Dental Implants Research Articles

Marginal Bone Loss and Clinical Evaluation of Angled Implants: A Retrospective Study

Aim: The volume of the edentulous crest and its proximity to critical anatomical structures are important limiting factors for implant surgery. Surgical procedures with complications can be avoided by placing angled implants. The aim of this clinical study was to evaluate marginal bone loss and the complications of angled implants. Materials and Methods: Fifty-eight dental implants were examined in 32 patients (16 females, 16 males) with cone beam computed tomography (CBCT) images from patients with angled implants and complete edentation. The marginal bone loss in angled implants that were functional for 15 to 30 months was evaluated according to factors such as implant angle, connection type, opposing arch restoration type and planning of superstructure restoration. Marginal bone loss measurements were recorded from CBCT sections. Results: It was determined that 3.44% of the implants placed had an inclination of less than 15°, 75.86% had an inclination between 15° and 30° and 20.68% had an inclination of more than 30°. While there was no marginal bone loss on the mesial and distal surfaces, the average marginal bone loss was 0.66 on the buccal surfaces and 0.93 in the lingual region. Only one of the implants examined failed. No pain or infection was observed in any of the implants examined. Conclusion: According to the results of this retrospective clinical study, further clinical studies with larger sample sizes are needed to evaluate angled implants supported by full arch fixed prostheses as a predictable and valid treatment method in the prosthetic rehabilitation of edentulous jaws.

The effect of photobiomodulation therapy on implant stability: A systematic review and meta-analysis.

This study was designed to determine the effect of photobiomodulation therapy on dental implant stability. A complete systematic search was performed in PUBMED/MEDLINE, COCHRANE library databases, EMBASE, SCOPUS, and Google Scholar databases on articles published until June 2024. All the RCTs and CCTs reported the solo impact of photobiomodulation on dental implant stability in humans were included. The means and standard deviation for implant stability and sample size were extracted for the meta-analysis. The statistical analysis was conducted using Stata 17 software, and random effect models were applied to assess the source of heterogeneity. The I2 statistic was used to estimate the significance of any discrepancies in the therapy result. After a full-text inspection, 17 articles were qualified for systematic review, and 14 were included in the meta-analysis. Statically significant differences in implant stability were observed between the laser and the control groups on weeks 2 in ISQ reporting groups (p = 0.01, CI 95%) and weeks 4 and 8 in PTV reporting groups (p < 0.001, CI 95%). Despite limitations, the study suggests that PBM therapy benefits patients with dental implants at different periods, particularly during the early phases of healing.

Exploratory study on a novel minimally invasive tunnel like flap approach for orthodontic movement of dental implants.

To propose a new flap design that utilize a minimally invasive approach to move implants. We also propose a 3D method to track changes in implant position without the need for CBCT. Implants were inserted in two mongrel dogs then a minimally invasive tunnel like flap was made. Bone cutting around implants was done using piezotome device and orthodontic force was applied on the implants. For tracking positional changes of implants, an impression was taken then scanned with an identical implant copy inside. The pre- and post-treatment 3D images were then superimposed over each other to detect changes in implant position. Healing of the flap was rapid with minimal swelling and edema. The position of the interdental papilla was preserved maintaining optimal esthetic outcome. Implant pocket depth was maintained. Our 3D imaging method was able to accurately detect the movement that occurred in the dental implants after their movement with significantly higher resolution than CBCT (6μm for this method versus 76-300μm for the CBCT). This flap can preserve the esthetic soft tissue contour of implants during orthodontic movement allowing rapid healing with minimum swelling and edema. Moreover, our proposed 3D method has many advantages over CBCT in tracking the movement of implants by being non harmful and cheap thus allowing several follow up points. Orthodontic movement of implants can be required in cases of improperly placed implants or to intentionally place the implant in a certain position then altering it to avoid the need for bone grafting.

