Implantological Treatment Research Articles

Comparative Analysis of Osseodensification and Standard Implant Site Preparation Techniques in Low Density Bone

Introduction. Dental implantation is getting more popular with patients who require total dental rehabilitation. Patients note that possibility of immediate loading based on dental implants is more favorable treatment option due to active social life. Low bone density, often occurred in the maxilla, frequently presents challenges for clinicians to achieve successful implant primary stability for predictable immediate loading.The aim of our study was to increase the efficiency of treatment of patients who require dental implantation in the maxilla.Materials and methods. Twenty-seven patients aged from 27 to 66 years with missing teeth in the alveolar process of maxilla were treated. All patients in this randomized clinical trial were divided into two groups. We used two methods for implant site preparation: the standard technique according to manufacturer’s recommendations in the first group (n = 13) and the Osseodensification technique via Densah drills (n = 14) in the second. All patients were treated by Astra Tech dental implants with the same dimensions (diameter 4 mm, length 9 mm). Immediately after implant placement the data of the frequency-resonance analysis of the implant stability and insertion torque were installed and obtained. Furthermore, a comparison of the operation time was carried out. Clinical evaluation and patient appreciation of pain, edema and hyperemia of the mucosa were evaluated using a questionnaire at 1, 3, 5 and 7 days after surgery. The measurement of the values of the stability quotient of the implants was repeated and carried out after six months.Results. Higher values of implant primary stability (insertion torque and implant stability quotient during surgery) were showed in the osseodensification group (IT — (45,0±5,8), ISQ — (71,8±2,9)) in comparison with standard technique (IT — (27,7±3,8), ISQ — (62,8±3,2)); p < 0,05.Discussion. Osseodensification technique promotes compaction of a low density bone in direct contact with the implant, which leads to higher implant primary stability due to the physical interaction between bone and implant.Conclusion. The obtained results allow us to consider that the osseodensification method is progressive for improving the effectiveness of implantological treatment on maxilla.

Diagnostic Significance of Proinflammatory Cytokines in Planning Dental Implantation in Patients with General Somatic Pathologies

INTRODUCTION: The current stage of development of dental implantology permits to perform a complete dental rehabilitation even in complicated clinical situations. However, there are some difficulties which prevent achievement of a high success of implantological treatment in certain somatic pathologies that manifest in the form of systemic inflammation, and present relative contraindications for implantation. Important general somatic pathologies include chronic obstructive pulmonary disease, atherosclerosis, non-insulin-dependent diabetes mellitus, osteoporosis, etc., they are associated with the risk of acute inflammatory response of an organism to surgical implantological intervention. The risk of unpredictable complications also increases because of insufficiently wide laboratory diagnostic spectrum for planning dental implantation that includes a biochemical blood test, coagulogram, reaction to the presence of specific infections and viral diseases. This list of diagnostic data is not always sufficient for a complete prognosis of success of planned treatment in patients with a complicated general somatic or dental status. Besides, the interrelation between dental chronic diseases and general somatic pathologies which in some cases have common etiopathogenetic factors, is often not taken into account, but without the adequate diagnostic range they often remain unnoticed and lead to persistent complications in different periods after completion of treatment. Development of technologies of surgical and orthopedic dentistry permits to provide full dental care to patients even with different pathologies of organs and systems. But in this case, of importance is extended laboratory diagnostics aimed at identification of factors of chronic systemic inflammation, vascular risk, bacterial threats, for example, evaluation of some interleukins, tumor necrosis factor, C-reactive protein.
 CONCLUSION: A complex of clinical, laboratory and instrumental diagnostic methods will permit to adequately evaluate risk for treatment failure and construct a prognostic tactics of complex therapy, thereby reducing the probability for unpredictable complications in dental implantation in patients with different somatic pathologies.

