Crestal Bone Loss Research Articles

Hard and soft tissue healing around implants with Ag coating: An experimental study in dogs

Introduction The purpose of this randomized controlled canine experimental study was to evaluate peri‑implant hard and soft tissue healing around implants with silver coating.Methods All mandibular premolars and molars of five male beagle dogs were extracted. 25 test and 25 control implants were randomly installed and connected with the healing abutments. After 2 and 4 month healing period, implants with soft and hard tissues were obtained for histologic and histomorphometric analysis.Results In mesio-distal sections, supracrestal tissue attachment dimensions were 4.03±0.48 mm and 4.25±0.66 mm for test and 4.34±0.6 mm and 5.21±0.72 mm for control implants at 2 and 4 month healing time. The respective crestal bone loss values were 1.10±0.69 mm and 0.74±0.67 mm for test and 1.13±0.48 mm and 1.49±0.65 mm for control implants. The differences were statistically significant only in the 4-month healing period. In buccolingual sections, supracrestal tissue attachment height at 2 and 4 month healing periods were 4.09±0.64 mm and 4.5±0.8 mm for test implants and 4.17±0.76 mm and 4.48±0.76 mm for control implants. The respective mean values for crestal bone loss were 1.31±0.6 mm and 1.02±0.58 mm for test implants, and 1.28±0.61 mm and 1.29±0.69 mm for control implants. No statistical significant differences were recorded, apart from the height of connective tissue at the 2 month healing group. No significant difference in terms of BIC between implants or healing periods was recorded.Conclusions The Ag implant coating resulted in smaller supracrestal tissue attachment dimensions and less bone loss. Within the limits of a canine study, prevention of crestal bone loss along with the effectiveness of Ag antimicrobial properties in dental implantology is demonstrated.

Impact of Chitosan-Coated Implants on the Alveolar Ridge: Preliminary MicroCT and Radiographic Study in a Canine Model.

To compare crestal bone loss (CBL) 12 weeks after immediate implant placement in the mandible of a canine model between titanium (Ti) implants with a conventional etched surface (SLA type) and Ti implants coated with chitosan (Cht). A total of 48 Ti-Al16-V4 implants (24 experimental and 24 control) with an internally connected tapered screw design were randomly placed into six canine maxillae, 4 per hemiarch. The experimental implants were coated with Cht by immersion and sterilized with ethylene oxide. Primary stability was measured using the Osstell device, and no grafting materials were used. The 3D microCT measurements included crestal bone volume (CBV) and bone volume change in crestal area (ΔCBV), which were considered outcome measures. Parallelized periapical radiographs were also taken at the time of implant placement and after 12 weeks to assess changes in crestal bone levels. In terms of volumetric changes, it was observed that the experimental group showed better results than the control group (P = .049 and P = .303, respectively). Regarding the implant sites, no significant differences were found between the experimental implant sites and control sites. The implants placed at P4 level in the experimental group obtained the best result (P = .041). The linear data obtained from the periapical radiographs indicated greater bone loss in the control group compared to the experimental group (3.2 ± 0.45 mm and 2.75 ± 0.55 mm, respectively). Despite the better results obtained for the Cht-coated surface group, further preclinical studies are necessary to confirm these results.

Injectable platelet rich fibrin versus hyaluronic acid with bovine derived xenograft for alveolar ridge preservation. A randomized controlled clinical trial with histomorphometric analysis.

