International journal of oral implantology (Berlin, Germany)最新文献

Purpose: To evaluate the clinical outcomes and prosthetic complications in patients rehabilitated with full-arch fixed implant-supported prostheses according to the Columbus Bridge Protocol who did not adhere to a structured supportive peri-implant care programme.

Materials and methods: This cross-sectional study included 56 patients (mean age 67.8 ± 9.2 years; 28.6% smokers; 80% response rate) rehabilitated with 229 implants (implant survival rate 100%) according to the Columbus Bridge Protocol. Patients were divided into three groups based on follow-up duration: 1 to 2 years (n = 19), 3 to 6 years (n = 16) and > 6 years (n = 21). Through a comprehensive examination, clinical parameters (probing depth, plaque index, bleeding on probing and keratinised tissue width) and mechanical and technical complications were examined by a single experienced operator. Plaque accumulation on the prosthesis was assessed through clinical images using a plaque disclosing solution and ImageJ software (National Institutes of Health, Bethesda, MD, USA). Finally, patient satisfaction was assessed using the Oral Health Impact Profile-14 scale.

Results: Mean probing depth values remained stable across groups (2.03 to 2.49 mm, P = 0.125), with most sites ≤ 3 mm. No significant differences were found for bleeding on probing among groups (14.8% to 23.1%, P = 0.331). Plaque levels were high both at implant (43.8% to 57.1%, P = 0.233) and prosthesis level (42.9% to 47.0%, P = 0.707), with no significant differences between groups (P > 0.05). Keratinised tissue width ranged from 3.05 to 3.49 mm (P = 0.650). Prosthetic complications showed an increasing trend as follow-up duration increased (5.3% at 1 to 2 years, 18.8% at 3 to 6 years and 33.3% at > 6 years) (P = 0.086). Overall Oral Health Impact Profile-14 scores indicated a high level of patient satisfaction.

Conclusions: Despite the lack of adhesion to a supportive peri-implant care programme, reflected by the high plaque values at implant and prothesis level, the Columbus Bridge Protocol resulted in positive clinical outcomes; however, prosthetic complications occurred and increased over time.

Purpose: To achieve a consensus among international experts regarding the management of postoperative complications after maxillary sinus floor elevation.

Materials and methods: A total of 32 experts were enrolled and divided into dental implant providers (21), experts with a well-established reputation as sinus specialists (8), ear, nose and throat specialists (2), and experts with a well-established reputation as ear, nose and throat specialists (1). Before starting, a systematic literature search was conducted on the topic, and a list of articles was sent to the panel. The development group formulated 20 statements, which were sent out in the form of a survey. After each round, the statements upon which a consensus was not reached were reformulated based on anonymous comments from participants. A total of three rounds were planned.

Results: After the third round, a consensus was reached on 15 key statements regarding the management of postoperative complications following sinus floor elevation. Agreement was established on issues including common postoperative symptoms, use of radiographic assessments, the necessity of surgical interventions such as partial or total graft removal, and the potential need for functional endoscopic sinus surgery. Near-consensus was achieved on additional points concerning normal postoperative symptoms, timing of total graft removal and approaches to late graft infections.

Conclusions: The present Delphi consensus suggests that postoperative symptoms such as pain and swelling are generally manageable with appropriate pharmacological treatment. It also outlines conditions where radiographic evaluation is recommended for further assessment. Surgical options, including partial or total graft removal and functional endoscopic sinus surgery, are recommended based on the clinical scenario and response to initial treatments. Variability in practices, particularly regarding antibiotic use and specific intervention timing, suggests a need for further research to be conducted in order to standardise treatment protocols and address gaps in evidence.

Purpose: To utilise high-frequency ultrasound echo intensity as a method for identifying a safe harvesting zone and assessing tissue thickness, density and vascularisation in the palatal region for soft tissue harvesting.

