European Journal of Oral Implantology最新文献

Purpose: To report a case of osteonecrosis of the jaw (ONJ) occurring in an implant area possibly related to denosumab, a relatively new antiosteoporotic agent.

Materials and methods: Two months following the extraction of both maxillary first molars, a bilateral maxillary sinus floor elevation was performed on a 64-year-old female patient under a biannual 
60 mg denosumab antiosteoporotic treatment. Seven months later, two implants were inserted in a single-stage procedure in each of the grafted sinuses. After 3 months, the implants underwent prosthetic rehabilitation at one side, and a series of failures that led to an ONJ instalment at the other side.

Results: The ONJ persisted over 7 months and was only resolved by a surgical approach consisting of a piezoelectric osteotomy and platelet-rich fibrin with a tension-free wound closure.

Conclusions: A cumulative effect of denosumab is likely to be associated with a jaw osteonecrosis, which in this case was manageable using a surgical approach with no need to interrupt the appropriate drug treatment course. Conflict of interest statement: The authors certify that they are not affiliated with, or involved in any organisation or entity with any financial or non-financial interest in the subject matter or materials discussed in this manuscript.

Purpose: To evaluate the influence of at least three abutment changes in conventionally loaded implants against placement of a definitive abutment in immediately non-occlusal loaded implants on hard and soft tissue changes.

Materials and methods: Eighty patients requiring one single crown or one fixed partial prosthesis supported by a maximum of three implants were randomised, after implants were placed with more than 35 Ncm, according to a parallel group design to receive definitive abutments which were loaded immediately (definitive abutment or immediate loading group) or transmucosal abutments. These were delayed loaded after 3 months and were removed at least three times: 1) at impression taking (3 months after implant placement); 2) when checking the zirconium core on titanium abutments at single crowns or the fitting the metal structure at prostheses supported by multiple implants; 3) at delivery of the definitive prostheses (repeated disconnection or conventional loading group). Patients were treated in four centres and each patient contributed to the study with only one prosthesis followed for 1 year after initial loading. Outcome measures were: prosthesis failures, implant failures, complications, pink esthetic score (PES), buccal recessions, patient satisfaction, peri-implant marginal bone level changes and height of the keratinised mucosa.

Results: Forty patients were randomly allocated to each group according to a parallel group design. Two patients dropped out from the definitive abutment group but no implant failed. Four provisional and one definitive single crowns had to be remade (due of misfitting) and one definitive crown (due to ceramic fracture) in the repeated disconnection group versus one provisional prosthesis of the immediate loading group due to frequent debondings (difference = 12%; CI95%: 0%, 25%; P = 0.109). Eight patients were affected by complications: four patients from each group (difference = 1%; CI95%: -13%, 14%; P = 1). PES scores assessed at 1 year post-loading were 11.4 (1.5) mm for the definitive abutment group and 11.0 (2.0) mm for the repeated abutment changes group (difference = 0.4; CI95%: -0.4, 1.2; P = 0.289). Buccal recessions at 1 year post-loading amounted to 0.07 (0.35) mm for the definitive abutment group and 0.12 (0.65) mm for the repeated abutment changes group (actually it was a soft tissue gain; difference = 0.05 CI 95%: -0.19, 0.29; P = 0.659). All patients declared to be very satisfied or satisfied with the function and aesthetics of the prostheses and would undergo the same procedure again. Mean peri-implant marginal bone loss at 1 year after loading was 0.06 (0.12) mm for the definitive abutment group and 0.23 (0.49) mm for the repeated abutment changes group (difference = -0.16; CI95%: -0.33,-0.00; P = 0.046). The height of the keratinised mucosa at 1 year post-loading was 2.8 (1.5) mm for the definitive abutment group and

Purpose: The aim of this case series was to compare magnetic resonance imaging (MRI) with cone beam computed tomography (CBCT) in the representation of periapical osteolyses. Based on the histological findings, the potential of MRI for further lesion characterisation was investigated.

