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ElNahass H, Tawfik OK, Naiem SN, Zazou N, Moussa M. Evaluation of buccal bone resorption in immediate implant placement in thin versus thick buccal bone plates: An 18-month follow-up prospective cohort study. Clin Implant Dent Relat Res 2024; 26:532-544. [PMID: 38380779 DOI: 10.1111/cid.13312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/16/2024] [Accepted: 01/25/2024] [Indexed: 02/22/2024]
Abstract
OBJECTIVES The current guidelines recommend that immediate implants be placed in patients with thick (>1 mm) buccal bone due to the inevitable tissue remodeling that follows tooth extraction. The aim of the current study was to investigate the effect of buccal bone thickness on bone resorption in immediate implant placement and compare two measuring techniques of the aforementioned resorption. MATERIALS The present study was designed as a prospective nonrandomized, controlled clinical trial. A total of 30 implants were split between the two study arms, thin buccal bone and thick buccal bone. The primary outcome was to assess vertical bone changes radiographically by cone beam scans preoperatively, at 2 months and 18 months after implant placement in patients with thin and thick buccal plate. Secondary outcomes included the change in the thickness of the buccal bony plate, marginal bone loss, and pink esthetic score. RESULTS Only 26 implants were statistically analyzed as one early failure was observed in each group. Furthermore, 2 patients of the thick group withdrew from the study. Cone beam computed tomography measurements revealed that at 2 months the vertical bone loss was 1.09 for the thin group and 0.85 for the thick group. The buccal bone plate resorption of the thin group was 0.39 mm while it was 0.52 mm for the thick group. The buccal bone plate was 1.25 mm in the thin group and 1.88 mm in the thick group. The PES did not show any significant difference with very good esthetic results. CONCLUSION Within the limitations of the current study, the amount of buccal bone plate resorption and the subsequent thickness obtained after implantation in both groups suggest successful long-term results. The two measuring techniques have proven to be comparable and reliable in the measurement of buccal bony plate changes. https://classic. CLINICALTRIALS gov/ct2/results?cond=&term=NCT04731545&cntry=EG&state=&city=&dist=.
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Affiliation(s)
- Hani ElNahass
- Department of Periodontology, Faculty of Dentistry, Cairo University, Cairo, Egypt
- Universitätsmedizin Mainz, Mainz, Germany
| | - Omnia K Tawfik
- Department of Periodontology, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Suzy N Naiem
- Department of Periodontology, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Nada Zazou
- Faculty of Dentistry, MSA University, Cairo, Egypt
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Mello HN, Bonadiman EA, Bruneli GL, Pitol GA, de-Azevedo-Vaz SL. Influence of CBCT filters and contrast adjustments on peri-implant buccal bone thickness measurement and blooming expression. Clin Oral Investig 2024; 28:315. [PMID: 38748313 DOI: 10.1007/s00784-024-05712-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 05/07/2024] [Indexed: 07/03/2024]
Abstract
OBJECTIVES To assess whether filter and contrast adjustments can improve the accuracy of CBCT in measuring the buccal bone thickness (BBT) adjacent to dental implants by reducing blooming artifacts. MATERIALS AND METHODS Homogeneous bone blocks with peri-implant BBT of 0.3 mm, 0.5 mm, and 1 mm were scanned using the Orthophos SL system. Three dentists measured the BBT in 234 CBCT scans under different settings of contrast adjustments and 'Sharpen' filter activation. Additionally, implant diameter measurements were taken to assess blooming artifact expression. The differences between tomographic and actual measurements of BBT and implant diameter [(CBCT - actual) * 100 / actual] were subjected to Mixed ANOVA (α = 0.05). RESULTS The group with the thinnest BBT (0.3 mm) had the greatest difference between tomographic and actual measurements (79.9% ± 29.0%). Conversely, the 0.5 mm (36.1% ± 38.4%) and 1 mm (29.4% ± 12.3%) groups exhibited lower differences (p < 0.05). 'Sharpen' filter activation reduced blooming expression since it resulted in a lower difference for implant diameter (p < 0.05), but it did not influence BBT measurements (p = 0.673). Contrast settings had no impact on BBT (p = 0.054) or implant diameter measurements (p = 0.079). CONCLUSION Although filter activation reduced blooming artifacts, neither filter nor contrast adjustments improved the accuracy of CBCT in measuring peri-implant BBT; actual BBT influenced this task. CLINICAL RELEVANCE When assessing the peri-implant buccal bone plate in the CBCT system studied, dental surgeons may find it beneficial to adjust contrast and apply filters according to their preferences, since such adjustments were found to have no adverse effects on the diagnostic accuracy of this task. The use of the 'Sharpen' filter may lead to improved representation of implant dimensions.
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Affiliation(s)
| | | | | | | | - Sergio Lins de-Azevedo-Vaz
- Dental Sciences Graduate Program, Federal University of Espírito Santo (UFES), Av. Marechal Campos 1468, Maruípe Vitória, ES, 29043900, Brazil.