Materials and methods: Four consecutive patients requiring soft tissue augmentation were recruited. Optical scans were taken and imported into design software, where customised guides were developed based on the patient's palatal anatomy and the harvesting zone. The guides were tailored to fit the shape of the ultrasound probe. They were 3D printed and allowed for a standardised examination of the palate, the identification of a safe harvesting zone and the evaluation of tissue thickness, quality and vascularisation using high-frequency ultrasound. Following these steps and using an echo-harvesting guide, a de-epithelialised free gingival graft was obtained, ensuring preservation of the main vascular flow while avoiding fatty or glandular tissues.

Results: In all four cases, high-frequency ultrasound scans were successfully obtained and the mean measured soft tissue thickness increased from 3.2 mm (anterior) to 6.0 mm (posterior), with a mean transversal increase from 0.9 to 6.0 mm. Ultrasound imaging revealed a layer of hypoechogenic fatty/glandular tissue located 3 to 4 mm beneath the epithelial layer. Using colour Doppler analysis, the vascular flow was identified and mapped to help design a safe harvesting zone. The tissue density, evaluated using a grayscale analysis, showed hypoechogenicity corresponding to fatty/glandular tissues and areas with blood vessels, whereas dense connective tissue appeared isoechoic. This differentiation allowed for precise localisation of the safe harvesting zone, an optimal zone for connective tissue harvesting, while ensuring that regions with higher fat/glandular content and/or large vascular structures were avoided.

Conclusion: The echo-guided harvesting approach is a promising technique for soft tissue palatal harvesting, enabling clinicians to identify a standardised safe zone away from major blood vessels when assessing tissue quality and quantity. This approach enhances surgical precision and control, and facilitates preoperative planning for alternative treatments when graft size or tissue quality or quantity are inadequate due to proximity to the greater palatine artery. It is crucial to note that a learning curve is required to interpret the obtained images accurately and integrate this tool into daily clinical practice.

The following amendments are made to the published article: Int J Oral Implantol 2025;18(1):73-84; First published 17 March 2025.

Purpose: To evaluate the failure rate of trans-sinus implants for full-arch rehabilitation in atrophic maxillae, comparing their outcomes to those achieved with axial and tilted implants.

Materials and methods: The review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, including studies where patients underwent rehabilitation with trans-sinus implants alone or in combination with axial or zygomatic implants. The review was registered on the International Prospective Register of Systematic Reviews (ID: CRD42024537320). A meta-analysis using Haldane and hybrid corrections compared failure rates between implant types.

Results: Out of 2,359 articles, 10 studies employing trans-sinus implants were selected. In the meta-analysis, the trans-sinus group was composed of 232 implants, 5 of which failed, compared to 5 of the 675 implants in the axial/tilted group. There were no statistically significant differences in failure rate between the groups (RRHaldane = 2.80, 95% confidence interval 0.89 to 8.77, P = 0.076; RRHybrid = 2.74, 95% confidence interval 0.91 to 8.17, P = 0.070). The pooled analysis indicated a comparable success rate.

Conclusions: Trans-sinus implants represent a viable alternative, in terms of survival rate, to axial/tilted implants for rehabilitation of the atrophic maxilla, minimising the need for invasive procedures such as extensive bone grafting; however, further controlled clinical trials with longer follow-up periods are needed to confirm these results.

Background: The treatment of advanced peri-implantitis-related bone defects is often associated with ineffective efforts to halt disease progression. The objective of this case series was to evaluate the performance of reconstructive therapy for the management of advanced peri-implantitis using recombinant human platelet-derived growth factor-BB as an adjunctive biological agent.

