Simultaneous implant placement and restoration with guided bone regeneration in the mandibular anterior region.

BACKGROUND: Restoring the mandibular anterior teeth by implants can be difficult due to potential complications arising from using prosthetic implant connections that are larger than the incisors at the cementoenamel junction level. METHODS: This retrospective study is aimed at determining the survival and esthetic outcomes of anterior mandible implants immediately placed and restored in patients diagnosed with stages 3-4 periodontitis. The study included 75 implants that were inserted along with guided bone regeneration in 42 patients. Over a follow-up period of 3 to 8 years (mean of 6.95 ± 1.78 years), the study evaluated esthetic, marginal bone loss (MBL), and biological and prosthetic complications. RESULTS: No failures were recorded during the follow-up period; after eight years, the survival rate was 100%. Patient's age and gender did not have a statistically significant impact on MBL, but smokers had a greater MBL than non-smokers at the 8-year (2.98 mm vs. 1.23 mm, respectively, p = 0.016) time-point. At 3 years, only 13.3% of the implants had mesial papillae, 36.0% had distal papillae, and 16.0% had the cervical metallic part of the abutment exposed. Peri-implantitis was diagnosed in 20.7% of the patients at the 8-year follow-up time. CONCLUSIONS: Based on the limitations of this study, immediate placement and restoration of the mandibular incisors can be a feasible procedure, but only a few implants achieved the complete restoration of the papillae.

Radiographic signs of excessive occlusal forces are associated with marginal bone loss: a retrospective clinical study.

OBJECTIVES: Work in animal models has implicated excessive occlusal forces and occlusal trauma as co-destructive factors for periodontitis. The main aim of the present study was to make a radiographic assessment of the effects of excessive occlusal forces, ie occlusal/incisal tooth wear, widening of the periodontal space, and the presence of a mandibular torus, on interproximal marginal bone loss in a large series of patients. A secondary aim was to evaluate the statistical correlation between the parameters in two specific teeth and those of 12 teeth for marginal bone loss and six teeth for occlusal/incisal tooth wear within the same individual. METHOD AND MATERIALS: A total of 1,950 full-mouth radiographic surveys were analyzed retrospectively. Interproximal marginal bone loss was quantified relative to the root length (Schei ruler technique). In addition, occlusal/incisal tooth wear and periodontal ligament space widening of the periodontal space were assessed, as well as the presence of a mandibular torus. Odds ratio and logistic regression analysis were used to determine the association between occlusal trauma and marginal bone loss. RESULTS: The correlation of the measured parameters between the values for specific teeth and the whole dentition was evaluated from data from the first 400 radiographs. Teeth 41 and 33 showed the best correlation to the whole dentition: 0.85 for interproximal marginal bone loss, 0.83 for widening of the periodontal space, and 0.97 for occlusal/incisal tooth wear. The results of a logistic regression analysis with age as an independent variable, revealed a significant association between bone loss and both tooth wear (odds ratio = 2.767) and bone loss and widening of the periodontal space (odds ratio = 2.585). CONCLUSION: Tooth wear was positively correlated to both widening of the periodontal space and marginal bone loss. No correlation was found between the presence of a mandibular torus and marginal bone loss.

Effect of alveolar ridge preservation on peri-implant mucositis and peri-implantitis prevalence: A multicenter, cross-sectional study.

OBJECTIVES: Alveolar ridge preservation (ARP) is a procedure with the aim to reduce bone resorption that occurs after tooth extraction, facilitating the following implant placement. The aim of this cross-sectional study was to evaluate the prevalence of mucositis and peri-implantitis around implants inserted in sites treated with ARP and to investigate possible risk factors. MATERIALS AND METHODS: Patients who received at least one dental implant inserted in a grafted socket were considered eligible for this study. Patients were recalled for a follow-up visit; medical history, clinical and demographic data were collected. Univariate logistic regression analyses have been performed for both implant-level and patient-level variables. Indeed, moderation analysis was used to investigate the indirect relationship between age and marginal bone level. RESULTS: Fifty-one patients who received 61 implants were enrolled in this cross-sectional study. Thirty-three implants were classified as "healthy" (54.1%), 23 implants showed signs of peri-implant mucositis (37.7%), and 5 implants were diagnosed with peri-implantitis (8.2%). Data analyzed at the patient level showed that 49% of the patients were healthy, 45.1% of the patients had mucositis and 5.9% of the patients were affected by peri-implantitis. Mandibular sites and type III grafted sockets showed a significant association with peri-implantitis; in addition, a history of periodontitis and an increase in age showed higher risks of developing mucositis or peri-implantitis. CONCLUSIONS: Implants inserted in grafted sockets showed favorable rates of healthy implants in the long term. CLINICAL RELEVANCE: The ridge preservation procedures do not seem to increase the risk of developing mucositis or peri-implantitis.

