Clinical practice guideline of the spanish society of oral surgery for oral surgery in patients with coagulation disorders / Guía de práctica clínica de la sociedad española de cirugía bucal para cirugía oral en pacientes con trastornos de la coagulación

Background: The number of patients treated with coagulation disorders, and more specifically with anticoagulanttherapy, has increased worldwide in recent years due to increased life expectancy in developed countries. Theprotocols for managing this type of patient in oral surgery has varied over recent years, especially after the appear-ance of new direct-acting oral anticoagulants (DOACs). The assessment of risk of bleeding in this type of patientwhen undergoing a surgical procedure continues to be a controversial issue for patients, dentists and general prac-titioners. The objective of this document is to offer recommendations, based on evidence, for decision making forpatients with coagulopathies who require dental surgical intervention. Material and Methods: Based on the indications of the “Preparation of Clinical Practice guidelines in the NationalHealth System. Methodological manual”, we gathered a group of experts who agreed on 15 PICO questions basedon managing patients with coagulation disorders in dental surgical procedures, such as fitting of implants or dentalextractions.Results: The 15 PICO questions were answered based on the available evidence, being limited in most cases due tothe lack of a control group. Two of the PICO questions were answered by the experts with a grade C recommendation,while the rest were answered with grade D.Conclusions: The results of this review highlight the need to undertake well designed clinical trials with controlgroups and with a representative sample size.(AU)

Comparison of patient-centered outcomes measures between low-speed drilling without irrigation and high-speed drilling with irrigation: A randomized clinical trial.

OBJECTIVE: To compare patient satisfaction during surgery, postoperative pain and inflammation and quality of life between high-speed drilling with irrigation and low-speed drilling without irrigation for implant bed preparation. MATERIALS AND METHODS: Sixty-six posterior single edentulous patients were included in a randomized controlled clinical trial. Implant beds were created using high-speed drilling with irrigation (control group) or low-speed drilling without irrigation (test group). Patient satisfaction during surgery (in relation to drilling-time perception, vibration, pressure, noise, comfort, and drowning sensation) and postoperative pain and inflammation were evaluated using a 100-mm visual analogue scale (VAS)-based questionnaire. Quality of life was analyzed with a Likert scale (in relation to mouth opening, chewing, speaking, sleeping, daily routine, and job). The follow-up period was 7 days. RESULTS: Patient satisfaction in relation to drilling-time perception, vibration, pressure, and noise did not show statistically significant differences (p > .05). The highest scores of drowning sensation (p < .05) were correlated (moderate correlation (r = .57)) with lowest scores of comfort (p < .005). Both postoperative pain and inflammation means were significantly higher in the control group than in the test group. No significant differences in quality of life were observed during the postoperative period (p > .05). CONCLUSION: Low-speed drilling without irrigation for single implant site preparation was more comfortable for patients than high-speed drilling with irrigation, due to the correlation between important drowning sensation and low perceived comfort. Postoperative pain and inflammation were lower for low-speed drilling without irrigation. Further studies are needed to validate or refute these results.

Influence of abutment shape on peri-implant tissue conditions: A randomized clinical trial.

OBJECTIVE: To analyze the influence of 3-mm high abutments with different shapes (cylindrical abutment vs. wide abutment) on marginal bone-level changes (bone loss and bone remodeling). The influence of abutment shape on implant success, probing pocket depth (PPD), and bleeding on probing (BoP) was studied as secondary objectives. MATERIALS AND METHODS: Patients with a partially edentulous area requiring fixed dental prostheses by two implants in the posterior mandible or maxilla were included. The implants were 1 mm subcrestally placed, and osseointegration healing was submerged. Three-mm high abutments with two different shapes were randomly placed in second-stage surgery: cylindrical abutments (cylindrical group) and wide abutments (wide group). Marginal bone-level changes were measured using parallelized periapical radiographs at abutment placement, at definitive prosthesis placement, and at 1, 3, 6, and 12 months after loading. PPD and BoP were likewise measured at the control visits. RESULTS: Sixty-four dental implants in 25 patients were included. Statistically significant differences were found in bone-level changes. The cylindrical group exhibited less mean marginal bone remodeling (MBR) and marginal bone loss (MBL) than the wide group (p < .05). Moreover, the cylindrical group showed significantly less BoP (p < .05). CONCLUSION: Abutment shape had a significant influence upon marginal bone-level changes during the first 12 months. Cylindrical abutments caused less MBR and MBL than wide abutments. More clinical studies involving longer follow-ups and analyzing other abutment modifications are needed to improve our understanding of how abutments can affect peri-implant tissue stability.

