Clinical implant dentistry and related research最新文献

Aim: Technology improvement and a better understanding of sinus anatomy and wound healing in the past decade have allowed the development of minimally invasive surgical techniques. This systematic review focused on identifying and describing these techniques for vertical and lateral sinus augmentation (VSA and LSA).

Materials and methods: Electronic and hand search were conducted to screen the literature published from January 2003 to May 2024. The selected studies had to include detailed techniques for minimally invasive SA. Data extraction included the study types, sample size, technique/instrument details, and outcome measurements.

Results: A total of 36 articles (27 VSA, 8 LSA with an additional 1 article included both procedures) with 2732 sinus augmentation met the inclusion criteria. Minimally invasive VSA includes the use of modified rotary instruments with stopper, balloon, hydraulic pressure, digital planning, endoscope, and operating microscope. These techniques aim for conservative flap reflection, precise sinus window preparation, and/or controlled sinus membrane elevation. Most of the selected studies (n = 15) did not report the incidence of sinus membrane perforation.

Conclusion: Within the limitations of this review, minimally invasive VSA and LSA achieved sufficient sinus augmentation and implant success with the potential advantages of reduced surgical complications and morbidity. Comparative studies with defined outcomes are encouraged to further validate these useful minimally invasive techniques for SA.

Objective: To evaluate the efficacy of 3D-printed scaffolds that were osteoinductively functionalized with a bone morphogenetic protein 2 (BMP-2)-incorporated biomimetic calcium phosphate particles (BMP-2-inc. BpNcCaP)/hyaluronic acid (HA) composite gel in vertical bone augmentation in beagle dogs.

Materials and methods: Four Beagle dogs were used in this study. Three months after the extraction of 1st, 2nd, 3rd, and 4th premolars at both sides of the lower jaws of Beagle dogs, one or two critical-size vertical bone defects (4 mm vertical bone defect without buccal and lingual bone) on each side were surgically created. The defects were randomly subjected to the following groups: (1) Control (without bone-defect-filling materials); (2) 3D scaffold; (3) BMP2-inc. BpNcCaP/HA-functionalized 3D scaffold. Six weeks post-surgery, samples were harvested and subjected to micro-CT and histomorphometric analyses.

Results: The struts of the BMP2-inc. BpNcCaP/HA-func. 3D scaffold were covered by a thick layer of cemented irregular particles with an average pore size at 327 ± 27 μm. The BpNcCaP/HA-func. 3D scaffold group bore significantly higher bone volume, bone volume fraction, trabecular number, trabecular thickness, bone mineral density, connectivity density, and bone volumes in three directions (mesiodistal, buccolingual, and apicocoronal) when compared with the groups of Control and 3D scaffold. Moreover, the BMP2-inc. BpNcCaP/HA-func. 3D scaffold group bore significantly lower trabecular separation and exhibited significantly higher bone-to-scaffold contact percentage and newly formed bone area percentage within pores in comparison with 3D scaffold.

Conclusions: BMP2-inc. BpNcCaP/HA-func. 3D scaffold dramatically enhanced vertical alveolar bone augmentation, which suggests a promising application potential of BMP2-inc. BpNcCaP/HA-func. 3D scaffold in dental clinic.

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.

Objectives: The objective of this study is to investigate the effect of collagen matrix with polydeoxyribonucleotide (PDRN) at two concentrations on keratinized tissue (KT) regeneration for buccally positioned implants in canines.

Methods: Four implants were placed in the edentulous mandible of five dogs simultaneously with KT removal. The implants were positioned buccally with respect to the ridge crest. After 2 months, KT augmentation was performed applying the following treatment modalities:(1) free gingival graft (FGG), (2) xenogeneic collagen matrix (XCM), (3) XCM loaded with 2 mg/mL PDRN (PDRN2), and (4) XCM loaded with 4 mg/mL PDRN (PDRN4). All animals were sacrificed 3 months later. Outcomes included clinical (KT height) and histomorphometric measurements (KT height/length, level of the mucosa, mucosal thickness, supracrestal soft tissue height).

