Early and late implant failure of submerged versus non-submerged implant healing: A systematic review, meta-analysis and trial sequential analysis

Influence of toothbrushing methods on tightening torque with healing abutments of different lengths: An in vitro study

STATEMENT OF PROBLEM

Early tightening torque at the implant-healing abutment interface is a recognized concern in implant treatment. However, little is known regarding the effects of toothbrushing methods on the interface established between the implant and healing abutments of different heights.

PURPOSE

The purpose of this in vitro study was to evaluate the effect of different toothbrushing methods on tightening torque for healing abutments of different heights.

MATERIAL AND METHODS

A total of 60 implants (Bilimplant; Proimtech) were embedded in epoxy resin blocks. The following 6 test groups were established: healing abutments with manual toothbrush group (Oral B Pro Expert All in one; Oral B) and 4 mm height (MTB-4, (which served as the control); 6 mm height (MTB-6, which served as the control); sonic toothbrush group (Philips Sonicare 3100 Series; Philips Oral Healthcare) and 4 mm height (S-4); 6 mm height (S-6); oscillating/rotating toothbrush group (Oral B Smart 6 6000N; Oral B) and 4 mm height (OR-4) and 6 mm height (OR-6). Each specimen was tightened to 15 Ncm and brushed. The digital torque meter (Cap Torque Tester Series TT01; Mark10) was used to calculate the reverse torque values.

RESULTS

The highest torque loss value in the average torque losses in the test groups was 1.3 (OR-6); the lowest was 0.3 (S-4). While a significant difference was found between groups S-4 and S-6 (P=.018), no statistically significant difference was found among the other groups (P>.05).

CONCLUSIONS

Torque loss was greater in the healing abutment with a height of 6 mm and with the oscillatory and rotational brushing method.

Analysis of risk factors related to early implant failure: A retrospective study

STATEMENT OF PROBLEM

Factors influencing early implant failure (failure during the healing period) in the rehabilitation and restoration of oral function in partially edentulous patients are unclear.

PURPOSE

The purpose of this clinical study was to investigate several factors that may be associated with early implant failure.

MATERIAL AND METHODS

This retrospective study was conducted on 3247 implants in 2061 patients between 2009 and 2022. Patient-related and surgery-related factors, including smoking; sex; diabetes; bone grafting; implant length, diameter, and design; adjacent teeth; and insertion torque, were manually retrieved and analyzed. Using univariate and multivariate analyses, a generalized estimating equation (GEE) model with chi-squared tests was employed to evaluate factors related to early implant failure (the failure before restoration) (α=.05).

RESULTS

The mean ±standard deviation age of the study patients was 49.2 ±15.0 years (range 18 to 91). Ninety-nine implants (3.05%) failed during the healing period. Three factors were statistically significant regarding early implant failure: smoking (odds ratio [OR]=1.92, P=.008), implant design (tapered implants) (OR=1.84, P=.007), and implant length <10 mm (OR=2.98, P=.011). Factors including diabetes, bone grafting, anatomic location, adjacent teeth (endodontic therapy in the adjacent teeth and the distance between implant and adjacent teeth), healing method, and insertion torque did not exhibit a statistically significant higher early implant failure rate. Ninety-three sites with failed implants received new implants, and 6 of these 93 implants failed during the healing period.

CONCLUSIONS

Within the limitation of sample size, smokers, implant length (<10 mm), and implant design (tapered implant) exhibited higher risk of early implant failure in this retrospective study. Implant insertion torque, healing method, adjacent teeth, and diabetes did not significantly influence the risk of early implant failure.

Use of Concentrated Growth Factor (CGF) in Prosthetic-Guided Reconstruction on Two-Wall Bone Defect after Cystectomy: An Alternative to Traditional Regeneration

This clinical case report's objective was to describe an alternative technique executed to ensure bone regeneration after removing a cystic lesion in the upper jaw. The bone defect after the cystectomy was filled with autologous fibrin-rich clots containing concentrated growth factor (CGF). A 45-year-old female patient was presumed to have a cystic lesion with massive bone destruction on the vestibular and palatal walls between teeth 2.2 and 2.3. CGF was applied to fill the gap to promote the development of the bone. The tooth was asymptomatic and repair was still increasing steadily after a year, according to the results of the clinical and radiological follow-up assessment. This article describes a different way to treat a two-wall defect involving both the palatal and buccal bone, after removing a cystic lesion, with the use of CGF as an equivalent to the traditional use of autologous or heterologous bone. A promising substance for bone repair is CGF fibrin, which may encourage the growth of new bone in jaw deformities and promote bone tissue healing.