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Inchingolo AM, Patano A, De Santis M, Del Vecchio G, Ferrante L, Morolla R, Pezzolla C, Sardano R, Dongiovanni L, Inchingolo F, Bordea IR, Palermo A, Inchingolo AD, Dipalma G. Comparison of Different Types of Palatal Expanders: Scoping Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1258. [PMID: 37508755 PMCID: PMC10378123 DOI: 10.3390/children10071258] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 07/14/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023]
Abstract
Maxillary bone contraction is caused by genetics or ambiental factors and is often accompanied by dental crowding, with the possibility of canine inclusion, crossbite, class II and III malocclusion, temporomandibular joint disorder, and obstructive sleep apnea (OSAS). Transverse maxillary deficits, in which the maxillary growth is unusually modest, are frequently treated with maxillary expansion. The purpose of this study is to compare the dental and skeletal effects of different types of expanders, particularly the Leaf Expander, rapid and slow dental-anchored or skeletal-anchored maxillary expanders. METHODS We chose studies that compared effects determined by palatal expansion using a rapid palatal expander, expander on palatal screws, and leaf expander. RESULTS Reports assessed for eligibility are 26 and the reports excluded were 11. A final number of 15 studies were included in the review for qualitative analysis. CONCLUSIONS Clinically and radiographically, the outcomes are similar to those obtained with RME and SME appliances; Therefore, it might be a useful treatment choice as an alternative to RME/SME equipment in cases of poor patient compliance or specific situations. Finally, all of the devices studied produce meaningful skeletal growth of the palate. The use of skeletally anchored devices does, without a doubt, promote larger and more successful growth in adolescent patients.
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Affiliation(s)
| | - Assunta Patano
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70121 Bari, Italy
| | - Matteo De Santis
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70121 Bari, Italy
| | - Gaetano Del Vecchio
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70121 Bari, Italy
| | - Laura Ferrante
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70121 Bari, Italy
| | - Roberta Morolla
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70121 Bari, Italy
| | - Carmela Pezzolla
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70121 Bari, Italy
| | - Roberta Sardano
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70121 Bari, Italy
| | - Leonardo Dongiovanni
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70121 Bari, Italy
| | - Francesco Inchingolo
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70121 Bari, Italy
| | - Ioana Roxana Bordea
- Department of Oral Rehabilitation, Faculty of Dentistry, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Andrea Palermo
- College of Medicine and Dentistry, Birmingham B4 6BN, UK
| | | | - Gianna Dipalma
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70121 Bari, Italy
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Cicciù M, Pratella U, Fiorillo L, Bernardello F, Perillo F, Rapani A, Stacchi C, Lombardi T. Influence of buccal and palatal bone thickness on post-surgical marginal bone changes around implants placed in posterior maxilla: a multi-centre prospective study. BMC Oral Health 2023; 23:309. [PMID: 37217911 DOI: 10.1186/s12903-023-02991-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 04/26/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Numerous clinical variables may influence early marginal bone loss (EMBL), including surgical, prosthetic and host-related factors. Among them, bone crest width plays a crucial role: an adequate peri-implant bone envelope has a protective effect against the influence of the aforementioned factors on marginal bone stability. The aim of the present study was to investigate the influence of buccal and palatal bone thickness at the time of implant placement on EMBL during the submerged healing period. METHODS Patients presenting a single edentulism in the upper premolar area and requiring implant-supported rehabilitation were enrolled following inclusion and exclusion criteria. Internal connection implants (Twinfit, Dentaurum, Ispringen, Germany) were inserted after piezoelectric implant site preparation. Mid-facial and mid-palatal thickness and height of the peri-implant bone were measured immediately after implant placement (T0) with a periodontal probe and recorded to the nearest 0.5 mm. After 3 months of submerged healing (T1), implants were uncovered and measurements were repeated with the same protocol. Kruskal-Wallis test for independent samples was used to compare bone changes from T0 to T1. Multivariate linear regression models were built to assess the influence of different variables on buccal and palatal EMBL. RESULTS Ninety patients (50 females, 40 males, mean age 42.9 ± 15.1 years), treated with the insertion of 90 implants in maxillary premolar area, were included in the final analysis. Mean buccal and palatal bone thickness at T0 were 2.42 ± 0.64 mm and 1.31 ± 0.38 mm, respectively. Mean buccal and palatal bone thickness at T1 were 1.92 ± 0.71 mm and 0.87 ± 0.49 mm, respectively. Changes in both buccal and palatal thickness from T0 to T1 resulted statistically significant (p = 0.000). Changes in vertical bone levels from T0 to T1 resulted not significant both on buccal (mean vertical resorption 0.04 ± 0.14 mm; p = 0.479) and palatal side (mean vertical resorption 0.03 ± 0.11 mm; p = 0.737). Multivariate linear regression analysis showed a significant negative correlation between vertical bone resorption and bone thickness at T0 on both buccal and palatal side. CONCLUSION The present findings suggest that a bone envelope > 2 mm on the buccal side and > 1 mm on the palatal side may effectively prevent peri-implant vertical bone resorption following surgical trauma. TRIAL REGISTRATION The present study was retrospectively recorded in a public register of clinical trials ( www. CLINICALTRIALS gov - NCT05632172) on 30/11/2022.