A clinical protocol for immediate dental implant placement in post-extraction-infected sites decontaminated with Er,Cr:YSGG laser.

BACKGROUND: Placement of dental implants into fresh extraction sockets offers some advantages, such as reduced treatment times and enhanced patient comfort. The Er,Cr:YSGG (Erbium, Chromium-doped: Yttrium, Scandium, Gallium, and Garnet) laser can significantly reduce bacterial concentration after the extraction of a compromised tooth. The aim of this article is to provide a clinical protocol for the management of implants placed in infected extraction sites decontaminated with Er,Cr:YSGG laser. METHODS: A compromised tooth, which was an abutment for a fixed bridge, with clinical and radiological signs of infection was extracted. The infected site was treated and decontaminated with an Er,Cr:YSGG laser device (Biolase iPlus®) and two implants (Straumann®) were placed in the same surgery, in order to rehabilitate the edentulous area. The intervention was completed by tissue regeneration with biomaterials. RESULTS: Prosthetic rehabilitation after the surgical phase allowed us to provide correct function and satisfactory esthetics. In the follow-up visit, clinicians found good tissue healing and did not observe any complications, such as implant loss or peri-implantitis. The technique used in our study is repeatable and predictable, but patient selection is very important for this type of protocol as the presence of contraindications can lead to failure. The photoacoustic effect exerted by this type of laser has been proven to be effective against many pathogens. Several authors have previously demonstrated the effectiveness of this technique. CONCLUSIONS: Immediate implantation in infected sites decontaminated with Er,Cr:YSGG laser does not seem to contribute to an increased risk of failure; however, it is necessary to follow a certain set of protocols and procedures to prevent peri-implantitis and other complications.

Influence of Splint Support on the Precision of Static Totally Guided Dental Implant Surgery: A Systematic Review and Network Meta-analysis.

Purpose: To assess the accuracy of totally guided implant placement with static surgical splints in relation to the different types of supporting tissues (tooth, mucosa, or bone). Materials and Methods: This review was carried out following the PRISMA guidelines. An electronic search was done of the MEDLINE (PubMed), Embase, and Cochrane Library databases, without publication year or language restrictions. Results: The literature search yielded a total of 877 articles; 18 were included in the qualitative synthesis, and 16 of these articles were included in the quantitative analysis. The included studies presented a high risk of bias, except for one randomized clinical trial. The strength of the recommendations is therefore weak. In the angular deviation treatment, statistically significant differences were observed in the accuracy of the implants with tooth vs bone support: Bone support yielded 1.31 degrees greater deviation vs tooth support (SD = 0.43; 95% CI: 0.47, 2.15, P = .002). No significant differences were observed in the linear deviations. Conclusion: Tooth support proved to be significantly more precise than bone support splints. There were no differences referring to horizontal coronal deviation, horizontal apical deviation, or vertical deviation according to the type of splint support used.

Immediate dental implant placement in post-extraction-infected sites decontaminated with Er,Cr:YSGG laser: a retrospective cohort study.

Dental implants placed in fresh extraction alveoli provide several advantages, including shorter treatment periods and improved patient comfort. After a compromised tooth extraction, the Er,Cr:YSGG laser can considerably reduce bacterial concentration. The objective of this controlled study conducted after at least 1 year of follow-up was to compare the use of immediate post-extraction implants in infected sites treated with laser (test group) versus conventional implants in edentulous sites (control group) through an analysis of pre- and post-operative radiographs. The study was based on a series of patients treated between 2014 and 2019, with a 1-year minimum follow-up, and up to over 4 years. An analysis of the clinical history of the treated patients and pre- and post-operative radiographs was performed to evaluate the implant success and to measure the marginal bone level (MBL). Overall, 149 implants were studied. There was only one failure in the test group (1%) and no failures in the control group. The test group gained 0.1 mm of the MBL compared to the baseline, while the control group lost 0.1 mm of the MBL. The difference between the two groups of only 0.2 mm was not statistically significant (P = 0.058). Immediate dental implants in infected sockets debrided and decontaminated using Er,Cr:YSGG laser do not appear to enhance the likelihood of failure; however, peri-implantitis and associated problems must be avoided by following a certain set of protocols and procedures.