Ортопедическая реабилитация с использованием дентальной имплантации в государственной системе здравоохранения

INTRODUCTION: New modern technology – rehabilitation of missing teeth by dental implantation is relevant nowadays, since it determines the high result of orthopedic rehabilitation and improves the quality of patients’ life. The work presents the aspects of the implantological treatment in the system of public healthcare of the Ryazan region. The article, on an example of the united city dental organization providing dental services to the entire population of the regional center, presents difficulties in identifying the real need for dental implantation at the regional level, which is associated with the fact of receiving dental care by a part of patients in private clinics that do not submit statistical data to the reports of the region. The data of a scientific study conducted in the Ryazan region to identify the loyalty of old-age pensioners to public dental organizations are presented. The influence of preventive measures aimed at combating the pandemic of the new coronavirus infection (COVID-19) on the implementation of the volumes of dental care, including dental implantation, is noted. CONCLUSION: The development of the method of orthopedic rehabilitation using dental implantation in the public healthcare system is an important method of rehabilitation of patients with partial and complete loss of teeth, including a socially unprotected group of people of non-working age – pensioners by age who are loyal mainly to public dental organizations.

Role of implant loading time in the prevention of marginal bone loss after implant-supported restorations: A targeted review.

The implant-supported restoration of missing teeth is a recognized method of treatment that ensures a functional, esthetic and durable effect, along with patient satisfaction. However, the preferable time of dental implant loading is under debate. Currently, 3 protocols are used: immediate loading; early loading; and conventional (late) loading. Immediate loading provides benefits such as short treatment time, the elimination of the second surgery required for later loading protocols, the protection of the gingival papilla, an immediate esthetic effect, and high patient satisfaction. This review aimed to summarize the evidence on the impact of loading time on marginal bone loss (MBL) around dental implants, which is considered a useful measure of implantological treatment effects. A literature search was conducted based on the PubMed/MEDLINE database. The search focused on studies providing the MBL values by protocol. Out of the 1,366 hits received in the initial search, 10 studies were included in the qualitative analysis. At 12 months, the MBL range was 0.17-1.86 mm in patients undergoing the immediate protocol, 0.14-1.22 mm in patients undergoing the early protocol, and 0.44-0.91 mm in patients undergoing the late protocol. The studies were heterogeneous, but no significant differences in the occurrence of MBL were reported between the immediately and early loaded implants as compared with the conventionally loaded ones. Further studies are needed to determine other factors that might be related to the type of protocol, important for optimal patient treatment.

Удаление радикулярной кисты верхней челюсти с одноэтапной хирургической коррекцией структур полости носа

A radicular cyst is the most common odontogenic cyst. It gets its development from the periapical focus of infection that arose against the background of a complicated course of dental caries. In clinical practice, odontogenic cysts must be differentiated from other neoplasms of the maxillofacial region. One of the radiological signs of an odontogenic cyst is the presence of a bone shell with radiolucent contents. As a rule, the clinical manifestations of a radicular cyst are scanty, and the diagnosis is made on the basis of an X-ray examination, being an accidental finding. The article presents a clinical case of a radicular cyst of the upper jaw that grows into the maxillary sinus and pushes the lower wall of the sinus without violating its integrity. The cyst turned out to be an accidental finding during examination by an otorhinolaryngologist. The patient complained about the discharge of their nasal cavity, difficult nasal breathing. After performing computed tomography and joint examination of the patient by an otorhinolaryngologist and a maxillofacial surgeon, the diagnosis was formulated: curvature of the nasal septum, vasomotor rhinitis, radicular cyst of the right maxillary sinus from the 26th tooth. After the diagnosis and comprehensive assessment of the oral cavity and paranasal sinuses, surgical treatment was performed jointly by an otorhinolaryngologist and a maxillofacial surgeon with a satisfactory result. This case is of particular clinical interest in the practice of an otorhinolaryngologist and a maxillofacial surgeon preparing for dental implantological treatment of the oral cavity.

