Journal of Oral Implantology最新文献

This study aims to determine the gingival phenotype around dental implants and the clinical evaluation of the existing phenotype in relation to the tissue health around the implant. Included were 202 dental implants applied to 60 individuals who applied to our service and had at least 1 implant in the mouth, whose prosthetic restoration was completed at least 1 year ago. The effects of keratinized mucosa width (KMW) and gingival thickness (GT), which form the gingival phenotype, on clinical periodontal parameters were evaluated with the obtained data. Of the implants included in the study, 115 were found to have adequate KMW and 87 had insufficient KMW. At the same time, the GT around 74 implants was found to be thick, and the GT around 128 implants was found to be thin. The KMW of those with thin GT was lower than those with thick GT. Plaque index (PI), gingival index (GI), bleeding on probing (BoP), probing depth (PD), gingival recession (GR), and suppuration (SuP) were found to be low in those with adequate KMW. GI, BoP, PD, GR, and SuP were low in patients with thick GT, but there was no significant difference between GT and PI. KMW and GT were associated with peri-implant tissue inflammation and GR. To maintain the health of the peri-implant tissues, it is recommended to have a KMW of at least 2 mm and a thick gingiva.

Focal osteo-cavitation in the posterior mandible is a condition that clinicians do not know well. Inadvertent implant placement in such areas may result in nerve damage due to abrupt drill penetration and implant displacement in the medullary space. In the present case series, focal osteo-cavitation was managed with the following procedures: (1) undersized drilling, (2) gentle trabecular curettage, (3) bone substitute material grafting in the cavity, and (4) long healing period for osseointegration. In all cases, a sudden loss of drilling pressure immediately after passing through the thin cortical layer revealed focal osteo-cavitation. Following undersized drilling and gentle trabecular curettage, the bone substitute material was packed into the cavity with care not to press the inferior alveolar canal. Implant placement was subsequently performed. Despite a lack of primary implant stability in 3 of 4 cases, all implants were successfully osseointegrated after 6-9 months. Over 5-24 years, all implants functioned well.

The literature identified variations in socket seal surgery, each with limitations. This case series aimed to observe the outcome of using autologous dental root (ADR) for socket sealing on socket preservation (SP). A total of 9 patients with 15 extraction sockets were documented. After flapless extraction, the xenograft or alloplastic grafts were placed in the sockets. Autologous dental roots were prepared extraorally and applied to seal the socket entrance. All SP sites healed uneventfully. Cone-beam computed tomography (CBCT) scan was performed after 4-6 months of healing to evaluate ridge dimensions. The preserved alveolar ridge profiles were verified on CBCT scans and during implant surgery. Implants were placed successfully with a reduced need for guided bone regeneration. Histological biopsy specimens were examined in 3 cases. The histological examination demonstrated vital bone formation and osseointegration of graft particles. All patients completed the final restorations and were monitored for 15.56 ± 9.08 months after functional loading. The favorable clinical outcomes support the use of ADR for SP procedures. It was not only accepted to patients but also easy to perform with low complication rates. The ADR technique is thus a feasible method for socket seal surgery.

The socket shield technique and subepithelial connective tissue graft following immediate implant placement with provisionalization had been advocated for peri-implant facial contour and gingival architecture preservation. This case report used three-dimensional volumetric analysis to longitudinally assess the peri-implant facial contour change before and after these procedures. The results demonstrated comparable and acceptable preservation of peri-implant facial contour between the two procedures after 2 years of function.

Initiation of the inflammatory response begins with the surgical placement of an implant that stimulates bone remodeling. The occurrence of crestal bone loss during submerged healing affects the prognosis of an implant. Hence, this study was conducted to estimate the early implant bone loss during the preprosthetic phase on bone level implants placed equicrestally. This retrospective observational study included evaluation of crestal bone loss around 271 two-piece implants placed in 149 patients from the archived postsurgical (P1) and preprosthetic (P2) digital orthopantomographic records using MicroDicom software. The outcome was categorized based on (1) sex (male or female), (2) time of implant placement (immediate [I] vs conventional [D]), (3) duration of healing period before loading (conventional [T1] vs delayed [T2]), (4) region of implant placement (maxilla [M1] vs mandible [M2]), and (5) site of implant placement (anterior [A] vs posterior [P]). To find the significant difference between the bivariate samples in the independent groups, an unpaired sample t test was used. The average marginal bone loss during the healing phase was 0.56 ± 0.573 mm in the mesial region and 0.44 ± 0.549 mm in the distal region of the implant, with a statistically significant difference (P < .01). There was no statistically significant difference in crestal bone level with the (1) sex of the patient (male or female), (2) type of implant placement (I or D), (3) time of implant loading (T1 or T2), (4) region of implant placement (M1 or M2), or (5) site of implant in the arch (A or P) (P > .05). An average of 0.50 mm crestal bone loss occurred in the peri-implant region during the preprosthetic phase. We found that the delayed placement of an implant and a delay in the healing period would further increase the early implant bone loss. The difference in the healing period did not alter the outcome of the study.