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Affiliation(s)
- Marco Cicciù
- School of Dentistry, Department of General Surgery and Surgical-Medical Specialties, University of Catania, Catania, 95124, Italy
| | | | - Luca Fiorillo
- School of Dentistry, Department of General Surgery and Surgical-Medical Specialties, University of Catania, Catania, 95124, Italy
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, University of Campania "Luigi Vanvitelli", Naples, 80121, Italy
- School of Dentistry, Aldent University, Tirana, 1001, Albania
| | | | | | - Antonio Rapani
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, 34125, Italy.
| | - Claudio Stacchi
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, 34125, Italy
| | - Teresa Lombardi
- Department of Health Sciences, Magna Graecia University, Catanzaro, 88100, Italy
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Alveolar bone remodeling in virtually planned, bone-grafted vs non-grafted guided flapless implant surgery in the anterior maxilla: a cross-sectional retrospective follow-up study. Oral Maxillofac Surg 2023; 27:43-52. [PMID: 35175458 PMCID: PMC9938045 DOI: 10.1007/s10006-022-01048-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 02/10/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE In patients who underwent virtual planning and guided flapless implant surgery for teeth missing in the anterior maxilla, we compared buccal bone loss between those treated with and without autogenous bone augmentation. METHODS Of 22 patients with teeth missing because of trauma or aplasia, 10 (18 implant sites) were reconstructed with buccally placed bone graft harvested from the mandibular ramus, and 12 were non-reconstructed (16 sites). Baseline cone-beam computed tomography allowed for implant planning using the NobelClinician® software and was performed again at 1 year after functional loading. The marginal bone level was assessed radiographically at post-implant baseline and at follow-up. RESULTS At follow-up, buccal bone loss differed significantly between groups at the central level of the implant (p = 0.0005) but not at the coronal level (p = 0.329). The mean marginal bone level change was 0.6 mm, with no significant between-group difference (p = 0.876). The actual implant position often deviated in the vertical or sagittal plane by an average of 0.3-0.6 mm from the planned position. CONCLUSION Compared with non-reconstructed patients, reconstructed patients experienced significantly more buccal bone loss at the central level of implants. The groups did not differ at the coronal level or in marginal bone loss, possibly because of the more augmented bone at the central level among reconstructed patients. Differences between planned versus actual implant positions should be considered in situations of limited bone volume at the planned implant site.
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Lan Y, Huang X, Fan M, Yu H, Xie Z, Zhou Y. Accuracy evaluation of cone beam computed tomography applied to measure peri-implant bone thickness in living patients: an ex vivo and in vivo experiment. Clin Oral Investig 2022; 26:6347-6359. [PMID: 35802190 DOI: 10.1007/s00784-022-04590-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 06/19/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES This study aims to study the accuracy of cone beam computed tomography (CBCT) for measuring peri-implant bone thickness in living patients via a novel visualization method (NVM). MATERIAL AND METHODS The validity of the NVM was verified ex vivo by measuring the same peri-implant bone thicknesses in bovine ribs by using raw postoperative CBCT (clinical measurement, CM), the visualized fused images obtained using the NVM (visualized fused measurement, VF), and hard tissue sections (gold standard measurement, GS). The NVM was applied by deconstructing the postoperative CBCT model into the Modelpost-bone and Modelimplant and replacing it with bone from preoperative CBCT and standard implant models, respectively. In vivo, 52 implants were included, and the VF of each implant was obtained using data processing methods similar to those used ex vivo. Then, we compared the results of CM and VF. RESULTS Ex vivo, the VF was similar to GS, while CM usually underestimated the peri-implant bone thickness, especially at the implant shoulder (P < 0.01). In vivo, on CBCT, areas with a peri-implant bone thickness of 0-0.50 mm were not visible, while those with a thickness of 0.50-1.00 mm were occasionally visible. There was less underestimation of bone along the implant long axis. CONCLUSIONS Thin peri-implant bones could be completely underestimated on CBCT. CBCT scans alone are insufficient to warrant surgical intervention. Our NVM facilitates the accurate visual assessment of implant dimensions. CLINICAL RELEVANCE The thickness of peri-implant bone could be completely underestimated when thinner than 1.0 mm in living patients. Familiarity with these confusing CBCT results may help clinicians and patients avoid further unnecessary evaluation, misdiagnosis, and invasive treatment.
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Affiliation(s)
- Yanhua Lan
- School of Stomatology, Zhejiang Provincial Clinical Research Center for Oral Diseases, Stomatology HospitalZhejiang University School of MedicineKey Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310006, People's Republic of China
| | - Xiaoyuan Huang
- School of Stomatology, Zhejiang Provincial Clinical Research Center for Oral Diseases, Stomatology HospitalZhejiang University School of MedicineKey Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310006, People's Republic of China
| | - Mingxing Fan
- Hangzhou 6D Dental Technologies Co., Ltd, Hangzhou, 310001, People's Republic of China
| | - Huazhen Yu
- School of Mathematical Sciences, Zhejiang University, Hangzhou, 310012, People's Republic of China
| | - Zhijian Xie
- School of Stomatology, Zhejiang Provincial Clinical Research Center for Oral Diseases, Stomatology HospitalZhejiang University School of MedicineKey Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310006, People's Republic of China.
| | - Yiqun Zhou
- School of Stomatology, Zhejiang Provincial Clinical Research Center for Oral Diseases, Stomatology HospitalZhejiang University School of MedicineKey Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310006, People's Republic of China.