The cumulative survival rate of dental implants with micro-threads: a long-term retrospective study

PURPOSE

This study aimed to evaluate the long-term cumulative survival rate (CSR) of dental implants with micro-threads in the neck over a 10-year follow-up period and to examine the factors influencing the survival rate of dental implants.

METHODS

This retrospective study was based on radiographic and dental records. In total, 151 patients received 490 Oneplant® dental implants with an implant neck micro-thread design during 2006-2010 in the Department of Periodontology of Seoul National University Dental Hospital. Implant survival was evaluated using Kaplan-Meier analysis. Cox proportional hazard regression analysis was used to identify the factors influencing implant failure.

RESULTS

Ten out of 490 implants (2.04%) failed due to fixture fracture. The CSR of the implants was 97.9%, and no significant difference was observed in the CSR between external- and internal-implant types (98.2% and 97.6%, respectively, P=0.670). In Cox regression analysis, 2-stage surgery significantly increased the risk of implant failure (hazard ratio: 4.769, P=0.039). There were no significant differences in influencing factors, including sex, age, implant diameter, length, fixture type, location, surgical procedure, bone grafting, and restoration type.

CONCLUSIONS

Within the limitations of this retrospective study, the micro-thread design of the implant neck was found to be favorable for implant survival, with stable clinical outcomes.

Influence of different mucosal phenotype on early and long-term marginal bone loss around implants: a systematic review and meta-analysis

OBJECTIVES

To investigate the influence of different mucosal phenotypes on peri-implant marginal bone loss.

MATERIALS AND METHODS

The search was conducted in five databases including PubMed, Embase, Cochrane, Scopus, and Web of Science (until 1st Sept. 2022) to identify relevant clinical studies. Potentially relevant journals were also manually searched. Two reviewers independently screened studies, extracted data, and evaluated the quality of the studies. Prospective clinical trials and observational studies investigating peri-implant marginal bone loss in thick-mucosa and thin-mucosa groups were included.

RESULTS

A total of 14 studies were included in this systematic review. Results of the meta-analysis revealed a weighted mean difference of 0.38 mm for marginal bone loss between thick- and thin-mucosa groups (95% confidence interval = 0.02-0.74, P = 0.002). Statistical significance existed in short-term (follow-up ≤ 1 year) data (WMD = 0.41 mm, 95%CI = 0.11-0.70, P = 0.007), but not in long term (follow-up ≥ 3 y) data (WMD = 0.17 mm, 95%CI = - 0.02-0.36, P = 0.07). Survival rate revealed no difference between thick and thin mucosa groups. In subgroup analyses, a positive association between thick mucosa and less marginal bone loss was found in the non-submerged group, cement-retained group, and bone-level group.

CONCLUSIONS

A significantly less marginal bone loss occurred in implants with thick mucosa than with thin mucosa in the short term, whereas no significant difference was observed in the long term. Due to the substantial heterogeneity and limited long-term data, further high-quality evidence is warranted to confirm the results.

CLINICAL RELEVANCE

Clinicians are advised to use caution in treating patients with thin mucosa and adhere closely to indications and protocols to minimize marginal bone loss.

Dental implant failure rates with low insertion torque with a nonsubmerged surgical approach: A retrospective clinical study

BACKGROUND

It is currently unclear if a low insertion torque (IT) should prompt a clinician to submerge the dental implant at time of placement.

PURPOSE

This study aimed to analyze implant failure rates and marginal bone loss (MBL) as a function of IT and surgical approach.

MATERIALS AND METHODS

A total of 197 patients who had received 295 Mozo Grau (MG) implants were included in this study. The healing of submerged or nonsubmerged implants was evaluated in regular IT (≥20-25 Ncm) or low IT (<20-25 Ncm) cases. Implant failure and MBL were evaluated before prosthesis placement and at 6 and 12 months after functional loading with generalized estimating equations.