This article seeks to provide the most relevant aspects of the etiology, prevention, and management of bleeding in routine implant surgery. A comprehensive and systematic electronic search was conducted in MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews databases until June 2021. Further references of interest were retrieved from bibliographic lists of the selected articles and the "Related Articles" feature of PubMed. Eligibility criteria were papers about bleeding, hemorrhage, or hematoma associated with routine implant surgery on human subjects. Twenty reviews and 41 case reports fulfilled eligibility criteria and were included in the scoping review. Involved implants were mandibular in 37 and maxillary in 4 cases. The major number of bleeding complications was in the mandibular canine region. The most injured vessels were sublingual and submental arteries, due mainly to perforation of the lingual cortical plate. Time to bleeding occurred intraoperatively, at suturing, or postoperatively. The most reported clinical manifestations were swelling and elevation of the mouth floor and the tongue with partial or complete airway obstructions. First aid to manage airway obstruction was intubation and tracheostomy. For active bleeding control, gauze tamponade, manual or digital compression, hemostatic agents, and cauterization were applied. When conservative procedures failed, hemorrhage was controlled by intra- or extraoral surgical approaches to ligate injured vessels or by angiographic embolization. The present scoping review provides knowledge and evidence on the most relevant aspects of the etiology, prevention, and management of implant surgery bleeding complications.

A sinus floor elevation via lateral window (LSFE) is one of the most widely used bone augmentation procedures for implant therapy in the posterior area of the maxilla. Locating and preparing a correct opening window on the lateral sinus wall is a key step of this procedure. Conventionally, the surgeon designs and locates the window after the flap is reflected based on the information obtained from cone-beam computed tomography (CBCT) images or other diagnostic aids. Nevertheless, in spite of the advancements in CBCT imaging, clinicians may still experience hardships in situating and procuring meticulous access to the maxillary sinus by using CBCT alone. Therefore, in cases requiring an LSFE simultaneous to implant placement, a maxillary sinus surgical guide has been tested and reported to be the amiable method to be utilized as a conjunct to prevent unpredictable consequences according to its application in implying both the direction for the implant and the location of the lateral window. This article presents 3 clinical cases with a fully digital approach to guide the opening of the lateral wall of the maxillary sinus as well as the simultaneous placement of a single implant in an ideal 3D position. Based on the CBCT images and intraoral scan, a surgical guide was fabricated based on 3D software. During surgery, this teeth-supported template can be placed intraorally, guiding sinus window opening preparation. This technique makes the sinus window opening procedure simple and predictable, reduces surgical time and the risk of complications, and allows the placement of the implant in the ideal 3D position.

This study aimed to evaluate temperature changes in titanium and ceramic implants after using a 445-nm diode laser under different in vitro conditions. Titanium (Ti) and ceramic (Zr) dental implants were placed into a bone analog, and an intrabony defect was created at each implant. A 445-nm diode laser was used to irradiate the defects for 30 seconds, noncontact, at 2 W in continuous wave (c.w.) and pulsed mode. The experiment was done at room temperature (21.0 ± 1°C) and in a water bath (37.0 ± 1°C). Two thermocouple probes were used to record real-time temperature changes (°C) at the coronal part of the implant (Tc) and the apex (Ta). The temperature was recorded at time 0 (To) and after 30 seconds of irradiation (Tf). The average temperature change was calculated, and a descriptive analysis was conducted (P < .05). The Ti implant resulted in the highest ΔT values coronally (29.6°C) and apically (6.7°C) using continuous wave at 21°C. The Zr implant increased to 26.4°C coronally and 5.2°C apically. In the water bath, the coronal portion of the Ti and Zr implants rose to 14.2°C and 14.01°C, respectively, using continuous waves. The ΔT values for Ti were 11.9°C coronally and 1.7°C apically when placed in a water bath using pulsed mode. The lowest ΔT occurred on the Zr implant with ΔTc and ΔTa of 4.8°C and 0.78°C, respectively. Under in vitro conditions, the 445-nm diode laser in pulsed mode seems to be safe for use on ceramic implants and should be used with caution on titanium implants.

The placement of implants in the anterior maxillary and mandibular region requires esthetic proficiency and surgical finesse. It is important to consider the esthetic outcome while avoiding any type of nerve injury for the patient. In this literature review, anatomical structures of the anterior jaw were reviewed from a gross anatomical and radiographic interpretation. A discussion on the frequency of neurosensory complications for patients as a result of nerve damage in this region was evaluated. The purpose of this literature review was to educate the dental surgeon to consider the anterior jaw's neurological structures when performing procedures like implant surgery. The mandibular incisive canal (MIC) presents as an extension of the inferior alveolar canal that runs between the mental foramina. The MIC is a structure that is easily depicted in cone-beam computed tomography (CBCT) imaging and is present in most subjects in gross anatomical studies. The anterior loop of the mental nerve is another structure that is discussed in this paper. Although its structure is accurately depicted in CBCT images, its anatomical variations in patients can make implant treatment planning difficult. The maxilla contains 2 neurovascular structures that were discussed. First, the nasopalatine canal and its relation and impact on implant placement is evaluated. Case reports are reviewed that outline a prophylactic enucleation and bone grafting of the canal prior to implant placement. Second, the canalis sinuosus, which houses the anterior superior alveolar nerve, is of concern during implant placement in the lateral incisor region. Case reports involving nerve damage with follow-up are discussed.