International Journal of Oral & Maxillofacial Implants最新文献

Purpose: To evaluate the survival rate and marginal bone level (MBL) of calcium phosphate-blasted acid-etched titanium implants placed in a cohort of patients with different ridges after a follow-up period of at least 10 years. Materials and Methods: A total of 61 patients with a minimum implant follow-up of 10 years were selected for this historical prospective, best clinical practice cohort study. Between 2009 and 2012, 121 titanium implants were placed using a flap, flapless, or postextractive technique. The implant placement timing was performed according to pre-extractive diagnosis and divided into immediate (immediately after tooth extraction with an absence of infection), early (within 2 to 3 months with an acute periapical lesion), delayed (6 to 12 months from extraction with a large periapical infection), or late (> 12 months from extraction with healed edentulous ridges). All implants were loaded after 3 months with provisional and definitive cemented restorations. Periapical radiographs were taken before implant insertion and at 3, 6, 12, 24, 36, 48, 96, and 120 months (T3, T6, T12, T24, T36, T48, T96, and T120, respectively). The MBL was calculated in single blind by an additional examiner. Linear logistic regression was performed to analyze statistically significant differences in relation to different operative variables at all evaluation times. Multilevel mixed logistic regression was made to evaluate the factors associated to MBL at 10 years (T120). Results: After 10 years, 47 patients and 92 implant restorations were analyzed, showing that 88 implants (95.6%) survived and 4 implants (4.4%) failed. The cumulative drop-out rate was 22.1%. Loosening and/or mobility was observed in a total of 9 abutments (9.7%) during the observational time. No other complications were reported. Implants placed with a flapless technique revealed a similar MBL to those placed with a flap technique. No significant differences were observed between the surgical techniques at T96 and T120. Immediate and early implants revealed a more stable MBL than both delayed and late implants up to T48. At longer evaluation times (T96 and T120), the MBL values were not statistically significant (P > .05). Narrower diameter implants (3.5 mm) revealed a higher bone loss when compared to the 4.1-mm- and 5.0-mm-diameters, especially in the first year from implant insertion (from T3 to T12) and at longer follow-up (T36 and T48). After that, the difference was reduced. Multilevel analysis showed that none of these variables appear to significantly influence MBL at 120 months. Conclusions: MBL was not influenced by surgical technique or implant placement timing after 10 years. Maintaining a strict occlusal and hygiene control created the conditions to preserve bone integrity and achieve a high implant survival rate.

Purpose: To assess, using CBCT, the volume and height of bone formation after open maxillary sinus elevation without the use of grafts. Materials and Methods: The study was retrospective and included 24 patients with a total of 67 implants. CBCT examinations were conducted at baseline (0 to 43 days postsurgery) and after an average healing period of 6.2 months (range: 5.1 to 7.8 months). The image analysis included metal artifact reduction, registration, and a standardized protocol for segmenting the anatomical structures of the maxillary sinus, including calculating the 3D volumetric changes after bone formation. Conventional manual 2D measurement of vertical bone formation was executed for comparison. Clinical factors assumed to be relevant for bone formation were obtained from patient medical records. Results: One implant was lost before prosthetic loading, representing an early implant loss rate of 1.5%. Differences in intra- and interexaminer reproducibility were registered for the conventional 2D method (P < .05). The average vertical bone formation measured with the 2D method was 4.8 mm (4.6 to 5.0 mm), covering 60.2% of the implant height within the sinus. The average volumetric bone formation measured with the developed 3D image-analysis method was 801 mm³ in total and 195 mm³ in a restricted region around each implant. Bone formation was registered in 62% of the volume of the restricted region. A correlation regarding bone formation was found between the two methods (R² = 0.705). Clinical factors such as age, smoking, general health, and postoperative complications did not correlate with the amount of bone formed. Conclusion: CBCT image analysis is a promising method for objective 3D evaluation of bone formation after sinus elevation. A correlation was seen between the manually measured bone height (2D) and the bone volume in a restricted region around each implant using the developed method (3D). Reducing visual interpretation minimizes errors related to examiner reliability. Clinical factors did not significantly affect the volumetric bone formation.

Objective: To assess the effect of topically applied hyaluronic acid (HA) on the stability of immediately loaded implants in the posterior maxilla. Materials and Methods: For the clinical study, a total of 20 implants were placed in 14 patients seeking the replacement of missing single or multiple posterior maxillary teeth. The patients were randomly divided into two groups. In the clinical control group (CC group), 10 implants were placed and immediately loaded, while in the clinical study group (CS group), 10 implants were coated with HA immediately before placement and immediately loaded. All patients had implant stability clinically evaluated at implant placement time (T₀) and 1 (T₁), 3 (T₃), and 6 (T₆) months after loading. Peri-implant pocket depth and modified sulcus bleeding index were evaluated clinically at 6 months in all patients. Bone density was evaluated radiographically after 3 months. All the clinical and radiographic data were subjected to statistical analysis. For the animal study, a total of 12 implants were placed in the tibiae of six rabbits. For each rabbit, 1 implant without any applied HA was placed in the left tibia (AC group), and 1 implant coated with HA was placed in the right tibia (AS group). The rabbits were euthanized at 21 and 45 days after implant insertion. Results: There were no significant statistical differences between the two groups regarding implant stability, peri-implant pocket depth, modified sulcus bleeding index, or bone density from the palatal and apical aspects. However, there was a significant statistical difference in the bone density from the buccal aspect in favor of the study group. The animal study showed that the newly formed bone in the right tibiae showed improved quantity and quality of bone, as it had denser bone trabeculae and smaller marrow spaces compared to the left tibiae. Conclusion: In the clinical study, the application of hyaluronic acid had a superior effect on the buccal bone density around immediately loaded implants. In the animal study, hyaluronic acid had a synergistic effect on the quality and quantity of bone formation around dental implants.