Effect of posterior implant restorations on adjacent teeth and tissues: A case-control study.

INTRODUCTION: Dental implants are an artificial substitute for extracted or missing teeth in the oral cavity and are valuable for improving dental health and quality of life. While many studies on implants can be found, few studies examine their effects on adjacent teeth and tissues. The study aimed to examine complications of teeth adjacent to dental implants in the posterior region. METHODS: In this retrospective case-control study, clinical data of patients treated with implants in the posterior segment were extracted from the medical records in a single community dental clinic between January 9, 2010 and January 9, 2020. The patients were examined clinically and radiographically every 6 months. Data on the adjacent teeth to the dental implants were collected and divided into two groups, complications ("study group") versus no-complications ("control group"). Multivariate logistic regression analysis was performed to find a possible correlation between the complications and the variables checked, followed by checking specific variables in the complication group. RESULTS: A total of 1072 patients were included in the study. There were 179 patients (16.7%) with complications in adjacent teeth, while 893 patients had no documented complications. Predisposing factors for secondary caries were smoking (OR = 2.2, CI = 1.3-3.8) and a higher number of implants (OR = 1.6, CI = 1.1-2.5). Tooth crack and tooth fracture were analyzed together and found to be related to osteoporosis (OR = 8.9, CI = 2.9-27.6), whereas males were more prone to teeth fracture (OR = 2.8, CI = 1.1-7.4). Tooth mobility was related to a higher number of implants (OR = 16.5, CI = 3.7-73.8). Further analyzing the complication group solely, there was a statistical significance for age in primary caries and tooth mobility (p = 0.045). In addition, a higher number of implants was more prevalent with tooth mobility (p = 0.002), wider implant platform was more significant with primary caries (p = 0.012), and periodontal Stage III was more prone to tooth mobility (p < 0.001). The distance between the implant and adjacent tooth was also statistically significant-close proximity with tooth mobility and high distance with dental caries (p = 0.04). CONCLUSIONS: We found a relatively high rate of complications in teeth adjacent to dental implants. Secondary caries was the most common complication. Good understanding and proper position of the implants is essential to avoid adjacent teeth complications.

The Effect of Proton Pump Inhibitors on Early Implant Failure A Retrospective Cohort Study.

Background and Objectives: Maintenance of a firm and long-term stable osseointegration is the primary goal of implant dentistry. Time is used to define implant failure characteristics. Early implant failure (EIF) occurs up to one year after loading. Recent studies indicated an association between proton pump inhibitors (PPI) therapy and failure of osseointegration. The present study assessed whether the use of PPIs is a risk factor to EIF. Materials and methods: A retrospective cohort study including 687 patients and 2971 dental implants. The study group (PPIs users) comprised 17.3% (119) individuals and 18.7% (555) implants. The remaining cohort (82.7% (568) individuals and 81.3% (2416) implants) served as control. The information was taken from the patients' files. The following information was collected: age, gender, physical status, systemic diseases, HbA1C values before and after implant-supported prosthesis delivery in cases of diabetes mellitus, smoking, implant location, number of implants per individual, bone augmentation, implant brand, length and width, and EIF. EIF was defined as implant removal within a period of up to 12 months from loading. Results: EIF in PPIs vs. non-PPIs users was 19.3% vs. 14.3% (p = 0.16) at patient level and 5.4% vs. 3.5% at implant level (p = 0.03). Univariate analysis yielded factors significantly associated with PPIs use, including older age, physical status of the American Society of Anesthesiology (ASA) 3, hypertension, hyperlipidemia, diabetes mellitus, osteoporosis, cardiovascular accident (CVA), location (anterior mandible), shorter and narrower implants, and higher number of implants per individual. Multivariate analysis yielded statistically significant OR of 1.91; p = 0.01 for EIF following PPIs use and 2.3; p < 0.001 for location in anterior mandible. Conclusions: Patients and their healthcare providers are advised to carefully consider the potential risks of taking PPIs prior to dental implant surgery. Further research is needed to confirm these risks and elucidate systemic and local factors that may be involved in such outcomes.