The study of bone healing after endodontic microsurgery using cone beam computed tomography: A retrospective cohort study.

Background: The main aims of this study were to evaluate mean volume reduction, radiographic healing rate and healing outcome two years after endodontic microsurgery. The effects of certain preoperative clinical factors upon preoperative volume, volumetric changes and healing outcome were also studied. Material and Methods: A clinical database was searched for patients who had undergone endodontic microsurgery and with the availability of a cone beam computed tomography (CBCT) scan preoperatively and after a control period. Volumetric analysis of the periapical area was made to assess volumetric reduction. The modified Penn 3D criteria were applied. The relationship between preoperative volume, volumetric reduction and healing outcome and certain preoperative factors was also studied. Results: Fifty-seven cases were evaluated. Initially, the bone cavities had a median volume of 163.2 mm3, and this volume decreased by 147.7 mm3 after treatment, with a radiographic healing rate of 6.2 mm3 per month. After applying the modified Penn 3D Criteria, 53 cases were classified as successful healing (93%). Regarding the influence of the different preoperative factors, patient age and sex, dental arch and cortical bone significantly influenced preoperative volume, while only the dental arch exerted a significant influence upon volumetric changes and preoperative symptoms on healing outcome. Conclusions: The CBCT data evidenced a significant volume reduction of 79.1%, with a monthly volume reduction rate of 6.2 mm3. The success rate obtained was 93%. Patient age and sex, dental arch and cortical bone influenced preoperative volume, tooth type had an impact upon the volumetric changes, and the preoperative symptoms influenced healing outcome. Key words:Cone beam computed tomography, endodontic microsurgery, healing, lesion volume, prognostic factors.

Healing of 295 Endodontic Microsurgery Cases After Long-Term (5-9 Years) Versus Middle-Term (1-4 Years) Follow-up.

INTRODUCTION: Some evidence suggests that teeth treated with endodontic surgery and considered to have healed over the short term are seen to relapse when evaluated again after 3 or more years. However, long-term evidence is limited. This study compares healing after endodontic microsurgery over long-term (5-9 years) vs middle-term (1-4 years) follow-up and assesses the influence of different healing predictors over time. METHODS: A retrospective study was made, comparing the endodontic microsurgery healing rates after 1-4 vs 5-9 years of follow-up. Healing was assessed based on clinical and radiographic parameters. Simple binary logistic regression models were used to analyze the influence of patient age and gender, the type of tooth, previous radiographic lesion size, apical extent of previous root canal filling, the presence of a post, type of restoration, and interproximal bone level upon the endodontic microsurgery healing rate. A sensitivity analysis was used excluding cases of vertical root fracture. Two calibrated observers independently evaluated the periapical radiographs. RESULTS: A total of 332 patients (60% women and 40% men) were included in the study. Of the 332 analyzed teeth, 198 were subjected to middle-term follow-up (1-4 years), with a healing rate of 86.9%, while 134 were subjected to long-term follow-up (5-9 years), with a healing rate of 67.2%. There were no statistically significant differences in terms of gender, age, type of tooth, size of the lesion, apical extent of previous root canal filling, presence of a post, or type of restoration. The regression models identified 2 statistically significant associations: cohort and interproximal bone level (P < .05). CONCLUSIONS: A success rate of 86.9% was recorded after 1-4 years of follow-up, vs 67.2% after 5-9 years. Excluding cases of vertical root fractures, in the shortest follow-up cohort (1-4 years), the healing rate was 92.5%, vs 82.6% in the cohort with longer follow-up (5-9 years). The prognosis was influenced by the crestal bone level in relation to the cementoenamel junction of the tooth, being significantly poorer when probing depth was >3 mm mesial or distal to the treated tooth.

Is Healing of Periapical Surgery Influenced by Endoscopic Findings Detected on the Cut Root Surface?

