HIGHLIGHTS

Highlights

Clin Oral Implants Res. 2019 Apr;30(4):306-314. doi: 10.1111/clr.13416.

Peri-implantitis prevalence, incidence rate, and risk factors: A study of electronic health records at a U.S. dental school

K K Changi, J Finkelstein, P N Papapanou

Study objectives and methods

We assessed peri-implantitis prevalence, incidence rate, and associated risk factors by analyzing electronic oral health records (EHRs) in an educational institution. We used a validated reference cohort comprising all patients receiving dental implants over a 3.5-year period (2,127 patients and 6,129 implants). Electronic oral health records of a random 10% subset were examined for an additional follow-up of ≥2.5 years to assess the presence of radiographic bone loss, defined as >2 mm longitudinal increase in the distance between the implant shoulder and the supporting peri-implant bone level (PBL) between time of placement and follow-up. "Intact" implants had no or ≤2 mm PBL increase from baseline. Electronic oral health record notes were reviewed to corroborate a definitive peri-implantitis diagnosis at implants with progressive bone loss. A nested case-control analysis of peri-implantitis-affected implants randomly matched by age with "intact" implants from peri-implantitis-free individuals identified putative risk factors.

Results

• The prevalence of peri-implantitis over an average follow-up of 2 years was 34% on the patient level and 21% on the implant level. • Corresponding incidence rates were 0.16 and 0.10 per patient-year and implant-year, respectively. • Multiple conditional logistic regression identified ill-fitting fixed prosthesis (OR = 5.9; 95% CI: 1.6-21.1), cementretained prosthesis (OR = 4.5; 2.1-9.5), and radiographic evidence of periodontitis (OR = 3.6; 1.7-7.6) as statistically associated with peri-implantitis. • Implant location in the mandible (OR = 0.02; 0.003-0.2) and use of antibiotics in conjunction with implant surgery (OR = 0.19; 0.05-0.7) emerged as protective exposures.

Conclusions

Approximately 1/3 of the patients and 1/5 of all implants experienced peri-implantitis. Ill-fitting/ill-designed fixed and cementretained restorations, and history of periodontitis emerged as the principal risk factors for peri-implantitis.

Adapted from K K Changi, et al., Clin Oral Implants Res. 2019 Apr;30(4):306-314, for more info about this publication click HERE

Sci Rep. 2021 May 4;11(1):9526. doi: 10.1038/s41598-021-89112-8.

Evaluation of clinical performance and survival rate of Straumann dental implants in Saudi Population based on cross-sectional study

R Al Jasser, M AlSarhan, D Alotaibi, S Aloraini, P Koppolu, S Andreana

Study objectives and methods

Risk indicators of peri-implantitis is still contradictory and somehow unclear in present literature therefore efforts should be done for better understanding of the exact etiology of peri-implant disease progression. The present study aimed to assess risk indicators associated with peri-implantitis by observing the changes in several periodontal parameters after implant placement. This cross-sectional study included 213 female and 271 male patients aged 26-87 years, who received 484 titanium implants (Straumann, Switzerland) at King Saud University's Dental College, Saudi Arabia. Patients were called for dental visits. During these visits; full clinical and radiographic assessment of implants were done.

Results

• The periodontal pocket depth (PPD) was greater around implants placed at grafted sites than non-grafted sites and around bone-level implants than tissue-level implants. • The plaque index (PI) was associated with poor oral hygiene. There was a strong association between graft (yes/no) and bleeding on probing (BOP). • Patients with good oral hygiene showed high radiographic bone stability. • Keratinized tissue width < 2 mm was associated with a higher PPD, higher PI, higher BOP, more edematous gingiva, and more exposed implant threads on radiography.

Conclusions

In patients receiving implants, poor oral hygiene status and inadequate keratinized tissue level can be proposed as risk indicators for developing periimplantitis due to strong association found between them and developments of peri-implantitis.

Adapted from R Al Jasser et al., Sci Rep. 2021 May 4;11(1):9526, for more info about this publication click HERE

Clin Oral Investig. 2021 May 3. doi: 10.1007/s00784-021-03957-x.

One-year performance of posterior narrow diameter implants in hyperglycemic and normo-glycemic patients-a pilot study

A Friedmann, M Winkler, D Diehl, M S Yildiz, H Bilhan

Study objectives and methods

The aim of the study was to compare the performance of narrow diameter implants in patients with uncontrolled diabetes mellitus type 2 (T2DM) and normo-glycemic individuals during the first 12 months after implant loading.