Purpose: To compare the standard 360-degree CBCT acquisition protocol to the low dose 180-degree CBCT protocol for implant planning.

Materials and methods: Two groups of patients, each consisting of 35 patients, were included in the study. The first group was imaged with the conventional 360-degree CBCT protocol, and the second group was imaged with the low dose 180-degree CBCT protocol. The primary outcome of this study was the number of scans that needed to be repeated due to poor image quality. In addition, six secondary parameters were evaluated quantitatively and qualitatively.

Results: The results showed that there was no need to repeat any of the CBCT scans that were obtained in either group, which showed that 360-degree and 180-degree protocols had comparable image quality. As for the secondary parameters, the results showed that the evaluators were able to evaluate the six chosen parameters in a comparable manner.

Conclusion: The 180-degree low dose CBCT scan is a viable option for dental implant treatment planning in the posterior mandible as it provides comparable and adequate information regarding accuracy of measurements, identification of critical structures, evaluation of bone quality, and any pathology.

Purpose: To evaluate how guided and navigation surgical approaches for implant placement affect survival and accuracy. Materials and Methods: An electronic literature search was conducted in PubMed/Medline and the Cochrane Library. The reviews were refereed by two independent investigators using the following PICO question: population-patients with missing maxillary or mandibular teeth; intervention-dental implant guided surgery, dental implant navigation surgery; comparison-conventional implant surgery or historical control; outcome-implant survival, implant accuracy. Single-arm, weighted meta-analyses were performed on navigational and static guided surgery groups for cumulative survival rate and accuracy of implant placement (ie, angular, depth, and horizontal deviation). Group metrics with less than five reports were not synthesized. The study was compiled under PRISMA 2020 guidelines. Results: A total of 3,930 articles were screened. Full-text review of 93 articles resulted in a total of 56 articles included for quantitative synthesis and analysis. Implant placement with a fully guided approach resulted in the following means and 95% CI: cumulative survival rate of 97% (96%, 98%), angular deviation of 3.8 degrees (3.4 degrees, 4.2 degrees), depth deviation of 0.5 mm (0.4 mm, 0.6 mm), and horizontal deviation at the implant neck of 1.2 mm (1.0 mm, 1.3 mm). Implant placement with a navigation approach resulted in an angular deviation of 3.4 degrees (3.0 degrees, 3.9 degrees), horizontal deviation at the implant neck of 0.9 mm (0.8 mm, 1.0 mm), and horizontal deviation at the implant apex of 1.2 mm (0.8 mm, 1.5 mm). Conclusion: Static guided and navigation surgical approaches for dental implant placement have survival rates comparable to historical controls. Accuracy of implant placement does not differ markedly between these two approaches.

Purpose: To evaluate the performance of one- and two-piece ceramic implants regarding implant survival and success and patient satisfaction. Materials and Methods: This review followed the PRISMA 2020 guidelines using PICO format and analyzed clinical studies of partially or completely edentulous patients. The electronic search was conducted in PubMed/MEDLINE using Medical Subject Headings (MeSH) keywords related to dental zirconia ceramic implants, and 1,029 records were received for detailed screening. The data obtained from the literature were analyzed by single-arm, weighted meta-analyses using a random-effects model. Forest plots were used to synthesize pooled means and 95% CI for the change in marginal bone level (MBL) for short-term (1 year), mid-term (2 to 5 years), and long-term (over 5 years) follow-up time intervals. Results: Among the 155 included studies, the case reports, review articles, and preclinical studies were analyzed for background information. A meta-analysis was performed for 11 studies for one-piece implants. The results indicated that the MBL change after 1 year was 0.94 ± 0.11 mm, with a lower bound of 0.72 and an upper bound of 1.16. For the mid term, the MBL was 1.2 ± 0.14 mm with a lower bound of 0.92 and an upper bound of 1.48. For the long term, the MBL change was 1.24 ± 0.16 mm with a lower bound of 0.92 and an upper bound of 1.56. Conclusion: Based on this literature review, one-piece ceramic implants achieve osseointegration similar to titanium implants, with a stable MBL or a slight bone gain after an individual initial design depending on crestal remodeling. The risk of implant fracture is low for current commercially available implants. Immediate loading or temporization of the implants does not interfere with the course of osseointegration. Scientific evidence for two-piece implants is rare.