Alveolar ridge preservation (ARP) is a technique that aims to maintain bone volume and minimize resorption after tooth extraction. This study aimed to compare the effectiveness of injectable platelet-rich fibrin (I-PRF) versus hyaluronic acid (HA) in combination with xenografts for ARP. This randomized controlled trial included 36 patients (20 females and 16 males) who required implant placement in the upper arch. The patients were randomly allocated to one of three groups (n = 12 each): I-PRF with xenografts, HA with xenografts, or xenografts alone. All patients underwent ARP, and the extraction sockets were sealed with a free gingival graft harvested from the palate, a total of 36 implants were inserted. Cone-beam CT scans were performed before and 4 months postoperatively to measure radiographic bone gain as the primary outcome. Clinical parameters, including soft tissue thickness and clinical bone width, were evaluated preoperatively, and at 4 months and 1 year postoperatively. Additionally, histological assessment of core bone biopsies was performed 4 months postoperatively using histomorphometric analysis to determine the percentages of newly formed bone, mature bone, and residual grafts. Regarding the radiographic bone gain 4 months postoperative the HA group exhibited the highest value (9.78 ± 0.87), which was significantly greater than the values observed in the I-PRF and control groups (8.60 ± 1.27 and 7.99 ± 0.89, respectively) (one-way ANOVA, p = 0.007). Crestal bone loss was significantly higher in the control group (-0.98 ± 0.18) than in the I-PRF group (-0.53 ± 0.11) and HA group (-0.33 ± 0.15) groups (one-way ANOVA, p < 0.001). In the histomorphometric analysis, the mean area fraction of newly formed bone trabeculae was significantly higher in the HA group (56.66 ± 7.35) than in the I-PRF group (28.74 ± 5.15) and the control group (24.05 ± 3.64) (repeated measures ANOVA, p < 0.001). Additionally, the mean area fraction of residual graft material was higher in the I-PRF group (6.76 ± 2.59), followed by the control group (2.71 ± 1.24), while the HA group had the lowest value (2.63 ± 1.27) (Repeated measures ANOVA, p < 0.001). The combination of HA with xenografts yielded better radiographic and histological outcomes in terms of new bone formation and degree of bone maturation than the I-PRF and control groups. Furthermore, I-PRF improved soft tissue thickness. Please note that clinical trial registration was not completed prior to participant recruitment and randomization. The registration link for this trial is https://clinicaltrials.gov/ct2/show/NCT05781529.

Comparison of Radiographic and Clinical Status and Peri-implant Crevicular Fluid Prostaglandin E2 Levels Among Patients with Peri-implant Mucositis and Peri-implantitis.

The aim of this study was to compare radiographic and clinical status and peri-implant sulcular fluid (PISF) prostaglandin E2 (PGE2) levels among patients with and without peri-implant disease. Patients with peri-implant mucositis (PiM) (Group 1) and peri-implantitis (Group 2) and individuals without peri-implant disease (Group 3) were included. Demographic information was collected, and peri-implant modified plaque and bleeding indices (mPI and mBI), probing depth (PD), and crestal bone loss (CBL) were recorded. PISF samples were collected and PGE2 levels measured. Statistical significance was set at P < .01. A total of 22 patients with PiM, 22 with peri-implantitis, and 23 without peri-implant disease (controls) were included. Scores of mPI (P < .01), mBI (P < .01), and PD (P < .01) were higher in patients with PiM and peri-implantitis than the controls. The volumes of collected PISF were significantly higher in patients with peri-implantitis (P < .01) compared to patients with PiM and the controls. The PISF volume was significantly higher in PiM patients (P < .01) than in the controls. There was a significant correlation between peri-implant PD and PISF PGE2 levels in patients with peri-implantitis (P < .001). Raised PISF PGE2 levels indicate poor peri-implant health; therefore, PGE2 is a potential biomarker for the assessment of peri-implant health status.

Evaluation of Endo Perio Lesions Using Cone Beam Computed Tomography (CBCT) - A Cross Sectional Study.

An accurate assessment of the disease extent and lesion size is needed for appropriate therapy decisions of endodontic-periodontic (endo-perio) lesions. CBCT imaging with less radiation and high spatial resolution can provide a comprehensive evaluation of endo-perio lesions. A total of 71 teeth with endo-perio lesions were assessed using CBCT. Periodontal bone defects were studied for bone loss pattern (horizontal/vertical) along with bone loss levels on mesial and distal sides in association with furcation involvement. The periapical lesions were studied for their prevalence and extent based on CBCT PAI Score. Horizontal and vertical bone loss were detected in 54 teeth (76.1%) and 17 teeth (23.95%), respectively. Mean crestal bone loss levels on mesial and distal aspects were 4.80 ± 3.21 mm and 5.74 ± 3.91 mm, respectively. The mean height, width, and depth of furcation defects were 3.19 ± 2.99 mm, 1.94 ± 0.98 mm, and 4.44 ± 1.92 mm, respectively. Periapical lesions were recorded in 55 teeth (77.5%). A CBCT PAI score of 5 was scored in 35 teeth with a mean lesion diameter of 11.3 ± 2.83 mm, while 16 teeth had healthy periapical tissues (scores of 0 and 1). CBCT is a valuable diagnostic tool that can help assess endo-perio lesions by providing morphometric measurements of periodontal bone defects and the extent of associated periapical lesions.

