International Journal of Implant Dentistry最新文献

Background: Dental implant success critically depends on the primary stability of the implant, which is significantly influenced by the bone density at the osteotomy site. Traditional drilling techniques for osteotomy preparation often compromise bone volume and quality. This study aimed to evaluate the impact of osseodensification, a novel osteotomy preparation technique, on bone density and implant stability. The technique utilizes specialized drills that operate in a counter-clockwise direction to compact autografted bone laterally and apically, preserving and enhancing bone density.

Methods: A total of 32 patients undergoing dental implant surgery were included in this study. Pre-operative and post-operative bone densities at the apical, mesial, and distal regions of the osteotomy sites were measured using Dentascan (CT) and analyzed with Radiant DICOM software. The study utilized osseodensification drills for osteotomy preparation, comparing pre-operative and post-operative bone densities to assess the technique's efficacy.

Results: The study found a statistically significant increase in bone density post-operatively (p < 0.001), with the greatest improvement observed in the distal region, followed by the mesial and apical regions. The findings underscore osseodensification's effectiveness in enhancing bone density and primary stability, with the distal region exhibiting the highest bone density.

Conclusion: Osseodensification represents a significant advancement in implant dentistry for osteotomy preparation. By preserving and increasing bone density through compact autografting, this technique not only improves primary stability but also offers potential benefits in indirect sinus lifting and alveolar ridge expansion. The study advocates for the broader adoption of osseodensification drills in clinical practice to achieve better outcomes in dental implantology.

Trial registration: This study received ethical approval from The Research Ethics Committee at King Khalid University's under Approval no. ECM#2024 - 216. Additionally, it was registered with ClinicalTrials.gov, identifier no: NCT06268639.

Purpose: To review the current literature to answer the focused question: in the experimental pig model (population), which types of peri-implant bone defects (exposure) have been used evaluate different modes of therapy and what is their capacity for spontaneous healing and regeneration (outcome)?

Methods: Following PRISMA guidelines, electronic databases were searched for studies reporting peri-implant bone defects in the maxillae or mandibles of pigs. Those studies which reported a control group of untreated defects with assessment of spontaneous regeneration [new bone area (BA)] and/or re-osseointegration [new bone-to-implant contact (BIC)] via quantitative radiography or histomorphometry were included in a random effects meta-analysis for the outcomes BA and BIC.

Results: Overall, 21 studies, mostly performed in the mandibles of minipigs, were included. Most studies reported 'acute' intrabony (circumferential and/or dehiscence; n = 12) or supra-alveolar defects (horizontal; n = 4). Five studies attempted to induce 'chronic' peri-implantitis lesions using ligatures with conflicting results. Meta-analyses revealed pooled estimates (with 95% confidence intervals) of 48.07% BIC (30.14-66%) and 64.31% BA (42.71-85.91%) in intrabony defects, and 52.09% BIC (41.83-62.35%) and 28.62% BA (12.97-44.28%) in supra-alveolar defects. Heterogeneity in the meta-analysis was high (I² > 90%).

Conclusion: Current evidence for peri-implant bone regeneration in pigs is mainly based on acute intrabony defects, which demonstrate a high capacity for spontaneous regeneration and re-osseointegration. The evidence for chronic peri-implantitis is limited and does not clearly indicate a spontaneous progression of the disease in this animal model.

Purpose: Wound healing disorders caused by bacterial infections in dental surgery, especially where membranes are used, are a common issue in oral surgery. Cold atmospheric plasma (CAP) offers a non-invasive solution for surface decontamination, including dental implants. The aim of this study was to evaluate the antibacterial effectiveness of CAP on various clinically applied membranes made of collagen and polytetrafluoroethylene (PTFE).

