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OBJECTIVE: Peri-implantitis has been attributed to a myriad of factors, including microleakage at the abutment-implant interface. Implant abutment access channel sealing materials (IACSM) are readily used in implant dentistry, with little evidence on their effect on microleakage. This study aims to evaluate the effect of IACSM on the microbial composition in the implant access channel and the peri-implant sulcus. METHODS: A total of n = 8 patients (64 implants) were included in this single-blinded, randomized controlled trial, whereas four different materials (cotton, polytetrafluoroethylene [PTFE], synthetic foam, or polyvinyl siloxane [PVS]) were randomly placed as an IACSM. Following 6 months, microbial analysis was completed on the IACSM and samples from the peri-implant sulci via PCR and high-throughput sequencing. Bacterial samples on the IACSM and in the peri-implant sulci were classified according to Socransky's microbial complexes. RESULTS: There was a preponderance of early colonizing bacteria within the IACSM, while the peri-implant sulci were dominated by Orange complex bacteria. The proportion of Red and Orange complex members on the IACSM was significantly less than in the peri-implant sulci. The proportion of Green, Yellow, and Blue complex members found on the IACSM was significantly greater than in the peri-implant sulci. Atopobium, a diverse species not included in the microbial complexes, was frequently detected in the peri-implant sulcus samples. CONCLUSIONS: No detectable effects of IACSM on the microbial community in the peri-implant sulcus or on the IACSM were identified. Variation of bacterial species was most dependent on the individual patient. No significant differences were found in the periodontal parameters between the different treatment groups.
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Implantes Dentários , Microbiota , Peri-Implantite , Bactérias , Materiais Dentários , HumanosRESUMO
BACKGROUND: Perforated barrier membranes (PBM) were suggested to enhance periodontal regeneration by allowing positive charity of wanted elements from the gingival tissue side. The present study was designed to evaluate clinically and biochemically the use of PBM combined with simvastatin (SMV) gel with and without an associated EDTA gel root surface etching as a suggested option that could improve SMV availability and clinical outcomes of PBM. METHODS: Forty patients having moderate-to-severe chronic periodontitis with 40 intrabony defects were randomly divided into four treatment groups (10 sites each). Patients in group 1 received 1.2% SMV gel and covering the defect with occlusive membrane (OM). Patients in group 2 received 1.2% SMV gel and covering the defect with PBM. Group 3 received 24% EDTA root surface etching, 1.2% SMV gel, and defect coverage with OM (eOM). Patients in group 4 were treated as in group 3 but the defect was covered with PBM (ePBM). Clinical parameters were recorded at baseline before surgical procedures and were reassessed at 6 and 9 months after therapy. The mean concentration of SMV in gingival crevicular fluid (GCF) was estimated by reverse-phase high-performance liquid chromatography at days 1, 7, 14, 21, and 30. RESULTS: At 6- and 9-month observation periods, groups 3 and 4 showed a statistically significant improvement in PD reduction and CAL gain compared with groups 1 and 2. Group 4 showed a statistically significant more defect fill compared with groups 1, 2, and 3 (P ≤ .05). Group 2 showed statistically significant higher defect fill compared with group 1 and group 3 (P < .05). Bone density was significantly increased with no significant difference between the four groups at 6- and 9-month observation periods. SMV-GCF concentration in group 4 showed the highest mean concentration with no significant difference than that of group 3. CONCLUSION: The use of perforated barrier membranes in association with SMV enhances the clinical hard tissue parameters compared with occlusive ones in treating intrabony periodontal defects. Moreover, EDTA root surface treatment could enhance SMV availability in the defect area.
