Radiographic Marginal Bone Loss Research Articles

Proper Management of Amalgam Powder Embedded in the Alveolus.

The presence of foreign bodies in the mandible is not listed as a risk factor or absolute contraindication for implant rehabilitation. However, possible complications caused by foreign bodies, such as infection and cyst formation, could lead to implant failure. The authors report a case of dental implant placed 4 months after the surgical removal of embedded amalgam in the mandibular alveolus using a trephine bur and bone grafting with mineralized freeze-dried bone allograft. Clinical and radiographic evaluations were performed at each appointment to assess factors such as pain, implant mobility, probing depth, and marginal bone loss around the implant. Within 3 years of implant placement, there were no clinical signs and symptoms and no obvious radiographic marginal bone loss. Dental implant installation appears to be safe following the elimination of foreign materials, so long as anatomic and biological factors and appropriate implant choice, are taken into consideration.

Radiographic marginal bone level evaluation around two different tissue-level implant systems: a one-year prospective study.

Marginal bone loss, is a frequently reported variable in the evaluation of dental implants. The primary objective of this study was to evaluate radiographic marginal bone level changes around the two different tissue-level implant systems placed adjacently in the posterior maxilla or mandible. The influence of implant macro-geometry and vertical soft tissue thickness on marginal bone loss were also evaluated. Seven patients were included in the study and a total of 18 implants were analyzed. Each patient received two different implants placed adjacently in the maxilla or the mandible. The implants used in our study were either Straumann® SP cylindrical implants or JD Octa® tapered implants. During the surgery, vertical soft-tissue thickness was measured with a periodontal probe placed on the top of the bony crest and in the center of the future implant site. Healing abutments were then seated. Three months following implant placement, impressions were taken, and screw-retained metal ceramic prostheses were delivered. Standardized intraoral radiographs were taken immediately after implant placement and one year following implant loading in order to assess marginal bone level changes. Results showed a mean marginal bone loss of 0.55±0.5 mm for Straumann® SP implants and 0.39±0.49 mm for JD Octa® implants after one year of loading and the difference was not statistically significant between the two systems. A statistically significant correlation was found between soft tissue thickness and marginal bone loss; in sites with thin mucosal tissues (≤2 mm), there was significantly greater bone loss compared to sites with thick, soft tissues (> 2 mm) in both implants. Radiographic marginal bone loss was not statistically different between the two implant systems at the one-year examination period. Moreover, vertical soft tissue thickness influenced marginal bone loss regardless of the implant system used.

Antibiotics in the non-surgical treatment of peri-implantitis.

Four electronic databases (MEDLINE via Pubmed; EMBASE via Ovid; EBSCO Dentistry and Oral Science Source), in addition to six related journals (Clinical Implant Dentistry and Related Research; Clinical Oral Implants Research; International Journal of Oral and Maxillofacial Implants; International Journal of Oral Implantology; Journal of Clinical Periodontology; Journal of Periodontology), were searched for publications until 2022. Randomised controlled trials (RCTs), evaluating the effectiveness of local or systemic antibiotics as an adjunct in the non-surgical treatment (NST) for peri-implantitis (PI), were assessed. The eligibility criteria included RCTs with a parallel group, split-mouth design and appropriate NST interventions over a three to twelve month period. Data were extracted from RCTs to capture a multitude of primary outcomes, including: implant success rate, radiographic marginal bone loss rate, periodontal health changes and PI resolution. Risk of bias assessments were made using the Cochrane Collaboration's tool, by two authors independently and in duplicate. RCTs with similar observation periods and interventions were included in the meta-analyses. Random-effects meta-analyses of mean differences or relative risks with 95% confidence intervals were calculated, in additional to data heterogeneity calibration through I2 statistics. Following the screening of 270 papers, six RCTs were included, which resulted in the evaluation of 391 patients (375 implants). Adjunctive local antibiotic therapy at disease sites showed statistically significant periodontal outcomes; improvements in success rate (risk ratio = 9.89; 95% CI 2.39-40.84), probing pocket depth (mean difference (MD) = 0.6 mm; 95% CI 0.42-0.78) and bleeding on probing (MD = 0.15%; 95% CI 0.10-0.19). Conversely, adjunctive systemic antibiotics improved probing pocket depths (MD = 1.15 mm; 95% CI 0.31-1.99) and probing attachment levels only (MD = 1.10 mm; 95% CI 0.13-2.08). Across the six included RCTs, the bone loss rate and PI resolution rate determined no significant differences between the groups; mirrored in the single studies and in the meta-analysis. Disease resolution ranged from 2 to 65%. Two of the studies were found to be at low risk of bias and four presented with some concerns. Adjunctive antibiotics aid NST. However, the heterogeneity of study methods and low quality of current RCTs evidenced, deem their role in NSTs of PI as inconclusive.