Results: Clinical and histomorphometric KT formation at 3 months was greatest in groups with FGG (4.70 ± 1.00/3.94 ± 0.93 mm) and PDRN2 (4.85 ± 1.43/3.95 ± 0.87 mm). Group PDRN2 (1.87 ± 1.50 mm) showed a higher marginal mucosal level with respect to the implant platform compared to other groups (range: 0.57 ± 0.97-0.69 ± 1.14 mm). All groups presented a soft tissue thickness of < 2 mm on the buccal aspect of the implants.

Conclusions: Based on the limitations of this pilot preclinical study, XCM with 2 mg/mL of PDRN demonstrated a potential for KT augmentation.

Maxillary sinus floor elevation is usually performed in two different ways: the lateral approach involves the creation of a bony window on the maxillary sinus lateral wall, providing direct access to the sinus cavity for membrane elevation and subsequent graft placement, and the transcrestal approach is considered less invasive. The aim of this article is to describe, based on the literature, how to anticipate, avoid, and manage the intraoperative complications that can occur with both approaches. For both approaches, the most common complication is the sinus membrane perforation. For the lateral approach, an average frequency ranging from 15.7% to 23.1% is reported, but because of the better visibility, their management will be easier compared to the transcrestal approach. Mean perforation rate reported for the transcrestal approach is lower (3.1%-6.4%), but it should be noted that a significant number of perforations cannot be detected and managed given the blind nature of this technique. Anatomical parameters such as sinus width and buccal wall thickness may be a risk factor for one approach and not the other. As it is impossible to assess the resistance of the Schneiderian membrane, the transcrestal approach is more likely to lead to infectious complications in the event of perforation. Others, such as the risk of vascular damage, are encountered only with the lateral approach, which can be prevented easily by dissecting the alveolo-antral artery. For both approaches, prevention is essential and consists in analyzing the anatomy, mastering the surgical technique, and collaborating with the ENT to manage the essentially infectious consequences of intraoperative complications.

Background: This cross-sectional study aimed to compare the composition of the submucosal microbiome of peri-implantitis with paired and unpaired healthy implant samples.

Methods: We evaluated submucosal plaque samples obtained in 39 cases, including 13 cases of peri-implantitis, 13 cases involving healthy implants from the same patient (paired samples), and 13 cases involving healthy implants from different individuals (unpaired samples). The patients were evaluated using next-generation genomic sequencing (Illumina) based on 16S rRNA gene amplification. The sequences were grouped according to the amplicon sequence variant (ASV) to define the taxonomic categories. Alpha diversity was analyzed using Shannon's and Simpson's indices, while beta diversity was evaluated using principal coordinate analysis, analysis of similarities, and permutational multivariate variance analysis. Additionally, UniFrac distances were evaluated using Quantitative Insights into Microbial Ecology 2. Finally, we evaluated between-group differences in the taxonomic components.

Results: There were no significant between-group differences in alpha diversity. The average bacterial ratios of Filifactor alocis, Porphyromona endodontalis, Tannerella forsythia, Treponema denticola, Peptostreptococcaceae [Eubacterium nodatum], Desulfobulbus sp. HTM 041, and Mogibacterium timidum significantly differed between peri-implantitis samples and unpaired samples from the healthy implants (p < 0.05). However, there were few differences in the microbiota between peri-implantitis samples and those paired with healthy implants in the same patient.

Conclusions: Future studies comparing the microbiome compositions using sequencing techniques between healthy implants and implants with peri-implantitis should focus on retrieving samples from the same patient, especially in individuals with a history of periodontitis.

Objective: To evaluate the feasibility of ultrasound-image-based computer-assisted implant planning and placement.

Materials and methods: Intraoral scans, cone-beam computerized tomography (CBCT), and ultrasound (US) scans with a custom positioning device were acquired in nine patients. Prosthetic-driven surgical guides were planned and fabricated based on ultrasound images and intraoral scans. Implants were then placed. Postoperative implant position was obtained intra-surgically by intraoral scan. Aside from the ultrasound-based plan, conventional implant planning was performed by the same operator on a pre-surgical CBCT for comparison. Linear deviations between ultrasound and CBCT-planned implant positions were measured and compared with the intra-surgical implant position, and the position deviations between two consecutive plannings were performed on the same CBCT by the same operator. The linear deviation between the 3D scan surface of the edentulous region and the ultrasonographic soft tissue profile segmentation was also assessed with reverse-engineering software. Means, standard deviations, and root mean square differences (RMSD) were calculated for every variable.

