Clinical implant dentistry and related research最新文献

Objectives: To in vitro investigate the effect of different implant surface decontamination methods and treatment storing conditions on implant surface morphology and cell viability.

Materials and methods: Titanium disks with a sand-blasted and acid-etched surface (Promote, PRO) were treated with diamond polishing brushes (BRUSH), nickel-titanium brushes (NITI), or phenol and sulfuric acid-gel (GEL). The disks were stored in saline (-S) or left exposed to air overnight (-A). Untreated (PRO) and machined (MACHINED) disks were used as controls. GEL samples were treated for the 60 s, while the operative time was recorded for BRUSH and NITI. The samples were subjected to scanning electron microscopy (SEM), surface roughness measurements, and cell viability (SaOS-2 cells, 7 days) assessment.

Results: The operative time was shorter for NITI than for BRUSH (p = 0.017). The original surface morphology (PRO) was not altered in the GEL group, in contrast with what was observed for BRUSH and NITI. The type of storage did not influence the surface morphology. No significant differences in Sa and Sz were observed among the groups, except for MACHINED, which presented lower Sa values (p < 0.05). Cells were able to proliferate on all surfaces. NITI-S showed significantly higher cell viability compared to all groups (p ≤ 0.001), except for NITI-A and MACHINED. Among the treated groups, only one additional significant difference was found, as NITI-A performed better than GEL-S.

Conclusions: None of the investigated protocols compromised the cytocompatibility of the titanium dental implant surface. The best results were registered in the NITI group when the samples were stored in saline. Future studies should confirm the effectiveness of the proposed methods in removing bacterial biofilm from contaminated implant surfaces.

Objectives: This in vitro study compared the accuracy of conventional impressions (CNVs), photogrammetry (PG), and intraoral scanning (IOS) for recording implant impressions of edentulous segments, ranging from part to complete arches by different evaluation methods.

Methods: The master model for an edentulous maxillary arch was created with six implants (a-f). CNVs, PG, and IOS were used for impressions. Three impression ranges (bcde, bcdef, and abcdef) were chosen for analysis. The best-fit algorithm, absolute linear deviation, and angular deviation were used for evaluation. Trueness and precision were analyzed by two-way ANOVA and the Kruskal-Wallis test, respectively.

Results: The accuracy of multiple implant impressions was significantly influenced by the impression method and impression range (p < 0.05) regardless of the evaluation methods used. At smaller ranges (bcde and bcdef), there was no difference in the trueness of the three impression methods, whereas at a larger range (abcdef), both PG and CNV exhibited similar trueness, which was significantly higher than that of IOS(p < 0.05). The precision of PG was significantly better than that of CNV and IOS in most of cases (p < 0.05). As the range expanded, the trueness and precision of PG and IOS decreased (p < 0.05), whereas the accuracy of CNV remained stable.

Conclusions: In the case of large-range impressions, PG demonstrated a similar degree of trueness and better precision compared with CNVs, whereas the trueness and precision of the intraoral scanning were worse. This indicated that PG might be a promising method for multiple implant impressions.

Introduction: Using mini implants as transitional implants (TIs) for complete arch implant-supported rehabilitations may overcome limitations associated with mucosa-supported surgical guides and facilitate immediate fixed provisionalization. This study aimed to assess the success of TIs in supporting surgical guides for implant placement and fixed provisional prostheses.

Methods: Patients who received TIs between 2012 and 2023 for a complete arch implant-supported prosthesis were evaluated retrospectively. Patient demographic data, TI functionality in supporting a surgical guide and supporting a complete arch provisional prosthesis, and dates of TI placement and regular implant placement were collected. Descriptive statistics were used to determine the survival rate and success rate for TIs.

Results: Twenty-six patients, 35 jaws, 136 TIs, and 216 regular implants were included. The survival rate of TIs was 74.26%; however, the use of TIs yielded success in 97% of jaws for supporting a surgical guide and a fixed complete-arch provisional prosthesis throughout the complete provisional phase. An average of 4 TIs per maxilla and 3 TIs per mandible supported surgical guides. Thirty-five provisional prostheses were placed on an average of 4 TIs in the maxilla and 3 TIs in the mandible. Thirty-four provisional prostheses were successfully supported by TIs and regular implants until final restoration delivery. The survival of regular implants placed in conjunction with the use of TIs was 98%.