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Perda do Osso Alveolar/terapia , Regeneração Tecidual Guiada Periodontal , Membranas Artificiais , Sinvastatina/uso terapêutico , Adulto , Perda do Osso Alveolar/cirurgia , Ácido Edético , Feminino , Seguimentos , Líquido do Sulco Gengival , Humanos , Masculino , Pessoa de Meia-Idade , Perda da Inserção Periodontal , Bolsa Periodontal , Estudos Prospectivos , Resultado do TratamentoRESUMO
The aim of this review was to determine the most common peri-implant mucositis and peri-implantitis case definitions used worldwide in the implant dentistry literature. A systematic assessment of peri-implant disease classification was conducted using all publications in MEDLINE, EMBASE, SCOPUS, and Google Scholar between 1994 and November 2017. Screening of eligible studies and data extraction were conducted in duplicate and independently by 2 reviewers. The search protocol identified 3049 unique articles, of which 2784 were excluded based on title and abstract. In total, 265 full texts were screened, 106 of which met the eligibility criteria. Of these, 41 defined peri-implant mucositis. Eight (19.6%) used bleeding on probing (BOP) only; 8 (19.6.7%) used a combination of probing depth (PD), BOP, and radiograph; and 5 (12.3%) used PD and BOP. Cases with crestal bone loss of ≤2 mm in the first year and ≤0.2 mm in each subsequent year were considered as peri-implant mucositis. Ninety-three articles defined peri-implantitis; 28 (30.1%) used a combination of PD with suppuration, BOP, and radiograph, followed by 25 (26.9%) using a combination of PD, BOP, and radiograph. The main criteria in most of the studies were considered to be BOP, PD, and radiograph. Cases of crestal bone loss of ≥2 mm and PD ≥3 mm are considered peri-implantitis. Different peri-implant disease case definitions may affect disease prevalence and treatment strategies. We need to standardize case definitions to avoid discrepancies in case diagnosis and prognosis.
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Implantes Dentários , Mucosite , Peri-Implantite , Estomatite , Implantes Dentários/efeitos adversos , Humanos , Mucosite/diagnóstico , Peri-Implantite/diagnóstico , Índice Periodontal , Estomatite/diagnóstico , Terminologia como AssuntoRESUMO
A classification for peri-implant diseases and conditions was presented. Focused questions on the characteristics of peri-implant health, peri-implant mucositis, peri-implantitis, and soft- and hard-tissue deficiencies were addressed. Peri-implant health is characterized by the absence of erythema, bleeding on probing, swelling, and suppuration. It is not possible to define a range of probing depths compatible with health; Peri-implant health can exist around implants with reduced bone support. The main clinical characteristic of peri-implant mucositis is bleeding on gentle probing. Erythema, swelling, and/or suppuration may also be present. An increase in probing depth is often observed in the presence of peri-implant mucositis due to swelling or decrease in probing resistance. There is strong evidence from animal and human experimental studies that plaque is the etiological factor for peri-implant mucositis. Peri-implantitis is a plaque-associated pathological condition occurring in tissues around dental implants, characterized by inflammation in the peri-implant mucosa and subsequent progressive loss of supporting bone. Peri-implantitis sites exhibit clinical signs of inflammation, bleeding on probing, and/or suppuration, increased probing depths and/or recession of the mucosal margin in addition to radiographic bone loss. The evidence is equivocal regarding the effect of keratinized mucosa on the long-term health of the peri-implant tissue. It appears, however, that keratinized mucosa may have advantages regarding patient comfort and ease of plaque removal. Case definitions in day-to-day clinical practice and in epidemiological or disease-surveillance studies for peri-implant health, peri-implant mucositis, and peri-implantitis were introduced. The proposed case definitions should be viewed within the context that there is no generic implant and that there are numerous implant designs with different surface characteristics, surgical and loading protocols. It is recommended that the clinician obtain baseline radiographic and probing measurements following the completion of the implant-supported prosthesis.
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Implantes Dentários , Placa Dentária , Peri-Implantite , Estomatite , Animais , Consenso , HumanosRESUMO
BACKGROUND: In guided tissue regenerative surgery, membrane perforations may serve as a mechanism for the passage of cells and biologic mediators from the periosteum and overlying gingival connective tissue into the periodontal defects. To test this assumption, this study was designed to evaluate levels of bone morphogenetic protein-2 (BMP-2) in gingival crevicular fluid (GCF) during the early stages of healing for sites treated with modified perforated membranes (MPMs) as compared with occlusive membranes (OMs). METHODS: Fifteen non-smoking patients with severe chronic periodontitis participated in this prospective, randomized and single-blinded clinical trial. Each patient contributed two interproximal contralateral defects that were randomly assigned to either an experimental modified perforated membrane group (15 sites) or a control occlusive membrane group (15 sites). Plaque index, gingival index, probing depth(PD), clinical attachment level (CAL) and the relative intrabony depth of the defect (rIBD) were measured at baseline and reassessed at three, six and nine months after therapy. Gingival crevicular fluid samples were collected on day 1 and 3, 7, 14, 21, and 30 days after therapy. RESULTS: The MPM-treated group showed a statistically significant improvement in PD reduction and clinical attachment gain compared to the OM control group. Similarly, rIBD was significantly reduced in MPM-treated sites as compared with those of the OM group. BMP-2 concentrations peaked in the MPM samples obtained during the early postoperative period (days 1, 3 and 7) with a statistically significant difference compared with OM-treated groups. BMP-2 levels decreased sharply in the samples obtained at days 14, 21 and 30 with non-significant higher levels in MPM samples as compared with those of OM sites. CONCLUSION: Within the limits of the present study, one can conclude that MPM coverage of periodontal defects is associated with a significant initial increase in GCF levels of BMP-2, a factor that could improve the clinical outcomes of guided tissue regenerative surgery.