PURPOSE: An analysis was made of the association between the endoscopic findings of the sectioned root end surface and healing of the lesion 1 year after periapical surgery, although no studies appear to have analyzed them in relation to healing after periapical surgery. METHODS: A retrospective cohort study was made of patients subjected to periapical surgery between 2011 and 2019. After apicoectomy, the root end surface was examined, evaluating the number of canals, isthmuses, dentin cracks and craze lines, opaque dentin, and gaps between the filling material and the root canal wall. An analysis (using Generalized Estimating Equation models) was made of the association between the endoscopic findings and healing evaluated by von Arx and Kurt criteria and the modified PENN 3D criteria. The possible influence of patient age and gender and the type of tooth involved on healing was evaluated. RESULTS: A total of 108 patients (114 teeth and 128 roots) were subjected to periapical surgery. Two or more canals were detected in 27.3% of the roots (8.6% not subjected to orthograde filing), and isthmuses were identified in 18%, craze lines in 7%, cracks in 3.1%, opaque dentin in 69.5%, and gaps in 53.1% of the roots. The healing rate at 1 year according to the criteria of von Arx and Kurt was 95.4% versus 82.2% according to the modified PENN 3D criteria. Failure was more common in roots with cracks, although statistical significance was not reached (odds ratio [95% confidence interval]: 0.20 [0.01 to 4.04]; P = .200). The rest of the endoscopic findings as well as patient age and gender and the type of tooth did not influence healing (P > .05). CONCLUSIONS: In the present sample, no statistically significant associations were observed between the endoscopic and healing at 1 year after periapical surgery. Failure was more common in roots with cracks, however.

Is periapical surgery follow-up with only two-dimensional radiographs reliable? A retrospective cohort type sensitivity study / ¿El seguimiento de la cirugía periapical se realiza únicamente con radiografías bidimensionales confiable? Un estudio retrospectivo de sensibilidad de tipo cohorte

Background: Two-dimensional (2D) radiographic techniques are commonly used for assessing lesion prognosisafter endodontic surgery. The present retrospective cohort study analyzes the sensitivity and ability of differentradiographic techniques in obtaining area and volume measurements of periapical lesions.Material and Methods: Preoperative and follow-up (6-48 months) periapical and panoramic radiographs (indextest) and cone-beam computed tomography (CBCT) images (reference standard) were selected from an endodonticmicrosurgery database. Sensitivity was analyzed independently by two examiners. The areas of the 2D radio-graphic images and CBCT volumes were studied using Itk-Snap software and Romexis viewer.Results: The sample comprised 105 patients and 105 teeth, with a mean follow-up of 21 months (range 6-48). Preop-eratively, CBCT detected all the periapical areas, periapical radiography detected 67, and panoramic radiographydetected 60. Postoperatively, of the 52 cases in which CBCT detected remains of the periapical area, periapical ra-diography detected 22, and panoramic radiography detected 17. The measurements of the areas obtained by the 2Dmethods, and the volumes obtained by CBCT, had to be transformed into linear measures for comparison purpos-es. The measurements were found to be significantly different in both the preoperative and the follow-up images. Conclusions: Periapical radiography showed greater sensitivity than panoramic radiography, both preoperatively andat follow-up. The lesions measured with CBCT were larger, with significant differences than as evidenced by theperiapical and panoramic radiographs.(AU)

Indications of the extraction of symptomatic impacted third molars. A systematic review.

BACKGROUND: A literature review was made to determine when third molar (3M) extraction is recommended in symptomatic patients and when it is not recommended. MATERIAL AND METHODS: A Medline (PubMed) and EMBASE search was made for articles related to indications for the extraction of 3Ms, published in the last 10 years and up until September 2018. RESULTS: The electronic search yielded 175 articles. After eliminating duplicates, a total of 173 articles were subjected to review of the title and abstract. Only 19 studies were finally included in the systematic review. There was a well documented increase in morbidity associated to impacted 3Ms (non-restorable caries, fracture, infection, periodontal disease, repeated pericoronitis, cysts and tumors), and in the presence of disease, extraction was considered to be indicated. The extraction of 3Ms with signs and/or symptoms of periodontal disease improved periodontal health at the distal surface of the second molar. Postoperative quality of life of patients with symptomatic 3Ms and with disease improved after surgical extraction. CONCLUSIONS: Extraction is indicated in the presence of disease associated to an impacted 3M, whether symptomatic or not. In contrast, extraction is not indicated in the absence of infection or other associated disease conditions. Key words:Third molar, periodontal disease, periodontitis, pericoronitis, dental caries, occlusal caries, mandibular cysts, osteomyelitis, odontogenic tumor.

Prognostic Factors after Endodontic Microsurgery: A Retrospective Study of 111 Cases with 5 to 9 Years of Follow-up.