The mouthguard for sports is capable of protecting the implant/crown complex when there is a frontal impact? Responding with finite element analisys

For athletes, the use of a mouthguard is fundamental. This device allows for the absorption and dissipation of energy from the impact. These rehabilitated patients will be subjected to oral-facial injuries and trauma again once they return to contact sports. Evaluate the mechanical effect of an impact over a maxilla region where implant-abutment-crown are present, and this mechanical behavior will be analyzed through the evaluation of maximum stress distributions. A three-dimensional geometry of an implant system (implant-abutment-crown and the bone) was obtained from computed tomography and transformed into separate meshes. A mouthguard was created to cover the surface, and a steel ball with a velocity of 1 m/s was used as the impact object. The results were divided into the individual analysis of the stress generated on each variable studied. The mouthguard was capable of reducing the stress on the implant by 71.81%, stress on the abutment by 73.20%, on both pieces by 74.30%, as well as reducing the impact on the prosthetic crown by 98.32%, thus preventing its fracture. A mouthguard is capable of reducing stress on the implant-abutment-crown complex and bone cortex. Clinical implications The present data contribute to the specialties of Sports Dentistry and Implantology, offering scientific evidence of the importance of a mouthguard to provide the best protection for athletes rehabilitated with dental implants.

The proceedings of the 23rd Congress of the Iranian Academy of Periodontology: New Approaches in Periodontal and Dental Implant Treatment

The proceedings of the 23rd Congress of the Iranian Academy of Periodontology: New Approaches in Periodontal and Dental Implant Treatment

Maintenance Costs, Time, and Efforts Following Implant Therapy With Fixed Restorations Over an Observation Period of 10 Years: A Randomized Controlled Clinical Trial.

To assess the costs and efforts of maintenance therapy following implant treatment with fixed restoration over an observation period of 10 years. This randomized controlled clinical trial included 64 patients who were randomly assigned to receive one of two implant systems (AST or STM) and fixed restoration. Patients were included in a regular maintenance program and were examined at loading, 1, 3, 5, 8, and 10 years. Outcome measures included technical and biological complications, time, efforts, and costs to resolve them. A total of 97 implants were placed in 64 patients (AST: 54, STM: 43). Patient recall rates at 5 and 10 years were 89% and 67%. In general, technical complications were resolved within one to two appointments (mean = 1.5), and biological complications required a mean of 1.3 appointments. The overall regular maintenance time for the period of 10 years amounted to 77 min per year. Technical complications occurred in 39.5% of the patients, with screw-loosening being the most common one (43.4% of all complications). The most time-consuming technical complication was abutment fracture (94 min ± 68), followed by screw fracture (84 min ± 38). The prevalence of peri-implant mucositis on the patient level was 30.2%, and it was 9.3% for peri-implantitis. The average annual maintenance costs amounted to 9% of the initial cost of the implant treatment over the period of 10 years. Additional regular maintenance costs and costs due to the treatment of potential complications have to be taken into consideration when placing dental implants. The majority of technical complications could be resolved within one appointment, whereas the time needed to treat biological complications varied between one and three appointments for peri-implantitis.

Development of a Bioactive Titanium Surface via Alkalinization and Naringenin Coating for Peri-Implant Repair: In Vitro Study

This study assessed the effects of titanium (Ti) surface modification with sodium hydroxide (NaOH) associated or not with Naringenin (NA) citrus flavonoid-coating on osteoblastic-like cells (Ob) metabolism. Ti discs were submitted to alkalinization by NaOH solution (5 M, 60 °C) for 24 h; then, the discs were impregnated or not with 100 µg/mL of NA and dried for 1 h at room temperature. The chemical composition, surface topography, and NA release were evaluated. For the biological assays, the discs were placed on 24-well cell culture plates and Ob (Saos-2; ATCC HTB-85) was seeded onto the discs. After different periods, cell adhesion and viability, alkaline phosphatase activity (ALP), and mineralized nodules deposition (MND) were assessed. In addition, cells stimulated with tumor necrosis factor-alpha (TNF-α) were submitted to matrix metalloproteinase (MMP)-2 synthesis and ALP gene expression assessment. Since data presented normal distribution and homogeneity (Shapiro-Wilk; Levene), Student’s t-test or one-way ANOVA/post-hoc tests were selected for data analysis (α = 0.05). Higher roughness was observed on Ti discs submitted to NaOH treatment, while the chemical and NA release evaluations indicated the successful adsorption of NA to alkali-treated Ti surface. Higher cell adhesion, cell viability (after 7 days of culture), ALP activity, and MND were observed on Ti NaOH coated with NA compared to the control group (Ti NaOH) (p &lt; 0.05). Moreover, NA coating also promoted decreased MMP-2 synthesis and increased ALP gene expression in the presence of the inflammatory stimulus TNF-α (p &lt; 0.05). The modification of Ti disks with NaOH associated with NA-coating enhanced bone cell metabolism, suggesting that this type of surface modification has a promising potential to accelerate bone repair and formation around dental implants.