In 16 T2DM patients with HbA1C > 6.5% (test group) and 16 normo-glycemic patients (HbA1C < 6.0%; control group), one to two narrow diameter tissue level implants were placed in the posterior maxilla or mandible. After 3-month lasting integration period, implants were loaded by fixed dentures. The clinical parameters probing depth (PD), bleeding on probing (BOP), attachment loss (CAL), recession and papilla bleeding index (PBI) were assessed manually at loading and after 12 months of function. The paired digital periapical radiographs were analyzed with regard to the change in marginal bone level (MBL) from baseline to 12 months' control. The mean values calculated for both patient groups were statistically analyzed. The technical complications were recorded.

Results

• The T2DM group accounted 13 patients due to 3 dropouts. The overall implant survival rate after 12 months was 100%. • The differences in means for the clinical parameters and the MBL were statistically non-significant between the T2DM and normo-glycemic patients for the short period of loaded function reported here. • No technical complications were recorded.

Conclusions

The study demonstrated an encouraging clinical outcome with narrow diameter implants in patients with uncontrolled T2DM compared to non-diabetics after 12 months post loading. For the short observation period, no biological and technical complications were reported regardless the glycemic status.

Adapted from A Friedmann.et al., Clin Oral Investig. 2021 May 3, for more info about this publication click HERE

Clin Oral Implants Res. 2021 Jun 15. doi: 10.1111/clr.13796.

Early implant placement with or without alveolar ridge preservation in single tooth gaps renders similar esthetic, clinical and patient-reported outcome measures: One-year results of a randomized clinical trial

B P Jonker , F J Strauss, N Naenni, R E Jung, E B Wolvius, J Pijpe

Study objectives and methods

To test whether early implant placement with alveolar ridge preservation (ARP) results in different esthetic, clinical and patientreported outcome measures (PROMs) compared with early implant placement without ARP. Seventy-five patients requiring single tooth extraction in the anterior maxilla were recruited. Following tooth extraction, the patients were randomly allocated to three groups: (a) ARP using demineralized bovine bone mineral containing 10% collagen (DBBM-C) covered by a collagen matrix (CM) (n = 25), (b) ARP using DBBM-C covered with a palatal graft (PG) (n = 25) and (c) spontaneous healing (control) (n = 25). Eight weeks after tooth extraction, a CBCT was taken and early implant placement was performed in all patients. Esthetic, clinical and PROMs were evaluated one year post-loading.

Results

• A total of 70 patients were available for re-examination at one year post-loading. • The median mid-facial mucosal margin change amounted to -0.02 mm (IQR -0.27-0.46) in the CM group, -0.13 mm (IQR -0.44-0.25) in the PG group and -0.14 mm (IQR -0.29-0.07) in the control group, with no significant differences between the groups. • Mean PES scores amounted to 7.0 ± 1.4 in the CM group, 7.1 ± 1.5 in the PG group and 7.3 ± 1.7 in the control group without significant differences between the groups. Plaque, bleeding on probing and probing depth did not differ between treatment groups. • PROMs in general revealed no significant differences between the groups..

Conclusions

Early implant placement with ARP using either a collagen matrix or a palatal graft rendered similar esthetic, clinical and PROMs to early implant placement without ARP. When a failing tooth can be replaced with an implant within 2 months after tooth extraction, the added value of ARP might be clinically negligible.

Adapted from B P Jonker et al., Clin Oral Implants Res. 2021 Jun 15., for more info about this publication click HERE

Clin Oral Implants Res. 2021 Jun 24. doi: 10.1111/clr.13800.

Maxillary implant overdentures on two or four implants. A prospective randomized cross-over clinical trial of implant and denture success and survival

S Kappel, A Klotz, L Eberhard, J L Bermejo, P Rammelsberg , N N Giannakopoulos

Study objectives and methods

To determine implant survival and success of four conventionally but initially asynchronously loaded implants in implantsupported overdentures for the edentulous maxilla, in participants with opposing mandibular two-implant overdentures.

Twenty-six participants received four implants in the region of the maxillary canines and molars. After healing, 24 of these participants (mean age: 68.3 years) were randomly allocated to one of two treatment groups, and the adapted overdenture was attached to two unsplinted cylindrical attachments. The other two matrixes remained unattached to the implants for 3 months. After this period, the other two implants were loaded for 3 months (cross-over design). Then, all four implants were loaded for another 3 months. Kaplan-Meier curves were used to evaluate survival and success of implants and dentures.

Results

• During the active prosthetic study phase, three participants lost one implant. • Two participants lost three implants during the recall period. Implant survival after loading was 93.8% after a mean observation period of 3.1 years. • Denture survival was 100%, but denture success was 95.8%, due to major prosthetic complications. Most participants preferred four implants to two.