Conclusions: Using TIs to support a surgical guide and provisional prosthesis may be a predictable approach with a high success rate. All surgical guides planned to be supported on TIs were successful. Despite premature loss or replacement of TIs, this approach was able to support most provisional prostheses until the regular implants could be loaded.

Aim: To report the 10-year clinical and radiographic outcomes of implants placed in grafted (GBR) and non-grafted (no-GBR) sites in a Swiss specialist private practice using hydrophilic implants with a low surface roughness flange.

Methods: Fifty consecutively enrolled patients received 159 hydrophilic implants with a low surface roughness flange. A first re-evaluation was performed 1 year after delivery of restoration (T1). An additional examination was performed at the 10-year follow-up (T2) including the assessment of clinical (i.e., periodontal/peri-implant pockets probing depths (PPD) (mm), full-mouth bleeding score (%), implant survival rate, mid-buccal keratinized mucosa (KM) width in mm, and peri-implant phenotype), and radiographic (i.e., marginal bone level change [ΔMBL]) outcomes. Biological, mechanical and technical complications were also recorded.

Results: Out of the initial cohort, 22 patients (9/40.9% male and 13/59% female) and 63 implants (47 with GBR, 16 without GBR), could be re-examined at T2. Overall, ΔMBL (T2-T1) was -0.56 ± 0.96 mm. In the GBR group, ΔMBL were significantly higher at the distal sites compared to the no-GBR group (-0.75 ± 1.17 mm vs. -0.12 ± 1.29 mm, p = 0.045), however, in the GBR group MBL started at a higher level at T1 but were similar with the no-GBR group at T2. Implant survival was 100% with only very few technical complications (6.3%). Mean PPD amounted to 3.84 ± 1.00 mm with significantly higher values in the GBR group (3.98 ± 1.08 mm vs. 3.45 ± 0.60 mm; p = 0.016). Nineteen implants (30.1%) were diagnosed with peri-implant health while 44 (69.9%) presented with peri-implant mucositis.

Conclusion: Within the limitations of this study, favorable clinical and radiographic conditions were recorded around hydrophilic implants with a low surface roughness flange placed in pristine and augmented bone after 10 years in function.

Aim: To investigate the influence of lateral hard-tissue grafting performed simultaneously to implant placement on peri-implant health or disease.

Materials and methods: A total of 299 patients exhibiting 897 implants placed either simultaneously with lateral bone grafting using a bovine bone mineral with or without adjunctive native collagen membrane (n = 131/269 patients/implants; LatGr group) or at pristine bone sites without lateral bone grafting (n = 168/628 patients/implants; NoGr group) were enrolled in this cross-sectional analysis. Clinical outcomes (i.e., modified plaque index (mPI), bleeding on probing (BOP), probing depth (PD), mucosal recession (MR)), keratinized mucosa (KM), and the frequency of peri-implant disease were evaluated. Univariate and multiple ordinal regression analyses with mixed effects were conducted to identify factors associated with peri-implant disease.

Results: After a mean follow-up period of 59.47 ± 24.66 months, mPI, BOP, and KM values were significantly higher in the control group, whereas no difference between the groups was found for PD and MR. Peri-implantitis was diagnosed in 31.30% of patients and 13.4% of implants in the LatGr group, and in 32.74% of patients and 24.8% of implants in the NoGr group. The corresponding values for peri-implant mucositis at the patient and implant level in the LatGr and NoGr groups were 29.77% and 29.0%, and 26.19% and 28.5%, respectively. Implants of the LatGr group were associated with a significantly lower chance to be affected by peri-implant disease (OR = 0.69, 95%-CI: (-0.72, -0.03), p = 0.032). The presence of plaque at implant sites and smoking significantly correlated with peri-implant disease (OR = 2.92, 95%-CI: (2.11, 4.03), p < 0.001 and OR = 0.22; 95%-CI: (0.06, 0.84), p = 0.027, respectively).

Conclusions: Lateral hard-tissue grafting performed simultaneously with implant placement demonstrated comparable peri-implant tissue health to pristine bone sites without lateral bone grafting.