RESULTS

The overall 12-month implant failure rate was 4.8% (95% confidence interval [CI]: 2.7%-8.2%). When successful at 12 months, dental implants placed with low IT and nonsubmerging had the same MBL as implants dental implants placed with other approaches (mean difference = -0.02 mm; 95% CI -0.05 to 0.02). Low IT combined with nonsubmerging of the dental implant was associated with a 30-fold increased odds for dental implant failure (95% CI: 3.8-236.6).

CONCLUSION

low IT and nonsubmerged healing was associated with a high failure rate.

Clinical effects of conventional and underprepared drilling preparation of the implant site based on bone density: A systematic review and meta-regression

PURPOSE

There is no clinical consensus to determine the right balance between underpreparation and marginal bone level changes. The purpose of this systematic review and meta-regression was to investigate the influence of the type of drilling preparation of the implant site in relation to the bone mineral density on the clinical success, expressed in terms of the MBL and implant failure rate.

STUDY SELECTION

A thorough search was performed using the digital databases MEDLINE PubMed, EMBASE, and Cochrane Central Register of Controlled Trials by entering research lines or various combinations of free words. The main keywords used were "dental implants", "bone density", and "torque".

RESULTS

The mean bone resorption in the conventional preparation group was -0.43 (± 0.28) mm, whereas it was -0.80 (± 0.37) mm in the underprepared group. For the D1/D2/D3 bone group, the slope was significantly different from zero and linearity; the D4 bone group slope was not significantly different from zero and was almost parallel, although it was significantly different from linearity. The box and whiskers plot shows that the MBL in underprepared sites tended to be significantly higher with a higher variation than that in conventionally prepared sites.

CONCLUSIONS

Within its limits, our meta-regression analysis showed that MBL is influenced by the type of drilling preparation and bone mineral density. In particular, a lower MBL was observed in the D1 bone with conventional preparation than with underpreparation. Moreover, a greater implant-to-osteotomy site mismatch was positively associated with greater MBLs in the bone densities of D1/D2/D3.

Antibacterial and Anti-Inflammatory Properties of Peptide KN-17

Peri-implantitis, an infectious disease originating from dental biofilm that forms around dental implants, which causes the loss of both osseointegration and bone tissue. KN-17, a truncated cecropin B peptide, demonstrated efficacy against certain bacterial strains associated with peri-implantitis. This study aimed to assess the antibacterial and anti-inflammatory properties and mechanisms of KN-17. The effects of KN-17 on oral pathogenic bacteria were assessed by measuring its minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC). Moreover, the cytotoxicity and anti-inflammatory effects of KN-17 were evaluated. KN-17 inhibited the growth of Streptococcus gordonii and Fusobacterium nucleatum during in vitro biofilm formation and possessed low toxicity to hBMSCs cells. KN-17 also caused RAW264.7 macrophages to transform from M1 to M2 by downregulating pro-inflammatory and upregulating anti-inflammatory factors. It inhibited the NF-κB signaling pathway by reducing IκBα and P65 protein phosphorylation while promoting IκBα degradation and nuclear P65 translocation. KN-17 might be an efficacious prophylaxis against peri-implant inflammation.

One-stage versus two-stage technique using two splinted extra-short implants: A multicentric split-mouth study with a one-year follow-up

OBJECTIVE

To compare the clinical outcomes of extra-short implants (≤6.5 mm) inserted with one-stage versus two-stage technique in adjacent sites of the upper or lower jaw.

MATERIALS AND METHODS

In this split-mouth multicenter study, implants were randomly divided into two groups according to the healing phase: two-stage and one-stage technique. Primary outcome measures were implant survival, implant success, and prosthodontic complications. Secondary outcome measurements were: implant stability quotient (ISQ) collected at surgery time (T0), and after 3 (T3) and 12 (T12) months, marginal bone level (MBL) evaluated at T0, T3, T6, and T12, marginal bone loss evaluated at T6 and T12, plaque index (PI), probing depth (PD), bleeding on probing (BoP) evaluated at T3, T6, and T12. Significances of differences between groups were tested by linear mixed model with random intercept.