Screw-retained internal connection zirconia CAD-CAM abutments in single implant reconstructions: Results of a 1-year prospective case series study.

To evaluate the clinical and radiographic outcomes of single-tooth implant restorations using one-piece, internally connected, screw-retained, computer-aided design and computer-aided manufactured monolithic zirconia restorations fabricated on regular diameter implants. Following a 2-stage surgical procedure, 22 implants placed in anterior and posterior areas in 21 partially edentulous patients (mean age of 55 years; 9 males/12 females) were evaluated in terms of plaque index, pocket probing depth, bleeding on probing, level of oral hygiene (OH), signs of mucositis/peri-implantitis, esthetic score (ES), gingival zenith position (GZP), papilla index score, the thickness of peri-implant gingiva, radiographic marginal bone loss, and technical complications. Implants and restorations were prospectively followed from the insertion of the restoration (baseline), up to 12-months post-loading. A 100% implant survival rate resulted after loading; one implant was lost before loading. Clinically, patients performed an adequate OH, and tissues were kept healthy. Probing depth showed a slightly lower value at baseline compared to any follow-up examination (2.26 [0.94] at baseline vs. 2.53 [0.66]mm at 12 months). ES, GZP, and the thickness of the peri-implant gingiva improved throughout the course of the study. Radiographically, average marginal bone level (MBL) was 0.40 (0.40)mm after 1-year follow-up with no differences in average MBL at all time points. Technically, after 1 year of clinical function, neither abutment fracture nor any other serious complications occurred. Hence, prosthetic reconstruction survival rate was 100%. Clinical outcomes of single-tooth implant restorations using internally connected, screw-retained, computer-aided design and computer-aided manufacturing monolithic zirconia abutments can be considered a reliable treatment alternative after 1-year clinical observation.

The efficacy of implant surface decontamination using chemicals during surgical treatment of peri-implantitis: A systematic review and meta-analysis.

To answer the following PICOS question: "In adult patients with peri-implantitis, what is the efficacy of surgical therapy with chemical surface decontamination of implant surfaces in comparison with surgical therapy alone or surgery with placebo decontamination, on probing pocket depth (PD) reduction and bleeding on probing (BoP)/suppuration on probing (SoP), in randomized controlled clinical trials (RCTs) and non-RCTs with at least 6months of follow-up?" Six databases were searched from their inception up to 20 May 2022. Data on clinical outcome variables were pooled and analysed using mean differences (MDs), risk ratios (RRs), or risk differences (RDs) as appropriate, 95% confidence intervals (CIs), and prediction intervals (PIs) in the case of significant heterogeneity. Primary outcomes were determined as changes in PD and BoP/SoP. Secondary outcomes were radiographic marginal bone loss (MBL), implant loss, and disease resolution. PROSPERO registration number: CRD42022325603. Six RCTs-two with moderate, three with high, and one with low risk of bias (RoB)-were included. These studies test the adjunctive effect of photodynamic therapy (PDT), chlorhexidine (CHX), and administration of local antibiotics (LAbs) during surgery on the clinical outcome. In a single 12-month study, the adjunctive use of local antibiotics showed a clinically relevant reduction of PD [MD=1.44; 95%CI (0.40 to -2.48)] and MBL [MD=1.21; 95%CI (0.44-1.98); one trial, 32 participants]. PDT showed a small but significant reduction in BoP [MD=7.41%; 95%CI (0.81-14.00); p= 0.028; two trials; 42 participants]. Treatment with CHX resulted in no significant changes in PD, BoP, or MBL compared to placebo (saline solution). None of the interventions affected disease resolution and implant loss. Certainty of the evidence was very low for all outcome measures assessed. Within the limitations of this systematic review and the meta-analysis, adjunctive use of chemicals such as PDT, CHX, and LAbs for surface decontamination during surgery of peri-implantitis cannot be recommended as superior to standard debridement procedures (mechanical debridement with or without saline).

The significance of vertical platform discrepancies and splinting on marginal bone levels for adjacent dental implants.