Materials and methods: To assess the antibacterial properties of CAP, enterococcus faecalis were seeded on different membranes: Memlock (collagen), Memlock Pliable (collagen), Agronaut (collagen), and PermaPro (PTFE); n = 4. After in vitro cultivation for 6 days, CAP using a kINPen^® MED with an output of 5 W was applied 5 min and 10 min. Bacterial colony-forming units (CFU) were quantified to detect decontamination effectiveness. In addition, live and dead staining as well as scanning electron microscopy (SEM) of membranes was performed for validation and surface texture analysis.

Results: Bacterial colonization was highest on collagen-based membranes (CFU Memlock: 14.38 ± 8.91). The results showed that CAP significantly reduced bacterial colonization on all membrane types after 10 min application of CAP; Memlock (CFU after 10 min 0.22 ± 0.16^10⁶; p = 0.0256), Argonaut (CFU after 10 min 0.02 ± 0.01^10⁶; p = 0.0129) and PermaPro (complete bacterial decontamination; p = 0.0058). This was paralleled by fluorescence and scanning electron microscopy. CAP was most effective on smooth membrane surfaces as SEM revealed.

Conclusion: CAP thus offers a non-invasive, cost-effective method to reduce bacterial infections in guided bone regeneration using membranes.

Objective: To systematically assess studies regarding the efficacy of lasers in the nonsurgical treatment of peri-implantitis.

Methods: Electronic and manual searches were performed by two reviewers independently. Randomized controlled trials (RCTs) comparing lasers vs. mechanical debridement or air abrasive on primary outcome (probing depth (PD)) and secondary outcomes (bone loss, bleeding on probing (BOP), clinical attachment level (CAL) and plaque index (PI)) were included. Data extraction and quality assessment were conducted independently. Weighted mean difference (WMD) or standardized mean difference (SMD) and 95% confidence interval (CI) were calculated for continuous outcomes. Publication bias, leave-one-out analysis and GRADE assessment were conducted.

Result: 13 eligible publications were included in the review and 12 in the meta-analysis. Solid-state lasers significantly improved in PD (WMD = -0.39, 95% CI (-0.70, -0.09), p = 0.01, moderate-certainty evidence), BOP (SMD =-0.76, 95% CI (-1.23, -0.28), p = 0.002, moderate-certainty evidence) and CAL (WMD =-0.19, 95% CI (-0.39, -0.00), p = 0.05, moderate-certainty evidence), but not in bone loss (WMD = 0.03, 95% CI (-0.13, 0.18), p = 0.74, low-certainty evidence) and PI (SMD =-0.19, 95% CI (-0.42, 0.04), p = 0.11, moderate-certainty evidence) compared with the control group. However, the diode lasers showed no clinical advantages. No publication bias was detected, and leave-one-out analysis confirmed the robustness of findings.

Conclusion: In the nonsurgical treatment of peri-implantitis, solid-state lasers yielded positive influence in term of PD, BOP and CAL, while diode laser provided no beneficial effect. Future well-designed large RCTs are still needed, considering the limitations of included studies.

Clinical relevance: This review aimed to guide clinicians in choosing the appropriate laser for peri-implantitis, enhancing treatment strategies and attaining better outcomes.

Aim: To compare three-dimensional changes of aporcine derived collagen matrix (CM) and free gingival grafts (FGG) for increasing keratinized tissue (KT) at dental implants over a 24-month follow-up period.

Materials and methods: This retrospective study enrolled 25 patients exhibiting 41 implants with deficient KT width (i.e., < 2 mm) who underwent soft tissue augmentation using either CM (11 patients/15 implants) or FGG (14 patients/26 implants). The primary outcome was tissue thickness change (mm) at treated implant sites between 1- (S0), 12- (S1), and 24-months (S2). Secondary outcome was the changes of KT width over a 24-month follow-up period.