Materials and methods: Thirteen patients (average age: 41 ± 27 years) with a total of 15 periapical lesions (five molars, five premolars, and five front teeth) were examined. Lesion characterisation was based on the homogeneity/heterogeneity of the lesions, the signal intensity within the lesion compared to the surrounding tissue and differences in the signal intensities between different MRI contrast weightings. Results were compared with CBCT and histological findings.

Results: Although all patients presented with dental restorations, such as fixed partial dentures and filling materials, all periapical lesions could be diagnosed with either imaging modality. Histologically, 13 cysts and two apical granuloma were confirmed. In CBCT, the similar appearance of all lesions did not allow any further characterisation. In MRI, radicular cysts and granuloma could be characterised by their appearance in the MRI images with different contrast weightings. The MRI-derived characterisations were consistent with the histological findings.

Conclusions: The presented study shows that the application of multi-contrast MRI may lead to better characterisation of apical lesions, thus enabling an improved patient-specific selection of the optimal treatment option. Conflict-of-interest statement: MAG, ESS, and LKS do not report any potential conflict-of-interest; EH and JU are employees of Sirona Dental Systems; VR is receiving a research grant by Sirona Dental Systems.

Purpose: To assess the beneficial or harmful effects of systemic prophylactic antibiotics at extraction of teeth, apart from third molars, vs no antibiotic or placebo administration. Furthermore, if antibiotics are beneficial, to determine which type, dosage, duration and timing of administration is the most effective.

Materials and methods: The Cochrane Oral Health Group's Trials Register (to 30 January 2016) and MEDLINE (1 January 1950 to 30 January 2016) were searched. There were no language or date restrictions placed on the searches of the electronic databases. Randomised controlled trials (RCTs) of parallel group design, with a follow-up of at least 2 weeks, comparing the administration of various prophylactic antibiotic regimens vs no antibiotics to people undergoing extraction of teeth, not including third molars, were included. Outcome measures were postoperative complications/adverse events, post-operative pain and swelling. Screening of eligible studies, assessment of the risk of bias of the trials and data extraction were conducted in triplicate by three independent review authors. Results were to be expressed as risk ratios (RRs) using a random-effects model for dichotomous outcomes, with 95% confidence intervals (CIs). Heterogeneity, including both clinical and methodological factors, was to be investigated.

Results: No relevant RCT was identified.

Conclusions: There is no RCT to determine if the antibiotic therapy is needed at extraction of teeth, excluding third molars. Properly designed and conducted RCTs are needed to understand the role of the antibiotic therapy for tooth extraction. Conflict-of-interest statement: This systematic review was self-funded and the authors have no conflict of interests to declare.

This section presents a brief review of articles on dental implants considered of special interest for the reader, in order to encourage the development of research, the interest for data analysis and the attention to scientific publications. Your comments are welcome. Please contact Dr Michele Nieri at michelenieri@gmail.com.

Purpose: To evaluate whether there are some clinical benefits by placing single dental implants either 0.5 or 1.5 mm subcrestally in healed bone crests.

Materials and methods: Sixty partially edentulous patients requiring two single implant-supported crowns had both sites randomly allocated either to 0.5 mm or 1.5 mm subcrestal implant placement according to a split-mouth design at six centres. Implants were submerged in aesthetic areas or non-submerged in non-aesthetic areas for 3 months. Provisional acrylic crowns were delivered and were replaced after 2 months by definitive metal-ceramic crowns. Patients were followed to 1 year after loading. Outcome measures were: crown and implant failures; complications; aesthetics assessed using the pink esthetic score (PES); peri-implant marginal bone level changes; and patient preference, recorded by blinded assessors.