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Dhondt R, Quirynen M, Tarce M, Teughels W, Temmerman A, Jacobs R. The accuracy of probing, ultrasound and cone-beam CT scans for determining the buccal bone plate dimensions around oral implants - A systematic review. J Periodontal Res 2022; 57:754-767. [PMID: 35612409 DOI: 10.1111/jre.12998] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/29/2022] [Accepted: 04/19/2022] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The objective of this review was to assess the accuracy of available means of determining the BBT (buccal bone thickness) and/or BBL (buccal bone level). This was translated into the following research question: What is the accuracy of the available means of visualizing the BBP (buccal bone plate) to establish the BBT and/or the BBL, when compared to control measurements? As control measurements histomorphometric measurements, direct measurements and cone-beam computed tomography (CBCT) measurements in the absence of metal are accepted. BACKGROUND DATA METHODS: The literary search was performed by searching the databases of MEDLINE, Embase, and Web of Science, up to July 13, 2021. Types of studies included were clinical, in vitro and animal trials, specifically looking into the bone level and/or bone thickness of the buccal bone plate at oral implants. Reference lists were hand searched for relevant articles. Two reviewers performed the data extraction and analysis. Only studies using reliable control measurements to evaluate the accuracy of the tested means of visualizing BBT and/or BBL were included for analysis. The QUADAS-2 tool was used to perform bias analysis on the relevant studies. Extracted data was tabulated to show the differences between test and control measurements for BBT and BBL. For in vitro studies on CBCT measurements of BBT meta-analysis could be performed. RESULTS A total of 1176 papers were identified in the search. Twenty-two articles were used for data extraction and qualitative analysis. Of these studies nine were animal studies, 9 were in vitro studies and four were human studies. Six animal studies and three human studies provided data on probing. CBCT and sonography as techniques for visualizing the buccal bone plate. Probing at implant sites seems to provide data that correlates with a consistent distance from the BBP. Meta-analysis for probing studies could not be performed due to heterogeneity in the setups of these studies. Eleven studies on CBCT were eligible for inclusion. Of these three were animal studies, the remaining 8 studies were all in vitro studies. Meta-analysis was performed on the accuracy of CBCT for in vitro studies, finding a significant underestimation of the BBT when compared to control measurements by a mean difference of -0.15 mm with 95%CI [-0.26,-0.03]. Three studies were identified on measurement of BBT and/or BBL by sonography. This included one human study and two in vitro studies. The identified studies show a low error when determining the buccal bone level or thickness using sonography. All included studies possess a high risk of bias according to risk of bias analysis, mostly due to selection of the patient. CONCLUSION A strong limitation of this systematic review is the inclusion of different studies with heterogeneous designs. Within the limits of this analysis it cannot be concluded that probing is an accurate way of visualizing the BBP. CBCT cannot yet be recommended as a standard diagnostic tool for follow-up of the BBP at oral implants. The application of sonography as a diagnostic tool to visualize the BBP needs further scientific validation.
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Affiliation(s)
- Rutger Dhondt
- Katholieke Universiteit Leuven Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Marc Quirynen
- Katholieke Universiteit Leuven Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Mihai Tarce
- Katholieke Universiteit Leuven Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Wim Teughels
- Katholieke Universiteit Leuven Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Andy Temmerman
- Katholieke Universiteit Leuven Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Reinhilde Jacobs
- Katholieke Universiteit Leuven Universitaire Ziekenhuizen Leuven, Leuven, Belgium
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Wanis RW, Hosny MM, ElNahass H. Clinical evaluation of the buccal aspect around immediate implant using dual zone therapeutic concept versus buccal gap fill to bone level: A randomized controlled clinical trial. Clin Implant Dent Relat Res 2022; 24:307-319. [PMID: 35507735 DOI: 10.1111/cid.13091] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 04/01/2022] [Accepted: 04/04/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Soft tissue esthetics for immediate implant is considered challenging when restoring a tooth in an esthetic zone. This study aimed to evaluate the buccal aspect after immediate implant using the dual-zone therapeutic concept compared to grafting the buccal gap to the bone crest. MATERIALS AND METHODS Twenty-four patients were randomly assigned into either immediate implant with the dual-zone therapeutic concept (DZ, test group) or with bone grafting till buccal bone crest with immediate temporization (BCG, control group). Pink esthetic score (PES), buccal bone loss (BBL), mid-facial recession (MFR), soft tissue thickness (STT), keratinized tissue width (KTW), post-operative swelling (POS), and patient satisfaction (PS) were evaluated for 1 year. RESULTS At 12 months the PES in the test group was 11.36 ± 1.69, and 10.80 ± 1.55 in the control group, with no statistically significant difference (p = 0.45). MFR in the DZ and BCG groups was 0.27 ± 0.34 and 0.45 ± 0.44 after 12 months with no statistical significance difference (p = 0.195). The STT assessment showed a statistically significant increase in both groups, however the intergroup comparison was statistically not significant (p = 0.23). The mean KTW in the DZ and BCG groups was 4.55 ± 1.08 and 4.20 ± 0.82 mm, respectively with no statistical significance (p = 0.42). There was no statistical significant difference in patient satisfaction between the two groups except in question number 10 concerning the post-operative swelling which was higher in the DZ group (p = 0.009). CONCLUSIONS Both treatment modalities are considered reliable methods to achieve good soft tissue esthetics. However, both treatment modalities were not effective in preventing facial bone resorption despite the use of bone graft.