Assessment and Evaluation of Implantology Courses for Post Graduate Students

Introduction- In dentistry, dental implants have become an indispensable established therapy to replacemissing teeth in different clinical situations. Henceforth, implant education has become an integral partof postgraduate prosthodontic curriculum.Materials and Methods- This study was conducted in the Department of Prosthodontics, Crown andBridge at S. Nijalingappa Institute of Dental Science & Research, Gulbarga, Karnataka. A questionnaireof 22 questions was mailed to the postgraduate students of prosthodontics. A total of 83 studentsparticipated in the study. The forms were analyzed by using suitable descriptive statistics.Results- A variety of responses were received from the participants. A total of 82 (98.8%) participantswere included in the study. Most of the participants (around 56 of them) start to place implants fromthe second year and remaining. 69 of the participants responded in affirmation with the use of CBCTfor routine implant cases. 54 participants reported that overall, in a month, more than 10 implants wereplaced in their department. In culmination, out of the 83 participants 69 of them want to learn more asimplantology is evolving as a separate branch in dentistry.Conclusion- Implantology treatment is constantly evolving as the prime line of treatment in differentedentulous situations. Within the limitation of this study, it is concluded that dental colleges of Indiahaving active postgraduate program are moderately equipped with Implantology syllabus and courses.Although, there are variations in responses, but it has made necessary to review and standardize dentalimplant curricula among institutions.

Study Of The Possibilities Of Using Augmented Reality In Dentistry

Using augmented reality glasses with the HoloDoctor program for implantological treatment, a new method of simulating implantological and surgical treatment in the maxillofacial region demonstrated good visualization of the anatomical features of the implant placement area, the possibility for the surgeon to carefully study the intervention area before the operation, performing surgery in the conditions of the real anatomy of the patient including the use of navigation in augmented reality, whic

Dynamics of hygienic and periodontal indices at the stages of implantological treatment

The level of oral hygiene among many patients with implants is insufficient. In the absence of clinical examination and occupational hygiene, there is an averagely frequent development of inflammation in peri-implant tissuesperi-implantitis, which can cause implant disintegration. It is necessary to control hygiene indicators at the different stages of implantation.
 Objective: to analyze changes in hygiene and periodontal parameters during implant treatment.
 Materials and methods: At the stages before implantation, during osseointegration and the year after prosthetics on implants, the hygiene indicators and periodontal and microbiota status of 60 patients with dental implants were analyzed. Control methods used include Oral Hygiene Index Green J.C., Vermillion J.R. (OHI-S); gingivitis index Loe H., Silness J. (GI); Muhllemann index modified by Cowell; and PMA index modified by Parma. The level of halitosis was determined using the organoleptic index and the Halimeter instrument. Molecular genetic diagnosis of periodontopathogenic bacteria in the periodontal and peri-implant space was carried out.
 Results: Hygiene and periodontics after preimplantation tooth restoration, and periodontal deterioration by the time the implants open, then before replacing the temporary prostheses with permanent ones and after three months of functioning of the prostheses on the implants, which necessitates professional oral hygiene before these stages.
 Conclusion. Occupational hygiene every three months provides a stable adequate level of hygienic and periodontal indicators for users of prostheses on implants, and also reduces the detection of peri-implantitis.

Osteoporosis and periodontal diseases with HIV infection (review)