Conclusions

Within the limitations of the study, it can be concluded that maxillary implant overdentures on two or four implants are both recommendable treatment options. Two posterior implants are not superior to two anterior implants under overdentures retained by unsplinted cylindrical attachments. Implant and prosthetic complications and aftercare measures are common but are mostly easy to handle. However, 23 of the 24 participants preferred the 4-implant maxillary overdenture.

Adapted from S Kappel et al., Clin Oral Implants Res. 2021 Jun 24, for more info about this publication click HERE

Clin Oral Implants Res. 2021 Jun 3.doi: 10.1111/clr.13790.

Randomized Clinical Trial comparing clinical adjustment times of CAD/CAM screw-retained posterior crowns on ti-base abutments created with digital or conventional impressions. One-year follow-up

W Derksen, A Tahmaseb, D Wismeijer

Study objectives and methods

The purpose of this randomized clinical trial was to compare the required time of potential clinical adjustments of posterior screw-retained monolithic zirconia implant retained crowns based on intraoral optical scanning (IOS) or conventional impressions.

Patients with posterior tissue level implants (Straumann RN) replacing solitary teeth were recruited. Of all patients, impressions were taken with both an IOS (3M™ TDS) and a conventional (polyether) pick-up impression. Randomization was performed after impression taking and patients were to receive either a crown based on the digital or the conventional impression. The time required for adjustments at placement was recorded. Additionally, restoration survival and mechanical complications with a follow-up of one year were documented.

Results

• Thirty two patients with 45 implants were included: 23 restorations in the test (IOS) and 22 in the control (conventional) group. • The average adjustment time was 3.35 min (SD ± 3.38, range: 0-11 min) for the digital versus 6.09 min (SD ± 4.63, range: 0-18 min) for the conventional impressions (p = .039). • A proper fit (no adjustments required) was achieved 39,1% in the digital and 18,2% conventional group respectively. • All 45 restorations could be placed within the two planned appointments and only two minor mechanical complications occurred during the first year of function.

Conclusions

The use of IOS resulted in shorter adjustment times at try-in than conventional impressions for solitary CAD/CAM implant restorations. Screw-retained solitary monolithic zirconia restorations on ti-base abutments show low complication- and survival rates in the short term.

Adapted from W Derksen et al., Clin Oral Implants Res. 2021 Jun 3, for more info about this publication click HERE

Materials (Basel). 2021 Jun 5;14(11):3103.doi: 10.3390/ma14113103.

Hydrothermal Ageing and Its Effect on Fracture Load of Zirconia Dental Implants

L Gremillard, A Mattlet, A Mathevon, D Fabrègue, B Zberg, M Stephan

Abstract

Due to growing demand for metal-free dental restorations, dental ceramics, especially dental zirconia, represent an increasing share of the dental implants market. They may offer mechanical performances of the same range as titanium ones. However, their use is still restricted by a lack of confidence in their durability and, in particular, in their ability to resist hydrothermal ageing. In the present study, the ageing kinetics of commercial zirconia dental implants are characterized by X-ray diffraction after accelerated ageing in an autoclave at different temperatures, enabling their extrapolation to body temperature. Measurements of the fracture loads show no effect of hydrothermal ageing even after ageing treatments simulated a 90-year implantation.

Adapted from L Gremillard, Materials (Basel). 2021 Jun 5;14(11):3103, for more info about this publication click HERE

Clin Exp Dent Res. 2021 May 5. doi: 10.1002/cre2.414

Comparative barrier membrane degradation over time: Pericardium versus dermal membranes

F Bornert, V Herber, R Sandgren, L Witek, P G Coelho, B E Pippenger, S Shahdad

Study objectives and methods

The effectiveness of GBR procedures for the reconstruction of periodontal defects has been well documented. The objective of this investigation was to evaluate the degradation kinetics and biocompatibility of two resorbable collagen membranes in conjunction with a bovine xenograft material.

Lower premolars and first molars were extracted from 18 male Yucatan minipigs. After 4 months of healing, standardized semisaddle defects were created (12 mm × 8 mm × 8 mm [l˙̇ × W˙ × d]), with 10 mm between adjacent defects. The defects were filled with a bovine xenograft and covered with a either the bilayer collagen membrane (control) or the porcine pericardiumderived collagen membrane (test). Histological analysis was performed after 4, 8, and 12 weeks of healing and the amount of residual membrane evaluated. Non-inferiority was calculated using the Brunner-Langer mixed regression model.

