Clinical Oral Implants Research最新文献

Objectives

This study assessed 12-month post-loading 3D peri-implant radiographic bone changes in osteoporotic women receiving a single titanium-zirconium bone-level tapered dental implant with a hydrophilic surface.

Materials and Methods

This was a prospective case series involving 18 post-menopausal osteoporotic women in need of a single dental implant. A standardized CBCT scan was performed after implant placement and at 12 months post-loading to assess peri-implant bone changes. The Implant Stability Quotient (ISQ) was recorded after implant placement, at implant impression, loading, and 12 months post-loading. Peri-implant clinical parameters were recorded at 6 and 12 months post-loading and during the last visit implant survival and success were also evaluated.

Results

Seventeen patients completed all study visits, and implant placement was uneventful for all participants. A statistically significant difference (reduction) from implant placement to 12 months post-loading was observed in terms of radiographic buccal bone width and palatal/lingual width (ΔBw-0: 0.53 mm, p < 0.001 and ΔPw-0: 0.47 mm, p = 0.006), as well as in terms of vertical distance between the implant shoulder and the first bone to implant contact on the buccal and palatal/lingual aspect (ΔBICb: −0.26 mm, p = 0.005 and ΔBICp: −0.46 mm, p = 0.018). ISQ increased during osseointegration, and a high implant survival (100%) and success rate (from 81.3% to 100% based on 3 different sets of criteria) were recorded at 12 months post-loading.

Conclusion

In this case series, osteoporotic patients treated with single titanium-zirconium implants showed high survival rates, predictable 12-month implant outcomes, and physiologic peri-implant bone remodelling.

Trial Registration: NCT02884401

Introduction

To investigate the influence of bone density and guide protocol on the accuracy of static guided implant placement of self-cutting implants in vitro.

Methods

A total of 242 implant replicas of self-cutting implants and implants with a tapered design as a control were placed in 40 maxilla replica models with healed posterior ridges differing in bone density and anterior extraction sockets. After full-guided osteotomy, the implants in the healed ridge were either placed through the template or freehand. In anterior extraction sockets, a pilot-guided group was additionally investigated. Postoperative scans were superimposed with the planning and investigated for angular, coronal, and apical deviation.

Results

For 3D coronal deviation, the study indicates significantly lower deviations in soft bone (p < 0.01) and for guided implant placement (p < 0.01) in posterior sites. Apical and angular deviations are significantly influenced by the placement protocol (p ≤ 0.03) and the presence of reference points from neighbouring teeth (p < 0.01). In the anterior site, the coronal deviation seems to be improved by a direct view of the surgical field, while 3D apical and angular accuracy appears to benefit from a high degree of guidance (p < 0.01).

Conclusion

Within the limitations of this in vitro study, for low bone density, immediate implant placement, and in clinically challenging situations without reference to the adjacent teeth, the use of template guidance for insertion statistically significantly reduced deviation.

Objective

To evaluate, in a simulation of surgical peri-implantitis treatment, the impact of type of handpiece, device settings, and instrumentation time on the efficacy of airflowing in cleaning the implant surface, depending on the type of bone defect and implant surface.

Methods

Turned and modified surface implants (54 each) were coated with biofilm imitation and mounted on resin models replicating purely horizontal or circumferential intraosseous peri-implant defects (both 5 mm deep). Implants were instrumented with an airflowing device using a supra- or submucosal handpiece, with three settings: (a) power 5, 5 s (b) power 10, 5 s, and (c) power 5, 15 s per implant/defect sextant.

Results

The amount of residual biofilm imitation was associated with defect configuration, type of handpiece, and device settings (p < 0.15); implant surface did not have an effect. In horizontal defects, with the supramucosal handpiece, only 3 of 54 implants showed > 5% residual biofilm imitation and 23 of 54 implants were completely clean; with the submucosal handpiece, 12 of 18 implants showed ≤ 5% residual biofilm imitation when used for 15 s/sextant, yet none were completely clean. In intraosseous defects, all implants presented ≤ 5% residual biofilm imitation and 10 of 18 implants were completely clean with the submucosal handpiece used for 15 s/sextant; the supramucosal handpiece was largely inefficacious.