The aim of this retrospective study was to investigate the influence of vertical platform discrepancies for splinted and non-splinted adjacent implants on radiographic marginal bone loss (RMBL). Data from January 2000 to February 2021 were collected from the electronic charts of 156 patients with 337 implants at the UCSF School of Dentistry. Five different implant restoration categories were evaluated for radiographic evidence of proximal RMBL. Patients with (1) two adjacent single crowns, (2) two adjacent splinted crowns, (3) three-unit bridges supported by two implants, (4) three adjacent single crowns, and (5) three adjacent splinted crowns. Inclusion required baseline radiograph taken at the time of prosthesis delivery or final impression, and follow-up radiographs at least 12 months after restorations have been in function. Measurements assessed included vertical distance between adjacent implant platforms and proximal RMBL around implants. Odds ratios (ORs) and 95% confidence interval (95% CI) of implants with ≥1 mm RMBL between different type of restorations were calculated. In general, prostheses supported by splinted adjacent implants demonstrated a significant association with the presence of ≥1 mm RMBL (OR=2.55, 95% CI=1.17-5.17, p=0.018) when compared to prostheses supported by non-splinted adjacent implants. In addition, prostheses with a vertical platform discrepancy ≥0.5 mm demonstrated a significant association with the presence of ≥1 mm RMBL (OR=4.30, 95% CI=1.85 to 10.01, p=0.007) when compared to prostheses with a vertical platform discrepancy <0.5 mm. When adjacent implants had ≥0.5 mm vertical platform discrepancy, the majority (66.67%) of three splinted adjacent crowns had at least one implant with ≥1 mm RMBL. This was followed by two splinted adjacent crowns (58.97%), three-unit bridge (25.93%), two single adjacent crowns (24.24%), and three single adjacent crowns (18.18%). When adjacent implants had ≥1 mm vertical platform discrepancy, there was an increased percentage of implants with ≥1 mm RMBL. The restorative design associated with the highest percent of implants with bone loss was three splinted adjacent crowns (70%), two splinted adjacent crowns (61.11%), three single adjacent crowns (40%), and three-unit bridge and two single adjacent implants (21.05%). Three splinted adjacent crowns were significantly associated with ≥1 mm RMBL when compared to three-unit bridge (OR 6.56, 95% CI 1.59-27.07). Similarly, two splinted crowns were significantly associated with ≥1 mm RMBL when compared to two single crowns (OR=2.50, 95% CI=1.08-5.79). Two or three adjacent implants placed with a vertical platform discrepancy, when splinted together, are associated with higherincidence of ≥1 mm RMBL than non-splinted restorations.

Socket shield technique and delayed implant placement in maxilla: a series of five case reports

BackgroundTooth extraction is often followed by remodeling of hard and soft tissues, while socket shield technique has been proposed to prevent or minimize this remodeling. Socket shield accompanied with delayed implant placement is a novel technique that could be used when delayed implantation is selected; however, more scientific based evidence is required to recommend this technique as everyday clinical practice. Thus, the aim of this case series was to assess the clinical, radiographic, and esthetic outcomes of the delayed placed implants associated with previously prepared socket shield at 3–15 months follow-up after loading. The stability of the shield and the depth of soft tissue penetration palatal to the shield at reentry of 3–6 months were also assessed.Cases presentationFive case reports of socket shield with delayed implant placement were described in the study. The facial shields were prepared and simultaneously the sockets were grafted with mineralized allograft particles, then the implants were placed 3–6 months later. Periodontal probe was used to measure the depth of soft tissue penetration palatal to the shield at reentry. Clinical indices of bleeding index, plaque index, and probing depths were recorded. Radiographic evaluation to record the amount of marginal bone loss post-loading, esthetic assessment using modified pink esthetic score, and patient assessed outcomes were also evaluated at 3–15 months follow-up after loading. At 3–6 months reentry, all shields were stable with maintenance of the facial bone and with extreme hard tissue formation in the sockets. All five implants were successful and functional without any pain or inflammation, with optimal soft tissue health and esthetics, and with minimal radiographic marginal bone loss at the last follow-up visit (3–15 months after loading).ConclusionsWithin the limits of this study, socket shield technique with delayed implant placement could be a predictable minimally invasive option for cases requiring delayed implant placement; however, a long-term well-designed clinical proof is warranted.

Effect of Soft Tissue Condition on Peri-implant Health and Disease: A Retrospective Clinical Study.