RESULTS

Nineteen patients (8 males and 11 females) were included. A total of 38 implants were inserted. At T12 implant cumulative survival and implant success rate were 100% in both groups. No statistically significant differences were recorded for any of the analyzed parameters between the two groups at any time point. ISQ values were similar at T0 (two-stage: mean 67.53 ± SD 19.47; one-stage: mean 66.53 ± 19.07 p = 0.8738) and increased in both groups at the 12-month follow-up appointment (two-stage: 81.1 ± 7.04; one-stage: 81.39 ± 0.9266). MBL values were similar in the two groups at any time point. At T12 marginal bone loss was 0.46 ± 0.41 (two-stage) and 0.45 ± 0.38 (one-stage) mm (p = 0.9417), while mean PD was 2.7 ± 0.85 (two-stage) and 2.69 ± 0.89 (one-stage) mm.

CONCLUSIONS

Within the limits of the present short-term report, extra-short implants demonstrated optimal clinical outcomes using the one-stage technique, without statistically significant differences compared with the traditional two-stage approach.

Comparative Evaluation of Implants with Different Surface Treatments Placed in Human Edentulous Mandibles: A 1-Year Prospective Study

The aims of this study were to analyze prospectively and comparatively the peri-implant bone crest levels, bone density, stability and success rate of implants with different surface treatments in human edentulous mandibles. Twenty edentulous patients were selected. Four different implants were placed between the mental foramen. Four groups were evaluated: (1) laser-modified surface (LASER), (2) surface modified by laser with deposition of apatites (LASER + HA), (3) surface modified by double acid etching (ACID, Implacil De Bortoli) and (4) surface modified by sandblasting and acid etching (SLActive®, Straumann). Clinical, radiographic, resonance frequency and tomographic analyses were used. After 4 months, mandibular fixed implant prostheses were installed. Clinical and radiographic analyses were performed at times T0 (immediately after implant placement), T1 (15 days), T2 (30 days), T3 (60 days), T4 (90 days), T5 (120 days), T6 (180 days) and T7 (360 days), post-implant placement. The resonance frequency analysis (RFA) was measured at T0, T4, T6 and T7. The tomographic analysis was performed at T0, T4 and T7. In the radiographic bone density analysis, a statistical difference was found between the SLActive® and LASER + HA groups at T4 (p < 0.05). Statistical differences were observed in RFA at T4 (90 days), between the SLActive® and LASER groups (p < 0.05) and between the SLActive® and LASER + HA groups (p < 0.05). At T6 and T7, statistical differences were found between the SLActive® group and all other implant surfaces (p < 0.01). The experimental surfaces analyzed showed encouraging positive outcomes compared to those of the SLActive® surface. Long-term follow-up should be performed to confirm these results.

Influence of Serum Vitamin D Levels on Survival Rate and Marginal Bone Loss in Dental Implants: A Systematic Review

This systematic literature review set out to investigate the relationship between serum vitamin D levels and dental implants in terms of survival rates, marginal bone loss, and associated complications. The review was conducted according to PRISMA guidelines, performing an electronic search in four databases (Pubmed, Web of Science, Cochrane, and Scopus), complemented by a manual search up to April 2022. Four articles were selected for analysis. The Newcastle-Ottawa Quality Assessment Scale tool was used to assess the quality of evidence of cohort studies, and the Cochrane bias assessment tool was used to assess the quality of evidence of randomized clinical trials. The study included 1089 patients restored with 1984 dental implants, with follow-up periods ranging from 20-240 months. Cases presenting lower serum vitamin D levels obtained slightly worse results in terms of marginal bone loss. Longer follow-up periods are needed in order to determine whether serum vitamin D levels affect implant survival rates and osseointegration over time.

Validation of an implant stability measurement device using the percussion response: a clinical research study

Background

Several devices have been developed to measure implant-bone stability as an indicator of successful implant treatment; these include Osstell®, which measures the implant stability quotient (ISQ), and the more recent AnyCheck®, which relies on percussion for the implant stability test (IST). These devices make it possible to measure implant stability. However, no studies have compared the performance of AnyCheck® and Osstell® (i.e., IST and ISQ values) in clinical practice. Therefore, this study aimed to determine the correlation between primary and secondary implant stability using the Osstell® and AnyCheck® devices.