Conclusion

Within the limitations of this laboratory study, peri-implant bone defect configuration should dictate the choice of airflowing handpiece (i.e., for horizontal defects, the supramucosal handpiece; for intraosseous defects, the submucosal handpiece) and intrasurgical airflowing requires a prolonged instrumentation time, but not increased power.

Objectives

To report the 7-year outcomes of a randomized clinical trial evaluating a reconstructive surgical procedure of peri-implantitis with a bone substitute in combination with either concentrated growth factor (CGF) or collagen membrane (CM).

Materials and Methods

The original population consisted of 57 patients with at least one implant diagnosed with peri-implantitis exhibiting two-, three-, or four-wall intrabony defects ≥ 3 mm which were filled with a xenogenic bone grafting material and covered with either CGF or CM. Clinical and radiographic parameters, treatment success, and disease recurrence frequencies were evaluated over the 7-year follow-up period of supportive periodontal/peri-implant care. Relationships between prognostic indicators/predictors and treatment success and failure were investigated.

Results

Sixteen patients (24 implants) (CGF group) and 18 (25 implants) (CM group) completed the 7-year follow-up. Although short-term improvements in clinical and radiographic outcomes were observed, a tendency toward relapse was detected through time. At implant level, CM group demonstrated significantly more favorable outcomes for deepest PPD and radiographic vertical defect depth (p = 0.040 and p = 0.043) compared to CGF group. At 7 years, treatment success was achieved in 23.1% of CGF and 30.8% of CM patients, while disease recurrence occurred in 34.6% and 30.8%, respectively (p > 0.05). The presence of baseline suppuration was the only significant patient-level predictor for treatment failure (OR = 15.45; 95% CI: 1.42–168.5; p = 0.02).

Conclusion

Both protocols led to comparable clinical and radiographic outcomes. Long-term treatment success was limited, with increasing failure rates over time. Baseline suppuration had a significant negative impact on treatment outcomes.

Aim

To evaluate the medium-term efficacy of using a xenogeneic collagen matrix to augment the width of the peri-implant keratinized mucosa (PIKM) as an adjunct to the surgical treatment of peri-implantitis.

Material and Methods

In this 36-month parallel-arm randomized controlled clinical trial, patients with peri-implantitis were randomly assigned to a combined protocol of resective peri-implantitis surgery and a PIKM augmentation procedure, either with an autologous free gingival graft (FGG) or a collagen matrix (CM). Primary outcomes were the increase in the width of PIKM and probing pocket depth (PPD) reduction at 36 months. As secondary outcomes, radiographic and patient-reported outcomes were assessed.

Results

Forty-one patients (20 in the CM group and 21 in the FGG group) completed the three-year follow-up. PIKM increased in both groups, but the increase was significantly higher in the APF (apically positioned flap) + FGG group compared to the APF + CM group [2.0 (95% CI: 1.3, 2.7) mm in the FGG group compared to 1.0 (95% CI: 0.5, 1.5) mm in the CM group; p = 0.048]. PPDs were reduced by 1.5 mm (95% CI: 1.1, 1.9) and 1.4 mm (95% CI: 0.6, 2.2), respectively. Disease resolution (maximum one site with bleeding on probing, no suppuration, no further bone loss > 0.5 mm, and PD ≤ 5 mm) was 47.6% in the FGG group and 35.0% in the CM group.

Conclusion

Tested surgical modalities resulted in similar improvements in the clinical parameters. Both FGG and CM increased the PIKM, but PIKM was greater at the 36-month examination in the FGG group.

Objectives

To report oral health-related quality of life (OHRQoL) in a sample rehabilitated with dental implants and assess the influence of self-reported implant complications and clinical peri-implant status. A secondary aim was to investigate associations between OHIP-14 scores and patient-related variables.