The Impact of Corticosteroid Administration at Different Time Points on Mucosal Wound Healing in Rats: An Experimental Pilot In Vivo Study.

Background: Conflicting results were found regarding the effect of corticosteroid (CS) administration upon wound healing. The objective of this pilot study was to evaluate the impact of CS administration at different time points on palatal wound healing in rats. Methods: A 4.2 mm diameter punch created a secondary healing excisional palatal defect in thirty-six (36) Wistar-derived, two-month-old male rats weighing 250-270 g. We evaluated the effect of CS by comparing wound healing between three equal groups: 12 rats who were not exposed to CS and two additional groups in which 1 mg/kg dexamethasone (1 mg/kg) was administered daily, early (1-4 days) and late (5-9 days) after injury. The dynamics of the healing process were evaluated weekly in 4 sacrificed rats from each group for three weeks. The wound area was assessed both macroscopically and microscopically; the inflammation score was assessed microscopically. Results: The initial wound area in all the rats was 13.85 mm2. At the end of the study, it decreased to 4.11 ± 0.88 mm2, 7.32 ± 2.11 mm2, and 8.87 ± 3.01 mm2 in control, early, and late CS administration groups, respectively (p = 0.075). Inflammation scores showed a tendency to decrease in the third week in all groups, with no statistical differences. Conclusions: Our findings do not support the positive impact of CS administration on palatal wound healing. While microscopically, we found no difference between the CS and control groups, CS exposure was associated with a macroscopically larger final wound area, reflecting a possible harmful effect of CS.

Oral and Dental Considerations of Combat-Induced Post Traumatic Stress Disorder (PTSD)-A Cross-Sectional Study.

Objective: This study compared dental, periodontal, oral, and joint/muscle tenderness among Israeli combat-induced post-traumatic stress disorder (Ci-PTSD) war veterans to non-PTSD patients. Study design: This retrospective three-arm study compared oral and facial manifestations between 100 Israeli veterans with Ci- PTSD (study group) and 103 non-PTSD periodontal patients (Control group). The study group was further divided into two subgroups of individuals who received psychiatric medications (40 patients) or did not (60 patients). All patients underwent complete dental, oral, and periodontal examinations, including assessing signs of parafunction. Results: All PTSD patients had poor oral hygiene. The plaque index (PI) was higher in the PTSD group compared to the control group (0.72 ± 0.28 vs. 0.45 ± 0.29, respectively, p < 0.001). The decayed, missing, and filled teeth score (DMFt) was higher in the PTSD population than in the controls (19.97 ± 8.07 vs. 13.05 ± 6.23 p < 0.05). Severe periodontal disease was more common among the PTSD subgroup taking medications (med -group) (62.5%) compared to the nonmedicated group (non-med group) (30.0%) and the controls (27.2%) (p = 0.001). Heavy smoking was more prevalent in the medicated PTSD patients than in other groups. Conclusions: The present study shows higher morbidities in combat-induced PTSD patients, including oral, dental, and periodontal manifestations, especially in medicated patients.

Incidence and nature of claims against dental practitioners for dental implant treatment in Israel between 2005 and 2015.

PURPOSE: In recent years, dental malpractice claims have increased dramatically worldwide. The present study aimed to categorise and analyse claims related to implant dentistry that resulted in legal decisions in Israel, seeking to contribute to dental risk management and improve patient safety. MATERIALS AND METHODS: This study analysed legal claims registered by Medical Consultants International between 2005 and 2015. Only closed cases in which a decision was made were included. The parameters studied included patient age and sex, date of the complaint, treatment setting (private/public clinic), description of the adverse event and type of negligence claimed. RESULTS: The cohort included 709 settled claims out of a total of 1066 that were litigated against dental practitioners in Israel during the study period. Of the patients included, 60.0% were women and 63.9% were aged 40 to 59 years. The most common treatment-related damage was neural injury in 133 patients (18.7% of the cohort). Unplanned changes in the treatment plan and violation of autonomy were the most frequent documentation-/information-related claims (66.3% and 32.7%, respectively). The legal responsibility of the dental practitioner was acknowledged in 89.0% of cases. Dental practitioners working in the private sector were more likely to be sued due to violation of autonomy than those working in public clinics. CONCLUSIONS: Although the main cause for lawsuits was actual bodily injury, the high percentage of documentation-/information-related malpractice claims calls for increased awareness of patients' autonomy and rights. Practitioners should dedicate a significant part of the entire treatment time to preoperative diagnosis and planning.