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Perda do Osso Alveolar/cirurgia , Proteína Morfogenética Óssea 2/análise , Líquido do Sulco Gengival/química , Membranas Artificiais , Adulto , Perda do Osso Alveolar/patologia , Processo Alveolar/patologia , Periodontite Crônica/cirurgia , Índice de Placa Dentária , Feminino , Seguimentos , Regeneração Tecidual Guiada Periodontal/instrumentação , Humanos , Masculino , Pessoa de Meia-Idade , Perda da Inserção Periodontal/classificação , Perda da Inserção Periodontal/patologia , Índice Periodontal , Bolsa Periodontal/classificação , Bolsa Periodontal/patologia , Estudos Prospectivos , Método Simples-Cego , Retalhos Cirúrgicos/cirurgia , Cicatrização/fisiologiaRESUMO
PURPOSE: To compare the clinical outcomes of metal-ceramic vs metal-acrylic resin implant-supported fixed complete denture prostheses (IFCDPs). MATERIALS AND METHODS: An electronic literature database search was conducted in the CINAHL, EMBASE, PubMed, and Web of Science databases. Additionally, a manual search of the literature was performed. Studies conducted in edentulous human subjects comparing clinical outcomes of metal-acrylic resin IFCDPs to those of metal-ceramic IFCDPs were included if quantitative outcomes for the following variables were reported: implant failure, prosthetic failure, incidence of peri-implantitis, incidence of peri-implant mucositis, incidence of peri-implant mucosal recession, prosthetic complications, and any patient-centered outcomes. Data from included studies were pooled to estimate effect size. RESULTS: Five studies met the inclusion criteria. A quantitative analysis was possible for risk of implant failure, prosthesis failure, and incidence of peri-implantitis. Meta-analysis showed no statistically significant differences in the risk of implant or prosthesis failure between the two groups. However, meta-analysis showed a significantly greater risk of developing peri-implantitis at the implant level in the metal-acrylic group when compared to the metal-ceramic group (risk difference = 0.069; 95% CI = 0.028 to 0.06; P = .001; fixed-effects model). Furthermore, descriptive analysis of the literature indicated a higher incidence of other biologic complications such as peri-implant mucositis and peri-implant mucosal recession, as well as prosthetic complications such as abrasion and veneer fracture, in metal-acrylic resin IFCDPs compared to metal-ceramic IFCDPs. CONCLUSION: The available evidence suggests that a higher incidence of biologic and prosthetic complications, including a higher risk of peri-implantitis, are present with metal-acrylic resin IFCDPs compared to metal-ceramic IFCDPs.
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Produtos Biológicos , Implantes Dentários , Mucosite , Peri-Implantite , Humanos , Peri-Implantite/epidemiologia , Peri-Implantite/etiologia , Seguimentos , Resinas Acrílicas , Estudos Retrospectivos , Mucosite/complicações , Falha de Restauração Dentária , Falha de Prótese , Metais , Cerâmica , Prótese Dentária Fixada por Implante/efeitos adversosRESUMO
The 1st International Academy of Periodontology Research Conference (IAPRC) was successfully held in Giessen, Germany from October 2-4. The objectives of the IAPRC were: to examine the state of the art in periodontal research, to encourage new scientific collaborations and to develop new directions for research.