Evaluating the effect of mechanical debridement with adjunctive antimicrobial photodynamic therapy in comparison with mechanical debridement alone on the peri-implant parameters in type 2 diabetic mellitus patients with peri-implantitis: a systematic review and meta-analysis

BackgroundType 2 diabetes mellitus (T2DM) is a major risk factor for localized diseases such as peri-implantitis that may affect ideal implant treatment. This study was aimed to evaluate the effect of mechanical debridement (MD) + antimicrobial photodynamic therapy (a-PDT) in patients with peri-implantitis who have T2DM in terms of bleeding on probing (BOP) and probing depth (PD) as primary outcomes and plaque index (PI) and crestal bone loss (CBL) as secondary outcomes.MethodsPublications compared outcomes between MD + aPDT and MD alone in T2DM patients with peri-implantitis, containing more than 3-month follow-up duration, were involved in the systematic review and meta-analysis. Literature until July 2023 using MEDLINE (through PubMed), Scopus, Cochrane Library, Embase, Web of Science, and Google Scholar were collected.ResultsTwo randomized controlled trials (RCTs, 88 individuals) and one controlled clinical trial (CCT, 67 individuals) with follow-up periods ranged from 3 to 12 months were recruited. All studies used diode laser with wavelengths ranged from 660 to 810 nm. The results demonstrated that the MD + aPDT group showed significant benefits for BOP reduction after 6 months (SMD = -2.15, 95% CI: -3.78 to -0.51, p = 0.01). However, a great amount of heterogeneity was observed (I2 = 91.52%, p < 0.001). Moreover, there was a significant difference between MD + aPDT and MD alone groups in CBL (SMD = -0.69, 95% CI: -1.07 to -0.30, p < 0.001). In addition, homogeneity assumption was satisfied (I2 = 22.49%, p = 0.28). Significant differences in PD and PI reduction were not found except for PI reduction after 3 months (SMD = -0.79, 95% CI: -1.24 to -0.33, p < 0.001. Also, no heterogeneity was observed (I2 = 0.00%, p = 0.47).ConclusionGiven that high heterogeneity in BOP and PD outcome was found in this systematic review, future long-term CTs with MD + aPDT should be examined to arrive at a firm conclusion.

The effect of triangular cross-section neck design on crestal bone stability in the anterior mandible: A retrospective study with a 5-year follow-up.

The objective of this study, which included a 5-year follow-up, was to compare peri-implant soft tissue health, crestal bone loss (CBL), and buccal bone thickness (BBT) around triangular cross-section neck (TN) or round neck (RN) implants, using cone-beam computed tomography. This study was initially designed as a prospective 1-year randomized controlled study and then extended with a 5-year retrospective evaluation of clinical and radiographic records. In the initial 1-year study, a total of 20edentulous patients receiving 40 implants with similar diameters were randomly assigned to the RN or TN groups using a split-mouth design. Pocket probing depths (PPD), plaque index (PI), and gingival index (GI) were recorded at postoperative month 12. CBL and BBT at three levels (0, -2, and -4 mm) were evaluated 1 year after insertion. Five years after insertion, PPD, PI, GI, CBL, and BBT were recorded as patients were recalled for clinical and radiographic monitoring. Nineteen patients completed the study. After 5 years, no significant differences in PPD, PI, and GI scores and BBT values between the two groups (p > .05). The mean ± SD CBL values at the final follow-up visit were -0.71 ± 0.69 mm for TN and -1.03 ± 0.86 mm for RN (p < .01). These results suggest better crestal bone preservation using implants with TN when compared to RN after a 5-year follow-up. However, TN showed similar results to RN regarding peri-implant soft tissue health and BBT.