This study retrospectively evaluated the effect of soft tissue condition on peri-implant health. Clinical variables (Plaque Index, keratinized tissue width, gingival biotype, and vestibular depth) were recorded. Probing depth, soft tissue recession, bleeding on probing, and radiographic marginal bone loss were assessed in relation to independent variables. Statistical analysis was performed using Mann-Whitney U test or Kruskal-Wallis rank test and a logistic regression model at the implant level. A total of 139 implants in 43 patients were assessed. Bleeding on probing was recorded at 54.7% sites, which was significantly related to the biofilm accumulation. Gender, history of periodontal disease, patient adherence to recall visits, and the presence of plaque were associated with higher peri-implant probing-depth values. The maximum soft tissue recession was recorded at sites with a thin biotype and shallow vestibular depth (P = .0). The logistic regression analysis revealed that plaque (P = .002) and vestibular depth (P = .043) were significantly associated with peri-implantitis. Within the study limitations, patients with high plaque accumulation and shallow vestibular depth are more prone to peri-implant disease.

Prospective cohort study to evaluate narrow diameter implants for restoration of a missing lateral incisor in patients with a cleft palate: One-year results

Statement of problemPatients diagnosed with a cleft palate often have a congenitally missing maxillary lateral incisor. The congenital cleft presents the practitioner with challenges including the quantity and quality of bone, a surgically managed cleft correction, and limited clinical space. PurposeThe purpose of the present prospective investigation was to report preliminary results at the 1-year follow-up for this planned 5-year investigation of narrow diameter implants used to restore a missing lateral incisor in patients with a cleft palate. Material and methodsFourteen study participants with a cleft palate and a missing maxillary lateral incisor were enrolled based on established criteria. Narrow diameter implants (AstraTech OsseoSpeed TX 3.0S and 3.5 mm) were placed by using a 2-stage protocol and restored. All study participants received an Atlantis abutment and a cement-retained crown. Four probing depth measurements and bleeding on probing were measured at baseline and at 1 year. Probing depth measurements were evaluated using a 2-way repeated measures ANOVA with Tukey-Kramer multiple comparisons tests. Radiographic marginal bone loss was measured at 1-year by using a digital subtraction technique and evaluated by using a repeated measures ANOVA. Pretreatment cone beam computed tomography (CBCT) images were used to measure a mean gray level that was proportional to bone mineral density (BMD) in the implant site. One-way mixed ANOVA was used to compare the mean gray level and average implant stability quotient (ISQ) loading. A Pearson correlation was also tested between those parameters (α=.05) for each statistical analysis. ResultsThe mean marginal bone loss at 1 year was 0.601 ±0.48 mm. Regarding probing depth measurements, a 2-way repeated measures ANOVA found both the location (P=.012) and time (P=.009) were significant. The Tukey-Kramer multiple comparisons test showed a significant difference between the buccal and distal site (P=.006) from baseline to 1-year follow-up. ConclusionsNarrow diameter implants are a reliable treatment for replacing a missing lateral incisor in patients with a cleft palate at 1 year, with an implant survival rate of 100% and implant success rate of 94% using the established criteria. A negative association was found between the bone mineral density and the implant stability in the alveolar cleft site of a patient with a cleft palate. The peri-implant soft tissue probe depths exhibited significant change during the first year.

Clinical and radiographic variables related to implants with simultaneous grafts among type 2 diabetic patients treated with different hypoglycemic medications: a retrospective study