Relevance. The life expectancy of people with HIV has increased thanks to the use of specific antiretroviral therapy (ART). Currently, one of the urgent medical problems for this cohort is osteoporosis. Immune reconstitution during ART leads to a sustained inflammatory reaction in the body, the release of cytokines, and activation of osteoclasts. Osteoporosis often causes complications in periodontology and implantology. The significant need of HIV-infected people for these types of dental care and the prevalence of periodontitis, including generalized forms, also determine the importance of this issue. Purpose. To identify the common links in the pathogenesis of systemic (osteoporosis – hereinafter referred to as OP) and local (jaw bones in periodontitis) osteoresorption, the main methods for the diagnosis, treatment and prevention of OP associated with HIV infection, its effect on the results of implantological treatment of adentia in this population. Materials and methods . Analysis of publications in scientific periodicals on OP + Periodontal Pathology + HIV/AIDS over the past decade (PubMed, Medline, Elibrary). Results. The etiology of bone structure disorders is multifactorial: chronic inflammation, direct impact of HIV on osteocytes, effect of ART (viral protease inhibitors) on bone metabolism and remodeling. The planning of specific therapeutic interventions should be individualized and aimed at the key links in the pathogenesis of osteoresorption (osteoprotectors, antiinflammatory agents, bisphosphonates, calcium supplements, vitamin D). Conclusion. The effectiveness of the bisphosphonate therapy of OP in this cohort and DEXA screening to control the risk of osteoresorption suggest a very likely clinically justified implantation method for the treatment of tooth loss in HIV infection. Topical issues of OP and periodontal pathology in connection with the aging of HIV patients should be considered as related. For them, the planning of specific diagnostic (DEXA, biochemical screening) and therapeutic (remineralizing agents, osteoprotectors, etc.) strategies involving narrowly specialized doctors (endocrinologists, gastroenterologists, etc.) becomes a decisive.

Modified Two-Stage Split Technique for Controlled Ridge Augmentation in Horizontally Atrophic Posterior Mandible: the First Stage of Research.

Various bone grafting methods are applied to eliminate horizontal atrophy of the jaws. However, problem complexity brings about ongoing research and development of new ways to achieve the predicted stable and long-term results of implantological treatment.The aim of the study was to evaluate the results of the developed method for bone grafting, a modified two-stage split technique for controlled ridge augmentation in horizontally atrophic posterior mandible, using radiological analysis data.Materials and Methods.The study group included 18 patients with horizontally atrophic posterior mandible. According to cone beam computed tomography, 39 jaw segments were assessed before plastic surgery and after applying the two-stage split-crest technique for controlled ridge augmentation. The alveolar ridge width was estimated in the area of its top and at a distance of 1, 3, 5 mm from it using the vector of future implant position and taking into account the angle of inclination of the atrophic region of the mandible.Results.When analyzing edentulous areas in the posterior mandible before treatment, there was rather a large angle of lingual inclination of the alveolar ridge. After 6 months, the average increase in bone tissue width in the region of the alveolar ridge top was 82%, it was 50.6% at a height of 1 mm from the top of the crest, 58.8% at 3 mm height, 46.7% at 5 mm (p≤0.05). Certain patterns of bone tissue growth were revealed depending on the structure of the reconstructed area. The most significant results were obtained in the molar segments of the mandible.Conclusion.The developed modified two-stage split technique for alveolar ridge augmentation allows achieving the required volume of bone tissue in the posterior mandible for successful implant treatment.

Prevention and treatment of post-implantation maxillary sinusitis

The state of the nasal cavity, especially the region of the osteomyomatic complex, plays a significant role in the development of chronic maxillary sinusitis. Odontogenic maxillary sinusitis, as a complication of dental implantological treatment on the upper jaw, is increasingly common. The aim of the study was to increase the effectiveness of prophylaxis and treatment of odontogenic purulent upper jaw sinusitis during reconstructive operations on the alveolar region of the upper jaw. 3 groups of patients were examined: before dental treatment, after dental treatment in the development of odontogenic maxillary sinusitis and 30 patients were selected and examined, who underwent reconstructive surgeries on the alveolar process of the upper jaw and in whom the postoperative period was without complications. The diagnoses of 1st and 2nd group patients required surgical treatment. FESS allows restoring the physiological aeration of maxillary sinuses as naturally as possible, which is important for correct reparative bone regeneration in the alveolar region of maxilla.

Method of digital navigation for dental implantation using single drill

The method is given that in laboratory conditions allows you to create plastic templates made by 3D-printing. For planning a digital prototype of these patterns, computed tomography, laser surface scan of the dentition, as well as a number of computer programs are used, the use of which in the treatment of tooth loss allows you to accurately determine the implant placement area. This navigation is based on the principle of using one drill. The application of this method in the clinic will significantly improve the quality of implantology treatment, to obtain more predictable and long-term results.