Clinical Outcomes of Titanium Zirconium and Titanium Dental Implants under Immediate Functional Loading in Posterior Mandibular Region.

Studies comparing the clinical performance of titanium zirconium (Ti-Zr) and titanium (Ti) dental implants subjected to immediate loading in the posterior mandibular region where occlusal forces are higher are sparse in the current literature. Hence, the study aimed to evaluate and compare the clinical outcomes of Ti-Zr and Ti dental implants under immediate functional loading in the mandibular posterior region. Forty participants fulfilling the predetermined selection criteria were randomly grouped based on dental implant used; Titanium zirconium (Ti-Zr):20, and Titanium (Ti):20. Dental implants were placed through a standard full-thickness mucoperiosteal flap approach and loaded immediately fulfilling the principle of implant protective occlusion. Clinical parameters including crestal bone loss (CBL), modified plaque index (MPI), probing depth (PD) and modified sulcular bleeding index (MSBI) were measured at baseline and follow-up visits (4, 8, and 12 months). Obtained data were compared with standard tests such as the t-test, Chi-square test, and Mann-Whitney U test. On intergroup comparison, CBL was more in the Ti-Zr group as compared to the Ti group at 4 months (0.72 ± 0.16 mm versus 0.70 ± 0.13 mm), but it was less at 8 months (1.08 ± 0.16 mm versus 1.13 ± 0.13 mm) and 12 months (1.19 ± 0.17 mm versus 1.24 ± 0.12 mm) but the difference was not statistically significant (P > 0.05). Mann-Whitney test also revealed no statistically significant difference in MPI, PD and MSBI at 4 months, 8 months and 12 months recall (P > 0.05). CBL and periodontal parameters of Ti-Zr dental implants were found similar to Ti dental implants under immediate loading in the posterior mandibular region. However, further studies are needed to determine its long-term efficacy and cost-effectiveness.

Immediate Loading of Bicortically Engaged Long Implants in Maxillary and Mandibular Esthetic Region – A Clinicoradiographic Evaluation

Abstract Background: Bicortical engagement is the engagement of nasal cortical plate and basal cortical plate in maxillary and mandibular esthetic zone, respectively. These are longer implants which offer osseointegration along with high osseofixation. Increased length of implant provides increased bone–implant contact offering primary stability which permits immediate loading. Aim: The aim of the study was to clinicoradiographically evaluate immediate loading in bicortically engaged long implants in maxillary and mandibular esthetic region. Materials and Methods: Thirty patients with missing teeth in esthetic region were selected for the study. Implants were placed in both arches engaging nasal cortex and basal bone wherever required. One-time definitive abutment was placed and immediate loading was done. Results: No failure was observed in the study period of 9 months. The mean insertion and reverse torque was 66.67 ± 6.794 and 41.67 ± 3.101, respectively, indicating high primary stability. No pain, discomfort, infection, or implant mobility was observed. The mean crestal bone loss changes were statistically insignificant. Conclusion: Hundred percent implant survival was observed.

Immediate implant placement in fresh extraction sites in the maxillary esthetic zone: a case series with 2-years' follow-up.

The objective of the present case series with 24 months of follow-up was to document the clinicoradiographic status of IDI placed in fresh extraction sockets (FES) in the maxillary esthetic zone (MEZ). Immediate implants were placed in the FES of three adult patients. Medical history and demographics of these patients were retrieved from their respective healthcare records. All extractions were done using atraumatic techniques and performed in the MEZ. Diameter and lengths of IDI ranged between 4-4.1 mm and 14-16 mm, respectively. Osseous drilling was done at 2000 rpm and implants were inserted using an insertion torque of 45 Ncm. All implants were restored with screw-retained ceramic restorations. Follow-up clinicoradiographic investigations were done after 2-years. At follow-up, peri-implant plaque and gingival indices were measured and peri-implant probing depth was measured. Marginal bone loss was also measured. The two-year follow-up clinical and radiographic results from all cases showed that the implant success and survival rates were 100% and 100%, respectively. There was no clinical evidence of peri-implant soft tissue inflammation in all cases. Scores of peri-implant plaque index, bleeding on probing, probing depth and crestal bone loss showed no evidence of peri-implant inflammation at 2-years' follow-up. All implants and their prostheses were clinically stable. It is concluded that IDI can osseointegrate and remain functionally and esthetically stable when placed in FES located in the MEZ.