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Affiliation(s)
- Remon Wahid Wanis
- Oral Medicine and Periodontology Department, Faculty of Dentistry, Cairo University, Old Cairo, Egypt
| | - Manal Mohamed Hosny
- Oral Medicine and Periodontology Department, Faculty of Dentistry, Cairo University, Old Cairo, Egypt
| | - Hani ElNahass
- Oral Medicine and Periodontology Department, Faculty of Dentistry, Cairo University, Old Cairo, Egypt
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Van den Borre C, Rinaldi M, De Neef B, Loomans NAJ, Nout E, Van Doorne L, Naert I, Politis C, Schouten H, Klomp G, Beckers L, Freilich MM, Mommaerts MY. Radiographic Evaluation of Bone Remodeling after Additively Manufactured Subperiosteal Jaw Implantation (AMSJI) in the Maxilla: A One-Year Follow-Up Study. J Clin Med 2021; 10:jcm10163542. [PMID: 34441837 PMCID: PMC8397126 DOI: 10.3390/jcm10163542] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/07/2021] [Accepted: 08/08/2021] [Indexed: 12/12/2022] Open
Abstract
Additively manufactured subperiosteal jaw implants (AMSJI) are patient-specific, 3D-printed, titanium implants that provide an alternative solution for patients with severe maxillary bone atrophy. The aim of this study was to evaluate the bony remodeling of the maxillary crest and supporting bone using AMSJI. Fifteen patients with a Cawood–Howell Class V or greater degree of maxillary atrophy were evaluated using (cone beam) computed tomography scans at set intervals: one month (T1) and twelve months (T2) after definitive masticatory loading of bilateral AMSJI implants in the maxilla. The postoperative images were segmented and superimposed on the preoperative images. Fixed evaluation points were determined in advance, and surface comparison was carried out to calculate and visualize the effects of AMSJITM on the surrounding bone. A total mean negative bone remodeling of 0.26 mm (SD 0.65 mm) was seen over six reference points on the crest. Minor bone loss (mean 0.088 mm resorption, SD 0.29 mm) was seen at the supporting bone at the wings and basal frame. We conclude that reconstruction of the severely atrophic maxilla with the AMSJI results in minimal effect on supporting bone. Reduced stress shielding with a biomechanically tuned subperiosteal implant does not induce radiographically significant crestal bone atrophy.
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Affiliation(s)
- Casper Van den Borre
- Doctoral School of Life Sciences and Medicine, Vrije Universiteit Brussel, 1090 Brussels, Belgium
- Correspondence: ; Tel.: +32-2-629-16-53
| | | | - Björn De Neef
- Head of Department of Oro-Maxillo-Facial Surgery, General Hospital Oudenaarde, 9700 Oudenaarde, Belgium;
| | - Natalie A. J. Loomans
- Private Clinic Face Ahead Antwerp, 2000 Antwerp, Belgium;
- Division of Oro-Maxillo-Facial Surgery, GZA Hospitals, 2000 Antwerp, Belgium
| | - Erik Nout
- Oral and Maxillofacial Surgery, ETZ Hospitals, 5022 GC Tilburg, The Netherlands; (E.N.); (G.K.)
| | - Luc Van Doorne
- Oral and Maxillofacial Surgery Cosmipolis Clinic Brugge, Ghent University Hospital, AZZENO, 8300 Knokke-Blankenberge, Belgium;
| | - Ignace Naert
- Former Head Department of Prosthetic Dentistry, KU Leuven, Kapucijnenvoer 7, 3000 Leuven, Belgium;
| | - Constantinus Politis
- OMFS-IMPATH Research Group, Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, 3000 Leuven, Belgium;
| | - Hylke Schouten
- Department of Oral and Maxillo-Facial Surgery, Rode Kruis Ziekenhuis Beverwijk, 1566 NC Beverwijk, The Netherlands;
| | - Geert Klomp
- Oral and Maxillofacial Surgery, ETZ Hospitals, 5022 GC Tilburg, The Netherlands; (E.N.); (G.K.)
| | | | - Marshall M. Freilich
- Division of Oral and Maxillofacial Surgery, Humber River Hospital, Toronto, ON M3M 0B2, Canada;
| | - Maurice Y. Mommaerts
- Private Clinic Orthoface Ghent, 9830 Ghent, Belgium;
- European Face Centre, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, 1090 Brussels, Belgium
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Magdy M, Abdelkader MA, Alloush S, Fawzy El-Sayed KM, Nawwar AA, Shoeib M, ElNahass H. Ultra-short versus standard-length dental implants in conjunction with osteotome-mediated sinus floor elevation: A randomized controlled clinical trial. Clin Implant Dent Relat Res 2021; 23:520-529. [PMID: 34101342 DOI: 10.1111/cid.12995] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 03/08/2021] [Accepted: 03/08/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND The ability to restore missing teeth with dental implants is dictated by the available bone and by the presence of anatomical structures. The potential to insert ultrashort implants avoids additional surgical procedures and its inherent complications. The last European Association of Dental Implantologists consensus in 2016 defined ultrashort implants and standard-length dental implants as <6 and >8 mm, respectively. PURPOSE The present study aimed to investigate whether single standing ultrashort dental implants (US) could provide a viable therapeutic alternative to osteotome mediated sinus floor elevation in combination with standard-length dental implants (SL) 10 mm in posterior maxillary rehabilitation with reduced bone height. MATERIALS AND METHODS The study was conducted as a prospective parallel group controlled clinical trial with a 12 month follow-up, where 48 implants were randomized into two groups; US-group (5.5 mm) and SL-group (10 mm) implants placed with osteotome-mediated sinus floor elevation. Crestal bone loss (CBL) was defined as the study's primary outcome, while implant survival, buccal bone thickness, implant stability, probing depth, gingival recession, and adverse effects were assessed as secondary outcomes. RESULTS Mesial CBL was 1.13 ± 0.52 mm in SL- and 0.72 ± 0.52 mm in US-group (P = .021), while distal CBL was 1.44 ± 0.72 mm in SL- and 0.91 ± 0.69 mm in US-group at 12 months (P = .0179). Regarding implant stability, probing depth, and gingival recession there was no statistically significant difference between the two groups. Regarding implants' survival, three implants were lost in the US-while only one implant was lost in the SL-group (P = .6085; Fisher's exact test). Nevertheless, the ultrashort implants were associated with a tripling of the failure rate and uncertainty where the true failure rate is uncertain (relative risk 3.0; confidence interval 0.3-26.8). CONCLUSIONS Within the current trial's limitations, US-appear appear promising as they are associated less postoperative discomfort, minimal invasiveness and less CBL. However, larger sample size is required to determine whether the ultrashort have an acceptable survival rate.
