Dental implants in the medically compromised patient

Dental implant considerations in patients with systemic diseases: An updated comprehensive review

BACKGROUND

Various medical conditions and the drugs used to treat them have been shown to impede or complicate dental implant surgery. It is crucial to carefully monitor the medical status and potential post-operative complications of patients with systemic diseases, particularly elderly patients, to minimize the risk of health complications that may arise.

AIM

The purpose of this study was to review the existing evidence on the viability of dental implants in patients with systemic diseases and to provide practical recommendations to achieve the best possible results in the corresponding patient population.

METHODS

The information for our study was compiled using data from PubMed, Scopus, Web of Science and Google Scholar databases and searched separately for each systemic disease included in our work until October 2023. An additional manual search was also performed to increase the search sensitivity. Only English-language publications were included and assessed according to titles, abstracts and full texts.

RESULTS

In total, 6784 studies were found. After checking for duplicates and full-text availability, screening for the inclusion criteria and manually searching reference lists, 570 articles remained to be considered in this study.

CONCLUSION

In treating patients with systemic conditions, the cost-benefit analysis should consider the patient's quality of life and expected lifespan. The success of dental implants depends heavily on ensuring appropriate maintenance therapy, ideal oral hygiene standards, no smoking and avoiding other risk factors. Indications and contraindications for dental implants in cases of systemic diseases are yet to be more understood; broader and hardcore research needs to be done for a guideline foundation.

Pathology of Diabetes-Induced Immune Dysfunction

Diabetes is associated with numerous comorbidities, one of which is increased vulnerability to infections. This review will focus on how diabetes mellitus (DM) affects the immune system and its various components, leading to the impaired proliferation of immune cells and the induction of senescence. We will explore how the pathology of diabetes-induced immune dysfunction may have similarities to the pathways of "inflammaging", a persistent low-grade inflammation common in the elderly. Inflammaging may increase the likelihood of conditions such as rheumatoid arthritis (RA) and periodontitis at a younger age. Diabetes affects bone marrow composition and cellular senescence, and in combination with advanced age also affects lymphopoiesis by increasing myeloid differentiation and reducing lymphoid differentiation. Consequently, this leads to a reduced immune system response in both the innate and adaptive phases, resulting in higher infection rates, reduced vaccine response, and increased immune cells' senescence in diabetics. We will also explore how some diabetes drugs induce immune senescence despite their benefits on glycemic control.

Evaluation of Effect of Different Insertion Speeds and Torques on Implant Placement Condition and Removal Torque in Polyurethane Dense D1 Bone Model

The aim of this study was to evaluate the effect of two different insertion speeds at eight different insertion torque values ranging from 25 to 60 during implantation in a dense polyurethane (PU) D1 bone model on the placement condition and removal torque of dental implants. In this study, 50 pcf single-layer PU plates were used. In the study, a total of 320 implant sockets were divided into two groups, Group 1 (30 rpm) and Group 2 (50 rpm), in terms of insertion speed. Group 1 and Group 2 were divided into eight subgroups with 25, 30, 35, 40, 45, 50, 55 and 60 torques. There were 20 implant sockets in each subgroup. During the implantations, the implant placement condition and removal torque values were assessed. There was a statistically significant difference between the 30 and 50 rpm groups in terms of overall implant placement condition (p < 0.01). It was found that the removal torque values at 50 rpm were statistically significantly higher than those at 30 rpm (p < 0.01). This study showed that in dense D1 bone, the minimum parameters at which all implants could be placed at the bone level were 50 torque at 30 rpm and 40 torque at 50 rpm.

Strategies for Improving Impaired Osseointegration in Compromised Animal Models

Implant osseointegration is reduced in patients with systemic conditions that compromise bone quality, such as osteoporosis, disuse syndrome, and type 2 diabetes. Studies using rodent models designed to mimic these compromised conditions demonstrated reduced bone-to-implant contact (BIC) or a decline in bone mineral density. These adverse effects are a consequence of disrupted intercellular communication. A variety of approaches have been developed to compensate for the altered microenvironment inherent in compromised conditions, including the use of biologics and implant surface modification. Chemical and physical modification of surface properties at the microscale, mesoscale, and nanoscale levels to closely resemble the surface topography of osteoclast resorption pits found in bone has proven to be a highly effective strategy for improving implant osseointegration. The addition of hydrophilicity to the surface further enhances osteoblast response at the bone-implant interface. These surface modifications, applied either alone or in combination, improve osseointegration by increasing proliferation and osteoblastic differentiation of osteoprogenitor cells and enhancing angiogenesis while modulating osteoclast activity to achieve net new bone formation, although the specific effects vary with surface treatment. In addition to direct effects on surface-attached cells, the communication between bone marrow stromal cells and immunomodulatory cells is sensitive to these surface properties. This article reports on the advances in titanium surface modifications, alone and in combination with novel therapeutics in animal models of human disease affecting bone quality. It offers clinically translatable perspectives for clinicians to consider when using different surface modification strategies to improve long-term implant performance in compromised patients. This review supports the use of surface modifications, bioactive coatings, and localized therapeutics as pragmatic approaches to improve BIC and enhance osteogenic activity from both structural and molecular standpoints.

Chitosan nanoparticle applications in dentistry: a sustainable biopolymer

The epoch of Nano-biomaterials and their application in the field of medicine and dentistry has been long-lived. The application of nanotechnology is extensively used in diagnosis and treatment aspects of oral diseases. The nanomaterials and its structures are being widely involved in the production of medicines and drugs used for the treatment of oral diseases like periodontitis, oral carcinoma, etc. and helps in maintaining the longevity of oral health. Chitosan is a naturally occurring biopolymer derived from chitin which is seen commonly in arthropods. Chitosan nanoparticles are the latest in the trend of nanoparticles used in dentistry and are becoming the most wanted biopolymer for use toward therapeutic interventions. Literature search has also shown that chitosan nanoparticles have anti-tumor effects. This review highlights the various aspects of chitosan nanoparticles and their implications in dentistry.

Osteogenic effect of low-intensity pulsed ultrasound on peri-implant bone: A systematic review and meta-analysis

Purpose This study aimed to evaluate the effect of low-intensity pulsed ultrasound (LIPUS) on promoting osseointegration around dental implants.Study selection A comprehensive search was performed on two databases, including MEDLINE (PubMed) and Web of Science to identify relevant studies published before June 1, 2022. Randomized controlled trials that met the inclusion criteria were selected for the study. The year of publication, study design, animal species, number of animals, number of implants, implant position, implant size, intervention, follow-up time, bone volume ratio (BV/TV), bone-implant contact ratio (BIC), and implant removal torque value (RTV) measurements, including mean and SD, were extracted.Results Ten randomized trials were included in this meta-analysis. The results showed that LIPUS significantly promoted osteogenesis around dental implants. Furthermore, in animal models of pre-existing diseases such as osteoporosis and diabetes, LIPUS had the same effect. The included data were divided into subgroups to explore the effects of different follow-up time, acoustic intensities, and frequencies. Results showed that higher acoustic intensities and frequencies significantly improve the osteogenic effects of LIPUS. There was some degree of heterogeneity owing to bias in the included studies. More high-quality randomized controlled trials are necessary in the future.Conclusions LIPUS can promote bone healing around dental implants and is an attractive option for edentulous patients, especially those with pre-existing diseases. Further clinical trials on the use of LIPUS in implant dentistry are warranted. Furthermore, future studies must pay more attention to acoustic intensity and frequency.

Clinical analysis of the tooth-implant papilla for two narrow-diameter titanium-zirconium implants in the anterior area: prospective controlled clinical study

BACKGROUND

Rehabilitation of the anterior area when the mesio-distal space is reduced is a challenge for the clinician, due to the patient's anatomical limitations and aesthetic requirements. Narrow Diameter Implants (NDI) are an option of treatment when the standard diameter implant is not possible, but the evidence is scarce. This prospective clinical study aims to analyze the formation of the tooth-implant papilla between the implant and the adjacent natural tooth in the maxillary lateral incisors and mandibular incisors.