The Incidence and Nature of Claims against Dentists Related to Periodontal Treatment in Israel during the Years 2005-2019.

BACKGROUND: In recent years, worldwide dental malpractice claims have dramatically increased. The purpose of the present study is to analyze periodontal therapy related claims in Israel that led to legal decisions. METHODS: This retrospective cohort study includes malpractice claims against dental practitioners related to periodontology between 2005 and 2019. Only closed cases where a final decision was made were included. The chi-square test or Fisher exact test for categorical variables were performed and a p value of <0.05 was considered statistically significant. RESULTS: During the study period there were 508 legal claims related to periodontal disease. Most plaintiffs were women (63.4%), and 71.3% of the patients were >35 years old. Most claims (82.8%) were settled out of court and ended in compromise. Claims concerning the treatment of periodontal disease by periodontists accounted only for 4.5% (23/508) of the cases while 95.5% (485/508) of the claims were for complications secondary to another treatment. Prosthodontic treatment was involved with the highest number 54.5%, followed by dental implants 17.7%, and endodontics 11.6%. The allegations were related to pain and distress (84.8%), aggravation of existent periodontal disease (83.3%), tooth loss (78.1%), and violation of autonomy (47%). CONCLUSIONS: The main cause for lawsuits was related to aggravation of periodontal disease during prosthetic or implant therapy and related to suspected faulty or inexistent preoperative diagnosis and planning. PRACTICAL IMPLICATIONS: Periodontal consultation before dental treatment may reduce malpractice risks, adverse events, and un-necessary changes of treatment plans.

The Incidence and Nature of Malpractice Claims against Dentists for Orthodontic Treatment with Periodontal Damage in Israel during the Years 2005-2018-A Descriptive Study.

In recent years, dental malpractice claims have increased dramatically worldwide. The purpose of the present study is to analyze claims related to orthodontic treatment involving periodontal problems that resulted in legal decisions in Israel. This study analyzed legal claims registered by Medical Consultants International (MCI) between 2005 and 2018. Only closed cases of orthodontic claims involving periodontal problems in which a decision was made were included. The parameters studied included patients' demographic data, the main reasons of the claim, and complications. Statistical significance was found for aesthetic damage, which was more common in claims of females (p = 0.035) and in older claims (p = 0.004); tooth damage was more common in claims of older patients (p = 0.032); violation of autonomy was higher in private practice (p = 0.047) and in more recent claims (p = 0.001). As orthodontic treatment is becoming more popular in older patients, and as lawsuit claims become more common in recent years, the orthodontists should always analyze and document the periodontal status of their patients before and during treatment in order to maintain professional practice and avoid future claims.

Oral and dental considerations of combat-induced PTSD: a descriptive study.

OBJECTIVE: Stress experienced as an intense and traumatic event can increase the odds of orofacial morbidities that may affect oral, periodontal, or masticatory system health. The aim of this study was to evaluate the dental, periodontal, oral, and bruxism situation among Israeli posttraumatic stress disorder (PTSD) war veterans. METHOD AND MATERIALS: This retrospective cohort pilot study aimed to examine the oral and facial manifestations in 71 Israeli veterans with combat PTSD. All patients underwent full dental, oral, and periodontal examination. Signs of parafunctional activity were also evaluated, accompanied by a full set of periapical and/or panoramic radiographs. RESULTS: The patients were 37 to 77 (mean 60.7 ± 10.15) years of age and presented a poor overall oral hygiene status (Plaque Index 0.75 ± 0.26). All patients (100.0%) suffered from periodontal disease, and most of them (66.0%) were severely affected. A significant correlation was found between signs of parafunctional activity and severe periodontal disease (P = .035). The patients had a high decayed, missing, and filled teeth (DMFT) score (20.06 ± 8.86), which was mainly attributed to the large number of "filled" (F) teeth (11.95 out of 20.06). The DMFT score was significantly lower among light smokers than among heavy, former, or nonsmokers (P = .012). Most patients (90%) had signs and symptoms of parafunctional activities. A significant positive and dose-dependent correlation was found between smoking and periodontal disease (P = .012). CONCLUSIONS: An association was found between combat PTSD and oral, dental, and periodontal morbidity.