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Affiliation(s)
- Mostafa Magdy
- Faculty of Dentistry, Department of Oral Medicine and Periodontology, Cairo University, Cairo, Egypt
| | - Mennatalla A Abdelkader
- Faculty of Dentistry, Department of Oral Medicine and Periodontology, Cairo University, Cairo, Egypt
| | - Sobhy Alloush
- Faculty of Dentistry, Department of Oral Medicine and Periodontology, Cairo University, Cairo, Egypt
| | - Karim M Fawzy El-Sayed
- Faculty of Dentistry, Department of Oral Medicine and Periodontology, Cairo University, Cairo, Egypt.,Clinic for Conservative Dentistry and Periodontology, Christian Albrechts-Universität zu, Kiel, Germany
| | - Alaa A Nawwar
- Faculty of Dentistry, Department of Oral Medicine and Periodontology, Cairo University, Cairo, Egypt
| | - Mona Shoeib
- Faculty of Dentistry, Department of Oral Medicine and Periodontology, Cairo University, Cairo, Egypt
| | - Hani ElNahass
- Faculty of Dentistry, Department of Oral Medicine and Periodontology, Cairo University, Cairo, Egypt
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11
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Yogui FC, Verri FR, de Luna Gomes JM, Lemos CAA, Cruz RS, Pellizzer EP. Comparison between computer-guided and freehand dental implant placement surgery: A systematic review and meta-analysis. Int J Oral Maxillofac Surg 2020; 50:242-250. [PMID: 32921557 DOI: 10.1016/j.ijom.2020.08.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 06/05/2020] [Accepted: 08/12/2020] [Indexed: 11/15/2022]
Abstract
The purpose of this systematic review was to compare computer-guided (fully guided) and freehand implant placement surgery in terms of marginal bone loss, complications, and implant survival. This review followed the PRISMA guidelines and was registered in the PROSPERO database (CRD42019135893). Two independent investigators performed the search of the PubMed/MEDLINE, Scopus, and Cochrane Library databases for studies published up to April 2020 and identified 1508 references. After a detailed review, only four studies were considered eligible. These studies involved a total of 154 patients with 597 dental implants and a mean follow-up period of 2.25 years. There was no difference between computer-guided surgery and freehand surgery in terms of the marginal bone loss (mean difference -0.11mm, 95% confidence interval (CI) -0.27 to 0.04mm; P=0.16), mechanical complications (risk ratio (RR) 0.85, 95% CI 0.36-2.04; P=0.72), biological complications (RR 1.56, 95% CI 0.42-5.74; P=0.51), and implant survival rate (RR 0.53, 95% CI 0.11-2.43; P=0.41). This meta-analysis demonstrated that both computer-guided and freehand surgeries yielded similar results for marginal bone loss, mechanical and biological complications, and implant survival rate.
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Affiliation(s)
- F C Yogui
- Department of Dental Materials and Prosthodontics, Araçatuba Dental School, UNESP - Universidade Estadual Paulista, Araçatuba, Brazil.
| | - F R Verri
- Department of Dental Materials and Prosthodontics, Araçatuba Dental School, UNESP - Universidade Estadual Paulista, Araçatuba, Brazil
| | - J M de Luna Gomes
- Department of Dental Materials and Prosthodontics, Araçatuba Dental School, UNESP - Universidade Estadual Paulista, Araçatuba, Brazil
| | - C A A Lemos
- Department of Dental Materials and Prosthodontics, Araçatuba Dental School, UNESP - Universidade Estadual Paulista, Araçatuba, Brazil
| | - R S Cruz
- Department of Dental Materials and Prosthodontics, Araçatuba Dental School, UNESP - Universidade Estadual Paulista, Araçatuba, Brazil
| | - E P Pellizzer
- Department of Dental Materials and Prosthodontics, Araçatuba Dental School, UNESP - Universidade Estadual Paulista, Araçatuba, Brazil
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12
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Trombelli L, Pramstraller M, Severi M, Simonelli A, Farina R. Peri-implant tissue conditions at implants treated with Sub-periosteal Peri-implant Augmented Layer technique: A retrospective case series. Clin Oral Implants Res 2020; 31:992-1001. [PMID: 32781494 DOI: 10.1111/clr.13646] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 07/27/2020] [Accepted: 08/03/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To assess peri-implant tissue conditions on the short term in patients receiving the Sub-periosteal Peri-implant Augmented Layer (SPAL) technique and in patients with adequate thickness (≥2 mm) of the peri-implant buccal bone plate (PBBP) at placement. METHODS Patients where either a dehiscence defect or thin PBBP at implant placement was corrected by SPAL technique (SPALdehiscence and SPALthin groups, respectively) and patients presenting a residual PBBP thickness ≥2 mm at implant placement (control group) were retrospectively selected. The number of peri-implant sites positive to bleeding on probing (BoP) at 6 months following prosthetic loading was the primary outcome. Also, height of keratinized mucosa, marginal soft tissue level, Plaque Index, peri-implant probing depth, suppuration on probing, and interproximal radiographic bone level (RBL) were evaluated. RESULTS Thirty-four patients (11 in the SPALdehiscence group, 11 in the SPALthin group, and 12 in the control group) were included. In each SPAL group, 10 patients (90.9%) showed peri-implant tissue thickness ≥2 mm at the most coronal portion of the implant at uncovering. The prevalence (number) of BoP-positive sites was 2, 1, and 0 in the SPALdehiscence , SPALthin , and control groups, respectively. RBL amounted to 0.3 mm in the SPALdehiscence group, 0.2 mm in the SPALthin group, and 0 mm in the control group. CONCLUSION After 6 months of prosthetic loading, patients treated with SPAL technique show limited peri-implant mucosal inflammation in association with shallow PD and adequate KM. At implants receiving SPAL technique, however, interproximal RBL was found apical to its ideal position.