METHODS

A total of 40 patients treated with NDI, of titanium-zirconium (Ti-Zr) alloy i.e., 2.9 mm Test Group (TG) and 3.3 mm Control Group (CG), were included. The mesiodistal distance between the adjacent natural teeth was used for implant selection, maintaining 1.5 mm between the fixation and the adjacent tooth. Clinical assessment was performed by a clinical examiner at 6 and 12 months after the final prosthesis. The primary variable was the Jemt Papillary Index. Also, implant survival rate (SR), complications, Implant Stability Quotient (ISQ), and patient-reported outcomes measures (PROMs) such as aesthetics, chewing, phonation, comfort, and self-esteem were analyzed.

RESULTS

A significant amount of papilla filling was observed concerning the baseline, with a trend towards more formation of the papilla in the TG, with a JPI score of 3. No significant differences were observed between the two groups regarding implant SR, clinical parameters, and complications. In terms of PROMs, a higher satisfaction in the TG was observed, with significant intergroup differences for aesthetics, comfort, self-esteem, and primary stability ISQ (TG: 59.05 (SD: 5.4) vs. CG: 51.55 (SD: 5.7)).

CONCLUSIONS

The 2.9 mm diameter Ti-Zr implants achieved a formation of papilla similar to 3.3 mm implants in the anterior region at 12 months of follow-up after the final prosthetic restoration. The use of Ti-Zr implants with a diameter of 2.9 mm to rehabilitate single teeth in areas of the anterior region, where the mesiodistal distance is limited, showed favorable clinical results and a high degree of satisfaction during 1 year of observation similar to 3.3 mm dental implants.

TRIAL REGISTRATION

This study was retrospectively registered in ClinicalTrials.gov with the number NCT05642520, dated 18/11/2022.

Does hormone replacement therapy impact implant osseointegration in females- A systematic review and meta-analysis

Background

This review aimed to comprehensively investigate the impact of Hormone Replacement Therapy (HRT) on implant osseointegration and bone loss. The study considered factors such as HRT type, osteoporosis, smoking, and diabetes mellitus, and analysed the available literature to provide insights into the association between HRT and implant outcomes.

Methods

Multiple databases were utilized, and studies with diverse designs and methodologies were included that examined the relationship between HRT and implant osseointegration. The selected studies were analyzed and relevant data on implant success rates, bone loss, and other correlations was extracted.

Results

The review findings indicate that HRT has a detrimental impact on implant osseointegration, as evidenced by lower implant success rates and increased bone loss in HRT-treated individuals. The odds ratio analysis further strengthens this association, with significant values of 0.59 (95% CI: 0.50-0.70) and 0.64 (95% CI: 0.54-0.76), indicating a higher likelihood of implant failure in HRT-treated patients., highlighting the need for caution when considering HRT as a treatment option in patients undergoing implant procedures. Smoking and diabetes mellitus were also found to significantly affect implant outcomes, emphasizing the importance of addressing these factors in patient management.

Conclusion

The assessments demonstrate that HRT adversely affects implant osseointegration and increases bone loss. The results suggest the importance of considering the potential negative impact of HRT on implant outcomes and the need for thorough patient evaluation and management. Further research is warranted to explore the underlying mechanisms, assess the impact of specific HRT types and dosages, and evaluate preventive strategies to mitigate the detrimental effects of HRT on implant success.

Outcomes that may affect implant and prosthesis survival and complications in maxillary fixed prosthesis supported by four or six implants: A systematic review and meta-analysis

Objective

To investigate whether the clinical and radiographical outcomes are affected when four or six implants support the maxillary fixed complete denture (FCD).

Materials and methods

This study was registered on PROSPERO (CRD42021226432) and followed the PRISMA guidelines. The focused PICO question was, "For an edentulous maxillary patient rehabilitated with an implant-supported fixed prosthesis, do the clinical and radiographical outcomes differ when four or six implants support the prosthesis ". A thorough search of the relevant studies was designed and performed electronically. The survival rate of implant and prosthesis, marginal bone loss, and complications (mechanical and biological) were the primary outcomes, whereas implant distribution and using the surgical guide, follow-up, and framework material were evaluated as secondary outcomes.

Results

Out of 1099 articles initially retrieved, 53 clearly stated the outcomes of interest and were included in this study. There were no significant differences in implant and prosthesis survival, technical/mechanical complications, and biological complications between the 4-implant group (4-IG) and the 6-implant group (6-IG). However, marginal bone loss (MBL) was significantly higher in the 4-IG (p < 0.01). The surgical guide and follow-up period did not significantly affect implant/prosthesis survival. Additionally, using the CAD/CAM milled framework and anteroposterior implant distribution were associated with significantly higher implant survival in the 6-IG (p < 0.01).

Conclusion

The findings of this study indicated that having a greater number of implants, as seen in the 6-implant group, can lead to a decrease in technical and biological complications and reduce marginal bone loss. It is worth noting that factors such as using CAD/CAM frameworks and the anteroposterior distribution of implants were recognized as important in improving implant survival rates when more implants are present.

Full Arch Implant-Prosthetic Rehabilitation in Patients with Cardiovascular Diseases: A 7-Year Follow-Up Prospective Single Cohort Study

Aim: The rising average age increases edentulous cases, demanding more implant-prosthetic rehabilitation, with cardiovascular diseases being significant factors. This study compared healthy patients (CG = Control Group) and those with cardiovascular disease (TG = Test Group) for implant survival, Marginal Bone Loss (MBL), peri-implant tissue level parameters as Periodontal Screening and Recording (PSR), Plaque Index (PI), Bleeding on Probing (BoP) Peri-implant Probing Depth (PPD), and surgical complications. Smoking impact on both groups and medication influence in the TG were secondary outcomes. Patients underwent full-arch implant prosthetic rehabilitation. Methods: Implant survival rate, MBL, and surgical complications were recorded during the monitoring period (7 years), while peri-implant parameters were assessed at the end of the observational time. A total of 26 and 28 CG and TG patients were recruited, respectively. Results: A total of 128 implants were placed in CG, while 142 in the TG. Implant survival and MBL showed no significant differences (p > 0.05). Nevertheless, peri-implant parameters were more unfavorable in TG. The only significant surgical complication was higher bleeding rates in the TG (p < 0.05). Conclusions: Cardiovascular patients showed similar implant survival and MBL but had adverse peri-implant parameters and increased bleeding rates. Higher smoking levels may relate to unfavorable implant outcomes. Further investigation is needed on drug impact with larger samples.

Dental Implant Placement in Medically Compromised Patients: A Literature Review

As a discipline of dentistry, oral implantology deals with the diagnosis, design, insertion, restoration, and/or management of alloplastic or autogenous oral structures for the purpose of regaining contour, function, aesthetics, and speech in a partially or completely edentulous patient. The present review aims to provide the currently available knowledge about the impact of certain systemic disorders and the usage of some medications on the survival rate of dental implant therapy and to highlight the importance of patient management under these conditions. Diabetes, osteoporosis, cardiovascular diseases, and the intake of some medications can increase the risk of the failure of a dental implant. Even though there are relatively few medical contraindications to dental implant treatment, certain conditions may increase the risk of failure or complications.