Clinical Evaluation of Mandibular Posterior Three-Unit Combined Tooth-/Implant-Supported Fixed Partial Dentures: Controlled Prospective Clinical Study

The aims of the study were to evaluate the clinical performance and the complications of combined tooth-/ implant-supported three-unit fixed partial dentures (FPDs) in the posterior mandible. A total of 78 partially edentulous patients in the posterior mandible were recruited for the study (n = 26/group). Group 1 served as the control group and received two dental implants to support a three-unit FPD. Groups 2 and 3 were the experimental groups in which one implant was placed in conjunction with support from an adjacent tooth to support a three-unit FPD. Standard implants (≥ 8 mm) were included in Group 2, while short implants (< 8 mm) were included in Group 3. Periapical radiographs were taken for evaluation of crestal bone loss (CBL). Modified plaque index (MPI), bleeding index (BI), and sulcus depth values of the abutment teeth were recorded at the time of FPD delivery, 6 months after FPD delivery, and annually thereafter. Recorded complications included abutment tooth intrusions, cementation failures of the restorations, porcelain chipping/delamination, framework fracture, abutment screw loosening, abutment and abutment screw fracture, and implant fracture. Statistically significant differences were observed between Group 1 (0.06 ± 0.17) and Group 2 (0.18 ± 0.32) and between Group 1 and Group 3 (0.17 ± 0.30) in terms of MPI (P ≤ .05). No difference was observed between Group 2 (0.11 ± 0.34) and Group 3 (0.14 ± 0.36) or between Group 1 (0.04 ± 0.22) and Group 2 in terms of BI. There were statistically significant differences in terms of CBL between Group 1 (0.259 ± 0.05 mm) and Group 3 (0.11 ± 0.03 mm) and between Group 2 (0.03 ± 0.03 mm) and Group 3 (P ≤ .05). The mean abutment tooth sulcus depth was 1.11 ± 0.31 mm for Group 2 and 1.20 ± 0.46 mm for Group 3. Within the limitations of the current study, it was concluded that combined tooth/implant-supported prostheses (CTISPs) are a predictable treatment choice in the posterior mandible. When a CTISP is planned, it is more predictable to use a short implant than a standard-length implant.

Influence of Crown-to-Implant Ratio on Crestal Bone Loss at Implants with Single Crowns and Bridges: A 5- to 20-Year Long-Term Cohort Study in Patients with Periodontal Disease.

To evaluate how the crown-to-implant (C/I) ratio affects the loss of crestal bone at single-crown implants and bridges in patients with periodontal disease. A total of 39 patients treated for periodontitis were rehabilitated with 108 implant-supported single crowns and bridges. Each patient was examined over a 5- to 20-year period on a 3- to 6-month recall schedule. At each session, we recorded periodontal clinical parameters. In addition, intraoral radiographs were taken after superstructure insertion (baseline) and then at 1, 3, 5, 10, 15, and 20 years. The study population was divided by anatomical C/I ratio (Group 1: C/I ≤ 1, Group 2: C/I > 1). Implants had a 96.2% 5-year survival rate and 92.6% 20-year survival rate. The overall prevalence was 10.1% for mucositis and 1.1% for peri-implantitis. The survival rate (P = .68), incidence of mucositis (P = .325), and incidence of peri-implantitis (P = .077) did not significantly differ in the group comparison. The mean annual peri-implant bone loss was 0.09 ± 0.41 mm and was not significantly different between the groups. Mean bone loss was not significantly different until the 10th year of observation, during which Group 2 presented significantly less bone loss. The correlation of annual bone loss and clinical C/I ratio showed a small but significant negative effect throughout the entire study period (R = -0.217; P < .01). Increased crestal bone loss was not observed with implants with higher C/I ratios, both anatomical and clinical, and they even showed signs of less crestal bone loss.

Correlation between crestal bone loss and PPD at teeth and implants: a 5- to 20-year long-term cohort study in patients with treated periodontal disease.