Materials and methods: A prospective case series study on advanced intrabony peri-implantitis bone defects (≥ 50% bone loss) was performed. Clinical and radiographic variables were collected at baseline (after non-surgical therapy) and 12 months after surgical treatment. Implant surface decontamination of the intrabony component was carried out using titanium brushes and the electrolytic method. Before grafting, recombinant human platelet-derived growth factor-BB was applied on the implant surface. A mixture of mineralised allograft and xenograft hydrated with recombinant human platelet-derived growth factor-BB and covered by a collagen barrier membrane was used for reconstructive therapy. Disease resolution was defined as an absence of bleeding on probing, pocket depth 6 mm and no radiographic evidence of progressive bone loss. Descriptive statistics were performed to assess the effect of treatment on the clinical and radiographic variables.

Results: A total of 10 patients exhibiting 13 advanced peri-implantitis-related bone defects were included. Implant survival at the 1-year follow-up was 100%. No major complications occurred during the early healing phase. All the clinical parameters, with the exception of keratinised mucosa, and radiographic parameters yielded statistical significance. In particular, mean pocket depth decreased by 4.5 mm and the mean Sulcus Bleeding Index was reduced by 1.8. Radiographic intrabony defects displayed a significantly narrower, shallower and less angled configuration at the 1-year follow-up. The disease resolution rate at implant level was 61.5%.

Conclusion: The surgical reconstructive strategy involving the use of recombinant human platelet-derived growth factor-BB proved to be safe and effective for treating advanced peri-implantitis-related bone defects.

This manuscript introduces a concept that aims to optimise peri-implant health and ensure stability of peri-implant tissues in dental implant therapy. It encompasses the principles of platform switching, restorative abutment design, optimal (internal conical) connection and subcrestal implant placement, and is thus referred to as the PROS concept. Platform switching involves strategic repositioning of the implant-abutment junction to contain inflammatory infiltrate, whereas restorative abutment design emphasises the importance of abutment height and contour in peri-implant tissue stability. Optimal (internal conical) connection focuses on minimising micromovements to reduce microgaps and enhancing stability, and subcrestal placement explores the benefits of implant placement depth on peri-implant tissue health. By integrating these principles, clinicians can enhance the predictability of peri-implant bone stability, leading to successful outcomes in dental implant therapy. This clinical guideline has been developed in accordance with the Appraisal of Guidelines for Research and Evaluation, ensuring methodological rigour and transparency, and enhancing its credibility and usability in clinical practice.

Purpose: To conduct a comprehensive umbrella review to synthesise existing evidence and critically evaluate the significance of keratinised mucosa width in peri-implant health and assess the consistency and heterogeneity among previous systematic reviews on this topic.

Materials and methods: A comprehensive search strategy was implemented across multiple databases. Eligible studies were screened and data were extracted. Methodological quality was assessed using A MeaSurement Tool to Assess systematic Reviews version 2, and strength of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation criteria. A meta-meta-analysis using Hedges' g as the effect size measure was performed to investigate the outcomes of implant therapy in patients with (control) and without adequate keratinised mucosa width (case).

Results: Ten systematic reviews, published between 2012 and 2023, were included. Significant effect sizes were found for mucosal recession, Gingival Index/modified Gingival Index, modified Plaque Index and marginal bone loss. Specifically, narrow keratinised mucosa width ( 2 mm) was associated with increased mucosal recession (equivalent odds ratio 4.05, P = 0.03), higher Gingival Index/modified Gingival Index scores (equivalent odds ratio 3.131, P = 0.001), elevated modified Plaque Index scores (equivalent odds ratio 5.34, P = 0.005) and greater marginal bone loss (equivalent odds ratio 1.852, P = 0.0007). No significant associations were observed for bleeding on probing, pocket depth changes or pocket depth values. Follow-up time did not have a significant effect on these outcomes.

Conclusions: Inadequate keratinised mucosa width ( 2 mm) correlated with increased mucosal recession, higher Gingival Index/modified Gingival Index, Plaque Index/modified Plaque Index scores and greater marginal bone loss. However, there is still a lack of sufficient evidence indicating the impact on bleeding on probing, pocket depth, implant survival and disease prevalence (no significant association or insufficient evidence).