Differences in the shape and direction-course of the nasopalatine canal among dentate, partially edentulous and completely edentulous subjects.

We aimed to analyze the nasopalatine canal shape and anatomical variations of the buccal bone wall and compare the effect of the presence or absence of the central maxillary incisors on the nasopalatine canal. The shape of the nasopalatine canal and the dimensions of the buccal bone wall were measured in 150 patients who underwent a cone-beam computed tomography study. We found that the most prevalent shape of the nasopalatine canal was funnel (31%) and the most common direction-course was slanted-straight (33%). The buccal bone wall in relation to the nasopalatine canal was thickest at the anterior nasal spine level and narrowest at the level of the most anterior-inferior point of the buccal cortex of the maxilla. A statistically significant difference was detected between morphology and direction-course of the nasopalatine canal and dental status. In sum, the study of the nasopalatine canal showed multiple variations. Precise knowledge of these variations may help to decrease the incidence of complications during implantology treatment and during facial and dental surgery.

The method of vicryl frame formation in guided bone regeneration and dental implantation

The purpose of the article is to describe a new method of formation a situational vicryl frame (SVF) within the framework of improving the method of guided bone regeneration (GBR). The technique involves the use of woven resorbed filament of Polyglactin 5.0 (suture material on the example of Vicryl) and support-retaining titanium micro-screws as a formative aspect of the reconstruction. This is necessary to ensure the spatio-temporal stability of the combination of osteoplastic and barrier materials - of the plastic substrate (PS), which determines the volume-forming aspect of the reconstruction. The method of formation of situational acrylic frame in GBR is based on the idea of increasing the clinical and prognostic efficiency of dental implantological treatment. The descriptive part is supplemented by the presented clinical case, the positive outcome of which is confirmed by a preliminary qualitative analysis of the histological material in the form of data on the presence of mature bone beams in the regenerate. The proof of practical significance, as well as clinical and prognostic efficiency of the proposed technique, is obtained by theoretical analysis.

Evaluation of the effect of tissue-engineered constructs based on octacalcium phosphate and gingival stromal cells on dental implants osteointegration

Current treatment of patients with partial and complete teeth loss is based on the use of dental implants. As a result of continuous improvement of the medical devices and methods of implantological treatment and according to modern protocols dental implants could be placed immediately after teeth removal, which in most cases required single-stage bone grafting. The aim of this study was to evaluate the features of dental implants osseointegration under simultaneous bone grafting with tissue-engineered construction based on octacalcium phosphate (OCP) and autogenous gingival multipotent mesenchymal stromal cells (MMSC) in rabbits. In the tibial tuberosity of each limb, we performed a complex defect consisting of two adjacent cylindrical defects with diameters of 2.8 and 4 mm, correspondingly, and a depth of 8 mm, the circumferences of which intersected at the level of 5-7 hours of the conditional dial of the upper defect. Dental implants of 3x8 mm were placed in the upper defect, the lower defect was filled with "OCP+MMSC” in direct contact with the exposed surface of the dental implant. We used OCP without cells, autogenous bone tissue, blood clot as controls. Results were assessed 1, 2, 3 months after surgery using CT and histological analysis. Osteointegration was observed in both groups with OCP, while in the case of "OCP+ MMSC” a larger volume of newly formed bone tissue was formed. Autogenous bone fragments showed results similar to a defect filled with a blood clot. Thus, the preclinical evidence makes possible to use tissue-engineering constructs "OCP+MMSC” for single-stage with dental implants placement bone grafting.