A Pilot Study Showing Application of Palatal Bone Harvesting Under Dynamic Navigation Guidance in Oral Implantology.

In cases of insufficient bone volume in the implant area, bone augmentation surgery is often required to ensure an adequate amount of bone around the implant. In autologous bone grafting procedures, some patients face insufficient bone volume at conventional intraoral bone harvesting sites. Due to the high difficulty associated with completing palatal osteotomies freehand, fewer palatal lateral osteotomies have been reported, and palatal bone blocks are not routinely used in bone augmentation procedures. With the development of digitally guided implant technology, palatal bone harvesting has become feasible. In this paper, we will present a method of obtaining a circumferential bone block of the palate for implant surgical application through dynamic navigation guidance. A total of three patients had undergone this procedure to obtain circumferential palatal bone blocks and completed bone augmentation surgery. The bone augmentation results in the implanted area have been favorable, and there has been some bone recovery at the harvesting site. This is a safe and effective way to obtain intraoral bone blocks.

Comparison of the Inadequacies of Ultrasonography and Computed Tomography in the Diagnosis of Sialolithiasis.

This study aimed to determine the value of either ultrasonography and computed tomography (CT) alone or both for diagnosing salivary gland stones. Based on their clinical findings and physical examination, 188 patients with salivary stones were included. Initially, an ultrasound was performed, and then a non-contrast-enhanced thin-sliced CT scan was done. The study included 161 patients with suspected submandibular gland (SMG) sialolithiasis and 27 with parotid gland (PG) sialolithiasis. Among the SMG cases, stones were confirmed in 130 patients through interventional sialoendoscopy. Sixteen of the stones were detected by CT scan only and were not seen in the previous ultrasound examination. After the second follow-up ultrasound, which was conducted after reviewing the CT scans, 9 of them were identified. Five patients with distal stones and ductal dilation on ultrasound were confirmed to have sialolithiasis. In 5 patients with stones detected on ultrasound but not on CT, dental filling artifacts were identified as the cause. For PG cases, stones were observed in 18 out of 19 patients with suspected sialolithiasis based on ultrasound and CT findings. Three patients with positive CT findings but negative ultrasound showed stones during sialendoscopy. During an ultrasound examination, palpating the floor of the mouth with the other hand's index finger can help identify stones obscured by the shadow of the mandible, thereby enhancing the test's accuracy. Patients with dental fillings, implants, and permanent dentures should not be referred for a CT scan to avoid unnecessary exposure to ionizing radiation. They also cause significant metallic artifacts in the field of interest. In these cases, ultrasound should be considered. To minimize the effects of ionizing radiation, it is recommended to create limited field requests for the target, focusing solely on the submandibular and PGs.

A Comprehensive Analysis of Flapless and Conventional Flap Technique in Dental Implant Surgery - A Comparative Study

A Comprehensive Analysis of Flapless and Conventional Flap Technique in Dental Implant Surgery - A Comparative Study

Three-Dimensional Evaluation of Alveolar Bone Levels Around Dental Implants and Natural Teeth: A Prospective Study.