Introduction: Implantoplasty can be performed on implants diagnosed with peri-implantitis to facilitate implant decontamination and improve access for oral home care. However, its effect on the mechanical strength of the implant is still uncertain. This study aimed to evaluate the effect of implantoplasty on the fracture resistance of dental implants with various degrees of bone loss, as well as its surface changes.

Methods: Eighty 4.2 × 13 mm conical connection dental implants were allocated evenly into four groups based on the bone defect morphology: circumferential or semi-circumferential, and 3 or 5 mm vertical height. Half of the implants underwent implantoplasty with tungsten carbide finishing burs. Weight, volume, and surface roughness of the implants were recorded prior to and after instrumentation. All implants were subjected to static loading to failure or fracture and the implant surfaces were then analyzed using optical microscopy. Finite element analysis was carried out to assess the stress pattern on dental implants after implantoplasty.

Results: Implantoplasty significantly reduced the fracture resistance of implants with all defect morphologies, aside from those with 3 mm of circumferential bone loss. Implants with 5 mm of peri-implant bone loss also experienced significantly reduced fracture resistance compared to the 3 mm group. Significant decrease in fracture resistance was only observed between the circumferential and semi-circumferential groups with 5 mm of bone loss. Surface roughness was also significantly reduced following implantoplasty. The results from finite element analysis revealed a change in pattern of stress concentration in the implant after implantoplasty.

Conclusion: Implantoplasty negatively impacted the fracture resistance of standard diameter dental implants in most scenarios. The increase in exposed implant length resulted in a decrease in fracture resistance. This increase in fracture risk should be considered prior to implantoplasty, especially in implants with more advanced bone loss.

Introduction: This study aimed to analyze the factors affecting the occurrence of peri-implant medication-related osteonecrosis of the jaw (PI-MRONJ) in patients using anti-resorptive drugs (ARDs) on different implant position, inclinations, and types of prosthesis.

Methods: The data of 75 patients with bone necrosis that progressed around the implant between 2018 and 2022 were retrospectively examined to identify the factors influencing PI-MRONJ. Data, including patient demographics (age, sex, smoking status, concomitant disease, time of ARD therapy, dose of ARDs, and parafunctional habits) and implant-specific information (type of prosthesis, angle of insertion), were extracted from medical and dental records.

Results: Tilted implants with an angle ≥ 5.1° relative to the occlusal plane of the prosthesis had a stronger association with PI-MRONJ in comparison to non-tilted implants (inclination was < 5°). Additionally, the boundary of the area of osteonecrosis around the fixture was larger for the splinted implant-supported crowns than for the single implant supported crowns).

Conclusion: In patients taking anti-resorptive medications the inclination of the implant was associated with the occurrence of PI-MRONJ. Further studies are required to confirm the clinical findings.

Background: Full-arch immediate loading rehabilitations are now a widely used rehabilitation method that guarantees predictable medium- and long-term results. Numerous factors can influence its success and stability in the medium and long term. Among these the implant-abutment connection seems to play an important role, however there is still little information on which is the most suitable in this type of treatment.

Purpose: The aim of the present multicenter split-mouth controlled trial is to evaluate whether external hexagonal connections (EHC) and internal hexagonal connections (IHC) can influence success, bone resorption and peri-implant parameters in immediate-load full-arch rehabilitations.

Materials and methods: Twenty patients were rehabilitated with immediately loaded fixed full-arch rehabilitations. All the implants presented the same macro- and micro-topography but different implant-abutment connection. IHC were used in one randomly selected side of the jaw and EHC was used in the other side. Outcome measures were implant survival rate, peri-implant marginal bone loss (MBL), plaque index (PI), probing depth (PD), and bleeding on probing (BoP) evaluated at 3, 6, 12, 36, and 72-month post-loading. Technical and biological complications were recorded.

Results: In 20 patients, 43 EHC and 40 IHC implants were placed. Between 32 and 72 months of follow-up two patients withdrew (died) and no implants were lost. The cumulative survival rate (CSR) was 97.44% for EHC implants and 97.22% for IHC implants. The MBL presented a resorption of 2 mm in the EHC group and 1.9 mm in the IHC group. No statistically significant differences were found between the two groups for any of the parameters at any time. No biological or technical complications were detected between the 36th and 72nd month of follow-up.

Conclusions: After 72 months in function, both internal and external hexagon connections provided good clinical outcomes and were not associated with any significant difference in the clinical outcomes.