Methods

Ten patients (7 women; age [mean ± standard deviation]: 49.1 ± 13.3 years) with partially edentulous jaws who received a total of 15 implants were included. IST (AnyCheck®) and ISQ (Osstell®) values were measured immediately after implantation and at 1, 2, 3, 4, and 6 weeks post-implantation. Each measurement was performed three times, and the average value was used as the result. The correlation between measurements obtained using the two devices was determined using Spearman's rank correlation coefficient.

Results

The IST values ranged from 79.1 ± 2.87 to 82.4 ± 2.65. The ISQ values ranged from 76.0 ± 2.8 to 80.2 ± 2.35. Spearman's rank correlation coefficient was r = 0.64 immediately after implantation, r = 0.29 at 1 week, r = 0.68 at 2 weeks, r = 0.53 at 3 weeks, r = 0.68 at 4 weeks, and r = 0.56 at 6 weeks. A positive correlation was found in all cases, except at week 1 when the correlation was weak; the IST and ISQ values decreased the most during the first postoperative week and increased during the second week. The IST values were also slightly higher at all measurement points.

Conclusion

The ability to assess implant stability without removing the abutment during healing is essential for determining the timing of loading without the risk of bone resorption. The results of this study suggest that AnyCheck® is useful for determining primary and secondary implant stability.

Disinfection and Biocompatibility of Titanium Surfaces Treated with Glycine Powder Airflow and Triple Antibiotic Mixture: An In Vitro Study

The aim of this in vitro study was to compare three disinfection protocols of biofilm-coated machined (MAC) and acid etched (SLA) commercial pure Grade 4 Titanium disks. Samples were infected with a vial of polymicrobial biofilm to simulate peri-implantitis in vitro. Seventeen MAC and twenty SLA titanium disks were randomly assigned to: (1) glycine powder air-flow (GYPAP) for 1 min; (2) a local delivered triple paste antibiotic composed by a gel mixture with ciprofloxacin, metronidazole, and clarithromycin (3MIX) for 1 h; and (3) a combination of both (GYPAP + 3MIX). Biocompatibility of the titanium disks after each treatment protocol was assessed by measurement of adhesion and growth of adipose-derived mesenchymal stem cells (ASCs) after 24 and 72 h. A confocal laser scanning microscope (CLSM) assessed the antibacterial effect of each treatment. Data of the antibacterial efficacy and cell viability were presented as mean with standard deviation and calculated by one-way ANOVA with multiple comparisons via Bonferroni tests. Results were considered significant with p < 0.05. The higher cell viability was achieved by the 3MIX and GYPAP combination on the SLA surfaces after 72 h. CLSM analysis showed a mean ratio of dead bacteria statistically higher in the 3MIX + GYPAP group compared with the GYPAP and 3MIX subgroups (p < 0.05). In conclusion, data showed that the combination of GYPAP and 3MIX could be preferred to the other protocols, especially in presence of SLA titanium surface.

The Relationship Between Low Serum Vitamin D Level and Early Dental Implant Failure: A Systematic Review

The variety in shape and type of dental implants in the present time is considered one of the most successful evolutions in dentistry. This facilitates dental treatment options to restore patient function and appearance. However, numerous significant factors influence the predictability of survival or the success rates of dental implants, some of which, such as vitamin D levels, have not been included in many studies. The main purpose of this systematic review was to investigate whether there is a relationship between low serum levels of vitamin D and early dental implant failures (EDIFs). Our literature search involved international databases including PubMed, Directory of Open Access Journals (DOAJ), and Web of Science. Initially, according to our search criteria, 1200 studies were found. After excluding duplicates, incomplete studies, and studies not meeting our inclusion criteria, only six human studies were included in this research and analyzed. Finally, upon meticulous analysis of included studies, this systematic review revealed inconsistent results in articles with respect to the association between vitamin D deficiency and implant failures. Large-scale studies, especially clinically relevant studies, on this subject is recommended.