Materials and Methods

The Norwegian National Insurance Scheme registry for implant rehabilitation in 2014 was searched, and patients (n = 3083) were mailed a survey including OHIP-14, questions about peri-implant status, and patient-related variables. A subsample was examined clinically (n = 242). Associations of self-reported implant complications and clinical peri-implant status with OHIP-14 scores were evaluated by the Kruskal–Wallis test and logistic regression models.

Results

The OHIP-14 mean sum score reported by the 1299 survey respondents was 4.1 (± 6.4). Self-report of complications was associated with higher OHIP-14 scores in a dose-dependent manner. Lower education (OR 1.54, 95% CI 1.05–2.22), female sex (OR 1.75, 95% CI 1.23–2.56), technical complication(s) (OR 1.58, 95% CI: 1.07–2.34), biological complication(s) (OR 2.41, 95% CI 1.67–3.49) and poor cleansability (OR 2.94, 95% CI 1.64–5.37) were associated (p < 0.05) with higher OHIP-14 mean sum scores in the adjusted regression model. For the 242 patients examined clinically, the OHIP-14 mean sum score was 3.8 (± 6.5). Peri-implant soft tissue dehiscence (OR 2.53, 95% CI 1.17–5.49) was associated with higher OHIP-14 mean sum scores in the adjusted regression model.

Conclusions

OHIP-14 scores were low in this study, indicating good OHRQoL following implant rehabilitation in Norway. Complications lowered OHRQoL in a dose–response manner, confirmed by self-reports of complications and by the presence of peri-implant soft tissue dehiscence.

Objectives

This study aimed to investigate implant outcomes in patients with head and neck cancer undergoing radiotherapy or chemotherapy by incorporating the latest research findings.

Methods

The present review was conducted to update the focused question: What is the survival rate of implants placed in patients with head and neck cancer receiving radiotherapy or chemotherapy compared to non-irradiated patients? It built upon two previous systematic reviews (2014 and 2022) and provided an updated synthesis of the literature, focusing on clinical studies published between 2021 and 2024. The earlier reviews were included in the quantitative synthesis only to offer a broader longitudinal perspective.

Results

Nine studies were identified, with seven included in the quantitative synthesis and meta-analysis. The implant survival rate was significantly lower in irradiated patients (85.6%) compared to non-irradiated patients (90.0%) (RR = 1.62, 95% CI: 1.33–1.98, p < 0.0001, I² = 0.2%). Additionally, implant failure risk was higher in grafted bone (RR = 2.03, 95% CI: 1.39–2.96, p = 0.0018, I² = 21.9%) than in native bone. Among irradiated patients, those receiving radiochemotherapy exhibited an even greater risk of implant failure (RR = 1.97, 95% CI: 1.09–3.56, p = 0.0331, I² = 0%) compared to non-irradiated patients.

Conclusions

Current evidence indicates that radiotherapy/chemotherapy significantly increases the risk of implant loss in patients with head and neck cancer, with higher radiation doses possibly being associated with increased peri-implant bone loss, while implants placed in native bone exhibit a lower risk of failure compared to those placed in grafted bone.

Objectives

Patients receiving antiresorptive medication (AR) for osteoporosis or cancer are at risk of medication-related osteonecrosis of the jaws (MRONJ), especially after surgical procedures. Dental implant (DI) placement in high-dose AR (HDAR) patients is widely discouraged, and thorough counseling is recommended for low-dose AR (LDAR) patients. However, data on the role of AR type, dose, and duration remain limited. This review evaluates MRONJ associated with DIs, focusing on AR type and accumulated dose, and identifies local and systemic risk factors.