Current scientific evidence for why periodontitis should be included in diabetes management

This Perspective provides a brief summary of the scientific evidence for the two-way links between periodontal diseases and hyperglycemia (diabetes mellitus [DM] and pre-DM). It delivers in a nutshell current scientific evidence for manifestations of hyperglycemia on periodontal health status and effects of periodontal diseases on blood glucose levels and in turn incidence, progression, and complications of diabetes. Of outmost importance is presentation of scientific evidence for the potential of routine periodontal treatment to lower blood glucose levels, providing a novel, economical tool in DM management. Non-surgical periodontal treatment ("deep cleaning") can be provided by dental hygienists or dentists in general dental offices, although severe cases should be referred to specialists. Such therapy can decrease the costs of DM care and other health care costs for people with DM. The great importance of a healthy oral cavity free of infection and subsequent inflammation - especially periodontitis that if untreated will cause loosening and eventually loss of affected teeth - has largely gone unnoticed by the medical community as the health care curricula are largely void of content regarding the bi-directional links between oral health and systemic health, despite elevation of blood glucose levels being an integral part of the general systemic inflammation response. The importance of keeping disease-free, natural teeth for proper biting and chewing, smiling, self-esteem, and pain avoidance cannot be overestimated. Medical and dental professionals are strongly encouraged to collaborate in patient-centered care for their mutual patients with - or at risk for - hyperglycemia.

No increased risk of osteonecrosis of the jaw in osteoporotic patients with dental implants: a nationwide cohort study

OBJECTIVES

The occurrence of implant-associated osteonecrosis of the jaw (ONJ) has been reported in osteoporotic patients, particularly in association with bisphosphonate therapy. This study aimed to investigate the risk of implant surgery and implant presence for ONJ occurrence in osteoporotic patients longitudinally.

METHODS

Based on Korean National Health Information Database, subjects over the age of 65 who were diagnosed with osteoporosis between July 2014 and December 2016 were included. The implant group included subjects who had undergone dental implant surgery between January 2017 and December 2017, while the control group included those who had no history of dental implants. The primary outcome was the occurrence of ONJ, and the date of final follow-up was December 2020.

RESULTS

A total of 332,728 subjects with osteoporosis were included in the analysis: 83,182 in the implant group and 249,546 in the control group. The risk of ONJ among those who had undergone implant surgery (risk of implant surgery-associated ONJ) was not higher than that among those without implant surgery. The risk of ONJ among those with implants (risk of implant presence-associated ONJ) was lower than that among those without implants. Even in subjects with a history of bisphosphonates, steroids, periodontitis, or tooth extraction, those who had undergone implant surgery or had implants did not have a higher ONJ risk than those who had not undergone surgery or did not have implants; rather, they showed a lower risk.

CONCLUSIONS

The results may suggest that dental implants are not associated with an increased risk of ONJ. A further study on whether dental implants are associated with lower ONJ risk is needed.

CLINICAL RELEVANCE

Dental implants did not increase the risk of ONJ development in osteoporotic patients, even with a history of bisphosphonates. This may suggest that the risk profiles for ONJ occurrence between selective insertion of dental implants and other dentoalveolar surgery associated with infectious conditions are different.

Survival and Success of Dental Implants in Patients with Autoimmune Diseases: a Systematic Review

Objectives

The purpose of this systematic review is to disclose the impact of autoimmune diseases and their medical treatment on dental implant survival and success.

Material and Methods

A literature search was conducted using MEDLINE (PubMed), The Cochrane Library and Embase up to December 6th, 2021. Any clinical study on patients with an autoimmune disease in whom implant therapy was performed was eligible. The quality of included studies was assessed using the Newcastle-Ottawa Scale. For each autoimmune disease group, data synthesis was divided into three groups: 1) overall results of the autoimmune disease, 2) overall results of corresponding control groups and 3) overall results of the autoimmune disease with a concomitant autoimmune disease (a subgroup of group 1). Descriptive statistics were used.

Results

Of 4,865 identified articles, 67 could be included and mainly comprising case reports and retrospective studies with an overall low quality. Implant survival rate was 50 to 100% on patient and implant level after a weighted mean follow-up of 17.7 to 68.1 months. Implant success was sporadically reported. Data on immunosuppressive medication were too heterogeneously reported to allow detailed analysis.

Conclusions

Overall, a high implant survival rate was reported in patients with autoimmune diseases. However, the identified studies were characterized by a low quality. No conclusions could be made regarding implant success and the effect of immunosuppressants due to heterogeneous reporting.

Fluoride-modified implant surfaces improves osseointegration in the tibias of rats with induced diabetes

This study evaluated the influence of a fluoride-modified titanium surface on osseointegration in rats with induced diabetes. One hundred and eighty rats were randomly allocated into 3 groups with 60 animals each: Control group (C): Animals without diabetes; Diabetes Group (D): Animals with uncontrolled induced diabetes; Controlled Diabetes Group (CD): Animals with diabetes induced controlled by the insulin administration. Diabetes was induced by streptozotocin injection. Each animal received 2 implants in the proximal tibial metaphysis, one with the machined surface (M) and the other one with a fluoride-modified titanium surface (F), after 4 weeks of induction of diabetes. The animals were submitted to euthanasia 2, 4, and 6 weeks after the implant placement (n = 20 animals/group). The osseointegration was evaluated by the implant removal torque test and the histometric analysis of the non-decalcified histological sections: 1) Contact bone/implant (%BIC); 2) Bone tissue area between implant threads (%BBT). Implants with F surface showed a higher removal torque than implants with surface M in all groups. There was no difference in %BIC between the groups regardless of the surface used. The F surface showed a tendency to present higher %BBT values for the 3 evaluation periods in the D group. The fluoride-modified implant surface has no impact on the %BIC and %BBT. However, the fluoride-modified implant surface increases the locking of the implants with the bone. The hyperglycemia was associated with lower removal torque values despite the surfaces of the implant used.

Retrospective analysis of 50,333 implants on implant failure and associated patient-related factors

PURPOSE

The aim of this investigation was to retrospectively evaluate the long-term implant loss rates and to identify associations between implant failure and patient-related factors in a sample of patients who had consecutively received implant therapy in ten dental universities in the United States using a large database.

METHODS

Dental records of adult patients who had attended the dental clinics of the universities contributing data to the BigMouth network between 2011 and 2022 seeking dental therapy were evaluated. Information regarding patients' characteristics including age, gender, ethnicity, race, tobacco use and systemic medical conditions were extracted from patients' files.

RESULTS

A total of 20,842 patients who received 50,333 dental implants over a 12-year period (2011-2022) were included. The mean age of the cohort was 57.50±14.27 years which consisted of 51.8% females, 91.1% non-Hispanic, 66.3% white individuals and 8% tobacco users. In the univariate analysis, ethnicity, race and marijuana use were significantly associated with implant treatment outcome. Race and ethnicity were significantly associated with implant loss in the multivariate analysis. The implant failure rate was estimated to be 2.7% at the patient level and 1.4% at the implant level.

CONCLUSION

Within the limitations of this retrospective study that utilized records of 50,333 dental implants placed in ten institutions contributing data to the BigMouth network, the implant failure rate was estimated to be 2.7% at patient level and 1.4% at implant level. Ethnicity and race were significantly associated with implant failure, while none of the examined systemic conditions were associated with implant loss.

A 10-year survival rate of tapered self-tapping bone-level implants from medically compromised Korean patients at a maxillofacial surgical unit

BACKGROUND

The 10-year survival rate of dental implants in healthy subjects is 90-95%. While in healthy individuals, dental implants have become commonplace to solve problems of edentulism, whether dental implant treatment is optimal in patients with systemic disease remains unclear. The purpose of this study is to investigate the clinical outcomes of tapered, sand-blasted, and acid-etched internal submerged dental implants installed in medically compromised patients in our maxillofacial surgical unit.

METHODS

A total of 1019 Luna® dental implants were placed in 333 patients at the Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital. Kaplan-Meier survival estimates after 10 years of follow-up were computed for healthy vs. medically compromised patients.

RESULTS

The 10-year follow-up survival rate of 1019 Luna® dental implants in the Korean maxillofacial surgical unit was 97.0% with a mean follow-up of 41.13 ± 35.13 months (0-120 months). The survival rate was 97.0%, in which 31 implants were failed during the follow-up. Cumulative 10-year implant survival rates were 99.4% in healthy individuals without systemic disease and 95.9% in patients with systemic disease.

