Biological response to peri-implantitis treatment.

OBJECTIVE: To investigate biological markers of peri-implantitis (PIP) in crevicular fluid before and after surgical and antimicrobial therapy. MATERIAL AND METHODS: Forty-eight participants (24 healthy implants and 24 PIP) were clinically evaluated, and peri-implant crevicular fluid (PICF) samples were collected at baseline for both groups, and at 3-months after surgical and antimicrobial treatment (ie, n = 21 PIP completers). Samples were analyzed for interleukin-1ß (IL-1ß), matrix metalloproteinase-8 (MMP-8), and macrophage inflammatory protein-1α (MIP-1α) using immunoassay and the results compared between groups. RESULTS: Peri-implantitis sites at baseline demonstrated significantly higher mean periodontal probing depths, percentage bleeding on probing (P ≤ 0.001), and mean IL-1ß concentration in PICF compared to healthy implant sites (17.9 vs 1.7 pg/µL; P = 0.02). Three months after treatment, periodontal probing depths, bleeding on probing, suppuration (P < 0.05), and the mean concentration of MMP-8 decreased significantly compared with baseline (12.1 vs 6.7 ng/µL, P = 0.04). MIP-1α concentrations showed no differences between the groups. CONCLUSION: Elevated concentrations of IL-1ß in PICF were consistent with PIP. A decrease in MMP-8 concentration in PICF at three months after treatment is consistent with a healing biological response.

Resolution of Implant-Induced Neurosensory Disturbance: A Procedural Failure.

PURPOSE: This case report describes the improvement of a patient's neurosensory symptoms after the removal of a mandibular implant within 24 hours of initial placement. After 1 year, neurosensory symptoms resolved, and a different sized dental implant was successfully placed at the same surgical site. MATERIALS AND METHODS: A 45-year-old woman experienced neurosensory disturbance along the inferior alveolar mandibular nerve after a dental implant surgery. A panoramic radiograph, obtained within 24 hours of implant placement, suggested a possible case of implant intrusion into the inferior alveolar nerve canal. After thorough evaluation, the implant was removed within 24 hours of initial placement, and the patient was followed up for 1 year. The neurosensory functions of the patient's chin and lower lip regions were assessed before implant removal, and 1 month and 1 year after the removal of the implant. RESULTS: Almost complete resolution of altered sensation occurred 1 year after implant removal. A second, shorter implant was placed at the same site with no subsequent symptoms of impaired sensation. CONCLUSION: This report highlights the plausible placement of a different size dental implant in the same area of previous-implant-induced nerve injury. The authors report that a lack of postoperative radiograph by the surgeon was considered to be a procedural failure.

Key local and surgical factors related to implant failure.

The concept of osseointegration has revolutionized the treatment options for the replacement of missing teeth in both partially and completely edentulous patients. Dental implants are widely used because clinical practice and studies have documented its successful outcomes. However, implants can occasionally fail, and such failures can be classified as early or late. Measures that can aid in the early recognition of failing osseointegrated implants are needed, as are measures that can facilitate appropriate treatment methods aimed at saving failing implants by determining the probable etiologic factors. This article summarizes our current understanding of the local factors that can be linked to implant failure.

Persistent pain and neurosensory disturbance after dental implant surgery: pathophysiology, etiology, and diagnosis.

Many studies have documented the successful outcomes of dental implants, but have also reported the association of sensory disturbances with the surgical implant procedure. Postsurgical pain is a normal response to tissue injury, and usually resolves after the tissue heals. However, some patients who receive dental implants experience persistent pain even after normal healing. This article describes the basic anatomy and pathophysiology associated with nerve injury. The incidence and diagnosis of these problems, in addition to factors that result in the development of chronic persistent neuropathic pain and sensory disturbances associated with surgical implant placement, are discussed.

Effect of Bisphosphonate and Age on Implant Failure as Determined by Patient-Reported Outcomes.

The aim of the current study was to elucidate whether there is an association between selected risk factors and implant failure, as determined by patient-reported outcomes. A trained clinician administered a formal survey questionnaire to 415 patients who had received a total of 963 implants through the University of Kentucky College of Dentistry's implant training program. The questionnaire was designed to obtain information about potential risk factors that may affect implant failure. Patients were also asked to rate their satisfaction with the appearance and function of the implant, their surgical experience, and the levels of pain and mobility associated with the implant(s). Both patient-level and implant-level data were analyzed in this study. Multiple logistic regression analysis at the patient level indicated that the following variables did not contribute to the success or failure of the implants: sex, smoking status, diabetes, osteoporosis, and use of bisphosphonates. When the statistical analyses controlled for these variables, the odds of patient-reported implant failure increased with the patient's age (by 15% every 5 years). The results of implant-level analyses adjusted for smoking status, diabetes, and osteoporosis showed that the patient's age (odds of failure increased by 12% every 5 years) and no use of bisphosphonates (odds ratio, 9.22; 95% confidence interval, 1.849, 45.975) were significantly associated with poor implant outcome. Our findings suggest a possible association between implant failure and the patient's age and use of bisphosphonates.