The Association Between Suppuration on Palpation and Diagnosis of Peri-implantitis: A Cross-sectional Study.

PURPOSE: The aim of this study was to evaluate suppuration on palpation, used as a diagnostic test, in the detection of peri-implantitis. MATERIALS AND METHODS: A total of 65 patients with 267 implants were examined. Clinical inspection was performed by two blinded examiners: The first measured suppuration on palpation, and the second conducted a complete clinical examination. A third examiner combined the previously collected information with radiographic data and diagnosed the patients according to the European Federation of Periodontology/American Academy of Periodontology (EFP/AAP) classification system. Calibration was conducted previously to the fourth examiner on a set of five patients not belonging to the study sample. RESULTS: When suppuration on palpation was associated with diagnosis of peri-implantitis, the specificity and negative predictive value were high (88% and 84%, respectively), meaning that an implant that was negative to suppuration on palpation had a high chance of not being affected by peri-implantitis. Conversely, the sensitivity and positive predictive value were low (45% and 54%), demonstrating that a suppurating implant will be affected by peri-implantitis in only half of the cases. Area under the curve was calculated as 60.4 (P = .012), and accuracy was found to be 78%. CONCLUSION: Suppuration on palpation alone, as with any other clinical sign, does not allow a precise diagnosis of peri-implantitis. An implant without suppuration on palpation shows a high chance of being free of peri-implantitis, while an implant that suppurates upon palpation is not necessarily affected by peri-implantitis. Suppuration on palpation may be a valuable clinical sign, especially when evaluating implants that are difficult to examine via probing.

Full arch rehabilitation after failure of implants and teeth supporting an extensive fixed dental prosthesis: a staged approach.

The present clinical report describes athe treatment strategy for transition from of full-arch restorations supported, either partially or fully supported by failing implants that need to be removed. More specifically the staged approach proposes a deferred treatment sequence in which the failing implants or teeth are not all replaced simultaneously. On the contrary according to this technique, some failing natural or artificial abutments are preserved momentarily in order to maintain the patient with a fixed provisional restoration at all times throughout the execution of treatment, from the surgical phases until delivery of the final restoration. The present clinical report describes the staged approach in detail, compares it to other treatment options and illustrates all phases of therapy with a clinical case.

Influence of Bone Anatomy on Implant Placement Procedures in Edentulous Arches of Elderly Individuals: A Cross-Sectional Study on Computed Tomography Images.

PURPOSE: To describe the prevalence of alveolar bone atrophy in edentulous arches of elderly individuals in relation to insertion of dental implants and the eventual need for bone grafting procedures. MATERIALS AND METHODS: Computed tomography scan files of 228 edentulous arches of elderly patients (ages 65 to 100 years) were evaluated in relation to implant placement. Six measurements per arch were taken on cross-sectional reconstructions. Bone atrophy categories were described, in relation to implant placement, for the anterior and posterior sections of the arches. Six bone sections per arch were evaluated and allocated to the predetermined categories. Prevalence of each type of atrophy was calculated. RESULTS: In the maxilla, only 5.0% of the patients showed a bone anatomy capable of receiving implants without any augmentation both in the posterior and anterior regions; 64.4% showed the need for major reconstruction in both areas. In the mandible, 17.3% of the patients did not require any augmentation in both regions; 9.4% were in need of major reconstruction in both areas. The anterior part of the arches could eventually be treated without any bone augmentation in 10.9% of the maxillae and 72.4% of the mandibles, while minor augmentation was needed in 16.8% of maxillae and 15.8% of mandibles. CONCLUSION: Most edentulous elderly patients show some degree of alveolar bone atrophy. It is often feasible to insert implants in the anterior mandible to support a restoration. In most maxillary cases, alveolar atrophy calls for augmentation procedures in both the anterior and posterior areas. In elderly individuals, the anterior maxilla often shows bone deficiency interfering with simple implant placement procedures, thus also limiting the use of tilted implants.

Discrepancy between patient satisfaction and biologic complication rate in patients rehabilitated with overdentures and not participating in a structured maintenance program after 7 to 12 years of loading.

PURPOSE: There is a lack of studies reporting long-term prevalence of peri-implant diseases in patients rehabilitated with overdentures and not receiving maintenance, which is a common situation. The aim of this cross-sectional study was to evaluate the patient satisfaction and rate of biologic complications in patients rehabilitated at least 7 years before with mandibular/maxillary overdentures, who for personal or economic reasons decided not to participate in a structured supportive maintenance program. MATERIALS AND METHODS: Each of the patients filled out a health and dental history and a visual analog scale (VAS)-based satisfaction questionnaire; additionally, the patients received a clinical examination and a panoramic radiograph. The prevalence of periimplant diseases and the patient satisfaction were reported. Moreover, presumed risk indicators of peri-implant diseases and implant loss were tested through univariate analyses and multivariate, time-adjusted, logistic regressions. RESULTS: A total of 52 patients who received 63 overdentures on 252 implants were included. The included patients showed a high degree of satisfaction (mean VAS = 6.3; SD: 2.1) and very low discomfort rates and would repeat the type of rehabilitation (mean VAS = 6.99; SD: 2.6). The prevalence of peri-implantitis was 30.8% at patient level and 19.4% at implant level, while 23.1% of patients experienced implant loss at any time. A clear tendency toward increased prevalence of biologic complications after the eighth year of loading was noted. In loading time-adjusted regression analyses, bone-level implants were associated with a higher prevalence of recession with no/minimal inflammation (OR = 3.37; 95% CI: 1.16 to 9.77; P = .025), while the maxillary arch was associated with both severe peri-implantitis (OR = 4.18; 95% CI: 1.03 to 16.97; P = .046) and implant loss (OR = 9.27; 95% CI: 3.41 to 25.14; P = .000). CONCLUSION: Despite high levels of satisfaction, patients rehabilitated with overdentures not participating in a structured supportive schedule show high rates of biologic complications. For this reason, they should be strongly motivated, at the time of prosthesis delivery, to participate in a structured maintenance program.