CONCLUSIONS

Comparable success and survival rates were achieved with those of implants in healthy patients. Preoperative general health assessments including laboratory test results and checking the previous medication records are essential in diagnosing any unrecognized conditions for improved implant success rates in medically compromised patients.

Effect of Antibiotic Prophylaxis on Early Loss of Implants Installed by Unexperienced Operators

Routine use of antibiotics for dental implant installation is widely applied in dental practice to prevent postoperative infection and implant loss. However, the effectiveness and necessity of such protocols have not been consensual in the literature. This study aimed to evaluate the effect of antibiotic prophylaxis on survival of dental implants placed in clinically healthy patients by unexperienced operators. A double-blind, randomized, placebo-controlled trial was conducted. Ninety patients who received between 2 and 4 dental implants by unexperienced operators were enrolled in this study. Patients were randomly allocated in 2 groups. For the antibiotic group (n = 47), patients received 1 g of preoperative amoxicillin; in the placebo group (n = 43), patients received preoperative placebo administration. Each patient was evaluated preoperatively, 2 days, and 7 days postoperatively. Factors evaluated were mouth opening amplitude, assessment of referred pain through a visual analogue scale, and characteristic signs of infection (presence of fistula, ulceration in the surgical wound, tissue necrosis at the edges of the wound, dehiscence of the surgical flap, and presence of purulent exudate in the surgical wound). Implant survival was evaluated until 90 days postsurgical procedure. Results showed that there were no statistically significant differences in postoperative healing, swelling, and pain. However, more loss of dental implants was observed in the placebo group (14.9% vs 2.3%). Use of antibiotic prophylaxis reduced implant loss that was previously placed by unexperienced operators.

Fit and forget: The future of dental implant therapy via nanotechnology

Unlike orthopedic implants, dental implants require the orchestration of both osseointegration at the bone-implant interface and soft-tissue integration at the transmucosal region in a complex oral micro-environment with ubiquitous pathogenic bacteria. This represents a very challenging environment for early acceptance and long-term survival of dental implants, especially in compromised patient conditions, including aged, smoking and diabetic patients. Enabling advanced local therapy from the surface of titanium-based dental implants via novel nano-engineering strategies is emerging. This includes anodized nano-engineered implants eluting growth factors, antibiotics, therapeutic nanoparticles and biopolymers to achieve maximum localized therapeutic action. An important criterion is balancing bioactivity enhancement and therapy (like bactericidal efficacy) without causing cytotoxicity. Critical research gaps still need to be addressed to enable the clinical translation of these therapeutic dental implants. This review informs the latest developments, challenges and future directions in this domain to enable the successful fabrication of clinically-translatable therapeutic dental implants that would allow for long-term success, even in compromised patient conditions.

Bleeding Disorders and Dental Implants: Review and Clinical Indications

BACKGROUND

Bleeding disorders can be divided into three categories: congenital coagulation disorders (CCDs), antiplatelet-induced bleeding disorders (APBDs) and anticoagulant-induced bleeding disorders (ACBDs). Implant placement can be challenging in these kinds of patients. The aim of this study is to provide evidence on implant surgery in patients with bleeding disorders and to generate some practical recommendations for clinicians.

MATERIAL AND METHODS

Pubmed/MEDLINE, Scopus, Web of Science and Cochrane Library databases were screened. The latest search was performed in July 2022. Case reports, case series, cohort studies, cross-sectional studies, case control studies, reviews, consensus reports, surveys and animal studies were included in the analysis.

RESULTS

Seventeen articles on CCDs were found, fourteen on APBDs and twenty-six on ACBDs. Most of these articles were case reports or case series. Patients with CCDs can be treated after the infusion of the missing coagulation factor. Patients with APBDs can be treated without withdrawing the therapy. Patients with ACBDs should be treated depending on the anticoagulative medication.

CONCLUSION

Despite the low level of evidence, dental implants can be safely placed in patients with bleeding disorders. However, careful preoperative evaluation and the adoption of local and post-operative bleeding control measures are mandatory.

Avoiding implant-related complications in medically compromised patients with or without unhealthy lifestyle/Elevated oxidative stress

Increased human life expectancy broadens the alternatives for missing teeth and played a role in the widespread use of dental implants and related augmentation procedures for the aging population. Though, many of these patients may have one or more diseases. These systemic conditions may directly lead to surgical complications, compromise implant/bone healing, or influence long-term peri-implant health and its response to biologic nuisances. Offering patients credible expectations regarding intra- and postoperative complications and therapeutic prognosis is an ethical and legal obligation. Clear identification of potential types of adverse effects, complications, or errors is important for decision-making processes as they may be related to different local, systemic, and technical aspects. Therefore, the present review structures the underlying biological mechanisms, clinical evidence, and clinical recommendations for the most common systemic risk factors for implant-related complications.

The Effect of Anticoagulants on Early Implant Failure: A Retrospective Cohort Study

Background: Anticoagulants (AC) are among the most often prescribed drugs in the world. Data regarding ACs’ effect on the osseointegration of dental implants is lacking. Purpose: The aim of the present retrospective cohort study was to evaluate the effect of anticoagulants (AC) on early implant failure (EIF). The null hypothesis was that the use of AC increases the incidence of EIF. Materials and Methods: The research included 687 patients who underwent 2971 dental implant placements in the department of oral and maxillofacial surgery in Rabin medical center, Beilinson hospital, by specialists in oral and maxillofacial surgery. The study group comprised 173 (25.2%) patients and 708 (23.8%) implants using AC. The rest of the cohort served as a control. A structured form was used to collect data at patient and implant level. EIF was defined as implant failure within a period of up to 12 months from loading. EIF was the primary outcome parameter. A logistic regression model was used to predict EIF. Results: Implants placed in individuals ≥ 80 (odds ratio (OR) = 0.34, p = 0.05), and ASA 2/3 vs. ASA 1 individuals (OR = 0.30, p = 0.02/OR = 0.33, p = 0.03, respectively) had decreased odds of EIF, and implants in those using anticoagulants (OR = 2.64, p = 0.01) had increased odds of EIF. At the patient level, the odds of EIF in ASA 3 (OR = 0.53, p = 0.02) and IHD (OR = 0.40, p = 0.02) individuals decreased. In AF/VF (OR = 2.95, p = 0.01) individuals, EIF odds increased. Conclusions: Within the limitations of the present study, the use of AC is significantly associated with an increased likelihood of EIF: the OR was 2.64. Future research is required to validate and examine the prospective impact of AC on the osseointegration phenomena.

Implant Site Changes in Three Different Clinical Approaches: Orthodontic Extrusion, Regenerative Surgery and Spontaneous Healing after Extraction: A Systematic Review

Both surgical and non-surgical techniques are employed for implant site development. However, the efficacy of these methods has not been thoroughly evaluated and compared. This systematic review aims to compare the biologic, functional and esthetic outcomes of three different approaches before implant placement in both the maxillary and mandibular arches: orthodontic extrusion, regenerative surgery and spontaneous healing after extraction. The systematic research of articles was conducted up to January 2020 in Medline, Scopus and the Cochrane Library databases. Studies were selected in a three-stage process according to the title, the abstract and the inclusion criteria. The methodological quality and the risk of bias of the included studies were evaluated using ROBINS-I tools for non-randomized studies, Rob 2.0 for RCT. Quality evaluation of case reports was performed using CARE guidelines. Through the digital search, 1607 articles were identified, and 25 of them were included in the systematic review. The qualitative evaluation showed a good methodological quality for RCT, sufficient for non-randomized studies and poor for case reports. Based on the available results, both orthodontic extrusion and regenerative surgery allowed the development of the implant site with satisfying esthetic and functional outcomes. Studies about the spontaneous healing of the extraction socket showed resorption of the edentulous ridge, which complicated the implant insertion. No study referred to failures or severe complications. Most of the studies reported only qualitative results. The present systematic review demonstrated that there is a substantial lack of data and evidence to determine which of the presented methods is better for developing a future implant site. Both surgical and non-surgical procedures appear effective in the regeneration of hard tissue, whereas not all the techniques can improve soft tissue volume, too. The orthodontic technique simultaneously enhances both hard and soft tissue.