Dental implants' efficacy is influenced by the quality and quantity of the osseous tissue present at the site designated for dental implants. Therefore, this study was conducted with the primary objective of assessing marginal bone loss around mandibular posterior dental implants at six and 18 months after prosthesis placement, compared with the contralateral natural tooth. The secondary objective was to determine the correlation between various factors such as periodontal status, age, gender, duration between first and second-stage surgery, and marginal bone loss. This prospective, split-mouth study was conducted on 24 patients, consisting of two groups: group 1, with single tooth replacement by a dental implant in the posterior mandible, and group 2, a contralateral natural tooth. The bleeding index (BI), probing depth (PD), andmarginal bone loss were evaluated using cone-beam computed tomography at six and 18months follow-up period after prosthesis placement. Significant bone loss was observed in both groups across all regions (p < 0.05). The mean marginal bone loss was greater at 18 months in group 1 than at six months of follow-up, whereas in group 2, it was not significant. The total mean marginal bone loss during the follow-up period of 18 months was 0.05 mm on the buccal and lingual side, whereas it was 0.5 mm on the mesial side and 2 mm on the distal side. Similarly, in the control group, the total mean marginal bone loss was 0.03 mm on the buccal and lingual sides, whereas it was 0.04 mm on the mesial and distal sides. The PD and duration of second-stage surgery were significant predictors and showed a significant correlation with marginal bone loss. PD and marginal bone loss were significantly higher in the implant group than in the natural tooth group over the follow-up period of 18 months, particularly on the distal side.

Wide Restorative Emergence Angle Increases Marginal Bone Loss and Impairs Integrity of the Junctional Epithelium of the Implant Supracrestal Complex: APreclinical Study.

To assess the influence of the emergence angle on marginal bone loss (MBL) and supracrestal soft tissue around dental implants. In six mongrel dogs, the mandibular premolars and molars were extracted. After 3 months of healing, four dental implants were placed in each hemimandible. The implants were randomly allocated to receive one of four customized healing abutments, each with a different value of the restorative emergence angle: 20°, 40°, 60° or 80°. Intra-oral radiographs were taken after placing the healing abutments and at 6, 9, 16 and 24 weeks of follow-up. Then, micro-CT and undecalcified histology and synchrotron were performed. MBL over time was analysed with generalized estimating equations (GEEs) and adjusted for baseline soft-tissue thickness. From implant placement to 24 weeks, GEE modelling showed that the MBL at mesial and distal sites consistently increased over time, indicating MBL in all groups (p < 0.001). The model indicated that MBL varied significantly across the different restorative angles (angle effect, p < 0.001), with 80° showing the greatest bone loss. Micro-CT, histology and synchrotron confirmed the corresponding trends and showed that wide restorative angles (60° and 80°) impaired the integrity of the junctional epithelium of the supracrestal tissue. A wide restorative angle increases MBL and impairs the integrity of the junctional epithelium of the implant supracrestal complex.

A Cross-Sectional Study of Peri-Implant Diseases in a Random Norwegian Population: Prevalence, Risk Indicators, and Clinical Validation of Patient-Reported Outcomes.

The primary aim of this study was to investigate the prevalence of peri-implant diseases in a randomly selected Norwegian population. The secondary aims were to explore risk indicators for peri-implant diseases and to validate self-reported outcome measures from a survey with clinical parameters. Patients (n = 3083) rehabilitated with dental implants in 2014 were mailed a questionnaire and invited to a clinical examination. A randomly selected subset of responders underwent a clinical examination (n = 242). Full mouth clinical and radiographic examinations were conducted. Multiple logistic regression was used to assess patient-related risk indicators for peri-implantitis. Self-reported data were compared with data from the clinical examination using Spearman correlation and binary logistic regression. The prevalence of peri-implantitis was 17.0% at patient level and 8.6% at implant level, according to the 2018 classification. Risk indicators for peri-implantitis included smoking and periodontitis in the adjusted model. The correlation was strong (r = 0.91, p < 0.001) between number of self-reported implants and clinical counts, whereas self-reported peri-implant inflammation was associated with peri-implantitis (OR 6.4 [95% CI 3.0, 13.7]). Smoking and periodontitis were identified as key risk indicators for peri-implantitis. Questionnaire data rendered clinically valid estimates of implant number, and self-reported peri-implant inflammation was associated with clinical peri-implantitis.