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Periodontia , AlemanhaRESUMO
INTRODUCTION: Dental microbial biofilm initiates gingival inflammation, and its suppression is the current dominant strategy for treating periodontitis. However, the host response to the biofilm is largely responsible for the connective tissue breakdown including alveolar bone loss, which is mediated by proinflammatory cytokines and matrix metalloproteinases (MMPs). METHODS: The current study compared the efficacy of a novel host-modulation compound, a chemically modified curcumin (CMC 2.24), to that of its parent compound (natural curcumin), in both lipopolysaccharide (LPS) (a bacterial endotoxin)-induced cell culture and in vivo models of periodontitis. RESULTS: In cell culture, both CMC 2.24 and curcumin appeared similarly effective in suppressing LPS-induced cytokine (IL-1ß and TNF-α) secretion by mononuclear inflammatory cells; however, CMC 2.24 significantly reduced MMP-9 secretion by 78% (P<0.05) whereas curcumin was ineffective. In vivo, CMC 2.24 administration was more effective than curcumin in suppressing (a) IL-1ß in gingival tissue and (b) MMP-9 in both gingiva and plasma, the latter indicating a reduced severity of systemic inflammation. The difference in primary clinical outcome between the two treatments was that CMC 2.24 reduced the pathologically excessive alveolar bone loss, assessed morphometrically at multiple sites, by 80%-90% (P<0.01), whereas curcumin, surprisingly, either increased (P<0.05) or had no effect on alveolar bone loss at these sites. CONCLUSION: These data, plus that from previous studies, support the therapeutic potential of CMC 2.24 in the management of inflammatory periodontal disease and its ability to reduce the risk of associated systemic diseases. The current study also indicates that the MMP-9 inhibitor efficacy is associated with the ability of CMC 2.24 (but not curcumin) to inhibit alveolar bone loss in this rat model of periodontitis.
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Background: Glycogen storage diseases (GSDs) are genetic disorders that result from defects in the processing of glycogen synthesis or breakdown within muscles, liver, and other cell types. It also manifests with impaired neutrophil chemotaxis and neutropenic episodes which results in severe destruction of the supporting dental tissues, namely the periodontium. Although GSD Type Ib cannot be cured, associated symptoms and debilitating oral manifestations of the disease can be managed through collaborative medical and dental care where early detection and intervention is of key importance. This objective of the case report was to describe a child with GSD Ib and its associated oral manifestations with microbial, immunological and histological appearances. Case Presentation: An eight-year-old Hispanic male with a history of GSD type Ib presented with extensive intraoral generalized inflammation of the gingiva, ulcerations and bleeding, and intraoral radiographic evidence of bone loss. Tannerella forsythia was readily identifiable from the biofilm samples. Peripheral blood neutrophils were isolated and a deficient host response was observed by impaired neutrophil migration. Histological evaluation of the soft and hard tissues of the periodontally affected primary teeth showed unaffected dentin and cementum. Conclusions: This case illustrates the association between GSD Ib and oral manifestations of the disease. A multi-disciplinary treatment approach was developed in order to establish healthy intraoral conditions for the patient. Review of the literature identified several cases describing GSD and its clinical and radiographic oral manifestations; however, none was identified where also microbial, immunological, and histological appearances were described.
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A classification for peri-implant diseases and conditions was presented. Focused questions on the characteristics of peri-implant health, peri-implant mucositis, peri-implantitis, and soft- and hard-tissue deficiencies were addressed. Peri-implant health is characterized by the absence of erythema, bleeding on probing, swelling, and suppuration. It is not possible to define a range of probing depths compatible with health; Peri-implant health can exist around implants with reduced bone support. The main clinical characteristic of peri-implant mucositis is bleeding on gentle probing. Erythema, swelling, and/or suppuration may also be present. An increase in probing depth is often observed in the presence of peri-implant mucositis due to swelling or decrease in probing resistance. There is strong evidence from animal and human experimental studies that plaque is the etiological factor for peri-implant mucositis. Peri-implantitis is a plaque-associated pathological condition occurring in tissues around dental implants, characterized by inflammation in the peri-implant mucosa and subsequent progressive loss of supporting bone. Peri-implantitis sites exhibit clinical signs of inflammation, bleeding on probing, and/or suppuration, increased probing depths and/or recession of the mucosal margin in addition to radiographic bone loss. The evidence is equivocal regarding the effect of keratinized mucosa on the long-term health of the peri-implant tissue. It appears, however, that keratinized mucosa may have advantages regarding patient comfort and ease of plaque removal. Case definitions in day-to-day clinical practice and in epidemiological or disease-surveillance studies for peri-implant health, peri-implant mucositis, and peri-implantitis were introduced. The proposed case definitions should be viewed within the context that there is no generic implant and that there are numerous implant designs with different surface characteristics, surgical and loading protocols. It is recommended that the clinician obtain baseline radiographic and probing measurements following the completion of the implant-supported prosthesis.