Dental implant failure and factors associated with treatment outcome: A retrospective study

PURPOSE

The purpose of the present study was to retrospectively 1) investigate the association between implant-, patient- and bone-related parameters with the risk of implant failure; 2) analyze the survival rates of dental implants placed in a university clinical setting.

METHODS

Data were retrieved from patient charts from the University of Minnesota School of Dentistry to identify patients older than 18 years of age who received dental implant treatment by faculty, residents or students in the university dental clinics. Implant-, patient- and bone-related parameters such as implant system, length, diameter, jaw, region, installation protocol, gender, smoking, medical history, history of periodontal disease, self-reported oral parafunctions, type of bone, and operator were manually retrieved and analyzed.

RESULTS

Five hundred and fifty-three implants were randomly selected from a total of 4,424. Of these 553 implants, 440 (79.6%) were associated with a >10 mm length, 371 (67.1%) with a >4 mm diameter and 431 (77.9%) had replaced a single tooth. Submerged healing mode was followed in 363 (65.6%) of the implants with the mean healing time being 3.2 months. History of periodontal disease was identified in 294 (53.2%) of these cases. A total of 17 implants failed after a mean time of 6.29 ± 6.75 months, resulting in an overall survival rate of 96.9%. Based on a univariate analysis, implant system, operator, time between extraction and implant surgery, time between bone grafting and implant placement, tobacco use as well as clenching and grinding were considered potential implant failure predictors and were further included in the multivariate logistic regression analysis. Tobacco use (p < 0.001) was significantly associated with implant failure.

CONCLUSION

Within the limitations of this retrospective randomly selected university-treated sample tobacco use increased the risk for implant failure. Failure occurred in 17 implants representing a 3.1% failure rate.

Full Arch Implant-Prosthetic Rehabilitation in Patients with Type I Diabetes Mellitus: Retrospective Clinical Study with 10 Year Follow-Up

The aim of this retrospective clinical study was to evaluate and compare implant survival, marginal bone loss, and clinical and prosthetic complications in healthy patients and patients with type I diabetes undergoing full arch implant-prosthetic rehabilitation. A total of 47 patients needing total fixed rehabilitation of one or both arches were enrolled for this study. Based on the absence of any systemic diseases (Group A) or the presence of type I diabetes (Group B), the sample was divided into two groups. According to the grade of bone atrophy in the posterior region, patients received full arch rehabilitation (of one or both jaws) with 6 axial implants or, if the residual posterior bone height was insufficient, All-on-Four rehabilitation and a total 236 dental implants were placed. Follow-up visits were performed 1 week after surgery, at 3 and 6 months and then once a year for the next 10 years. No statistically significant differences between groups were recorded about implant survival rates, marginal bone loss, or clinical and prosthetic complications. However, concerning complications, post-surgical bleeding and wound infection were recorded in Group A more than in Group B. In cases of compensated diabetes compensation, implant placement could be considered a safe procedure.

Survival Rates and Clinical Outcomes of Implant Overdentures in Old and Medically Compromised Patients

Studies on the survival rate of implant overdentures in medically compromised patients are limited because most studies exclude patients with systemic diseases affecting implant prognosis. This retrospective study aimed to evaluate the survival rate and clinical outcomes of dental implants used for overdentures in medically compromised patients. A total of 20 patients (9 men, 11 women; mean age: 67.55 ± 6.84 years, range: 53-81 years) were included. Fourteen patients had more than two systemic diseases, and nine patients had more than three systemic diseases. The mean follow-up period was 39.05 months. Of the 60 implants, 2 failed, resulting in an implant survival rate of 96.6%. No statistical differences were found in implant survival rates according to sex, age, implant diameter, restored arch, or opposing dentition (p > 0.05). A significant difference in mean marginal bone loss (MBL) was noted for restoring the arch (p = 0.022) and opposing dentition (p = 0.036). Implants placed in the mandible and with opposing removable partial dentures and complete dentures showed lower mean MBL. No significant differences in implant MBL were observed in terms of age, sex, or implant diameter (p > 0.05). Favorable clinical outcomes can be expected from implant overdentures using two or four implants in edentulous patients with systemic diseases by ensuring that the patients have a sufficient healing period and regular checkups.

Survival Rates and Factors Affecting the Outcome Following Immediate and Delayed Implant Placement: A Retrospective Study

Background: Immediate implant placement into extraction sockets has become a widely acceptable treatment option to decrease treatment time and enhance esthetics. The objectives of this study were to assess and compare the survival rates of immediate and delayed implant treatment as well as to investigate the effect of patient- and site-related variables on the treatment outcome in a large-scale population-based study. Methods: Dental records of patients who received implant therapy were retrieved from the electronic records of the University of Minnesota School of Dentistry. Demographic characteristics, dental insurance status, socioeconomic status as well as medical history and tobacco use were recorded. The treatment outcome was included as a binary variable (survival/failure). Time to failure (date of procedure to date of visit with failure) was compared between immediate and delayed implant treatment in Cox regression models. Kaplan−Meier plots for the survival of both treatment modalities were created. Patient-sites without failure were censored at the last follow-up visit. Results: A total of 4519 records of implants were included. The sample mean age was 60.27 years and included 50.7% males and 12.9% tobacco users. High socioeconomic status was characterized for 82.3% of the included population and 63.0% of them were self-payers. Immediate implants were significantly more frequently placed in the maxillary arch (p < 0.001) than in the mandible. Tobacco users received more often a delayed rather than an immediate implant placement (p = 0.001). The survival rate analysis revealed there were no significant differences between immediate and delayed implant placements (p = 0.48). The mean follow-up time was 32.27 months during which 1.5% immediate and 1.1% delayed implants were removed. The estimated mean survival time for immediate implants was 68.90 months, while delayed implants placed in healed sockets showed a mean survival time of 75.11 months. A statistically significant association was found between gender (p = 0.03) and osteoporosis (p = 0.001) with treatment outcome. Conclusions: The placement of immediate implants achieved similarly high survival rates when compared to delayed implants placed in healed sites. Males and osteoporotic individuals showed significantly higher implant failure than females and non-osteoporotic patients. This study demonstrated that both immediate and delayed implant placements are sound options with predictable treatment outcome.

Quality of Life in Menopausal Women with Dental Restorations and Implants

Aim:

This multicenter study examined the relationship, possible interactions, and intermittent effects that dental implants and prostheses can have on menopausal women’s quality of life as well as provided information regarding the possible side effects of therapeutic regimens on menopause and osteoporosis or osteopenia.

Materials and Methods:

Questionnaires consisted of selected quality of life questions based on specific and additional medical and dental (mainly prosthodontic) questions, which were administered to 100 Greek menopausal/post-menopausal women (Age: Mean Value=63,62 years old) with osteopenia or with or without osteoporosis, with dental implants and implant restorations, or conventional prosthetic restorations visiting two University Hospitals. Menopausal/post-menopausal status was judged on the basis of either secondary, definitive amenorrhoea or based on follicular stimulation hormone ​​(FSH) values, estradiol, and clinical risk factors.

Results:

Participants had a statistically significantly better “functional” and “psychological” feeling after prosthodontic rehabilitation with and without implants. Three out of four reported that their dentist informed them of the possible implant problems that might arise from osteoporosis and its treatment (medications). Moreover, osteopenia was found to be associated with a very lower problem percentage. The bisphosphonate treatment had the highest rate (80%) of reported implant problems than non-bisphosphonate treatment (30%). The hormone replacement therapy (HRT) for menopause was reported to be more associated with problems in implant placement (19%) than in those without treatment (27.3%).