The correlation between crestal bone loss at teeth and probing pocket depth (PPD) has been established. Whether these findings can also be applied to implants is not known. The objective of this study was to determine the correlation between crestal bone loss and PPD at teeth and implants. Thirty-one periodontitis-susceptible patients were rehabilitated with fixed implant-supported single crowns and fixed partial dentures. Each patient was examined over a 5- to 20-year period in a 3- to 6-month strict recall program. At each session, periodontal clinical parameters were recorded at teeth and implants. In addition, standardized periapical radiographs were taken after superstructure insertion (baseline) and then at 1, 3, 5, 10, 15, and 20 years. The survival rate of implants (94.0%) and teeth (97.3%) did not significantly differ in all patients after 20 years (P = .68). Almost all patients had a PPD ≥ 5 mm at implants and teeth throughout the observation period. The crestal bone loss at implants and teeth increased continuously, especially in patients with advanced periodontitis, without a correlation with PPD. A few patients (n = 5) had a PPD ≥ 5 mm and annual bone loss ≥ 0.2 mm at one implant, with a correlation between bone loss and PPD. In healthy implants and teeth, moderate crestal bone loss is present without correlation with PPD. A few patients showed progressive crestal bone loss at only one implant, with a correlation with PPD.

Impact of Implant Diameter on Success and Survival of Dental Implants: An Observational Cohort Study

Narrow-diameter implants (NDIs) can be inserted instead of standard dental implants (SDIs) in sites with limited space and bone availability. The aim of this study was to evaluate the effect of implant diameter on peri-implant bone, attached mucosa, and on the associated probability of implant success and survival. The implants with progressive thread design and platform switching (Ankylos®, Dentsply Sirona; Mannheim, Germany) investigated were identified retrospectively and assigned to two groups based on their diameter: 3.5 mm (NDIs) and 4.5 mm (SDIs). Peri-implant bone loss was analyzed based on available radiographs. Descriptive and implant-associated factors were gathered from patient files. Data were statistically analyzed using the Kolmogorov–Smirnov–Lilliefors test and regression analyses. The level of significance was p ≤ 0.05. Results: In total, data for 415 implants in 194 patients were included in the study. Ten-year survival was 95.8% (NDIs) and 91.1% (SDIs). Implant diameter had no significant effect on peri-implant crestal bone loss (p = 0.098) or on the width of the attached gingiva (p = 0.052). Survival and success rates of NDIs were like or slightly better than those of SDIs. Because implant diameter had no effect on peri-implant tissue, NDIs can be recommended in selected cases.

Clinical and Radiographic Outcomes of a New Fully Tapered Implant with the One-Abutment One-Time Approach: In-Line Clinical Case Series with a 1-Year Follow-up.

To evaluate the bone level changes in a new implant design (fully tapered with platform switching) with the one-abutment one-time protocol after 1 year of loading. Thirty patients received 1 or 2 implants (6-, 8-, or 10-mm length and 3.5-, 3.75-, or 4.5-mm diameter, bone-level design) to replace one or multiple edentulous sites. Only the mesial implant was assessed. Radiographic, clinical, and esthetic results and the survival and success rates were evaluated 1 year after final loading. At 1 year, no peri-implant bone loss was seen in any of the cases. Mean marginal crestal bone loss between surgery and crown placement was 0.19 ± 0.17 mm (P < .0001). Between surgery and the 1-year follow-up, the mean marginal crestal bone loss was 0.25 ± 0.24 mm (P < .0001). The difference in the modified Plaque Index between 1 year of follow-up and crown placement was significant for in the mesial (0.33 ± 0.54 mm; P = .003) and distal surfaces (0.5 ± 0.73 mm; P = .001). The probing pocket depth was statistically significantly deeper at 1 year than at crown placement at the mesial and distal aspects (average depth = 0.75 mm; P < .0005). No statistically significant differences were found for any other clinical or esthetic parameters. The overall survival and success rates after 1 year were 100%. The fully tapered, deep-thread, platform-switched implant design placed with the one-abutment one-time protocol demonstrated minimal marginal crestal bone loss and crestal bone stability at 1 year of follow-up.