BackgroundThe influence of different hypoglycemic agents on peri-implant variables among type 2 diabetes mellitus patients is still unclear. Therefore, the aim of this study was to assess the radiographic marginal bone loss and clinical parameters around implants in patients using different hypoglycemic agents.MethodsIn this retrospective cohort study, the dental implant records of type 2 diabetes mellitus patients who met the inclusion criteria were collected. The patients using only single medication as follows: insulin, metformin, or glucagon-like peptide-1 (GLP-1) drugs, were grouped according to their medication. These patients received implant placement with the same initial status, and all the prosthesis restorations were cement-retained ceramic crowns. The peri-implant marginal bone levels were evaluated by periapical radiographs immediately after implant placement and at 1 and 2-year follow-up visits. The baseline characteristics were compared among groups. The peri-implant radiographic marginal bone loss and clinical parameters were preliminarily compared using the Kruskal–Wallis test, and then the covariates were controlled by covariance analysis. Bonferroni post hoc adjustment test was performed for the multiple comparisons.ResultsAfter a review of more than 7000 medical records, a total of 150 patients with 308 implants at 1-year follow-up were assessed. The peri-implant marginal bone loss in the GLP-1 drug group was significantly smaller than the insulin group and metformin group (P < 0.01). The radiographic bone loss in the metformin group was higher than the insulin group (P < 0.05). Some of these included patients were lost to follow-up. Only 74 patients with 129 implants completed the 2-year follow-up. The radiographic bone loss in the metformin group was still higher than the insulin group (P < 0.05) and GLP-1 group (P < 0.01). There was no significant difference in the BOP (+) and the mean PD among groups (P > 0.05).ConclusionsThe radiographic variables were not exactly the same among the patients with different hypoglycemic agents at both the 1 and 2-year follow-ups. After ensuring consistency in baseline characteristics, the positive effect of GLP-1 drugs on peri-implant bone remodeling may be no less than insulin or metformin. More studies are needed to verify the direct effect of these drugs on peri-implant bone.Clinical trial registration number ChiCTR2000034211 (retrospectively registered).

Evaluation of the effect of the lateralized inferior alveolar nerve isolation and bone grafting on the nerve function and implant stability. (Randomized Clinical Trial).

The inferior alveolar nerve lateralization (IANL), although allows for an implant full-length mandibular height engagement, coincides with depleting the buccal bone support and sensory deficits. This study aims to assess whether interposing a bone graft coupled with securing a collagen membrane separation between the inferior alveolar nerve (IAN) and the underlying dental implants would preserve the nerve function, enhance the implant stability, and minimize the radiographic marginal bone loss. Eighteen patients with 30 atrophic mandibular edentulous ridges were subjected to IANL after being randomly assigned to two treatment modalities which consisted of 15 patients each. The (control group) utilized conventional IANL in direct contact with 20 implants. The (test group) implemented the IAN collagen-membrane wrapping and interposing bone graft to overlay 23 implants. The neural function, the radiographic marginal bone loss, and the implant stability quotient were assessed and compared 6 months postoperatively. All the patients regained their full neurosensory function after 6 months, with statistically nonsignificant differences between both groups throughout the follow-up period. The mean marginal bone loss in the test group was (0.42 ± 0.09) mm versus (0.38 ± 0.14) mm for the control group, which was statistically similar (P= 0.401). The 6-month postoperative mean implant stability quotient values of the test group recorded (74.73 ± 2.68) versus (74.73 ± 1.79) for the control group, which was statistically nonsignificant with a value of P= 0.626. The interposed bone graft, coupled with the collagen membrane isolation, neither subsided the neural disturbances nor enhanced the secondary implant stability and marginal bone loss.

Does a history of periodontal disease affect implant survival?

Data sources Three electronic databases were searched (Medline, EMBASE and Cochrane Central) with date of publication between January 2003 and May 2018. Only articles written in English were included. Following electronic searches, the authors conducted manual searches of oral implant/periodontal journals from January 2012 to May 2018. In the event of disagreement on article selection, a further senior reviewer would make the final decision on its inclusion or exclusion following discussion.Study selection In total, 172 articles from the electronic search and ten from manual search were identified for initial screening. From the title and abstract, 18 articles were identified for full-text screening. Following this, 13 articles were included for quantitative synthesis and meta-analysis. The articles assessed the impact of history of periodontitis (HP) on implant survival, radiographic bone loss, pocket depth and bleeding on probing around the dental implant. All studies were either cohort or controlled studies. Seven of the 13 identified studies were prospective. Included studies fulfilled the following criteria: any human studies with supportive periodontal treatment (SPT) application, details of SPT provided in the studies for implant maintenance, compares the outcomes of implants from both patients with and without a HP and peri-implant conditions recorded.Data extraction and synthesis Data extraction followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance. The Newcastle-Ottawa Scale was used to carry out quality assessment. Data was extracted to calculate risk ratio (RR) of implant survival, weighted mean difference (WMD) for radiographic bone loss, pocket depth, bleeding on probing and plaque index in patients with and without a HP.Results Implant survival rate was assessed as the primary outcome. Secondary outcomes also assessed were radiographic bone loss, pocket depth, bleeding on probing and plaque indices. In implants with rough surfaces, the HP group showed a reduced implant survival rate (RR: 0.96, 95% CI: 0.94-0.98, P <0.001) even under regular supportive post-implant treatment. They also showed more radiographic marginal bone loss (WMD: 0.34 mm, 95% CI: 0.2-0.48, P <0.001), pocket depth (WMD: 0.47 mm, 95% CI: 0.19-0.74, P <0.001) and bleeding on probing (WMD: 0.08 mm, 95% CI: 0.04-0.11, P <0.001) when compared to the non-HP group. In implants with a machined surface, again the HP group had more radiographic bone loss (WMD: 0.88 mm, 95% CI: 0.65-1.11, P <0.001) than the non-HP group. However, in implants with machined surfaces, there was no statistically significant difference in survival rate between HP and non-HP groups (RR: 0.98, 95% CI: 0.92-1.04, P = 0.895).Conclusion In implants with rough surfaces, a history of periodontal disease has a negative impact on survival rate, even with SPT.