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Implantes Dentários , Placa Dentária , Peri-Implantite , Estomatite , Animais , Consenso , HumanosRESUMO
PURPOSE: This overview was prepared to describe how an evidence-based approach was used to develop an Academy of Osseointegration (AO) Workshop on the State of the Science on Implant Dentistry (SSID). MATERIALS AND METHODS: An AO SSID Workshop Planning Committee was appointed in 2001 to follow an evidence-based approach for reviewing published clinical data using strict inclusion and exclusion criteria in order to answer 8 closed-end 4-part clinical questions. A systematic approach was employed to assure coherent data management and analysis. Reviewers, co-reviewers, and a biostatistician were appointed. The workshop agenda was developed to include participants who had the primary responsibility for each of the 8 workshop sections to answer 5 consensus questions for the section's systematic review. The planned outcomes of the SSID Workshop included publication of the 8 consensus reports with their respective systematic reviews in The International Journal of Oral & Maxillofacial Implants (supplemental issue), 2007; the development of clinical guidelines responding to each of the 8 focused questions; and the identification and prioritization of questions or topics requiring further research. RESULTS: The evidence-based approach was utilized successfully in planning and carrying out the AO SSID Workshop held on August 3-6, 2006, in Oak Brook, Illinois, and the subsequent publication of its proceedings. DISCUSSION: Although successful in its objectives, the outcome of systematic reviews is only as good as the published data. Significant deficiencies in published implant studies were identified, including, but not limited to, a lack of randomized controlled prospective clinical trials, universal acceptance and publication of defined implant survival and success criteria, and clear questions with well-defined research design. CONCLUSION: The evidence-based approach can be used to systematically review the literature for a workshop on important questions related to implant dentistry. A major limitation is the lack of common outcome variables between published studies.
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Congressos como Assunto , Conferências de Consenso como Assunto , Implantação Dentária Endóssea , Medicina Baseada em Evidências , Humanos , Guias de Prática Clínica como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Literatura de Revisão como AssuntoRESUMO
INTRODUCTION: To the best of the authors' knowledge, this is the first case report to describe the use of a perforated resorbable barrier membrane (PRBM) to enhance lateral bone augmentation for implant site development. CASE PRESENTATION: A 41-year-old female presented to the Advanced Specialty Education Program in Periodontics at Stony Brook University, Stony Brook, New York, for implant consultation regarding a missing maxillary right lateral incisor. The tooth had been lost as a result of trauma 10 years prior to presentation. Clinical examination and radiographs showed significant horizontal ridge deficiency (<5 mm) that supported a staged intervention. Horizontal bone augmentation was performed following guided bone regeneration principles using a mineralized mixed corticocancellous (70:30) allograft followed by a PRBM. A cone beam computed tomography scan was obtained before surgery and 8 months after treatment, from which volumetric width changes were quantified. A bone biopsy was obtained at the time of implant placement to measure new vital bone (NVB) formation, residual graft (RG) particles, and connective tissue (CT) formation. Dimensional width changes were assessed during reentry for implant placement. The lateral bone gain was 5.0 mm, clinically and radiographically. Histologically, the amount of NVB formation, RG particles, and CT infiltration was 38.1%, 38.9%, and 23.1%, respectively. Implant placement was uneventful, with no further need for bone augmentation. CONCLUSIONS: Previous studies using similar techniques and regenerative materials have shown an average of 3.5 mm of horizontal bone augmentation. The use of a PRBM appeared to significantly enhance lateral bone augmentation. An ongoing clinical trial is underway to confirm these results.