Correlation of Serum Vitamin D with Crestal Bone Level in Dental Implant Patients Using CBCT: A Clinical Retrospective Study.

The purpose of this study is to correlate the role of serum vitamin D levels associated with crestal bone in dental implant patients using cone-beam computed tomography (CBCT). This retrospective study enrolled patients among whom implants were placed after a detailed planning using CBCT and the delayed loading protocol was followed. After 3 months and 6 months of loading, CBCT evaluations were carried out, serum vitamin D levels were also tested at the end of 6 months of loading. A total of 30 patients were recruited with 15 patients in each group based on normal and deficient levels of vitamin D to correlate with crestal bone levels using CBCT. Clinically acceptable crestal bone loss (CBL) was visible with all the implants at different time intervals. Statistical analysis was done for intergroup and intragroup comparisons which showed significant p-value (< 0.05) for CBL at the time of loading, at 3 months, and at 6 months follow-up for both normal and deficient serum values. In the deficient group, the mean value at baseline was 9.69 mm ± 1.10 and the CBL at 6 months follow-up was 8.80 mm ± 1.10 whereas for the normal group at baseline, the mean was 9.08 mm ± 1.21 and at 6 months follow-up was 8.12 mm ± 1.25 which showed meaningful difference. There is a positive correlation seen between CBL on CBCT and vitamin D serum levels. The success of the implant is significantly affected by vitamin D as it regulates the bone physiology and has systemic effects on accelerating bone formation around titanium implants. Vitamin D is essential in maintaining the balance of bone minerals and assists to preserve the crestal bone level making the implant treatment more predictable and successful.

Surface Corrosion from Implant–Abutment Couplings with Different Connection Designs Influences Osteoblasts’ Function: A Novel Technique

The improved peri-implant bone response demonstrated when utilizing the platform-switching concept may result from the reduced levels of metal ions released from implant–abutment surfaces to the surrounding tissues. These corrosion products may play a major role in crestal bone remodeling around dental implants. This study evaluated the effect of different implant–abutment couplings (platform-matched vs. platform-switched) on osteoblasts’ function. Titanium alloy and cobalt–chrome alloy abutments were coupled with titanium cylinders, forming either platform-switched or platform-matched groups, and were incubated in human osteoblast cultures utilizing a novel direct-exposure technique. Viability was evaluated over 21 days using Alamar Blue assay. Apoptosis was measured after 24 h using flow cytometry. The expression of genes related to bone resorption was analysed over 21 days using a real-time quantitative polymerase chain reaction assay. Cell viability was reduced from day 4 to day 21 (p &lt; 0.05), with higher rates of early apoptosis (p &lt; 0.05) compared to the controls. Apoptosis was higher in the platform-matched groups (p &lt; 0.05). The tested genes’ expression was up-regulated after 1 and 3 days of exposure to implant–abutment couplings (p &lt; 0.05). The upregulation was more pronounced in platform-matched groups (p &lt; 0.05). Exposure of osteoblasts to implant–abutment couplings induced adverse biological responses, which were more pronounced with platform-matched couplings. These reactions might be related to the increased amounts of metal ions released from the platform-matched couplings, highlighting the possible role of corrosion products in the mediation of crestal bone loss around dental implants.

Prevalence of bone loss surrounding dental implants as detected in cone beam computed tomography: a cross-sectional study.

The objective of this study was to assess the prevalence of crestal, and apical bone loss (CBL & ABL) associated with dental implants in CBCT scans. The second objective was to assess the radiographic stage of implant disease and the visible predisposing factors. The CBCT scans that were taken from January 2015 to January 2022 in King Saud Medical City were screened to examine the marginal and periapical condition of dental implants. Information related to demographic variables, stage of bone loss, and radiographically evident predisposing factors were collected. The results were analyzed using descriptive statistics, chi-square test, and logistic regression analysis. In total, 772 implant scans were analyzed. The prevalence of crestal bone loss and apical bone loss around the implants were 6.9% and 0.4% respectively. The amount of bone loss was moderate in 52.8% of cases of CBL and 100% mild in cases of ABL. The risk factors for CBL were patient age (p<0.001), implant location (p<0.001), bone loss in proximal teeth (p<0.001), and adjacent edentulous sites (p<0.001). The risk factors for ABL were adjacent periapical infection (p<0.001) and endodontic therapy (p=0.024). The prevalence of CBL and ABL was low. The CBCT can be used as a diagnostic tool for studying the prevalence of bone loss associated with peri-implant disease and relevant risk factors. The implantation of CBCT to evaluate the success and the prognosis of dental implants or the treatment of peri-implant diseases can be further considered in future research.