Materials and Methods

This review follows the PCC framework for PRISMA-ScR, comparing patients on AR who developed DI-related MRONJ to those who did not, based on the available clinical evidence. A systematic search was conducted on April 13, 2024, in PubMed, Embase, and Cochrane Library. Two reviewers independently screened and extracted data; a third reviewer resolved disagreements. Data extraction included demographics, primary disease, AR type, dose, treatment duration, DI location, and MRONJ details.

Results

Of 2201 articles, 28 studies were included involving 76 patients with 215 DI (154 in LDAR, 61 in HDAR). The development of MRONJ was reported in 15 studies involving LDAR and four studies on HDAR.

Conclusions

Evidence was insufficient to confirm an association between accumulated AR dose and MRONJ associated with DIs. No specific risk factors were identified, emphasizing the need for standardized reporting on AR type, dosage, treatment duration, and intervals to facilitate comprehensive risk assessment. Until evidence-based guidelines emerge, DI therapy in HDAR or long-term LDAR patients should be limited to specialized centers.

Objective

To evaluate the impact of implant surface and instrumentation time on the efficacy of two air powder water-jet (APWJ) devices in cleaning the implant surface in a simulation of non-surgical peri-implantitis treatment.

Materials and Methods

Turned and modified surface implants (28 each) were coated with a biofilm imitation and mounted on resin models replicating peri-implant intra-osseous defects, including a soft tissue replica. The entire implant periphery was instrumented for 5 or 15s per implant sextant (i.e., in total 30 or 90s per implant), with one of two different APWJ devices using either a glycine or an erythritol powder. Residual biofilm imitation was automatically assessed on standardized photographs and expressed as percentage of the exposed implant surface.

Results

Implant surface (ε²:0.253, p < 0.001) and instrumentation time (ε²:0.044, p = 0.036) had a moderate and small effect, respectively, on the outcome, that is, instrumenting turned compared to modified surface implants as well as using a longer compared to a shorter instrumentation time resulted in less residual biofilm imitation. Complete biofilm imitation removal was achieved only in four turned implants, treated for 15s per sextant. Every second turned implant presented with a maximum of 5% residual biofilm imitation, while only two modified implants achieved this level of cleanliness.

Conclusion

In a non-surgical peri-implantitis treatment simulation with APWJ devices, superior biofilm imitation removal was achieved at turned implants, and a longer instrumentation time resulted in less residual biofilm imitation. Modified implants had high chances of incomplete biofilm imitation removal, especially at the apical part of the defect. Complete biofilm imitation removal was in general largely unpredictable.

Objectives

This study aimed to evaluate the impact of drill diameter, rotational speed, and irrigation on critical heat generation (≥ 47°C) at the dynamic bone-drill interface during dental implant osteotomy in pre-existing pilot bone cavities.

Material and Methods

Bone samples were cut such that immediate and direct thermographic measurements at the dynamic bone-drill interface were possible. Osteotomy cavities of 2.4 mm width were expanded to either 3.2 or 3.8 mm in cortical bovine bone with a thickness of 3.5 mm, using two-bladed twist drills at rotational speeds of 200, 600, or 1000 rpm, with or without saline irrigation. A logistic regression model was developed to predict the likelihood of reaching temperatures ≥ 47°C during osteotomy based on these parameters.

Results

The absence of irrigation, major osteotomy diameter expansion, and higher rotational speeds were identified as significant risk factors for increasing the bone-drill interface temperature by more than 10°C (OR: irrigation 177.53; expansion step 9.94; speed by 400 rpm 4.94). No osteotomy performed at a low rotational speed (200 rpm) resulted in a critical temperature rise in either drill diameter group when irrigation was provided. However, temperatures exceeded 47°C across all groups when irrigation was absent.

Conclusions

Dental implant osteotomy procedures without irrigation result in critical heat stress at the bone-drill interface, even at low drilling speeds. Shortened protocols with large drill diameter differences of up to 1.4 mm can be safely implemented when drilling at 200 rpm with irrigation. Osteotomy protocols can therefore be shortened while maintaining safety.

Trial Registration

No clinical trial was included in the study