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PURPOSE: To evaluate the biochemical composition of bone nodules deposited by gingival mesenchymal stem cells (GMSCs) over titanium machined surfaces in vitro. MATERIALS AND METHODS: GMSCs were isolated from healthy gingival tissues of patients undergoing crown-lengthening surgical procedures. GMSCs were characterized following the International Society for Cellular Therapy guidelines. After incubation of the GMSCs with titanium discs, osteogenic differentiation was induced for 28 days. Osteogenic lineage was confirmed by means of Alizarin Red S staining. Bone nodule morphology and deposition by GMSCs were characterized by scanning electron microscopy (SEM). An elemental analysis of the bone nodules was done using energy-dispersive x-ray spectroscopy (EDS). The biochemical composition of these nodules was further characterized via Raman spectroscopy, with native alveolar bone used as a control. RESULTS: GMSCs adhered and proliferated on the titanium discs and exhibited a spindle-shaped fibroblast-like morphology under standard culture conditions. Their phenotype was confirmed by the expression of CD105, CD90, CD73, and CD146, observed using flow cytometry. Deposits of calcium bone nodules were evident in the cultures after staining with Alizarin Red S, but were absent in the controls. Calcium and phosphate, the major components of hydroxyapatite, were present in the bone nodules, as shown by means of the EDS analysis. The results obtained from Raman spectra of these nodules showed the phosphate ions (ν[PO4³â»], ~960 cm¹), amide III (δ[NH], ~1,245 cm⻹), CH2 scissors (~1,451 cm⻹), amide I (ν[C = O], ~1,667 cm⻹), and ν(CH) (2,800-3,100 cm⻹) bands were similar to those observed in native bone. CONCLUSION: GMSCs can deposit a bone-like mineral highly similar to native bone (HA) over titanium surfaces. Ongoing studies are aimed at determining whether GMSCs can deposit a similar bone matrix/tissue over removed failed dental implants. If HA can be placed over removed failed dental implants, it may be possible to re-osseointegrate dental implants that are failing as a result of peri-implantitis in vivo.
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The risk of developing osteochemonecrosis is increased in patients who are taking bisphosphonate drugs and must undergo extractions or other dental surgery. Because of the difficulty in predicting and preventing osteochemonecrosis and in managing patients after it has occurred, avoidance of surgery has been advised. This paper reports on the development of this complication in a patient who received nonsurgical periodontal treatment. Although it is believed that the risk of developing this severely debilitating complication is low when treating patients nonsurgically, practitioners must be able to recognize and understand the presentation and difficulties in managing osteochemonecrosis, even when only nonsurgical therapy is performed.
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Conservadores da Densidade Óssea/efeitos adversos , Difosfonatos/efeitos adversos , Doenças Mandibulares/induzido quimicamente , Osteonecrose/induzido quimicamente , Periodontite/terapia , Perda do Osso Alveolar/induzido quimicamente , Raspagem Dentária , Humanos , Imidazóis/efeitos adversos , Masculino , Pessoa de Meia-Idade , Fístula Bucal/etiologia , Aplainamento Radicular , Extração Dentária , Alvéolo Dental/patologia , Ácido ZoledrônicoRESUMO
PURPOSE: Multiple bone augmentation techniques are available to allow implant placement in the atrophic maxilla. However, questions remain, regarding which methods are most predictable and have the best dental implant survival rate (SR) in grafted bone. The aim of this systematic review was to evaluate literature from the last 30 years to determine predictability of bone grafting of the edentulous maxilla for implant placement as well as for implant SR. MATERIALS AND METHODS: A systematic review was performed of studies conducted during the period 1980 to 2014, specifically focusing on the edentulous maxilla and bone grafting. Surgical techniques discussed in the publications included were guided bone regeneration (GBR), sinus augmentation, onlay bone grafting, nasal floor grafting, and Le Fort I interpositional grafting. All identified articles were evaluated and screened to meet strict inclusion criteria of at least 10 patients, complete maxillary edentulism, 1-year follow-up, and information regarding implant SR. A total of 974 articles were identified with electronic and manual searches. On further evaluation of the titles and abstracts, 44 articles were excluded. Full texts of the articles that met the inclusion criteria were reviewed, of which 40 articles were included in the systematic review. RESULTS: For onlay bone grafting, 16 studies were included and analyzed, and the weighted mean implant SR was 85.2%. For the GBR technique, two studies were included, with a reported SR ranging from 96.1% to 100%. For Le Fort I interpositional grafting, 11 studies were included, with a weighted mean SR of 89.6%. For the sinus augmentation technique, 12 studies were investigated and the weighted mean SR was 91.5%. For the combination technique, six studies were analyzed and the weighted mean SR was 93.6%. CONCLUSIONS: All five treatment modalities discussed-onlay bone grafting, GBR, Le Fort I interpositional grafting, maxillary sinus augmentation, and/or nasal floor inlay grafting or the combination approach-can be successfully used to augment edentulous maxillary ridge with high implant SRs.