INTRODUCTION: A study was performed of the healing rate of teeth subjected to endodontic microsurgery after a minimum follow-up of 5 years with an analysis of the influence of different pre- and postoperative factors on the outcome. METHODS: This was a retrospective study of patients subjected to endodontic microsurgery with the use of mineral trioxide aggregate (MTA) for retrograde filling between January 2011 and December 2015. In patients with multiple treated teeth, only 1 random tooth was selected for the statistical analysis. Clinical and radiographic parameters were used to assess healing. Simple binary logistic regression models were used to analyze the influence of patient age and sex, the type of tooth, prior radiographic lesion size, the presence of a post, the type of restoration, and the apical extent of prior filling of the root canal on the endodontic microsurgery success rate. Two calibrated observers evaluated the periapical radiographs on an independent basis. RESULTS: A total of 111 patients (63.1% women and 36.9% men) were included in the study. Of the 111 teeth analyzed, 90 were classified as healed (mean healing rate = 81.1%). Patient age and sex, the presence of a post, the type of tooth, the type of restoration, and the apical extent of prior filling of the root canal had no significant impact on the outcome. Large lesions (>5 mm) were associated with a lower healing rate than smaller lesions, although the difference was not significant. Anterior teeth had a significantly higher healing rate (93.8% maxillary and 100% mandibular) than molars (70.8% maxillary and 57.1% mandibular) (P < .05). The differences between the anterior teeth and the molars were statistically significant. CONCLUSIONS: The mean healing rate of teeth subjected to endodontic microsurgery was 81% after 5-9 years of follow-up. The success rate was lower for upper and lower molars than for teeth in the anterior zone, although the sample was small and further studies are needed to establish whether the type of tooth influences the treatment outcome.

Radiological implications of crestal and subcrestal implant placement in posterior areas. A cone-beam computed tomography study.

BACKGROUND: Subcrestal implant placement has been suggested as a method that could contribute to maintain the periimplant soft and hard tissues in comparison with crestal placement. The objective of this study was to investigate the relationship between implant placement at different depths in the alveolar bone and (a) the thickness of the buccal bone plate (BBP); and (b) crestal cortical bone thickness, based on the use of cone-beam computed tomography (CBCT). MATERIAL AND METHODS: A cross-sectional study was performed, analyzing CBCT scans from the database of the Oral Surgery Unit of the University of Valencia. Individuals with single missing teeth in posterior sectors were included. Two trained dentists used a software application to plan implant placement at four different depths from the bone crest (from 0-2 mm subcrestal). The thickness of the BBP was measured at each established depth, tracing a line from the implant platform to the outermost part of the facial alveolar bone, and the ratio between the implant platform and cortical bone thickness was calculated. RESULTS: The study sample consisted of 64 patients. In the case of implants placed in a crestal position, the distance from the platform to the BBP was 1.99±1.10 mm. This distance increased significantly (p<0.001) with the planned implant placement depth, reaching an average of 2.90±1.22 mm when placement was 2 mm subcrestal. Subcrestal implant placement at this depth implied surpassing the cortical bone in 91% of the cases. CONCLUSIONS: Radiological planning of implant placement in a subcrestal position results in a greater distance from the implant platform to the BBP. In general terms, planning implant placement at a depth of 2 mm subcrestal surpassed the cortical bone in 91% of the cases. Key words:Subcrestal implant, cortical bone thickness, buccal bone plate, cone-beam computed tomography.

Hemostatic agents in endodontic surgery of maxillary molars: A randomized controlled pilot study of polytetrafluoroethylene (PTFE) strips as an adjunct to epinephrine impregnated gauze versus aluminum chloride

BACKGROUND: Hemostasis is of critical importance in endodontic surgery. Studies on bleeding control in maxillary molars are scarce. The present study compares the efficacy of two hemostatic techniques in controlling bleeding in endodontic surgery. MATERIAL AND METHODS: A randomized two-arm pilot study involving 30 patients with peri-radicular lesions in maxillary molars (first and second molars) was carried out including the following hemostatic agents: polytetrafluoroethylene (PTFE) strips as an adjunct to epinephrine impregnated gauze (test group; n = 15) and aluminum chloride (Expasyl(TM)) (control; n = 15). Bleeding control was independently assessed by the surgeon and by two blinded observers before and after application of the hemostatic agent, and was classified as either adequate (complete bleeding control) or inadequate (incomplete bleeding control). RESULTS: Bleeding control was similar in both groups. Simple binary logistic regression analysis failed to identify variables affecting bleeding control. Only the height of the keratinized mucosal band (≥ 2 mm) suggested a decreased risk of inadequate bleeding control of up to 89% (OR = 0.11; p = 0.06). CONCLUSIONS: No difference in the efficacy of bleeding control was observed between PTFE strips as an adjunct to epinephrine impregnated gauze and aluminum chloride in maxillary molars

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Efficacy of infiltrative local anesthesia and inferior alveolar nerve block in periapical surgery of lower premolars and molars: A preliminary report.

