Microbiological and clinical effects of adjunctive systemic metronidazole and amoxicillin in the non-surgical treatment of peri-implantitis: 1 year follow-up.

The aim of this study was to evaluate the effects of adjunct systemic antibiotic treatment with metronidazole (MTZ) and amoxicillin (AMX) in patients receiving non-surgical subgingival debridement (NSD) for peri-implantitis. Forty subjects presenting with at least one implant with severe peri-implantitis were randomized into an experimental group [treated with NSD plus MTZ (400 mg) and AMX (500 mg) three times a day for 14 days] and a control group treated with NSD plus placebo. Clinical parameters and submucosal biofilm profiles were evaluated up to 1 year post-treatment. Overall, both treatments improved clinical parameters over time. At 1 year, mean probing depth (PD), mean clinical attachment (CA) level and proportions of red complex pathogens did not differ significantly between the two groups. In addition, mean PD and CA changes to 1-year posttreatment did not differ significantly between the two groups between baseline and 1-year post-treatment. These results suggest that the addition of MTZ and AMX to the treatment protocol of patients undergoing NSD for with severe peri-implantitis does not improve the clinical and microbiological outcomes of NSD. The fact that half of the implants in both groups did not achieve clinical success (PD < 5 mm, no BoP, no bone loss) suggest that neither of the tested protocols were effective for treating severe peri-implantitis.

Microbiological and clinical effects of adjunctive systemic metronidazole and amoxicillin in the non-surgical treatment of peri-implantitis: 1 year follow-up

Abstract The aim of this study was to evaluate the effects of adjunct systemic antibiotic treatment with metronidazole (MTZ) and amoxicillin (AMX) in patients receiving non-surgical subgingival debridement (NSD) for peri-implantitis. Forty subjects presenting with at least one implant with severe peri-implantitis were randomized into an experimental group [treated with NSD plus MTZ (400 mg) and AMX (500 mg) three times a day for 14 days] and a control group treated with NSD plus placebo. Clinical parameters and submucosal biofilm profiles were evaluated up to 1 year post-treatment. Overall, both treatments improved clinical parameters over time. At 1 year, mean probing depth (PD), mean clinical attachment (CA) level and proportions of red complex pathogens did not differ significantly between the two groups. In addition, mean PD and CA changes to 1-year posttreatment did not differ significantly between the two groups between baseline and 1-year post-treatment. These results suggest that the addition of MTZ and AMX to the treatment protocol of patients undergoing NSD for with severe peri-implantitis does not improve the clinical and microbiological outcomes of NSD. The fact that half of the implants in both groups did not achieve clinical success (PD < 5 mm, no BoP, no bone loss) suggest that neither of the tested protocols were effective for treating severe peri-implantitis.

Enxerto autógeno Bone Ring e colocação concomitante de implante osseointegrável em região estética ­ relato de caso / Autogenous Bone Ring graft and concomitant placement of osseointegratable implant in an esthetic region ­ case report

A técnica denominada Bone Ring consiste no aumento vertical do rebordo alveolar através de anéis cilíndricos de osso autógeno ou aloplástico, os quais auxiliarão no ganho vertical tridimensional da crista óssea, favorecendo a estética da prótese, o ganho biomecânico, bem como a eliminação de tempo cirúrgico, uma vez que o implante e o enxerto podem ser instalados concomitantemente. O presente estudo apresenta um relato de caso clínico de uma paciente com complicações no canino superior esquerdo. Após insucesso na reabilitação protética com implante osseointegrável, optou-se pelo tratamento com o Bone Ring. A técnica mostrou-se um procedimento seguro e eficiente no caso em questão, otimizando a reabilitação protética funcional e estética (AU).

The Bone Ring technique consists of alveolar ridge vertical increase through cylindrical rings of autogenous or alloplastic bone, which will aid in the three-dimensional vertical gain of the bone crest, favoring prosthesis aesthetics biomechanical gain, as well as the elimination of surgical time, since the implant and the graft can be installed concomitantly. The present study presents a case report of a patient with complications in the upper left canine. After unsuccessful prosthetic rehabilitation with osseointegrable implant, the bone ring treatment was chosen. The technique proved to be a safe and efficient procedure in this case, optimizing functional and aesthetic prosthetic rehabilitation (AU).

Correção da extrusão dentoalveolar para carregamento imediato de implante dentário e uso concomitante do bloco removido para aumento horizontal na maxila: descrição de caso clínico / Correction of dentoalveolar extrusion for immediate implant loading with concomitant use of the grafted block for maxillary horizontal augmentation: case report description

A maxila atrófica anterior é um desafio na reabilitação estético-funcional em pacientes que perderam os dentes por traumatismos dentoalveolares, exodontias na infância, patologias e agenesias, resultando em deficiências horizontais e verticais, necessitando de regeneração óssea. O objetivo deste artigo foi relatar, em um caso clínico, a possibilidade de se utilizar o remanescente do nivelamento ósseo realizado na mandíbula em um enxerto de espessura na região de pré-maxila e posteriormente instalar dois implantes em um único estágio. Diminuindo assim o número de intervenções cirúrgicas

The atrophic maxilla is a challenge earlier in the functional aesthetic rehabilitation for patients who have lost teeth by: dento alveolar trauma, tooth extractions in childhood, disease and tooth agenesis, resulting in horizontal and vertical deficiencies, requiring bone regeneration. The objective of this paper is to report on a clinical case the possibility to use the remaining leveling performed in the jaw bone as a graft thickness in the region of the premaxilla and later install two implants in a single stage, thereby reducing the number of surgical interventions