Implants with a Laser-microgrooved Collar Placed in Grafted Posterior Maxillary Extraction Sockets and in Crestally Grafted Sinuses: a 5-Year Multicentre Retrospective Study.

ABSTRACTObjectivesThe aim of this retrospective multicentre cohort study was to compare clinical outcomes, soft tissues conditions and differences in marginal bone loss between implants with a laser-microgrooved collar placed in posterior maxillary extraction sockets grafted by 4 to 5 months, and in posterior maxillary pristine bone (spontaneously healed posterior maxillary extraction sockets) by means of osteotome-mediated sinus floor elevation, over a period of 5 years after functional loading.Material and MethodsPatients of Group 1 underwent extractions with sockets preservation using porcine-derived bone, covered with collagen membrane. Group 2 underwent extractions without socket preservation. Patients of Group 1 received implants in grafted sites, and Group 2 received implants in spontaneously healed bone using a maxillary sinus lift with crestal approach.ResultsOver the observation period, the overall clinical success rate in Group 1 and Group 2 was 98% and 100%, respectively, with no differences between the procedures and implants used. Cumulative radiographic marginal bone loss ranged from 0.03 to 0.39 mm after 60 months of functional loading. There were no statistically significant differences in marginal bone loss between short and standard-length implants placed in grafted extraction sockets and in pristine bone.ConclusionsShort and standard implants with a laser-microgrooved collar, placed in posterior maxillary extraction sockets grafted by 4 to 5 months, and in posterior maxillary pristine bone (spontaneously healed posterior maxillary extraction sockets) by means of osteotome-mediated sinus floor elevation, exhibited no statistical difference in success rate, clinical parameters and marginal bone loss.

Internal Hexagon vs Conical Implant-Abutment Connections: Evaluation of 3-Year Postloading Outcomes.

Different types of internal implant-abutment connections, namely hexagon and conical, have been used for implant restoration. However, data regarding the benefits of these internal connections in terms of clinical outcomes are scarce. Accordingly, the aim of this study was to compare radiographic marginal bone loss (RMBL) and associated implant complications between implants with internal hexagon (IH) connections and those with internal conical (IC) connections. Forty-nine patients with 98 implants (2 per patient) placed in the posterior mandible were recruited. All implants were inserted in pairs into solid D2 bone according to a randomized sequence; the first patient received an IH connection implant on the mesial side, while the second patient received an IC connection implant on the mesial side. Each patient received 1 implant with an IH connection and 1 with an IC connection, placed side by side. Four months after placement, all implants were loaded with single screw-retained ceramic restorations with IH or IC connections. RMBL and complications, including implant/prosthesis failure, were recorded at the time of implant loading (baseline) and at 6, 12, and 36 months after loading. The results revealed no significant between-group differences in RMBL (P = .74), gingival bleeding on probing (P = .29), and complications (P = .32). Thus, the type of internal implant-abutment connection did not affect clinical outcomes, including RMBL and implant/prosthesis failure. Future studies should additionally evaluate long-term prosthesis-related complications, such as screw loosening and fracture, between the 2 types of internal connections.

Randomized clinical trial evaluating the effect of splinting crowns on short implants in the mandible 3years after loading.