Results: One patient dropped out. One patient lost both implants to infection at impression taking. Three complications affected three patients of the 0.5 mm group and two complications affected two patients of the 1.5 mm subcrestally placed implants. One patient had complications at both implants. There were no statistically significant differences for complications between group (difference of proportion = 0.02; 95% CI -0.06 to 0.09; P (McNemar test) = 1.000). At delivery of definitive crowns, 2 months after loading, the mean aesthetic score was 11.22 ± 1.91 and 11.12 ± 1.59 for the 0.5 and 1.5 mm group, respectively. At 1 year after loading, the mean aesthetic score was 12.09 ± 1.66 and 12.10 ± 1.52 for the 0.5 and 1.5 mm group, respectively. There were no statistically significant differences between the two groups at 2 months (P (paired t test) = 0.626) or at 1 year (P (paired t test) = 0.920). One year after loading, patients of the 0.5 mm lost on average 0.21 ± 0.51 mm and those of the 1.5 mm group 0.11 ± 0.36 mm, the difference being not statistically significant (difference = 0.10; 95% CI -0.01 to 0.20; P (paired t test) = 0.078). Patients did not prefer any depth of the implant placement over the other. There were no differences in outcomes between centres.

Conclusions: No statistical or clinical differences were noticed when placing implants 0.5 mm or 1.5 mm subcrestally, therefore clinicians can do as they prefer. Conflict-of-interest statement: Anthogyr (Sallanches, France), the manufacturer of the implants used in this investigation, partially funded this trial and donated the implants and the prosthetic components, however data belonged to the authors and by no means did the sponsor interfere with the conduct of the trial or the publication of its results.

Purpose: To compare the clinical outcome of single implants placed immediately after tooth extraction with implants placed 6 weeks after tooth extraction (immediate-delayed placement), and with implants placed after 4-month extraction and socket healing (delayed placement).

Materials and methods: Two-hundred and ten (210) patients requiring a single implant-supported crown to replace a tooth to be extracted were randomised to receive immediate post-extractive implants (70 patients), immediate-delayed implants at 6 weeks (70 patients), and delayed implants after 4 months of healing (70 patients) according to a parallel group design. When needed, patients of the immediate and immediate-delayed group had the socket grafted with a bone substitute and covered with a resorbable membrane at implant placement. Sockets randomised to delayed implants were grafted in the same manner if poorly preserved or in the aesthetic areas (from second upper to second upper premolars). Implants inserted with at least 25 Ncm torque were left to heal unloaded for 4 months, whereas those inserted with less than 25 Ncm were left to heal unloaded for 6 months. Temporary crowns were delivered and were to be replaced by definitive ones after 4 months. Outcome measures were crown and implant failures, complications, peri-implant marginal bone level changes, aesthetically assessed using the pink esthetic score (PES), and patient satisfaction recorded by blinded assessors. Patients were followed up to 1 year post-loading.

Results: One year after loading, three patients dropped out from the immediate group, five from the immediate-delayed group, and six from the delayed group. Four implants (6%) failed in the immediate, four (6.2%) in the immediate-delayed, and one (1.6%) from the delayed group (P (chi-square test) = 0.369). Apart from the crowns (which failed due to implant losses), no other crown had to be remade. Six immediate, six immediate-delayed and four delayed implants were affected by one complication each (P (chi-square test) = 0.792). Mean peri-implant marginal bone loss after 1 year was -0.25 ± 0.17 mm (CI 95% -0.29; -0.20) at immediate, -0.29 ± 0.14 mm (CI 95% -0.32; -0.25) at immediate-delayed, and -0.31 ± 0.16 mm (CI 95% -0.35; -0.27) at delayed placed implants (P (Kruskal-Wallis test) = 0.015). One year after loading, the mean total aesthetic score was 12.52, 12.49 and 11.78 at the immediate, immediate-delayed and delayed groups, respectively (P (Kruskal-Wallis test) <0.001). All patients were fully satisfied both with function and aesthetics, and would undergo the same procedure again, with four exceptions (one from the immediate, one from the immediate-delayed and two from the delayed group), who were only partially satisfied with aesthetics (P = 0.785).

Conclusions: No statistically significant differences for failures, complications and patient satisfaction were observed