Conclusion:

The questionnaires revealed a significant improvement concerning women’s life quality and well-documented information about the problems their dental implants and restorations may cause in association with menopause and/or osteoporosis.

Comparative Analysis of Stress and Deformation between One-Fenced and Three-Fenced Dental Implants Using Finite Element Analysis

Finite element analysis (FEA) has always been an important tool in studying the influences of stress and deformation due to various loads on implants to the surrounding jaws. This study assessed the influence of two different types of dental implant model on stress dissipation in adjoining jaws and on the implant itself by utilizing FEA. This analysis aimed to examine the effects of increasing the number of fences along the implant and to compare the resulting stress distribution and deformation with surrounding bones. When a vertical force of 100 N was applied, the largest displacements found in the three-fenced and single-fenced models were 1.7469 and 2.5267, respectively, showing a drop of 30.8623%. The maximum stress found in the three-fenced and one-fenced models was 13.518 and 22.365 MPa, respectively, showing a drop of 39.557%. Moreover, when an oblique force at 35° was applied, a significant increase in deformation and stress was observed. However, the three-fenced model still had less stress and deformation compared with the single-fenced model. The FEA results suggested that as the number of fences increases, the stress dissipation increases, whereas deformation decreases considerably.

Methods of Topical Administration of Drugs and Biological Active Substances for Dental Implants-A Narrative Review

Dental implants are, nowadays, established surgical devices for the restoration of lost teeth. Considered as an alternative for traditional prosthetic appliances, dental implants surpass them in reliability and patient feedback. Local drug delivery around the implants promotes osseointegration and reduces peri-implantitis. However, there are currently no methods of a multiple, precise topical administration of drugs to the implant area. Engineering coatings on the implants, drug application on carriers during implantation, or gingival pockets do not meet all requirements of dental surgeons. Therefore, there is a need to create porous implants and other medical devices that will allow a multiple drug delivery at a controlled dose and release profile without traumatic treatment. Due to the growing demand for the use of biologically active agents to support dental implant treatment at its various stages (implant placement, long-term use of dental superstructures, treatment of the peri-implant conditions) and due to the proven effectiveness of the topical application of pharmacological biologically active agents to the implant area, the authors would like to present a review and show the methods and devices that can be used by clinicians for local drug administration to facilitate dental implant treatment. Our review concludes that there is a need for research in the field of inventions such as new medical devices or implants with gradient solid-porous structures. These devices, in the future, will enable to perform repeatable, controllable, atraumatic, and repeatable injections of active factors that may affect the improvement of osteointegration and the longer survival of implants, as well as the treatment of peri-implantitis.

Dental implant procedures in immunosuppressed organ transplant patients: a systematic review

During the last decades, the number of immunosuppressed organ transplant patients has increased consistently. Nevertheless, immunosuppression has been discussed as a contraindication for dental implant procedures for many years. Hence, the purpose of this systematic review was to assess the survival rate and outcomes of dental implants after solid organ transplantation. An electronic and manual literature search was conducted up to March 2021. Publications describing dental implants placed in patients after organ transplantation were included without any limitations regarding study design or date of publication. Ten articles met the inclusion criteria, leading to a sample of 93 patients with 249 implants. Implant survival rates were 100% over a mean follow-up of 60 months. In every case, implant surgery was performed under antibiotic coverage. No major medication-related complications were reported. Despite the limited amount of evidence in the literature, implant procedures seem to be a safe treatment option in immunosuppressed organ transplant patients. The observance of appropriate treatment protocols including a strict maintenance programme seems to be crucial for the long-term success of such treatments. However, stringent data regarding various influencing factors such as the prevalence of peri-implantitis are still missing.

Osteoconductivity of Porous Titanium Structure on Implants in Osteoporosis

In compromised bone conditions such as osteoporosis, developments of the implant surface are necessary to secure the stability of implants. This study investigated the effect of the surface porous titanium structure (PS) on the osseointegration of implants in osteoporotic bone. Bilateral ovariectomy (OVX) was performed in 4 female beagle dogs to induce osteoporosis for 32 wk. Success of induction was based on the evaluation of bone mineral density by Hounsfield units (HU) in computed tomography images. Posterior teeth in both mandibles were extracted 1 wk after OVX, and a total of 30 implants (15 implants in each group) were placed after 32 wk of osteoporosis induction. The control group implant underwent resorbable blast media (RBM) surface treatment, whereas the test group underwent RBM surface treatment in the coronal two-thirds and a PS added to the apical 3-mm portion. HU values in the mandibular trabecular bone, lumbar, and femoral head significantly decreased 32 wk after OVX, confirming osteoporotic condition after induction. Resonance frequency analysis and removal torque test showed comparable values between the 2 groups at 4 wk after implant placement. The surface topography of the implant after removal showed hard tissue integration at the PS in the test group. Bone-to-implant contact length was greater in the apical portion of the test group, although statistical significance was not found between the groups. Interthread bone area in the apical portion of the test group showed a significant increase compared to the control group (control: 0.059 ± 0.041 mm², test: 0.121 ± 0.060 mm², P = 0.028) with the histological feature of bone ingrowth at the PS. The findings of the study demonstrated that the surface PS could improve osteoconductivity in the osteoporotic trabecular bone by bone ingrowth at the pore space, thereby enhancing the osseointegration and stability of the implants.

[Characterization of third molar extraction]

The aim of this study was to characterize the main indications, contraindications and prophylactic actions for third molar extraction according to the literature. The Pubmed, Scopus and Web of Science databases were searched using a total of 3 search keys, including publications up to 5 years old, in English or Spanish, with availability of full text. Eighteen articles were selected and showed that the most frequent indication for third molar extraction was the diagnosis of pericoronaritis, followed by distal cervical caries in the lower second molar, and root resorption in adjacent teeth and cysts. In turn, it may be indicated to facilitate other types of dental treatment, such as orthodontics, orthognathic surgery and rehabilitation. In relation to contraindications, the risk of intraoperative complications was associated with the inferior alveolar nerve, advanced age and the predomination of systemic involvement. Prophylactic extraction was included in the analysis in 72.2% of the articles, with a predominance of exodontia of asymptomatic and disease-free third molars. Finally, there are clear indications and contraindications for third molar extraction, being mainly associated with pathological changes, indications for orthodontic treatment, orthognathic surgery and rehabilitative treatment. However, there is controversy in the literature regarding prophylactic extraction, emphasizing that not all retained and asymptomatic third molars should be extracted. Third molar extraction should be evaluated on a case by case basis, considering the benefits, the patient's characteristics and the risk of postoperative complications.

Dental Implants with a Calcium Ions-Modified Surface and Platelet Concentrates for the Rehabilitation of Medically Compromised Patients: A Retrospective Study with 5-Year Follow-Up

Background: Platelet concentrates are biological, autologous products obtained from the patient’s whole blood, consisting of a supraphysiological concentration of platelets and growth factors, that have proved beneficial in different applications in the medical and dental fields. They are used in several medical and dental applications to enhance tissue healing. Previous evidence shows that platelet concentrates may be beneficial in patients with compromised systemic conditions, in which the healing process is impaired. Aim: To evaluate the 5-year clinical outcome of implant treatment using acid-etched implants with calcium ions-modified surface in association with plasma rich in growth factors, in patients with systemic diseases of a different nature. Methods: Charts of 99 medically compromised patients, who had received a total of 224 dental implants from January 2013 to June 2013, were retrospectively evaluated. Patients were divided into four groups, according to their condition: diabetes (n = 39 patients), osteoporosis (n = 36), lupus erythematosus systemic (n = 5), rheumatoid arthritis (n = 19). The main outcomes were implant survival, marginal bone level (MBL) change and complications throughout follow-up. Results: Mean follow-up was 63.06 ± 1.90 months (range 60.1 to 66.4 months). In total, eight implants failed in 6 diabetic patients and 4 in 3 patients with rheumatoid arthritis. Overall 5-year implant survival was 94.6%. In total, 30 complications occurred in 24 patients, mostly transient, and no severe adverse event occurred. Overall MBL change was 0.45 ± 0.12 mm, with no significant differences among groups. Conclusions: In the present sample of medically compromised patients, rehabilitation with calcium ions-modified surface implants associated with plasma rich in growth factors proved to be a safe and effective treatment. The satisfactory results achieved after 5-year follow-up are comparable to those historically reported for healthy patients.