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Aumento do Rebordo Alveolar/métodos , Transplante Ósseo/métodos , Implantação Dentária Endóssea/métodos , Implantes Dentários , Arcada Edêntula/cirurgia , Maxila/cirurgia , Humanos , Seio Maxilar/cirurgiaRESUMO
INTRODUCTION: Asymptomatic displacement of dental implants into the maxillary sinus after a transcrestal sinus augmentation is a rare complication that can occur when there is poor bone quality and minimal residual bone height. Patient compliance with postoperative appointments and failure to comply with denture-wearing instructions are critical contributing factors. To the best of the authors' knowledge, no cases of implant dislodgement attributable to a removable prosthesis have been reported in the literature, although some studies have suggested that improper occlusal forces can cause a long-standing implant to develop peri-implantitis and subsequent displacement of an implant into the sinus cavity. CASE PRESENTATION: A 71-year-old female presented 6 months after undergoing transcrestal sinus lift and implant surgery that involved a modified Summers technique using mineralized solvent-dehydrated cancellous bone allograft and placement of six maxillary implants. A displaced dental implant was retrieved from the right maxillary sinus, which had an intact Schneiderian membrane. The patient was asymptomatic and infection free. The displaced implant was accessed and retrieved via a lateral window sinus technique. No clinical signs of sinus infection were evident, and there were no additional complications during the 2-year follow-up period. CONCLUSION: This case report demonstrates a technique for the retrieval of implants that have been dislodged and migrated into the maxillary sinus cavity caused by an ill-fitting denture and improper masticatory forces.
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BACKGROUND: Although retrograde peri-implantitis (RPI) is not a common sequela of dental implant surgery, its prevalence has been reported in the literature to be 0.26%. Incidence of RPI is reported to increase to 7.8% when teeth adjacent to the implant site have a previous history of root canal therapy, and it is correlated with distance between implant and adjacent tooth and/or with time from endodontic treatment of adjacent tooth to implant placement. Minimum 2 mm space between implant and adjacent tooth is needed to decrease incidence of apical RPI, with minimum 4 weeks between completion of endodontic treatment and actual implant placement. The purpose of this study is to compile all available treatment modalities and to provide a decision tree as a general guide for clinicians to aid in diagnosis and treatment of RPI. METHODS: Literature search was performed for articles published in English on the topic of RPI. Articles selected were case reports with study populations ranging from 1 to 32 patients. Any case report or clinical trial that attempted to treat or rescue an implant diagnosed with RPI was included. RESULTS: Predominant diagnostic presentation of a lesion was presence of sinus tract at buccal or facial abscess of apical portion of implant, and subsequent periapical radiographs taken demonstrated a radiolucent lesion. On the basis of case reports analyzed, RPI was diagnosed between 1 week and 4 years after implant placement. Twelve of 20 studies reported that RPI lesions were diagnosed within 6 months after implant placement. A step-by-step decision tree is provided to allow clinicians to triage and properly manage cases of RPI on the basis of recommendations and successful treatments provided in analyzed case reports. It is divided between symptomatic and asymptomatic implants and adjacent teeth with vital and necrotic pulps. CONCLUSIONS: Most common etiology of apical RPI is endodontic infection from neighboring teeth, which was diagnosed within 6 months after implant placement. Most common findings, radiographically and clinically, are lesions around implant apex and sinus tract. A small number of implants did not improve with treatment. Decision tree provides a path to diagnose and treat lesions to facilitate their management. Further studies are needed to focus on histologic data around periapical microbiota to establish specific etiology and differential diagnoses compared with marginal peri-implantitis and other implant-related conditions.
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Árvores de Decisões , Peri-Implantite/terapia , Tratamento do Canal Radicular , Implantes Dentários , Humanos , IncidênciaRESUMO
INTRODUCTION: This case report describes the treatment of peri-implantitis around a restored single-unit implant. CASE PRESENTATION: Clinical findings included deep probing depths (PDs), bleeding on probing (BOP), and suppuration. Radiographs suggested crater-like bone loss. The area was surgically treated via an access flap. The peri-implant defect was associated with cement that was found below the cement-retained permanent restoration. The cement was removed, and the implant was treated with tetracycline and enamel matrix derivative (EMD). After an uneventful 10-month period of healing, there was a significant reduction in PD and absence of BOP and suppuration. In addition, there was radiographic evidence of new bone formation. CONCLUSION: This case report proposes a new technique for treating peri-implantitis and a new application for EMD.