Reposicionamento de implante mal posicionado pela técnica de distração osteogênica modificada / Repositioning of malpositioned implants by modified distraction osteogenesis technique

A reabilitação oral por meio da instalação de implantes dentários é um procedimento frequente na clínica odontológica, porém, falhas no planejamento podem levar a casos em que o implante, apesar de osseointegrado, não apresente condições funcionais e estéticas satisfatórias, devido ao seu mau posicionamento tridimensional. Este artigo relata um caso clínico de paciente insatisfeita com o resultado final da prótese devido ao mau posicionamento do implante. Foi realizada a técnica de distração osteogênica, associada à técnica de osteotomia segmentada, utilizando-se um distrator modificado tipo Be Flash, reposicionando o implante tridimensionalmente de forma correta

The oral rehabilitation by dental implants is a common procedure in dental practice, but failure on planning can lead to cases where the implant, even though osseointegrated, has no satisfactory functional and aesthetic conditions due to its malpositioning in three dimensions. This case report shows a dissatisfied patient with the final implant result due to 3D malpositioning. Distraction osteogenesis (Be Flash) along with segmented osteotomie was applied to repositioning the implant in a proper relationship

Proposta de confecção da prótese protocolo nas cargas imediatas de implantes instalados por cirurgia guiada / A protocol for immediate-guided, implant-supported fixed prosthesis

Fundamentado em duas premissas, a saber: a) a posição do implante deve ser rigorosamente compatível com a reabilitação protética; b) o planejamento prévio e a exata transferência transoperatória são as chaves do sucesso em Implantodontia; este estudo buscou o emprego de imagens obtidas por tomografia computadorizada e a possibilidade de posicionar os implantes dentro do campo virtual 3D, e transferir essa resolução para o campo real através de cirurgia guiada. Apresentamos uma proposta de carga imediata com o uso de uma barra segmentada pré-fundida adaptada sobre os implantes colocados com cirurgia guiada.

Based on two premises: a) that the implant should be strictly compatible with the prosthetic rehabilitation and b) preplanning and intraoperative exact transfer are the keys to success, this study used computerized tomography images for placing implants inside the virtual 3-D plane, while transferring this resolution to the real scenario through a guided-surgery procedure. We propose the use of a precast segmented bar for immediate loading, adapted on the implants placed with guided surgery.

Influence of direct laser fabrication implant topography on type IV bone: a histomorphometric study in humans.

The aim of this histologic study was to evaluate the influence of the direct laser fabrication (DFL) surface topography on bone-to-implant contact (BIC%), on bone density in the threaded area (BA%) as well as bone density outside the threaded area (BD%) in type IV bone after 8 weeks of unloaded healing. Thirty patients (mean age 51.34 +/- 3.06 years) received 1 micro-implant (2.5-mm diameter and 6-mm length) each during conventional implant surgery in the posterior maxilla. Thirty micro-implants with three topographies were evaluated: 10 machined (cpTi); 10 sandblasted and acid etched surface (SAE) and 10 DFL micro-implants. After 8 weeks, the micro-implants and the surrounding tissue were removed and prepared for histomorphometric analysis. Four micro-implants (2 cpTi, 1 SAE and 1DLF) showed no osseointegration after the healing period. Histometric evaluation indicated that the mean BIC% was higher for the DFL and SAE surfaces (p = 0.0002). The BA% was higher for the DFL surface, although there was no difference with the SAE surface. The BD% was similar for all topographies (p > 0.05). Data suggest that the DFL and SAE surfaces presented a higher bone-to-implant contact rate compared with cpTi surfaces under unloaded conditions, after a healing period of 8 weeks.

Histologic analysis of human peri-implant bone in type 1 osteoporosis.

Osteoporosis is a disease that influences the quality of bone tissue. At present, osteoporosis represents a contraindication or a risk factor for osseointegration. The aim of this report was to evaluate the bone-to-implant contact of 2 loaded implants retrieved after prosthetic failure in a woman with type 1 osteoporosis. Histologically, only one implant was osseointegrated, and it appeared surrounded by healthy bone tissue. The bone-to-implant contact presented a mean of 51.25%. No foreign body reaction was found at the bone-to-implant contact, although epithelial downgrowth was observed at the interface. Data from this case report demonstrate that the peri-implant bone histology of the dental implant retrieved from an osteoporotic patient presented no alteration. However, the role of osteoporosis in the long-term success of dental implants needs further investigation.

Microbiologia das doenças periimplantares: revisão de literatura / Microbiology of peri-implant diseases: literature review

Vários estudos longitudinais têm reportado uma alta taxa de sucesso da utilização de implantes osseointegrados no tratamento reabilitador. Entretanto, outras investigações têm mostrado a perda de implantes osseointegrados por causa de infecções periimplantares ou trauma oclusal. A periimplantite é caracterizada pela presença de reações inflamatórias que afetam o tecido periimplantar sob função. Indivíduos portadores de periimplantes são colonizados por patógenos periodontais como Porphyromonas gingivalis, Tannerella forsythia, Fusobacterium nucleatum e Treponema denticola, enquanto sítios periimplantares sadios são colonizados por cocos Gram-positivos.

Longitudinal studies have reported a high success rate for rehabilitating treatment through the use of osseointegrated implants. However, other studies have reported osseointegrated implant failure due to peri-implant infections or occlusal overload. Peri-implantitis is characterized by the presence of inflammatory reactions that affect the peri-implant tissue under loading. Subjects with peri-implantitis harbor periodontal pathogens such as Porphyromonas gingivalis, Tannerella forsythia, Fusobacterium nucleatum and Treponema denticola while healthy peri-implant sites harbor cocos Gram-positives.