Polydopamine-based surface coating fabrication on titanium implant by combining a photothermal agent and TiO2 nanosheets for efficient photothermal antibacterial therapy and promoted osteogenic activity

Developing titanium-based dental implants with both excellent antibacterial properties and good osseointegration is crucial for the success of the implant operation and the long-term durability of the implant. In this study, a polydopamine-based coating was created by attaching TiO2 nanosheets-cyanine composites onto the titanium surface, enabling the integration of effective photothermal antibacterial therapy with osseointegration. The exceptional dual-photothermal conversion abilities of polydopamine and cyanine in the coating resulted in outstanding photothermal antibacterial and antibiofilm therapy against four types of bacteria. Furthermore, TiO2 nanosheets promoted the adhesion, proliferation and early osteogenic differentiation of osteoblasts. In an infected dental implant model in rats, the developed coating exhibited potent antibacterial activity and remarkable osteogenic differentiation in the bone, leading to increased bone formation around the implants. This innovative approach, combining photothermal therapy with osteogenic two-dimensional nanomaterials, presents a novel method for surface functionalization of implants to achieve effective antibacterial and osseointegration capabilities.

Unleashing the potential of applied UNet architectures and transfer learning in teeth segmentation on panoramic radiographs

Accurate tooth segmentation in panoramic radiographs is a useful tool for dentists to diagnose and treat dental diseases. Segmenting and labeling individual teeth in panoramic radiographs helps dentists monitor the formation of caries, detect bone loss due to periodontal disease, and determine the location and orientation of damaged teeth. It can also aid in both the planning and placement of dental implants, as well as in forensic dentistry for the identification of individuals in criminal cases or human remains. With the advancement of artificial intelligence, many deep learning-based methods are being developed and improved. Although convolutional neural networks have been extensively used in medical image segmentation, the UNet and its advanced architectures stand out for their superior segmentation capacities. This study presents four semantic segmentation UNets (Classic UNet, Attention UNet, UNet3+, and Transformer UNet) for accurate tooth segmentation in panoramic radiographs using the new Tufts Dental dataset. Each model was performed using transfer learning from ImageNet-trained VGG19 and ResNet50 models. The models achieved the best results compared to the other literature models with dice coefficients (DC) and intersection over union (IoU) of 94.64% to 96.98% and 84.27% to 94.19%, respectively. This result suggests that Unet and its variants are more suitable for segmenting panoramic radiographs and could be useful for potential dental clinical applications.

Enhanced alveolar ridge preservation with hyaluronic acid-enriched allografts: a comparative study of granular allografts with and without hyaluronic acid addition

PurposeRidge preservation is essential to restore alveolar ridge volume and to enhance esthetic and functional outcomes for dental implants. The addition of hyaluronic acid to allogeneic bone substitute materials might enhance these outcomes. This clinical study evaluated the efficacy of ridge preservation after tooth extraction using granular allografts with and without hyaluronic acid addition.MethodsIn this retrospective study, 40 patients with compromised extraction sockets were enrolled. Among them, 19 received particulate allogeneic bone substitutes (Allo), 21 received allogeneic bone substitutes with hyaluronic acid (AlloHya). Vertical and horizontal graft stability, graft shrinkage rate, and bone mineral density were assessed using radiographic measurements on CBCT scans conducted before tooth extraction, directly after ridge preservation and after four months. Patients were followed up 12 months post-implantation.ResultsVertical height loss after 4 months was significantly greater in the Allo group (-0.82 ± 0.95 mm) compared to the AlloHya group (-0.19 ± 0.51 mm; p = 0.011). Graft shrinkage rate was 16.9 ± 11.5% (Allo) and 10.3 ± 7.7% (AlloHya) (p = 0.038). After four months, average bone density was significantly higher in the AlloHya compared to the Allo group (p = 0.004). Nearly all implants (39 out of 40) were classified as “Success” according to the ICOI scheme, with no differences in implant quality between the two study groups.ConclusionsImproved graft stability, reduced resorption, and increased bone density were observed in hyaluronic acid-enriched allografts compared to pure allografts. Adding hyaluronic acid to allogeneic bone grafts significantly enhanced outcomes in ridge preservation.

Patient's Perspective on Miniscrews During Orthodontic Treatment-A Systematic Review With Meta-Analysis.