Results

• Histological analysis indicated the presence of residual membrane in both groups at all time points, with significant degradation noted in both groups at 12 weeks compared to 4 weeks (p = .017). • No significant difference in ranked residual membrane scores between the control and test membranes was detected at any time point.

Conclusions

The pericardium-derived membrane was shown to be statistically non-inferior to the control membrane with respect to resorption kinetics and barrier function when utilized for guided bone regeneration in semi-saddle defects in minipigs. Further evaluation is necessary in the clinical setting.

Adapted from F Bornert et al., Clin Exp Dent Res. 2021 May 5, for more info about this publication click HERE

J Oral Implantol. 2021 Jun 5. doi: 10.1563/aaid-joi-D-20-00378.

Prosthetically Driven Computer-Guided One-Piece Zirconia Implant Placement and Restoration Replacing Missing Central Incisor: A Case Report

S Alshali, R Asali, A Almarghlani

Abstract

Currently, the gold standard materials of choice for dental implants are the commercially pure titanium. However, these materials may have suboptimal anterior esthetic outcome due to the dark grayish burnout. To enhance the esthetic outcomes, zirconium dioxide materials, with reported long-term success in medical uses and with its tooth-like color, was introduced as a dental implants material.

This case report describes the fully guided planning and placement of one-piece zirconia implant replacing missing central incisor. A 21-years-old male patient, non-smoker in excellent general health, presented with a missing tooth #21. Straumann PURE® (4.1x10 mm) Ceramic implant was placed. Three months post-surgery, the soft tissues architecture has been achieved and stabilized, healing was satisfactory around the zirconia implant and provisional restoration.

The final layered zirconia crown was fabricated. Two-step cementation technique was used to minimize the excess cement during final delivery of the crown. After delivery of the final restoration, the patient was followed up after 1, 3, 6, and 12 months.

Adapted from S Alshali et al., J Oral Implantol. 2021 Jun 5, for more info about this publication click HERE

Clin Oral Implants Res. 2021 Jul;32(7):853-862. doi: 10.1111/clr.13761.

Clinical performance of implant crowns with customized zirconia abutments: A prospective cohort study with a 4.5- to 8.8-year followup

M Fonseca , P Molinero-Mourelle, F A Forrer, N Schnider, S P Hicklin, M Schimmel, U Brägger

Study objectives and methods

To assess the clinical and esthetic outcomes and patient satisfaction of screw-retained one-piece implant crowns fabricated with zirconia abutments after a 4.5- to 8.8-year follow-up.

Thirty-two patients (12 women and 20 men), who received 40 implant single crowns in anterior and premolar sites, were included in this prospective study. All restorations were based on ceramic hand-veneered customized CAD/CAM zirconia abutments. The follow-up consisted of clinical and radiological examinations. The pink esthetic score-white esthetic score (PESWES) was used to evaluate the esthetic outcome. Patients' satisfaction was assessed via visual analog scale (VAS).

Results

• Implant and prosthetic survival rates were 100% and 97.5%, respectively. • Mean marginal bone loss was -0.17 mm (SD 1.16 mm). • Probing depth was ≤4 mm in 98.7% and 5 mm in 1.3% of the sites; 8.3% of them were bleeding on probing positive. • No technical or biological complications were observed except for one abutment fracture. The mean PES-WES scores were 7.0 and 7.1, respectively. • VAS scores (10-point) of 9.41 for function and 9.26 for esthetics showed high patient satisfaction.

Conclusions

After a mean observation period of 6 years and 7 months, screw-retained implant crowns based on veneered customized CAD/CAM zirconia abutments with conical connection showed very good clinical performance and may be recommended for the replacement of missing anterior and premolar teeth.

Adapted from M Fonseca et al, Clin Oral Implants Res. 2021 Jul;32(7):853-862, for more info about this publication click HERE

J Oral Sci. 2021 Mar 31;63(2):152-156. doi: 10.2334/josnusd.20-0444.

Influence of preformed bone defects on key pathogens and bone loss during experimental peri-implantitis formation in a canine model

A Solderer, B Pippenger, Y Gager, K Fischer, P R Schmidlin

Study objectives and methods

To determine the impact of experimentally preformed peri-implant crater-shaped bone defects on the evolution of in situ microbiota and development of bone defects compared to those induced over time by ligature placement only.

Implants were installed in the mandibles of eight dogs. Standardized bone defects were preformed in four test animals but not in the other four control animals, prior to implant (3.3 mm × 8 mm) installation. After 2 months of healing, peri-implantitis was induced with silk ligatures in both groups for 2 months. Microbial samples were obtained from implants and teeth for analysis at three time points (qPCR), and the average depths of the bone defects were measured.