Results: Dimensional analyses from S0 to S1 and from S0 to S2 revealed a mean decrease in tissue thickness of -0.05 ± 0.35 mm and - 0.31 ± 0.41 mm in the CM group, and - 0.23 ± 0.38 mm and - 0.22 ± 0.81 mm in the FGG group, with no significant differences found between the groups (S0-S1: p = 0.14, S0-S2: p = 0.58). Within S1 and S2, the CM and FGG groups displayed comparable tissue thickness reduction (CM: -0.32 ± 0.53 mm, FGG: -0.02 ± 0.21 mm; p = 0.07). The FGG group exhibited a significantly greater KT gain 24-months compared to the CM group (CM: 1.50 ± 1.14 mm, FGG: 4.04 ± 1.65 mm; p < 0.001).

Conclusions: CM and FGG were associated with comparable three-dimensional thickness changes over a period of 24 months. A significantly wider KT band could be established in the FGG group.

Purpose: Pterygoid implants are an alternative approach to avoid sinus-lifting or other grafting procedures. During pterygoid implant placement, dental surgeons risk damaging the greater palatine canal (GPC). However, they do not have sufficient reasons to avoid GPC injury. This study performed a detailed morphological analysis of the GPC to determine susceptibility to damage during pterygoid implant surgery.

Methods: To understand the detailed morphology of the GPC, gross anatomical analysis, histological analysis, and bone morphometry via micro-computed tomography were performed.

Results: We found that the medial wall of the GPC communicated with the nasal cavity through the bone dehiscence. The dehiscence appeared near the inferior nasal concha in 72.4% of the cadavers. The nerve and artery passed from the GPC to the nasal mucous membrane through the dehiscence. Given that the greater palatine nerve passed medial to the descending palatine artery in the GPC, the descending palatine artery is damaged first rather than the greater palatine nerve during pterygoid implant surgery.

Conclusions: Dental surgeons who penetrate the GPC using an implant body may extend the bleeding to the nasal mucosa, which seems to spread the inflammation to the nasal cavity.

Purpose: Recently, rare cases of medication-related peri-implant osteonecrosis of the jaw (PI-MRONJ) have been reported. In patients with functional implants who begin using anti-osteoporosis medications (AOMs) after implantation, PI-MRONJ is unpredictable and poses a significant threat to the patient. In this study, we aimed to evaluate the impact of AOMs on peri-implant tissues and to examine risk factors for peri-implantitis, a presumed trigger for PI-MRONJ.

Methods: The study cohort consisted of patients who underwent implant maintenance treatment between January 2016 and February 2024. Patients were divided into AOM users (AOM group) and controls (control group). Clinical parameters were statistically evaluated, including implant probing depth (iPPD), implant bleeding on probing (iBoP), marginal bone resorption (MBL), and mandibular cortical index (MCI) measured at baseline and at the last visit. Risk factors were examined by multivariate analysis for adjusted odds ratios.

Results: A total of 94 patients (35 male, 59 female) with 270 implants were recruited. The AOM group had 93 implants (24 patients). Comparison of clinical parameters showed significantly greater changes in iBoP (p = 0.000768) and MBL (p = 0.000863) scores over time in the AOM group than in the control group. Risk factors for peri-implantitis were a history of moderate or severe periodontal disease (OR: 15.8, 95% CI 3.6-69.3, p = 0.000256) and MCI class 3 (OR: 3.3, 95% CI 1.4-7.8, p = 0.00534).

Conclusions: In implant treatment of AOM users, special attention should be paid to local inflammation, which is presumed to be the cause of PI-MRONJ.

Purpose: In recent years, dental implant treatment has become an option for prosthetic treatment for missing teeth and is often performed in older patients. However, the complex oral functional decline in old age presents challenges in terms of frailty prevention, making oral function management after prosthetic treatment crucial. Nonetheless, the actual status of oral function in older patients seeking dental implant treatment remains unclear. In this study, we aimed to assess the oral function status of older patients seeking dental implant treatment.

Methods: Among patients receiving prosthetic treatment for missing teeth, 227 older patients (111 in the pre-dental implant group and 116 in the pre-bridge/denture group) who underwent a thorough examination of their oral function were included in this study. Age, sex, comorbidities, smoking status, number of functional teeth, and occlusal support status were obtained from the medical records. Statistical analyses were performed using the t-test, chi-square test, and logistic regression (p < 0.05).