Results: All the ultrasound-planned implants were successfully placed, and no complications were recorded. The mean deviations in angles, shoulders, and apexes were 5.27 ± 1.75° (RMSD: 5.53°), 0.92 ± 0.26 mm (RMSD: 0.95 mm), and 1.41 ± 0.61 mm (RMSD: 1.53 mm), respectively, between the US and CBCT-planned implants; 2.63 ± 0.43° (RMSD: 2.66°), 1.16 ± 0.30 mm (RMSD: 1.19 mm), and 1.26 ± 0.27 mm (RMSD: 1.28 mm) between the planned implant and intra-surgically recorded positions; and 2.90 ± 1.36° (RMSD: 3.18°), 0.65 ± 0.27 mm (RMSD: 0.70 mm), and 0.99 ± 0.37 mm (RMSD: 1.05 mm) between two consecutive CBCTs planning performed by the same operator. The mean deviation between the 3D surfaces of model scans and ultrasound-derived soft tissue profile in the edentulous area was 0.19 ± 0.08 mm.

Conclusions: Ultrasound-guided implant surgery represents a feasible non-ionizing alternative to conventional static guided implant surgical protocols for implant placement in sites with favorable characteristics.

Introduction: This is a comprehensive, long-term follow-up study of single-implant treatments. At the Brånemark Clinic in Gothenburg, Sweden, during the period of 1982-1985, 16 patients received single-tooth implants.

Objective: This study evaluates the survival rate of the implants after nearly four decades, focusing on the biological and technical complications.

Methods: Of the original 16 patients with a total of 23 implants, 13 patients with 18 implants were available for the follow-up and were included in the study. Clinical and radiographic examinations were performed on these patients.

Results: The cumulative survival rates were 95.6% for the implants and 60.9% for the implant-supported crowns after 38-40 years in function. The marginal bone level changes were 0.9 ± 1.0 mm (range, -0.5─3.0 mm) over the follow-up period. The frequency of biological complications was low; although mucositis was common, no cases of peri-implantitis were observed. The mean plaque index was 16.9% ± 11.6% (range, 1%─34%) and the mean probing depth around the implants was 3.8 ± 2.2 mm (range, 0.0─7.0 mm). Few technical complications were observed, although many of the original implant-supported crowns had been replaced for esthetic reasons.

Conclusion: The findings emphasize the importance of long-term follow-up in implant dentistry, particularly for younger patients, to improve understanding of potential complications and the longevity of treatment outcomes. Overall, single-tooth implants have a favorable long-term prognosis, though crown replacement may eventually be necessary.

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.

Objectives: This study aimed to report the clinical and radiographic results of 2.8 mm two-piece narrow diameter implant (NDI) supporting fixed restorations.

Materials and methods: Clinical and radiographic data of 54 NDIs in 32 patients were retrospectively assessed after 2 to 11 (mean 8.17) years of follow-up. Clinical and radiographic measurements were taken. Survival rate, implant and prosthesis failure, pink aesthetic scores (PES), white aesthetic scores (WES), bleeding on probing (BOP), probing depth (PD), marginal bone loss (MBL), and mechanical and biological complications were evaluated.

Results: An implant failed during the follow-up period, resulting in a cumulative survival rate of 98.15% at the implant level and 96.88% in the patient. The total mean values of PES and WES for 2.8 mm NDIs were 7.09 ± 1.15 (range: 3.33-9.00) and 7.42 ± 1.03 (range: 3.67-9.33). The prevalence of sites with positive BOP was 38.14 ± 29.77%. The mean PD value was 2.46 ± 0.62 mm. The average MBL was 1.15 ± 0.74 mm (range: 0.25-4.03 mm). No implant or abutment fracture was detected. A veneer chipping was present in one patient, and a loose crown appeared in another patient. Two implants (3.7%) and two patients (6.3%) were diagnosed with peri-implantitis.

Conclusion: Within the limitation of the study, the results indicate that the use of two-piece 2.8 mm NDI for the fixed prosthetic rehabilitation of edentulous regions with reduced interdental and/or buccal-lingual width is viable.