaluate the effects on osseointegration of topical applications of melatonin vs. vitamin D over surfaces of immediate implants. MATERIALS AND METHODS: Mandibular premolar distal roots (P2 , P3 , P4 ) were extracted bilaterally from six American Foxhound dogs. Three conical immediate implants were randomly placed bilaterally in each mandible. Three randomized groups were created: melatonin 5% test group (MI), vitamin D 10% test group (DI), and Control group implants (CI). Block sections were obtained after 12 weeks and processed for mineralized ground sectioning. Bone-to-implant contact (total BIC), new bone formation (NBF), inter-thread bone (ITB), and histological linear measurements (HLM) were assessed. RESULTS: At 12 weeks, all implants were clinically stable and histologically osseointegrated. Total BIC values were 49.20 ± 3.26 for the MI group, 49.86 ± 1.89 for DI group and 45.78 ± 4.21 for the CI group (P < 0.018) with statistically significant difference between the three groups. BIC percentage were 42.44 ± 2.18 for MI, 44.56 ± 1.08 for DI, and 41.95 ± 3.34 for CI groups respectively (P > 0.05). Inter-thread bone formation values were MI 17.56 ± 2.01, for DI 19.87 ± 0.92, and CI 14.56 ± 1.24 (P > 0.05). Statistically significant differences in peri-implant new bone formation were found between the three groups: MI 28.76 ± 1.98, DI 32.56 ± 1.11 and CI 25.43 ± 4.67, respectively (P < 0.045). Linear measurements showed that the MI group showed significantly less lingual crestal bone loss (CBL) (MI 0.59 ± 0.71), compared to DI (0.91 ± 1.21) and CI (0.93 ± 1.21) (P < 0.042), and less lingual peri-implant mucosa (PIM) (MI 3.11 ± 1.34),(DI 3.25 ± 0.18 compared with CI 3.54 ± 1.81 (P = 0.429). Linear measurements of buccal CBL showed significantly less buccal bone loss in test DI (0.36 ± 0.12) than CI (1.34 ± 1.23) and MI (1.11 ± 1.38) (P = 0.078). CONCLUSIONS: Within the limitations of this animal study, topical applications of 5% Melatonin or 10% vitamin D improved bone formation around implants placed immediately after extraction and helped to reduce CBL after 12 weeks osseointegration.

Do topical applications of bisphosphonates improve bone formation in oral implantology? A systematic review.

BACKGROUND: The aim of this systematic literature review was to evaluate the feasibility of topical bisphosphonate application for preserving/enhancing alveolar bone in oral implantology. MATERIAL AND METHODS: An electronic search was conducted in the PubMed/Medline, EMBASE, Scopus, Web of knowledge, and Google-Scholar databases for articles dated from January 2000 to December 2016. Two reviewers assessed the quality of the studies independently. RESULTS: A total of 154 abstracts were identified, of which 18 potentially relevant articles were selected; a final total of nine papers were included for analysis. Comparison of the findings of the selected studies was made difficult by the heterogeneity of the articles, all of them animal research papers that showed heterogeneity in the methodologies used and a high or moderate risk of bias. CONCLUSIONS: The topical application of bisphosphonate solution would appear to favor new bone formation in alveolar defects, and boosts the regenerative capacities of biomaterials resulting in increased bone density.

Osseoinductive elements for promoting osseointegration around immediate implants: a pilot study in the foxhound dog.

OBJECTIVE: The aim of this study was to evaluate the effects of topical applications of melatonin over implant surfaces placed immediately after extraction by means of histological and histomorphometric analysis of peri-implant tissues. MATERIAL AND METHODS: Six American foxhound dogs were used in the study; mandibular premolar distal roots were extracted. Thirty-six immediate conical implants were randomly assigned to the distal site on each site of the mandible in three groups: (Group CI) 12 titanium implants alone; (Group MI) 12 titanium implants supplemented with melatonin; and (Group DI) 12 titanium implants supplemented with vitamin D (DI). Prior to implanting test, implants (MI) were submerged in melatonin 5% solution, and implants from (DI) group were submerged in vitamin D 10% solution. No treatment was applied at control implants. After 12 weeks, animals were sacrificed. Block sections were obtained and processed for mineralized ground sectioning. Bone-to-implant contact (total BIC), new bone formation (NBF), inter-thread bone (ITB) and histological linear measurements (HLM) were analyzed. RESULTS: At 12 weeks, all implants were clinically stable and histologically osseointegrated. Total BIC values were 48.36 ± 7.45* for the MI group and 44.82 ± 10.98 for the CI group (P = 0.035) with statistically significant difference between groups. BIC% were 41.36 ± 3.93 for MI and 41.34 ± 9.26 for CI (P > 0.05). Inter-thread bone formation values were MI 15.99 ± 2.43* and CI 14.79 ± 3.62 (P = 0.03), MI showing significantly better results. No statistically significant differences in peri-implant new bone formation could be found between the two groups: MI 25.37 ± 2.32, CI 26.55 ± 7.75 (P > 0.05). Linear measurements showed that the MI group showed significantly less lingual crestal bone loss (CBL) (MI 0.52 ± 0.74*, CI 0.92 ± 1.98) (P = 0.045) and less lingual peri-implant mucosa (PIM) (MI 3.13 ± 1.41*, CI 3.71 ± 1.81) (P = 0.042). No significant differences were observed in the buccal aspect. CONCLUSIONS: Within the limitations of this animal study, the topical application of melatonin improved bone formation around immediate implants and reduced lingual bone and lingual peri-implant mucosa, after 12 weeks of osseointegration.