Clinical and Radiographic Outcomes of Adjunctive Photodynamic Therapy for Treating Peri-Implant Mucositis Among Cigarette Smokers and Diabetics: A Systematic Review and Meta-Analysis.

Objective: This systematic review aimed to assess the influence of antimicrobial photodynamic therapy (aPDT) as an adjunct to mechanical debridement (MD) on peri-implant clinical and radiographic outcomes among cigarette smokers and diabetics with peri-implant mucositis (piM). Methods: Randomized controlled trials, assessing the clinical and radiographic parameters of aPDT versus MD alone among smokers and diabetics with piM, were included in the study. Meta-analyses were conducted to calculate the standard mean difference with a 95% confidence interval. The methodological quality of the included studies was assessed utilizing the modified Jadad quality scale. Results: The meta-analyses found statistically significant differences between the impact of adjunct aPDT and MD alone on the peri-implant plaque index (PI), probing depth (PD), and bleeding on probing among smokers and diabetics with piM at the final follow-up visit. However, no significant differences were found between the impact of adjunct aPDT and MD alone on the peri-implant crestal bone loss among smokers and diabetics with piM at the final follow-up. Conclusions: The application of aPDT as an adjunctive to MD demonstrated improved scores of the peri-implant clinical parameters among smokers and diabetics with piM in comparison with MD alone.

Pterygoid and tuberosity implants in the atrophic posterior maxilla: A retrospective cohort study

Statement of problemRehabilitation of the partially or completely edentulous posterior maxilla using dental implants is a clinical challenge because of the presence of the maxillary sinus, as well as the low quality and quantity of bone in that region. In addition to bone augmentation procedures, posterior maxillary rehabilitation using implants includes their anchoring in bones such as the zygoma, pterygoid, and maxillary tuberosity, as well as in short implants. However, the performance of pterygoid and tuberosity implants in the atrophic posterior maxilla is unclear. PurposeThe purpose of this retrospective cohort study was to evaluate the survival of tuberosity and pterygoid implants in patients with posterior maxillary atrophy. Material and methodsA nonprobability convenient sample of patients who had received fixed prostheses on implants placed in the maxillary tuberosity or pterygoid regions was analyzed retrospectively. Demographic variables included sex (male, female) and age. Implant-related variables included surface characteristics, site of placement, implant design, length, diameter, and anteroposterior insertion angle. Prosthetic-related variables included the type of reconstruction for rehabilitation and loading protocols. Implant survival, complications, crestal bone loss, and follow-up intervals were also documented. Collected data were analyzed at both patient and implant levels. The demographics and implant characteristics of patients receiving pterygoid or tuberosity implants were analyzed with a statistical software program (α=.05). Survival analysis was estimated by using the nonparametric Kaplan-Meier curve. ResultsA total of 119 patients had 183 pterygoid or tuberosity implants inserted. Most implants in the pterygoid region (71.5%) were Ø4.1 mm (87.4%) and 15 mm in length (60.1%). The most common prostheses were complete maxillary reconstructions (49.2%) with late loading (74.3%). The average implant anteroposterior insertion angle was 60.8 degrees. The cumulative survival rate was 97.3% (n=178) during the mean follow-up period of 57 months (range 1 to 168 months). Among all implants placed, 2.7% failed (n=5) within 2 months of their placement. The statistically significant differences noted between tuberosity and pterygoid implants were related to design, surface characteristics, and loading. The average crestal bone loss was 1.5 mm. ConclusionsThe survival of the implants placed in the maxillary tuberosity and pterygoid regions was high in patients with posterior maxillary atrophy.