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Affiliation(s)
- Leonardo Trombelli
- Research Centre for the Study of Periodontal and Peri-implant Diseases, University of Ferrara, Italy.,Operative Unit of Dentistry, Azienda Unità Sanitaria Locale (AUSL), Ferrara, Italy
| | - Mattia Pramstraller
- Research Centre for the Study of Periodontal and Peri-implant Diseases, University of Ferrara, Italy.,Operative Unit of Dentistry, Azienda Unità Sanitaria Locale (AUSL), Ferrara, Italy
| | - Mattia Severi
- Research Centre for the Study of Periodontal and Peri-implant Diseases, University of Ferrara, Italy
| | - Anna Simonelli
- Research Centre for the Study of Periodontal and Peri-implant Diseases, University of Ferrara, Italy
| | - Roberto Farina
- Research Centre for the Study of Periodontal and Peri-implant Diseases, University of Ferrara, Italy.,Operative Unit of Dentistry, Azienda Unità Sanitaria Locale (AUSL), Ferrara, Italy
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13
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Comparison between flapless and open-flap implant placement: a systematic review and meta-analysis. Int J Oral Maxillofac Surg 2020; 49:1220-1231. [PMID: 29685387 DOI: 10.1016/j.ijom.2018.04.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 02/18/2018] [Accepted: 04/08/2018] [Indexed: 12/16/2022]
Abstract
No consensus has been reached regarding the influence of the flapless and open-flap surgical techniques on the placement of dental implants. This systematic review compared the effects of flapless implant placement and implant placement with elevation of the mucoperiosteal flap in terms of marginal bone loss, implant survival rate and complications rates. This review followed PRISMA guidelines and was registered in PROSPERO with the registration number CRD42017071475. Two independent reviewers performed a comprehensive search of the PubMed/MEDLINE, Scopus, and Cochrane Library databases for studies published until December 2017. The search identified 559 references. After a detailed review, 24 studies were assessed for eligibility. A total of 1025 patients who had received a total of 1873 dental implants were included. There were no significant differences between the flapless and open-flap surgical techniques in terms of implant survival rates (P=0.34; risk ratio (RR): 1.36; confidence interval (CI): 0.72-2.56), marginal bone loss (P=0.23; MD: -0.20; CI: -0.52-0.13), or complication rates (P=0.67; RR: 1.10; CI: 0.70-1.73). The current meta-analysis showed that the implant survival rate, marginal bone levels, and complications of flapless surgery were similar to those of open-flap surgery over a mean follow-up period of 21.62 months.
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14
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Vanderstuyft T, Tarce M, Sanaan B, Jacobs R, de Faria Vasconcelos K, Quirynen M. Inaccuracy of buccal bone thickness estimation on cone‐beam CT due to implant blooming: An ex‐vivo study. J Clin Periodontol 2019; 46:1134-1143. [DOI: 10.1111/jcpe.13183] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 07/30/2019] [Accepted: 08/21/2019] [Indexed: 12/31/2022]
Affiliation(s)
- Tony Vanderstuyft
- Section of Periodontology Department of Oral Health Sciences KU Leuven & Dentistry University Hospitals Leuven Belgium
| | - Mihai Tarce
- Section of Periodontology Department of Oral Health Sciences KU Leuven & Dentistry University Hospitals Leuven Belgium
| | - Bahoz Sanaan
- Section of Periodontology Department of Oral Health Sciences KU Leuven & Dentistry University Hospitals Leuven Belgium
| | - Reinhilde Jacobs
- OMFS‐IMPATH Research Group Department of Imaging and Pathology Faculty of Medicine University of Leuven Leuven Belgium
- Department of Oral & Maxillofacial Surgery University Hospitals Leuven Leuven Belgium
| | - Karla de Faria Vasconcelos
- OMFS‐IMPATH Research Group Department of Imaging and Pathology Faculty of Medicine University of Leuven Leuven Belgium
- Department of Oral & Maxillofacial Surgery University Hospitals Leuven Leuven Belgium
| | - Marc Quirynen
- Section of Periodontology Department of Oral Health Sciences KU Leuven & Dentistry University Hospitals Leuven Belgium
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15
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Papapetros D, Karagiannis V, Konstantinidis A, Apatzidou DA. Interim tissue changes following connective tissue grafting and two-stage implant placement. A randomized clinical trial. J Clin Periodontol 2019; 46:958-968. [PMID: 31206749 DOI: 10.1111/jcpe.13159] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 05/10/2019] [Accepted: 06/09/2019] [Indexed: 12/14/2022]
Abstract
AIM To determine tissue changes at implants placed either conventionally or in combination with a connective tissue graft (CTG). MATERIALS AND METHODS Forty-eight partially edentulous subjects were randomized into two treatment Groups, and 46 completed the study. Group-A (NA = 23) received crestal implant placement. In Group-B (NB = 23), a CTG harvested from the palate was stabilized over the implant neck. At the time of implant placement (T0), Groups were categorized as having thin mucosa ≤ 2.5 mm at the surgical site (NS ubgroup- AI = 12, NS ubgroup- BI = 11) or thick mucosa > 2.5 mm (NS ubgroup- AII = 11, NS ubgroup- BII = 12). Mucosa thickness, width of keratinized tissue (WKT), crestal bone levels and relative bone thickness were determined at T0 and at the two-stage surgery (T1). RESULTS At T1, on the alveolar crest, mucosa thickness significantly decreased in the thick mucosa Subgroups (-AII/-BII, both p = 0.001), but increased at thin mucosa grafted sites (p = 0.049). No significant changes were noted in the WKT for either group. Thin mucosa grafted Subgroups (-AI/-BI) demonstrated significant decreases in crestal bone levels (both p ≤ 0.008). Crestal relative bone thickness decreased in all Subgroups (p ≤ 0.027 for significant changes). CONCLUSIONS Connective tissue grafting resulted in smaller reductions of mucosa thickness on the alveolar crest and appeared to have the greater effects at sites with initially thin mucosa.