During orthodontic treatment, undesirable reciprocal forces are generated during tooth movement, which explains the use of anchorage strategies to minimise their harmful effects through intra and/or extraoral appliances. Miniscrews are intraoral devices used for temporary skeletal anchorage. Miniscrews are small-sized intraoral devices used for temporary skeletal anchorage and are easy to place and remove. However, some studies refer to adverse effects such as inflammation, pain, and discomfort. This systematic review aims to synthesise the available evidence on the use of miniscrews during orthodontic treatment from the patient's perspective. The literature search was conducted using various databases MedLine through PubMed, Cochrane Library, Web of Science Core Collection, and EMBASE. A search was also carried out in the grey literature. The search terms used were "Orthodontic Anchorage Procedures," "mini-implant," "Mini Dental Implant," "Miniscrew," and "microimplant." Cochrane risk of bias tools was used to assess the quality of included studies. Patients tend to overestimate the pain inherent in this procedure. The insertion of micro implants is more accepted than the tooth extraction procedure, with less postoperative pain reported. The location, surgical technique, and type of anaesthesia used in the placement of miniscrews influence levels of discomfort. Additionally, the execution of a good surgical technique and the clinician's communication skills are factors that influence patient satisfaction and positive perception. The most frequent outcome reported is pain and discomfort, which varies depending on its location (less with mini interradicular screws than with extra-alveolar screws). Most patients are satisfied or very satisfied with this application.

Human gingival fibroblast response on zirconia and titanium implant abutment: A systematic review.

The peri-implant region, where restoration interfaces with mucosal tissue, plays an essential role in overall implant success and is just as important as osseointegration. The implant abutment materials are in intimate contact with human gingival fibroblasts (HGFs). This study compares the proliferation of HGFs between zirconia and titanium abutments used in dental implants. An electronic search was performed using PubMed, EMBASE, and Web of Science databases. English articles based on in vitro studies testing HGFs proliferation on zirconia and titanium implant abutment materials were included. A quality assessment of the selected study was performed using the web-based Science in Risk Assessment and Policy (SciRAP) tool. The HGFs proliferation and cellular morphology tests on zirconia and titanium materials from the included studies were summarized, exploring the role of material surface characteristics. The electronic search yielded 401 studies, of which 17 were selected for inclusion. Zirconia exhibited comparable or superior efficacy in promoting the proliferation of HGFs compared to titanium. Observations on cellular morphology showed similar outcomes for both materials. Establishing a definitive relationship between contact angle, surface roughness, and their influence on cellular response remains challenging due to the varied methodological approaches in the reviewed studies. Based on the findings of this systematic review, zirconia shows comparable reliability to titanium as an abutment material for HGFs proliferation, with comparable or superior HGFs proliferative outcomes.

Five Techniques of Osseodensification in One Case

Initial stability of implants is an important factor for the osseointegration of dental implants. Initial stability of implants can be lost when the bone is insufficient in cases of immediate implantation or when the bone density is insufficient, making it difficult to ensure good initial stability. Many techniques have been used to increase bone density. This study tested the use of five methods to increase bone density in one patient. This study concluded that the five methods used were effective in densifying the bone and achieving clinically acceptable primary stability in low-density bone.

Antifungal Ability of Novel Silane on Titanium Implant Surface

Titanium and its alloys are commonly used in dentistry for implants due to their strength, lightweight nature, durability, corrosion resistance, and biocompatibility. These implants can osseointegrate after surface treatments such as SLA, plasma-spray, and nanotubes, providing a stable foundation for prostheses. However, Candida albicans, an opportunistic fungal pathogen, can threaten the success of titanium dental implants, causing oral infections in vulnerable individuals. A dual novel silane blend of 3-acryloxypropyltrimethoxysilane (ACPS) and bis-1,2-(triethoxysilyl)ethane (BTSE) has been shown to improve the shear bond strength in resin cement bonds with titanium and ceramics. This study evaluated the effects of Candida albicans colonization on blended silane-coated SLA-Ti surfaces compared to non-coated SLA-Ti (positive control) and flat titanium (negative control). Candida albicans biofilms were cultured on all surfaces, and it was found that silane-coated SLA-Ti had significantly lower CFU counts than non-coated SLA-Ti. However, no significant differences were observed in the RT-PCR results. In conclusion, a combination of 1.0 vol% ACPS and 0.3 vol% BTSE shows promise as a silane coupling agent with potential antifungal properties for inhibiting Candida albicans proliferation.