Results: Compared with the pre-bridge/denture group, the pre-dental implant group had significantly better oral hygiene, occlusal force, tongue-lip motor function, tongue pressure, masticatory function, and swallowing function and a significantly lower prevalence of oral hypofunction. Older age and decreased occlusal support were associated with the diagnosis of oral hypofunction, even after adjusting for confounding factors including prosthetic treatment.

Conclusions: Although older patients seeking dental implant treatment have a higher oral function than those seeking general prosthetic treatment, older age and a lower number of occlusal supports suggest that appropriate oral function management is needed.

The sinus lift procedure has become the most common method for maxillary bone augmentation. The most frequently observed intraoperative complication is the perforation of the Schneiderian membrane. Various treatment options have been proposed for managing these perforations, including the use of resorbable membranes, centrifugated blood products as PRF, or PRGF, suturing, and fibrin glue application. While long-term studies exist for the use of resorbable membranes to close perforations, there is limited data on the long-term outcomes of suturing or gluing the perforated sinus membrane. The aim of this retrospective study is to evaluate the long-term outcomes of suturing and/or applying fibrin glue to repair perforated sinus mucosa during sinus floor elevation procedures. Between 2005 and 2009, a total of 692 patients underwent 923 sinus lift surgeries, and Schneiderian membrane perforation occurred in 202 sinus floor elevations (21.98%) across 168 patients. The main documented causes of perforations, which ranged from 2 to 10 mm in diameter, were the presence of septa, followed by thin and adherent membranes. Of the perforations, 100 (49.5%) were treated with microsurgical suturing combined with fibrin glue, 78 (38.6%) were treated with fibrin glue alone, and 24 (11.9%) were treated exclusively with suturing. Sinus grafting was performed using autogenous bone in combination with a biomaterial, following the layering technique. All surgeries resulted in primary healing without complications, enabling all patients to undergo restoration as planned. The long term clinical and radiological evaluations of 44 randomly selected patients who followed the recall program up to 10 years post operative confirmed the effectiveness of this treatment approach.

Purpose: Although bone morphogenetic protein-2 (BMP-2) possesses potent osteoinductivity, there have been some concerns on the safety of BMP-2 and BMP-2-incorporated bone substitutes used for bone formation. On the other hand, BMP-2-loaded calcium phosphate cement (BMP-2@CPC) has been developed and used for bone regeneration in oral implantology. Therefore, this study aims to investigate this product's biocompatibility and clinical safety after being used in maxillofacial surgery.

Materials and methods: A rat model was employed to assess the osteoinduction and biocompatibility of BMP-2@CPC. Further, a retrospective investigation was carried out: 110 patients who received BMP-2@CPC treatment after their maxillofacial surgery were recruited to describe relative adverse events.

Results: In vivo, BMP-2@CPC showed a significantly higher mean bone volume density and osteoblasts volume density (15 ± 2% and 3 ± 1%)than those of the CPC group (p < 0.05) after being implanted in the dorsal area of rats. Regarding biocompatibility, the mean fibrous tissue volume density was significantly lower in the BMP-2@CPC group (20 ± 5% compared to 31 ± 6%, p = 0.026). The retrospective clinical study showed that only five mild/moderate adverse events were identified in four patients based on the medical records of 110 patients, including swelling, bony mass, and wound dehiscence. This adverse event occurrence was not affected by gender, age, the dose of filled materials, and operations in the study (p > 0.05).

Conclusions: BMP-2-loaded CPC has osteoinductivity and more promising biocompatibility than pure CPC. However, its degradation is slower than CPC. The safety of BMP-2-loaded CPC with 0.5 or 1 mg BMP-2 is promising in oral maxillofacial surgery.

Clinical implications: This study confirmed the promising safety of this BMP-2 incorporated CPC used in dental clinical practice, which can promote its reassuring application for dental implant placement in bone insufficient areas.