Is Sjogren's syndrome a risk factor/contraindication for dental implants? An umbrella review

INTRODUCTION

There have been concerns that longstanding oral dryness secondary to Sjogren's syndrome may increase the risk of failure of dental implants.

AIMS

The aim of the present study was to determine the level of methodological quality of systematic reviews that evaluated the effectiveness of dental implants in patients diagnosed with Sjogren's syndrome.

METHODS AND RESULTS

Databases of PubMed/Medline, LILACS, Science Direct and Dare Cochrane to October 2020 were evaluated. A total of 833 articles were initially identified but following use of appropriate inclusion and exclusion criteria 4 papers were identified for detailed analysis. An eventual study sample comprised 722 implants placed in 189 patients with a 95.22% success rate, the minimum follow-up time was 45.2 ± 23.8 months and the maximum 125.5 months. The studies were assessed for their methodological quality by the AMSTAR 2 tool, in which 3 had critically low quality and one low quality.

CONCLUSION

Oral rehabilitation with dental implants in patients with Sjogren's syndrome seems to have a high success rate; however, the low quality of relevant reports highlights the need for primary and secondary studies with better methodological design in order to reduce bias and provide reassurance for this treatment option.

Implant-based oral rehabilitation in systemic sclerosis patients: a systematic review

Systemic sclerosis is a rare multisystem autoimmune disorder that significantly impacts the orofacial region. Several oral features including microstomia and increased tooth loss contribute to the mouth-related disability. Prosthetic rehabilitation is very challenging in these patients. As the spectrum of dental implants indications has been recently extended to patients with various systemic disorders, the aim of this systematic review was to evaluate the outcome of dental implants in patients with systemic sclerosis. A literature search was conducted in Medline/PubMed database to identify eligible case-reports. 10 publications were included in qualitative synthesis. A total of 71 implants have been reported in 10 patients with systemic sclerosis with a mean of 7.1 +/- 3.8 implants per patient. Pre-implant surgeries have been described for 3 patients. Implant survival rates were higher than 98% but the mean follow-up time was only 28.3 +/- 18.6 months. Complications have been observed in 3 patients with 1 implant failure and peri-implant bone resorption in 2 patients. Although implant survival rates were high, an individualized assessment of risk-benefit balance is mandatory before indicating implant-based rehabilitation in patients suffering from systemic sclerosis and a scrupulous maintenance program has to be implemented. Further studies are strongly required to establish clinical guidelines.

Clinical outcomes of single implant supported crowns versus 3-unit implant-supported fixed dental prostheses in Dubai Health Authority: a retrospective study

Background

This study assessed retrospectively the clinical outcomes of single implant-supported crowns and implant-supported fixed dental prostheses (FDPs).

Methods

This case series compared biological and technical complications in single implant-supported crowns and implant-supported bridges in a time framed sample of all patients who received dental implants between 2009 and 2016 in Dubai Health Authority. Only 3-unit implant-supported prostheses (FDPs) with one intervening pontic and an implant each end were included for comparison to single crown supported implants. Cantilevered implants, implant-supported dentures and cases involving bone grafts or sinus lifts were excluded. The primary outcome measure was marginal bone loss, measured on digital radiographs taken after prosthesis placement at baseline and one year after implant loading, whilst peri-implantitis and technical complications were secondary outcomes. Mixed regression models adjusted for clustering of implants within patients was used for patient and implant factor associations.

Results

A total of 454 patients (152 males; 302 females) had 1673 implants. The mean age of males (53.7 years, SD 14.6) was significantly greater than females (49.3 years, SD 12.9, p < 0.001). Mean mesial bone loss on the FDPs was significantly greater at 1 year (1.14 mm, SD 0.63) compared with the mesial surface of single implant-supported crowns (0.30 mm, SD 0.43, p < 0.001). Mean distal bone loss was also significantly greater at 1 year on the distal surfaces of implants supporting bridgework (1.29 mm, SD 0.71) compared with distal surfaces on single implant-supported crowns (0.36 mm, SD 0.54, p < 0.001). Mean marginal bone loss mesially and distally around implants placed in the lower anterior sextant was significantly greater compared to all other sites (p < 0.001). Bone loss by gender, patient’s age and medical condition was not different between the 2 implant groups. Screw loosening was the main technical complication (11.5%) whilst peri-implantitis occurred rarely (0.5%). The 66 cement retained implants had significantly more complications compared to the 1607 screw retained implants (p < 0.001).

Conclusions

Mean marginal bone loss around the supporting implants of FDPs (3-unit fixed bridgework) was greater than on single implant-supported crowns at one year after implant loading. Position in the mouth was associated with bone loss. Biological and technical complications occurred rarely.

Effect of hypothyrodism's medication (T4) on implant osstointegration: A case series and literature search

INTRODUCTION

Hypothyroidism reduces the recruitment, maturation, and activity of bone cells, decreasing bone resorption and formation. Several investigations have reported that T4 replacement therapy is associated with a significant decrease in bone mineral density in various skeletal parts, while others have failed to corroborate these results. The present study describes both a literature review and our own experience with dental implants in patients with hypothyroidism undergoing T4 replacement therapy.

CASE PRESENTATION

The study included two parts: a literature review and case series. The literature review included 12 articles documenting the success rate of osseointegrated dental implants in patients with hypothyroidism. The clinical cases were chosen from King Saud University Dental College, Riyadh. The patients' identity was only available to the main researcher. The inclusion criteria for the clinical cases were: T4-treated hypothyroidism, age 20-60 years, and use of dental implants with a follow-up period of 6-12 months after loading. The exclusion criteria were: any other medical condition alongside hypothyroidism, syndromic hypothyroidism, pregnancy, current smoking, bruxism, and hypothyroidism caused by surgical excision combined with radiotherapy. The following parameters were assessed: insertion torque (IT), crestal bone height (CBH), mesial bone width (MBW), and distal bone width (DBW) at different time points, probing depth, and signs of infection.

DISCUSSION

Seventeen dental implants placed in patients with T4-treated hypothyroidism showed median IT success (42.4 N⋅cm; range: 35-45 N⋅cm). The median crestal bone loss was measured at 6-12 months after loading was 0.6 mm (range: 0.5-0.7. mm). Conversely, the median bone loss differences in MBW and DBW at 6-12 months after loading were 0.3 mm and 0.2 mm, respectively.

CONCLUSION

After a 1-year follow-up, patients with T4-treated hypothyroidism who had received dental implants fulfilled the criteria for successful implants.

Effects of rehabilitation with complete dentures on bite force and electromyography of jaw and neck muscles and the correlation with occlusal vertical dimension

OBJECTIVES

The purpose of this study was to assess the effects of oral rehabilitation with complete dentures on bite force and electromyography of the suprahyoid and sternocleidomastoid muscles, and their correlation with occlusal vertical dimension (OVD). The research questions were "What are the effects of rehabilitation with complete dentures on bite force and electromyography of suprahyoid and sternocleidomastoid muscles, and how are they correlated with OVD?"