Results

• At the baseline, the total marker load of periodontal-pathogenic bacteria (TML) for teeth accounted for 5.2% (017.4%). • After implant healing, TMLs for implants and teeth were comparable (7.1% [0.3-17.4%]). • The TML of both groups was 3.5%, 2 months after ligature placement. Bone defects had a mean depth of 1.84 mm at preformed defects and 1.64 mm at control sites (P > 0.05).

Conclusions

Preformed defects in the test group showed comparable results to the control group in terms of TML, the incidence of periodontal-pathogenic bacteria, and bone defect depth.

Adapted from A Solderer et al, J Oral Sci. 2021 Mar 31;63(2):152-156., for more info about this publication click HERE

Materials (Basel). 2021 Jun 3;14(11):3045. doi: 10.3390/ma14113045.

The Applications of Enamel Matrix Derivative in Implant Dentistry: A Narrative Review

A Alberti, L Francetti, S Taschieri, S Corbella

Study objectives and methods

Enamel matrix derivative (EMD) has been successfully used for periodontal regeneration in intrabony defects. Recently, its use for peri-implant bone regeneration has also been hypothesized. The aim of this paper is to review preclinical and clinical studies investigating the use of EMD in correspondence with titanium implants, alone or as an adjunct to other biomaterials. Clinical trials and case series with more than five cases were included.

Results

• Seven in vitro studies evaluated the effect of EMD, placed on titanium surfaces: An increase in proliferation and viability of osteoblasts was observed in all but two studies. • An increase in TGF-β1 and osteocalcin production, alkaline phosphatase activity, and angiogenesis was also reported. • Nine animal studies investigated the use of EMD at implant placement or for bone regeneration of peri-implant bone defects, and some of them reported a significant increase in bone formation or bone-to-implant contact. • In four of eleven clinical trials on humans, EMD was successfully used at implant placement. • The other seven evaluated the use of EMD in protocols for the treatment of peri-implantitis.

Conclusions

In conclusion, the results of EMD seem promising, but further randomized clinical trials are needed to evaluate its efficacy.

Adapted from A Alberti et al, Materials (Basel). 2021 Jun 3;14(11):3045., for more info about this publication click HERE

J Biol Regul Homeost Agents. Mar-Apr 2021;35(2 Suppl. 1):53-65. doi:10.23812/21-2supp1-5

Dental implant survival rate in irradiated and non-radiated patients: a systematic review and meta-analysis

S Gupta, C Mortellaro, S Panda, M Rovati, M S Giacomello, L Colletti , A Greco Lucchina, M Del Fabbro

Abstract

Radiotherapy to head and neck has always been considered as a risk factor for rehabilitation with dental implants. Nevertheless, recent data suggest that overall, 5-year implant survival in irradiated patients can be greater than 90%. The purpose of this review was to compare the implant survival rates of irradiated and non-radiated head and neck cancer sites, and discuss the outcomes, through a systematic review approach of prospective and retrospective studies.

Electronic searches were performed in the EMBASE, Cochrane, and PubMed/Medline databases up to 2019 Dec, to identify retrospective and prospective clinical studies addressing the subject. This systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The primary variables collected from the studies were the site of tumor, age and sex of the patient, site of implant placement, radiation dosage, frequency and duration of radiotherapy, follow-up duration, implant survival and stability, hard and soft tissue changes after implant placement, any type of biological and mechanical complication, and oral health quality of life (QOL).

Fifteen studies including 1097 patients and a total of 4637 implants placed in irradiated and non-irradiated sites, with a follow up duration varying from 6 to 120 months, were selected for the systematic review.

The results of the quantitative synthesis suggested statistically significantly better survival rate of implants placed in nonradiated sites, as compared to irradiated sites (p<0.00001). However, the cumulative survival rates over a period of 7-10 years were reported to be comparable.

Quality of life (QOL) after implant rehabilitation was not found to be significantly different between the compared groups. Due to the limited number of information, insufficient data was available to draw conclusion on peri-implant complication rate.

No relationship was found between age, gender, and implant survival rates.

Implant placement in irradiated sites is challenging and often warrants protocol modifications. Although statistically the survival rates at irradiated sites were lower in comparison to non-radiated sites, a strict inclusion criterion in patient selection, timing of implant placement after radiotherapy, radiation dosage and regular oral hygiene maintenance could minimize the chances of implant failure in irradiated patients..

Adapted from S Gupta et al, J Biol Regul Homeost Agents. Mar-Apr 2021;35(2 Suppl. 1):53-65., for more info about this publication click HERE