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Affiliation(s)
- Dimitrios Papapetros
- Lab of Preventive Dentistry, Periodontology and Implant Biology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vassilis Karagiannis
- School of Mathematics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonis Konstantinidis
- Lab of Preventive Dentistry, Periodontology and Implant Biology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Danae A Apatzidou
- Lab of Preventive Dentistry, Periodontology and Implant Biology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
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16
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Effect of Primary Stability and Soft- and Hard-Tissue Thickness on Marginal Bone Loss: A Prospective Pilot Study. IMPLANT DENT 2019; 27:542-546. [PMID: 30188364 DOI: 10.1097/id.0000000000000810] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare prospectively the effect of different insertion torques (ITs) on marginal bone stability and study the effect of soft-tissue and buccal bone thickness as confounding factors while using a 3-dimensional radiographic evaluation. MATERIALS AND METHODS Thirty-nine implants were placed in 22 patients. IT, soft-tissue thickness, and buccal bone thickness were recorded at implant placement. Marginal bone loss was evaluated on individualized periapical radiographs and cone-beam computed tomography at 1 year after loading. RESULTS Three groups of implants emerged based on their IT: group I (<30 Ncm), group II (between 30-45 Ncm), and group III (>45 Ncm). Soft-tissue thickness was ≤2 mm in 10 implants (25.6% thin biotype) and more than 2 mm in 29 implants (74.4% thick biotype). No significant difference in marginal bone loss was found for different IT and different soft-tissue thickness. A significant correlation was found between initial buccal bone thickness (≥2 mm or <2 mm) and marginal bone loss at 1 year. CONCLUSIONS IT and mucosal tissue thickness did not influence marginal bone loss. Buccal bone thickness of ≥2 mm was associated with a minimal marginal bone remodeling.
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17
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Basler T, Naenni N, Schneider D, Hämmerle CHF, Jung RE, Thoma DS. Randomized controlled clinical study assessing two membranes for guided bone regeneration of peri-implant bone defects: 3-year results. Clin Oral Implants Res 2018; 29:499-507. [DOI: 10.1111/clr.13147] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2018] [Indexed: 01/18/2023]
Affiliation(s)
- Tobias Basler
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; University of Zurich; Zurich Switzerland
| | - Nadja Naenni
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; University of Zurich; Zurich Switzerland
| | - David Schneider
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; University of Zurich; Zurich Switzerland
| | - Christoph H. F. Hämmerle
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; University of Zurich; Zurich Switzerland
| | - Ronald E. Jung
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; University of Zurich; Zurich Switzerland
| | - Daniel S. Thoma
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; University of Zurich; Zurich Switzerland
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18
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Cariati P, Fernández-Solís J, Marín-Fernández AB, Valencia-Laseca A, Monsalve-Iglesias F. Accidental displacement of a dental implant into the sublingual space: A Case report. J Clin Exp Dent 2016; 8:e459-e461. [PMID: 27703616 PMCID: PMC5045695 DOI: 10.4317/jced.52994] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 02/10/2016] [Indexed: 12/04/2022] Open
Abstract
Dental implant surgery is continuously expanding. In fact, every day more and more surgeons are choosing dental implants for allowing great results in the field of oral rehabilitation. However, these procedures are not exempt from complications. This report presents the case of a 66 years old man underwent implant surgery by a specialized dentist. No problems were reported during implant placement. Despite this, three months later, it was displaced into the sublingual space at the time of uncovering. Against this backdrop, the patient was referred to an expert maxillofacial surgeon. Next day, the implant was removed using an intraoral approach to reach the sublingual space. According with our knowledge, there are no cases reported in the literature that describe this complication.
Key words:Dental implant, sublingual space, bone atrophy, complications of oral surgery.
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Affiliation(s)
- Paolo Cariati
- Oral and Maxillofacial surgery resident. Hospital Universitario Virgen de las nieves, Granada, Spain
| | - José Fernández-Solís
- Maxillofacial Surgeon. Hospital Universitario Virgen de las nieves, Granada, Spain
| | | | - Alfredo Valencia-Laseca
- Oral and Maxillofacial surgery resident. Hospital Universitario Virgen de las nieves, Granada, Spain
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