BACKGROUND: The aims of this study were: 1) compare the amount of anesthesia used with the anesthetic technique; 2) relate the quantity of anesthesia needed with the level of anxiety of the patient; 3) study the relationship between the anesthetic technique and the level of hemostasis; 4) correlate the amount of anesthesia with patient and tooth dependent variables. MATERIAL AND METHODS: A randomized controlled trial was designed with two parallel groups according to the anesthetic technique: infiltrative local anesthesia (infiltrative group) and inferior alveolar nerve block (block group). The following variables were collected: sex, age, smoking habits, plaque index, symptoms, signs, position of the tooth and amount of anesthesia. Before surgery, all patients were asked to assess their anxiety on a six-item questionnaire, the Amsterdam Preoperative Anxiety and Information Scale (APAIS). The analysis of the hemorrhage control of aluminum chloride was judged by the surgeon and two examiners independently and recorded it as: 0 (no hemorrhage control), 1 (slight but apparent intermittent bleeding persisted after application of the material), or 2 (complete hemorrhage control). RESULTS: Twenty patients were included in this preliminary report. The amount of anesthesia used was lower in block group and in less anxious patients, although these results did not reach statistical significance. A relationship was found between the quantity of anesthesia used and a good hemostasis of the bony crypt before the application of the hemostatic agent (p<.05); and between elderly patients and a lower amount of anesthetic reinforcement (p<.05). CONCLUSIONS: Based on these preliminary results, we can conclude that no statistical significance difference was found between the amount of anesthesia used and the anesthetic technique or the anxiety. A relationship was found between hemostasis of the bony crypt and the quantity of anesthesia used; and between younger patients and a greater amount of anesthetic reinforcement. Key words:Anesthesia, anxiety, endodontic surgery, hemostasis, hemostatic agents,periradicular surgery.

Sequential healing of the elevated sinus floor with different size of antrostomy: a histomorphometric study in rabbits.

PURPOSE: To study the influence of the access window dimensions on the healing at the antrostomy and within the augmented maxillary sinus. MATERIAL AND METHODS: A maxillary sinus augmentation was performed in twenty-four albino New Zealand rabbits. Antrostomies of 3 × 6 mm (small) or 5 × 6 mm (large) in dimensions were randomly prepared in each animal. A collagenated cortico-cancellous porcine bone was used to fill the elevated region, and an equine collagen membrane was placed on the antrostomies. Three different groups were formed, based on the time of euthanasia, i.e., 2, 4, and 8 weeks from surgery. RESULTS: No relevant changes of the height of the augmented sinus were detected over time. Mineralized bone increased between 2 and 4 weeks of healing while remained stable between 4 and 8 weeks. The highest amounts of new bone were found close to the sinus bone walls. No antrostomies were found healed with an even layer of corticalized bone, while large amounts of connective tissue were occupying the antrostomy in both groups. CONCLUSION: Antrostomies of different dimensions resulted in similar outcome in bone formation both in the antrostomy regions and within the elevated sinus.

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.

Factors associated with early apical peri-implantitis: A retrospective study covering a 20-year period.