To compare the radiographic marginal bone loss and clinical parameters of splinted and non-splinted fixed dental prostheses on short implants in the posterior region of the lower jaw 3years after loading. Twenty patients, 15 female and five males, with uni- or bilateral free-end situations in the mandible participated in the study. Two short implants (7mm) in the posterior mandible were placed and patients were randomized to receive splinted (n=11) or non-splinted (n=13) cemented crowns. Marginal bone loss (MBL) was assessed on radiographs taken with customized positioning jigs at baseline, 1 and 3years after loading. Plaque index (PI), gingival index (GI), probing depth (PD), and bleeding on probing (BOP) were measured. (ClinicalTrials.gov; identifier: NCT03558347). After 3-year survival rate of altogether 48 implants was 100% for both groups. Success rate (according to Papaspyridakos, Chen, Singh, Weber, & Gallucci, 2012) was 84.6% for non-splinted and 86.4% for splinted implants. At restoration level survival rate was 100% for both groups. Marginal bone level changes showed mean gain of 0.3 ± 0.8 mm for non-splinted and 0.1±0.5 mm for splinted implants 3 years after loading. Statistical analysis showed no significant difference in PI, GI, PD, BOP, and marginal bone loss between both groups (p>.05). Within the limitations of this study it can be concluded that splinting crowns on short implants neither seems to affect the amount of marginal bone loss nor peri-implant health 3years after loading.

Macrophage polarization in peri-implantitis lesions

ObjectivesTo immunohistochemically characterize and correlate macrophage M1/M2 polarization status with disease severity at peri-implantitis sites.Materials and methodsA total of twenty patients (n = 20 implants) diagnosed with peri-implantitis (i.e., bleeding on probing with or without suppuration, probing depths ≥ 6 mm, and radiographic marginal bone loss ≥ 3 mm) were included. The severity of peri-implantitis was classified according to established criteria (i.e., slight, moderate, and advanced). Granulation tissue biopsies were obtained during surgical therapy and prepared for immunohistological assessment and macrophage polarization characterization. Macrophages, M1, and M2 phenotypes were identified through immunohistochemical markers (i.e., CD68, CD80, and CD206) and quantified through histomorphometrical analyses.ResultsMacrophages exhibiting a positive CD68 expression occupied a mean proportion of 14.36% (95% CI 11.4–17.2) of the inflammatory connective tissue (ICT) area. Positive M1 (CD80) and M2 (CD206) macrophages occupied a mean value of 7.07% (95% CI 5.9–9.4) and 5.22% (95% CI 3.8–6.6) of the ICT, respectively. The mean M1/M2 ratio was 1.56 (95% CI 1–12–1.9). Advanced peri-implantitis cases expressed a significantly higher M1 (%) when compared with M2 (%) expression. There was a significant correlation between CD68 (%) and M1 (%) expression and probing depth (PD) values.ConclusionThe present immunohistochemical analysis suggests that macrophages constitute a considerable proportion of the inflammatory cellular composition at peri-implantitis sites, revealing a significant higher expression for M1 inflammatory phenotype at advanced peri-implantitis sites, which could possibly play a critical role in disease progression.Clinical relevanceMacrophages have critical functions to establish homeostasis and disease. Bacteria might induce oral dysbiosis unbalancing the host’s immunological response and triggering inflammation around dental implants. M1/M2 status could possibly reveal peri-implantitis’ underlying pathogenesis.

Suppuration as diagnostic criterium of peri-implantitis.

Suppuration (SUP) as a diagnostic parameter for monitoring dental implants is not yet well understood. The retrospective clinical and radiographic study was therefore performed to investigate the patient, implant, and site characteristics among individuals exhibiting SUP. Demographic characteristics and clinical parameters were recorded. Radiographic features were analyzed using cone-beam computed tomography. Peri-implantitis was defined based on the consensus report of Workgroup 4 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions: probing depth (PD) ≥6mm, presence of bleeding and/or SUP on gentle probing, and radiographic marginal bone loss (MBL) ≥3mm. SUP was graded according to profuseness (dot versus line/drop) and time after probing (≥15 seconds versus<15 seconds after probing versus spontaneous). Simple binary logistic regression models were estimated using generalized estimation equations to explain the probability of SUP based on demographic, clinical, and radiographic variables. A total of 111 eligible patients (nimplants =501) were assessed. Of them, 57 (nimplants =334) were diagnosed with peri-implantitis according to the established case definition, and of these individuals, 31 (nimplants =96) presented SUP. Therefore, the prevalence of SUP was 27.92% in the total sample size and 54.38% in peri-implantitis patients. Overall, 28.74% implants displayed SUP within patients with peri-implantitis. SUP was more frequently found at buccal sites (51%) and proved less prevalent at mesio-lingual sites (16.7%). Defect morphology (OR=6.59; P=0.004), PD (OR=1.63; P=0.024), and MBL (OR=1.35; P=0.010) were significantly associated with the presence of SUP. Likewise, defect morphology (P=0.02), PD (P=0.003), and MBL (P=0.01) were significantly correlated with the grade of SUP. The presence and grade of SUP are associated with peri-implant bone loss, probing depth, and defect morphology in patients with peri-implantitis.