Evaluation of the incidence and dimensions of the mandibular incisive canal – aspects of implantological treatment planning

Evaluation of the incidence and dimensions of the mandibular incisive canal – aspects of implantological treatment planning

Alveolar Ridge Preservation as a Way to Reduce the Need for Bone Augmentation: Implementation of a New, Non-invasive Method of Measuring Bone Preservation: Study Protocol of a Randomized Controlled Clinical Trial and Feasibility Testing Results

Introduction: The efficacy of alveolar ridge preservation (ARP) in preserving the bone after tooth extractions and before rehabilitation with an implant-supported restoration is examined. A new, non-invasive measurement method to determine the extent of bone preservation is presented. This measurement method is based on a 3D comparison of the condition immediately after extraction with the data of a cone-beam computed tomography (CBCT) eight weeks after extraction. Method: The study is a single-center, randomized, controlled parallel-group clinical investigation. 88 patients who required extraction of a maxillary tooth participated in the study. In 44 patients (intervention group), the socket is filled with a combination of a collagen plug and a collagen membrane introduced in the empty socket immediately after tooth removal (ARP). The 44 patients (control group) experience unassisted socket healing the hyporeflective space. Primary endpoints are (1) bone loss after tooth extraction; (2) the preservation of the alveolar ridge (soft tissue and bone); (3) the need for augmentation during the subsequent implant treatment; and (4) the question whether ARP is more costeffective than the therapy with unassisted socket healing. Patients will be followed for 5 years. Discussion: The extent of bone resorption after tooth extraction significantly influences the subsequent implant placement. Preserving the bone as well as possible is of great importance for the stability, prosthetically correct position and long-term functional success of the implantological treatment. A new, non-invasive method, without additional, study-related X-ray exposure, presented here for the first time, the change in volume of the bone bed can be analyzed. The preliminary results of this feasibility test report a median value of buccal and palatal bone loss of 6.2 mm (control)/4.4 mm (test) and 2.5 mm (control)/2.8 mm (test), respectively. These values are comparable to studies that also determined bone resorption by CBCT.

Genetic Risk Assessment of Periodontal Disease in Healthy Patients

Introduction: About 30% of the general population manifests periodontal disease (PD). Patients with parents with a compromised periodontal condition may need prosthetic or implantology treatment (PIT), therefore those patients are at increased risk of developing PD during or after dental treatment. Hence the use of a genetic test for identify those most at risk of PD and submit them to very closely oral hygiene protocols, is mandatory. PIT of these patients must be done safely having previously assessed the risk of developing PD. Polymorphisms of IL6 and IL10 constitute risk factors for chronic periodontitis, so the use of a genetic test is fundamental to ensure a correct preventive protocol and plaque control in healthy patients.

Non-linear numerical analysis of a double-threaded titanium alloy dental implant by FEM

The aim of this work is to study the performance of a double-threaded variable pitch titanium alloy dental implant in a maxillary molar tooth after an implantology treatment by the finite elements method (FEM). The study employed three-dimensional finite elements modelling in order to simulate typical occlusal loads. The three-dimensional basic design of the dental implant, consisting of a dental implant and a piece of jaw, was developed with a three-dimensional parametric design program. One of the major areas of non-linear analysis is the solution of problems where separate bodies or structures may come in contact with each other. The non-linearity due to the contact between the dental implant and the jaw has been taken into account here. In order to study the influence of the variable pitch in the biomechanical behaviour of the dental implant, several configurations of this screw were solved. The nominal occlusal load was applied in all of them. A total of 27 specimens were checked. The stresses and displacements of each are shown in different tables and figures. The optimum configuration was chosen according to these results. From an osseointegration point of view, the optimum dental implant configuration presents a major advantage over the other specimens considered: the bone-implant contact surface is greater than in the other ones and the maximum von Mises stress in the jaw remains close to minimum values. From the biomechanical point of view, one of the specimens was chosen as the best dental implant screw of those checked in the present article. Such selection was made taking into account the stresses produced in its checking and the total bone-implant contact surface. Finally, the stresses of the different elements of the dental implant, the configuration of the optimum dental implant screw as well as conclusions of this research are expounded.

Clinical appraisal of coDiagnostix® 5.5 computer program in implantology treatment planning

Clinical appraisal of coDiagnostix® 5.5 computer program in implantology treatment planning