PURPOSE: To explore risk indicators potentially associated with early apical peri-implantitis (EAP). MATERIALS AND METHODS: A retrospective survey was performed in 2017 with recorded information from patients receiving dental implants between 1996 and 2016. Reporting follows the STROBE (strengthening the reporting of observational studies in epidemiology) guidelines. Data were collected from the medical histories and radiographs: diagnosis of EAP (health/disease), gender, age, type of surgery (immediate/delayed placement), implants placed (position, width, length, location, mesial and distal tooth-implant distance measured at the apex, state of the adjacent tooth and tooth being replaced, and surgical complications. Once the EAP had developed, data were collected regarding days of evolution, symptoms, signs and radiological findings. RESULTS: A total of 2548 patients (57.1% females and 42.9% males) with 8110 implants were enrolled in the study. 46 patients with 58 implants were diagnosed with EAP - 23 in the maxilla (39.6%) and 35 in the mandible (60.4%) - between 6 and 50 days after implant placement, with a mean period of 21.7 days (SD 10.1). The frequency of EAP was 1.81% in patients and 0.71% in implants. Immediate placement multiplied the odds of developing EAP 21-fold (95% CI 6.74 to 65.7; P < 0.001) versus delayed placement. The existence of an apical lesion in the tooth being replaced multiplied the odds of developing EAP 26.3-fold (95% CI 4.24 to 162.8; P < 0.001). Replacing a tooth endodontically treated increased the odds 3.48 times (95% CI 0.99 to 12.3; P = 0.052). The presence of an adjacent endodontically treated tooth increased the odds 0.97-fold (95% CI 0.26 to 3.60; P = 0.963). An apical mesial distance of ≤ 1.5 mm increased the odds up to 5.12-fold (95% CI 2.12 to 12.4; P < 0.001). CONCLUSIONS: The presence of endodontic periapical lesions or endodontic treatment in the tooth being replaced, immediate implant placement or mesial tooth-implant distance measured at the apex were significantly associated with increased odds of EAP.

Oral rehabilitation with dental implants in patients with recessive dystrophic epidermolysis bullosa: A retrospective study with 2-15 years of follow-up

BACKGROUND: Epidermolysis bullosa (EB) comprises a group of hereditary disorders characterized by mechanical fragility of the skin and mucous membranes, with the development of blisters and vesicles in response to minimum tissue friction. Recessive dystrophic epidermolysis bullosa (RDEB) with generalized involvement is the most common subtype in the oral cavity. The present study was carried out to investigate dental implant survival, peri-implant tissue condition, patient satisfaction, and the impact of treatment upon the quality of life of patients with RDEB rehabilitated with implants and full-arch implant-supported prostheses. MATERIAL AND METHODS: Thirteen patients with RDEB underwent dental implant treatment between September 2005 and December 2016. A retrospective study was made to analyze implant survival, peri-implant tissue health and patient satisfaction. RESULTS: A total of 80 implants were placed (42 in the maxilla and 38 in the mandible) in 13 patients between 20-52 years of age and diagnosed with RDEB. All the implants were rehabilitated on a deferred basis with 20 full-arch prostheses. Fifteen fixed prostheses and 5 implant-supported overdentures were placed. The implant survival rate was 97.5% after a mean follow-up of 7.5 years after prosthetic loading. Fifty percent of the implants showed mucositis at the time of evaluation. Probing depth was maintained at 1-3 mm in 96.2% of the implants, and bleeding upon probing was observed in 67.5% of the implants. There was a high prevalence of bacterial plaque (85%). CONCLUSIONS: The treatment of edentulous patients with RDEB by means of implants and implant-supported prostheses is predictable as evidenced by the high success rate, and improves patient self-esteem and quality of life

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Laser Therapy for Infected Sites and Immediate Dental Implants in the Esthetic Zone: A Case Report and Review of Literature.

Placement of postextraction dental implants has become a common practice. Here, we reviewed current literature, along with clinical procedures, outcomes, and incidence of complications, associated with immediate implants in infected postextraction sites. The YSGG (yttrium, scandium, gallium, and garnet) laser can significantly reduce the bacterial concentration after extracting a compromised tooth. We treated a 40-year-old woman with a compromised tooth in the esthetic zone, presenting clinical and radiological signs of infection, particularly a periapical periodontitis. The tooth was extracted after administering local anesthesia using Optocain® (mepivacaine and adrenalin 1 : 100,000), following which the site was treated with an ErCr : YSGG (erbium, chromium-doped yttrium, scandium, gallium, and garnet) 2780 nm laser device (Biolase iPlus®). The implant (Straumann® fixture) was inserted with minimum 35 N torque, 1 mm below the most apical bone peak. Bio-Oss® and resorbable membrane were applied to improve bone healing. The use of ErCr : YSGG laser has ensured success of implant therapy performed on an infected site. There were no complications such as peri-implantitis or loss of peri-implant bone. The implant achieved good primary stability, immediate placement into an infected site did not increase complications, and the 5-year follow-up confirmed the treatment success.