Marginal Bone Loss Around Machined versus Plasma Sprayed Implant Supported Mandibular Overdenture Cases -A Split- Mouth Randomized Controlled Trial.

Abstract Aim of this study: To compare marginal bone loss around machined and plasma sprayed dental implant collar surfaces after 24 months follow up period in mandibular overdenture cases. Materials and methods: Eight patients with completely edentulous ridges received 32 implants; each patient received 4 implants at the lower arch; 2 machined collar implants were placed at one side and 2 plasma sprayed collar implants were placed at the other side. The implants were loaded 3 months after placement. Radiographic marginal bone loss was measured using CBCT at time of implant placement (baseline), 3,6,12 and 24 months follow up periods. Result: Marginal bone loss was observed for both machined and plasma sprayed implant collars throughout the follow up periods with statistically significant decrease in bone level through 24 months follow up period. Conclusion: Plasma sprayed implant collar promoted better bone repair with less bone loss than did machined implant collar.

Split crest technique for implant treatment of agenesis of the upper lateral incisors: results of a randomized pilot histological and clinical study at 24-month follow-up.

Agenesis of lateral incisors, besides the functional issues, represents a great esthetic drawback. The selection of an appropriate treatment is a complex decision, which should consider the stability of the clinical outcomes over time. The aim of the present study was a histological and clinical comparison of two-stage split crest technique (SCT), with bone chips alone or mixed with porcine bone in patients affected by unilateral and bilateral agenesis of the upper lateral incisors. Eleven patients were enrolled, and randomly assigned to receive a treatment with autologous bone chips (group 1) or autologous bone chips mixed 1:1 to porcine-derived xenogenic bone (group 2). After a 2-month healing period, implants were placed and biopsies harvested for histomorphometrical evaluation. Clinical assessment, according to ICOI PISA health scale, and radiographic marginal bone loss evaluation at 12- and 24-month follow-ups were conducted. The histomorphometry showed significantly greater new bone formation (p > 0.0229) in group 2. At 12- and 24-month follow-ups, all the evaluated implants, regardless of the group they were allocated, could be categorized as "success" in the ICOI Pisa Health Scale for Dental Implants, and did not show significant difference in crestal bone loss. To the best of our knowledge, these are the first histological and clinical outcomes indicating that the use of bone chips mixed 1:1 to porcine bone in SCT could be a promising technique for the rehabilitation of patients with agenesis of the upper lateral incisors, although studies with a larger number of patients and implants, and a longer follow up are needed.

Retrospective study on the clinical outcomes of small-diameter implants supporting fixed prostheses without bone augmentation in the posterior region after 2 to 12 years.

Small-diameter implants (SDIs: diameter <3.5 mm) are often chosen as an alternative to bone augmentation in clinical practice, but the scientific evidence regarding SDI application in the posterior area remains deficient. To evaluate the clinical and radiographic outcomes of SDIs supporting fixed prostheses without bone augmentation in the posterior region, and to analyze the potential influencing factors related to SDI failures. Clinical and radiographic data of 243 SDIs in 156 patients were retrospectively assembled after 2 to 12 (mean 4.75) years of follow-up. Implant and prosthesis failures, mechanical and biological complications, and radiographic marginal bone loss (MBL) were evaluated. The influence of patient/implant characteristics and prosthetic design on SDI failures was investigated. Five implants in five patients failed, contributing to 10-year cumulative survival rates of 97.9% on an implant-based analysis and 96.8% on a patient-based analysis. Biological complications and mechanical complications were detected in 22 (9.1%) and 31 (12.8%) of implants, respectively. No implant fracture was detected. Peri-implant MBL during 10 years was 0.60 ± 0.90 mm on average. The implant type (bone-level or tissue-level) was the only factor that significantly influenced SDI failures. SDIs supporting fixed prostheses in the posterior region achieved predictable long-term clinical outcomes. However, tissue-level titanium SDIs should be avoided where possible.