Treatment of peri-implantitis using multiple applications of chlorhexidine chips: a double-blind, randomized multi-centre clinical trial.

BACKGROUND: Universal strategies for managing peri-implantitis are yet to be adopted. The aim of this study is to examine a protocol of intensive application of chlorhexidine containing chips in sites with peri-implantitis. MATERIALS AND METHODS: This multi-centre, randomized, double-blind, parallel, two-arm clinical trial included 60 patients (77 implants) with probing depth (PD) 6-10 mm and bone loss ≥2 mm around 1-2 implants. One to two weeks following SRP, baseline measurements were made followed by implants' debridement. Patients were randomized to receive matrix chips (MatrixC) or chlorhexidine Chips (PerioC). Measurements and chips placement were repeated at weeks 2, 4, 6, 8, 12 and 18. At 6 months, patients returned for final examination. RESULTS: Probing depth reduction was greater in the PerioC (2.19 ± 0.24 mm) compared with MatrixC (1.59 ± 0.23 mm), p = 0.07. Seventy percentage of the implants in the PerioC and 54% in the MatrixC had PD reduction ≥ 2 mm. Likewise, 40% of the sites (PerioC) and 24% (MatrixC) had PD reduction ≥ 3 mm. Clinical attachment level gains for both groups were significant; however, the changes in the PerioC group were significantly greater than in MatrixC [2.21 ± 0.23 mm. and 1.56 ± 0.25 mm respectively, p = 0.05]. Bleeding on probing was reduced by half in both groups. CONCLUSION: Frequent placement of PerioC and MatrixC together with implants debridement resulted in a substantial improvement in sites with peri-implantitis. Further studies will be required to fully appreciate the mechanism of this treatment.

Dental implants in patients with type 2 diabetes mellitus: a clinical study.

PURPOSE: Systemic factors, such as diabetes mellitus, can influence the success rate of dental implants. The authors describe their experience using the MIS implant system (Medical Implant System, Shlomi, Israel) for retention of overdentures in patients with type 2 diabetes mellitus and provide data regarding the level of satisfaction of the patients, the improvement of function, mucosal and periimplant health, and bone level around implants in this group. METHODS: The study group consisted of 41 patients with type 2 diabetes mellitus who received 141 implants for retention of overdentures. RESULTS: The success rate was 97.3% and 94.4% 1 and 5 years following implantation, respectively. The majority of patients reported improvement of function following the new treatment. A high correlation was observed between mucosal health and improvement of function. No correlation was found between failed implants and glucose level. CONCLUSION: The clinical outcome of dental implants in a selected group of patients with well-controlled type 2 diabetes mellitus is satisfying and encouraging. Further investigations and clinical trials over a longer period of time are needed to determine the long-term survival of implants in diverse groups of patients with diabetes mellitus.

Fracture of dental implants: literature review and report of a case.

Fracture of dental implants is a rare phenomenon with severe clinical results. In this article, the literature is reviewed and various causative factors that may lead to fracture are presented. Galvanic activity has not been mentioned before as a possible cause for implant fracture, yet, it can occur at the level of contact with the superstructure. This is illustrated by the case of a titanium implant restored with a non-precious porcelain-fused-to-metal cemented crown that fractured 4 years after loading. The radiographs show alveolar bone resorption around the fixture. Metallurgical analysis of the implant indicated that the fracture was caused by metal fatigue and that the crown metal, a nickel-chromium-molybdenum alloy, exhibited corrosion. These findings suggest a new explanation for implant fractures; cytotoxic nickel ions, leaching from the base metal alloy may cause bone resorption. This in turn leads to increased mobility, facilitating washout of the luting cement. Contact of the base metal with titanium in the presence of oral fluids produces galvanic currents that hasten corrosion and leaching out of nickel ions, thus leading to further bone resorption. Loss of bone support allows lateral bending moments that cause metal fatigue, eventually leading to fracture. Therefore, good treatment planning and appropriate case selection might have prevented this fracture. Furthermore, the use of nonprecious metal alloy for the crown's infrastructure had further contribution to the chain of events that led to the implant's fracture.