MATERIALS AND METHODS

Patients who are wearers of unsatisfactory removable complete dentures were attended in three sessions (T0, T1, and T2). At T0, while the patients still wore the old dentures, they were submitted to bite force and surface electromyographic exams of the suprahyoid and sternocleidomastoid muscles. These exams were repeated, and the OVD was measured while the patients wore their old and new prostheses, 30 days after insertion of the new prosthesis (T1). The exams were repeated 100 days after the insertion of the new prosthesis (T2). The data were submitted to the Shapiro-Wilk normality test, analysis of variance (ANOVA), and Pearson correlation and linear regression, all with 5% significance.

RESULTS

Fifteen patients participated in the study. No statistically significant difference was observed for bite force or electromyography in T0, T1, or T2. However, the correlation and regression tests showed important interactions between the OVD and maximum voluntary occlusal bite force, as well as the OVD and electromyography during deglutition for the suprahyoid muscles.

CONCLUSION

Rehabilitation did not impact bite force nor the activity of the assessed muscles (electromyography). On the other hand, OVD was shown to be an important factor for bite force, and deglutition of water after rehabilitation.

CLINICAL RELEVANCE

This study shows what are the influences of rehabilitation on oral functions and reinforces the importance of corrected reestablishment of OVD because it has been found to be an important factor for bite force and electromyography during deglutition.

Oral Lichen Planus and Dental Implants: Protocol and Systematic Review

A systematic review was conducted to answer the following PICO question: “Can patients diagnosed with oral lichen planus (OLP) be rehabilitated with dental implants as successfully as patients without OLP?”. A systematic review of the literature was done following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statements to gather available and current evidence of oral lichen planus and its relationship with dental implants. The synthesis of results was performed using a Binary Random-Effects Model meta-analysis. Summary measures were odds ratios (ORs), frequencies, and percentages comparing the survival rate of dental implants placed in patients with OLP vs. those in patients without OLP. The electronic search yielded 25 articles, after removing the duplicated ones, 24 articles were selected. Out of the 24 articles, only 15 fulfilled the inclusion criteria. According to the results of the meta-analysis, with a total sample of 48 patients with OLP and 49 patients without OLP, an odds ratio of 2.48 (95% CI 0.34–18.1) was established, with an I² value of 0%. According to the Strength of Recommendation Taxonomy (SORT) criteria, level A can be established to conclude that patients with OLP can be rehabilitated with dental implants.

Influence of Implant Dimensions in the Resorbed and Bone Augmented Mandible: A Finite Element Study

Aims:

The scope of this study was to analyze the influence of clinically feasible implant diameter and length on the stress transmitted to the peri-implant bone in the case of a resorbed and bone augmented mandible through finite element analysis.

Settings and Design:

The study was carried out in silico.

Subjects and Methods:

Resorbed and bone-augmented 3D models were derived from in vivo cone-beam computed tomography scans of the same patient. Corresponding implant systems were modeled with the diameter ranging from 3.3 to 6 mm and length ranging from 5 to 13 mm, and masticatory loads were applied on the abutment surface.

Statistical Analysis Used:

None.

Results:

In the bone augmented ridge, maximum stress values in the peri-implant region drastically decreased only when using implants of a diameter of 5 mm and 6 mm. Implants up to 4 mm in diameter led to comparable stress values with the ones obtained in the resorbed ridge, when using the larger implants. The increase of length reduced stress in the resorbed mandible, whereas in the bone augmented model, it led to small variations only in implants up to 4 mm in diameter.

Conclusions:

It was concluded that bone augmentation provides the optimal framework for clinicians to use larger implants, which, in turn, reduces stress in the peri-implant region. Diameter and length play an equally important role in decreasing stress. Implant dimensions should be carefully considered with ridge geometry.

Medication-related osteonecrosis and osteoradionecrosis of the jaws: Update and current management

Medication related osteonecrosis of the jaws (MRONJ) and osteoradionecrosis of the jaws (ORNJ) are two different diseases of quite similar appearance. MRONJ is mainly due to antiresorptive or antiangiogenic drug therapy and ORNJ to radiotherapy. The present work aimed at presenting and comparing the current knowledge on MRONJ and ORNJ. They both present as an exposure of necrotic bone and differ in some clinical or radiological characteristics, clinical course and mostly in treatment. They share similar risk factors. A tooth extraction is more frequently found as a triggering factor in MRONJ. The frequency of a maxillary localisation seems higher for MRONJ. On computed tomographic images, a periosteal reaction seems characteristic of MRONJ. More frequent pathological fractures seem to occur in ORNJ. It is mandatory, for ORNJ diagnosis, to exclude a residual or recurrent tumour using histological examination. Both MRONJ and ORNJ are challenging to treat and cannot be managed similarly. For both, it would still be worth to optimise awareness within the medical community, patients' oral hygiene and dental cares to improve their prevention and make their incidences decrease. Conservative therapy is more frequently achieved for MRONJ than ORNJ and surgical resection is more often performed for ORNJ. For both diseases, the last treatment possible in refractory cases is a surgical extensive resection with free flap reconstruction. A MRONJ classification is widely used today, whereas no consensus exists to date for ORNJ classification. We propose a classification that could play this role.

Thrombocytopenia-Absent Radius (TAR): Case report of dental implant and surgical treatment

Thrombocytopenia-absent radius (TAR) syndrome is a congenital malformation in which affected individuals present reductions in the number of platelets, hypoplasia, or absence of radial bone unilaterally or bilaterally. Hematologic, skeletal, cardiac (particularly tetralogy of Fallot and septal-atrial defects), and gastrointestinal anomalies are most commonly associated with TAR syndrome. Skeletal changes result in a higher risk of dental and craniofacial trauma in patients with the syndrome. Thus, it is important for the dentist to be aware of the characteristics of TAR syndrome and its clinical management for better care of these patients. The objective of this study is to describe a case report of a 26-year-old patient with TAR syndrome with a history of trauma and root fracture of tooth 11 and alveolar bone ridge. During anamnesis, root fractures requiring the extraction of the 11 tooth, alveolar bone ridge fracture in the adjacent region, and dental trauma were observed. A hematological evaluation and blood and radiological examinations were performed. Osseointegrated implant was performed using the guided surgery and flapless technique, as well as prosthetic rehabilitation in the affected region. This report discusses the importance of careful planning, such as the use of incisions and conservative surgery, techniques for alveolar ridge preservation, gingival manipulation, and prosthesis confection. The patient was attended by a hematologist throughout the treatment.

Key words:TAR syndrome, absent radii and thrombocytopenia, dental implants, oral surgery.

Clinical practice guidelines: Oral health care for children and adults living with epidermolysis bullosa

BACKGROUND

Inherited epidermolysis bullosa (EB) is a genetic disorder characterized by skin fragility and unique oral features.

AIMS

To provide (a) a complete review of the oral manifestations in those living with each type of inherited EB, (b) the current best practices for managing oral health care of people living with EB, (c) the current best practices on dental implant-based oral rehabilitation for patients with recessive dystrophic EB (RDEB), and (d) the current best practice for managing local anesthesia, principles of sedation, and general anesthesia for children and adults with EB undergoing dental treatment.

METHODS

Systematic literature search, panel discussion including clinical experts and patient representatives from different centers around the world, external review, and guideline piloting.

RESULTS

This article has been divided into five chapters: (i) general information on EB for the oral health care professional, (ii) systematic literature review on the oral manifestations of EB, (iii) oral health care and dental treatment for children and adults living with EB-clinical practice guidelines, (iv) dental implants in patients with RDEB-clinical practice guidelines, and (v) sedation and anesthesia for adults and children with EB undergoing dental treatment-clinical practice guidelines. Each chapter provides recommendations on the management of the different clinical procedures within dental practice, highlighting the importance of patient-clinician partnership, impact on quality of life, and the importance of follow-up appointments. Guidance on the use on nonadhesive wound care products and emollients to reduce friction during patient care is provided.

CONCLUSIONS

Oral soft and hard tissue manifestations of inherited EB have unique patterns of involvement associated with each subtype of the condition. Understanding each subtype individually will help the professionals plan long-term treatment approaches.