Purpose: Although immediate-loading implant (ILI) treatment is a general treatment strategy for fully edentulous maxillae, long-term evidence is required. The purpose of this study was to evaluate the long-term clinical results of, and risk factors for, ILI treatment in fully edentulous maxillae.

Materials and methods: ILI treatments of maxillae using 526 implants in 117 patients were reviewed retrospectively. The longest and mean observation periods were 15 years and 9.2 years, respectively. Kaplan-Meier survival curve analysis, log-rank tests, and multilevel mixed-effects parametric survival analysis were used for statistical analyses.

Results: Overall, 38 of 526 implants failed in 23 patients, and the estimated 15-year cumulative implant-level and patient-level survival rates were 90.7% and 73.7%, respectively. The cumulative implant survival rate was significantly higher in female patients than in male patients. Sex, implant length, and implant diameter were significantly associated with implant survival.

Conclusion: ILI treatment of completely edentulous maxillae demonstrated viable long-term clinical outcomes. Male sex, shorter implant length, and narrow implant diameter negatively affected implant survival. Int J Oral Maxillofac Implants 2023;38:516-522. doi: 10.11607/jomi.10310.

Purpose: To evaluate the cumulative survival rate (CSR) of implants placed by Chinese dentists who lacked structured training and to identify the dentist-related risk factors associated with implant failure.

Materials and methods: Data from 2,036 patients who underwent implant-supported restoration at a university-affiliated stomatology hospital were collected. CSR was regarded as the dependent variable. Patient-related characteristics (age, sex, insertion site, and surgical complexity) and dentist-related factors (experience, number of implant brands used, education level, sex, and specialty) were collected as independent variables. The chi-square test was used to identify dentist-related factors for implant failure after addressing patient-related potential confounders using propensity score matching (PSM). Dentist- and patient-related risk factors were further analyzed using multivariable logistic regression within the subgroups.

Results: The CSRs were 98.48% for patients (with single or multiple implants) and 98.86% for implants after 48 to 60 months of observation. Dentists with < 5 years of experience and specialists in implant dentistry were significantly associated with implant failure after addressing potential patient-related confounders. Within the group of dentists with < 5 years of experience, complicated cases were the major risk factor. For the group of specialists in implant dentistry, < 5 years of experience and male patient were the major risk factors.

Conclusion: New dentists (< 5 years of experience) and specialists in implant dentistry are considered to be dentist-related risk factors for implant failure. This confirms that a learning curve exists for new specialists to reach the level of proficiency and expertise. Int J Oral Maxillofac Implants 2023;38:553-561. doi: 10.11607/jomi.9969.

Purpose: To compare the outcomes of maxillary horizontal alveolar ridge augmentation in the esthetic area, using either pericardium membrane or titanium mesh, clinically, radiographically, and histologically.

Materials and methods: A randomized clinical study was performed on 20 patients with insufficient edentulous ridge width. Subjects were equally allocated into two groups. For both groups, autogenous tenting bone blocks were harvested from the symphysis area. Bone block was covered by an equal mixture (1:1) of particulate graft of inorganic bovine bone and autogenous bone matrix. The barrier membrane used in group 1 (PM) was bovine pericardium membrane, and in group 2 (TM), it was titanium mesh.

Results: Both groups had a clinically statistically significant difference in buccopalatal alveolar ridge dimension between baseline and after 4 months. Radiographically, at both intervals, there was no significant difference in 3D volume between both groups. Within both groups, there was a significant volume increase postoperatively. Histologically, the PM group had a lower area fraction of the mean value of newly formed bone than the TM group, yet the difference was not significant. The PM group had a higher mean osteocyte count than the TM group, but again, the difference was not significant.

Conclusion: Guided bone regeneration using either pericardium membrane or titanium mesh is a reliable treatment for horizontal augmentation of insufficient maxillary alveolar ridge width. No significant differences between both treatment modalities were noticed clinically and histologically. However, percentage change in radiographic volumetric measurements using TM was significantly higher than that of PM. Int J Oral Maxillofac Implants 2023;38:451-461. doi: 10.11607/jomi.9715.

Purpose: To propose diffuse osteomyelitis as risk indicator for peri-implantitis following the loss of several dental implants in patients that present with highly sclerotic bone areas.

Materials and methods: A total of six "nightmare cases"-three of which were treated at the Department of Periodontology of the University Hospitals of the Catholic University Leuven and three of which were referred there for a second opinion-were retrospectively analyzed using radiographs obtained via contact with referring clinicians in order to fully reconstruct the treatment pathway and dental history for each of these patients.

Results: All patients suffered from early implant failures and/or severe peri-implantitis with bone loss and crater formation up to the apical level, as well as the loss of all or nearly all implants. Re-examination of their preand postoperative CBCTs, in combination with several bone biopsies, confirmed the diagnosis of a diffuse sclerosing osteomyelitis in the treated area. Osteomyelitis could be linked to a longstanding history of chronic and/or therapyresistant periodontal/endodontic pathology.

Conclusion: The current retrospective case series seems to suggest that diffuse osteomyelitis should be considered as a risk indicator for severe peri-implantitis. Int J Oral Maxillofac Implants 2023;38:503-515. doi: 10.11607/jomi.9773.