Implant Survival in Immediately Loaded Full-Arch Rehabilitations Following an Anatomical Classification System-A Retrospective Study in 1200 Edentulous Jaws

This retrospective study analyzed implant survival of immediate implant-supported fixed complete denture (IFCD) treatment options (TOs) based on the level of alveolar atrophy (CC). Records of 882 patients receiving a total of 6042 implants at one private referral clinic between 2004 and 2020 were considered. The mean follow-up period was 3.8 ± 2.7 years. Cumulative implant survival rates (CSRs) were analyzed as a function of CCs and TOs according to Mantel-Haenszel and Mantel-Cox. Hazard risk ratios for implant loss were compared using Cox regression. Confounding factors were identified using mixed Cox regression models. The 2- and 5-year CSRs were 98.2% and 97.9%, respectively. Maxillary 2- and 5-year CSRs were lower (97.7% and 97.3%) compared to mandibular CSRs (99.8% and 98.6%) (p = 0.030 and 0.0020, respectively). The CC did not influence CSRs of IFCDs in the mandible (p = 0.1483 and 0.3014, respectively) but only in the maxilla (p = 0.0147 and 0.0111), where CSRs decreased with increasing atrophy. TOs did not statistically differ in terms of survival rate for a given level of alveolar atrophy. The adaption of IFCD treatments to the level of atrophy and patient-specific risk factors can result in high CSRs, even at different levels of bone atrophy.

Vitamin D and Its Role in Oral Diseases Development. Scoping Review

Vitamin D is a fat-soluble secosteroid that plays a significant role in the whole body, including the maxillofacial region. The discovery of its receptors in many cells and organs made it possible to reveal the participation of vitamin D not only in the regulation of calcium phosphate metabolism, but also in immune processes, in providing anti-inflammatory and antimicrobial effects, slowing down cell proliferation and stimulating differentiation. In this literature review, we demonstrate the association between low vitamin D levels and the development of recurrent aphthous stomatitis, the course and response to treatment of squamous cell carcinoma of the oral cavity, the severity of periodontal diseases, and the processes of osseointegration and bone remodeling during dental implantation and guided tissue regeneration. The aim of our article was to demonstate a possible connection between vitamin D level and the oral diseases that can be presented at an oral surgery appointment, which will help clinicians to reduce the risk of early dental implant failure, ensure favorable outcomes of augmentative operations, as well as decrease the destructive effects of severe periodontitis and other conditions throug knowledge and timely lab tests and endocrinologist prescriptions.

Logistic Regression Analysis of the Factors Involved in the Failure of Osseointegration and Survival of Dental Implants with an Internal Connection and Machined Collar: A 6-Year Retrospective Cohort Study

Background

Although the long-term success rate of dental implants is currently close to 95%, it is necessary to provide more evidence on the factors related to the failure of osseointegration and survival.

Purpose

To establish the risk factors associated with the failure of osseointegration and survival of dental implants with an internal connection and machined collar and to establish a predictive statistical model.

Materials and Methods

An analytical, retrospective, and observational clinical study of a sample of 297 implants with a follow-up of up to 76 months. Independent variables related to the implant, patient, and surgical and rehabilitative procedures were identified. The dependent variables were failure of osseointegration and failure of implant survival after prosthetic loading. A survival analysis was carried out by applying the Kaplan-Meier model (significance for p < 0.05). The log-rank test and the Cox regression analysis were applied to the factors that presented differences. Finally, the regression logit function was used to determine whether it is possible to predict the risk of implant failure according to the analyzed variables with the data obtained in this study.

Results

The percentages of osseointegration and survival were 97.6 and 97.2%, respectively. For osseointegration, there were significant differences according to gender (p = 0.048), and the risk of nonosseointegration was 85% lower in women. Regarding survival, the Cox analysis converged on only two factors, which were smoking and treatment with anticoagulant drugs. The risk of loss was multiplied by 18.3 for patients smoking more than 10 cigarettes per day and by 28.2 for patients treated with anticoagulants.

Conclusions

The indicated risk factors should be considered, but the analysis of the results is not sufficient to create a predictive model.

Systemic Antibiotic Prophylaxis to Reduce Early Implant Failure: A Systematic Review and Meta-Analysis

Systemic antibiotics are routinely prescribed in implant procedures, but the lack of consensus causes large differences between clinicians regarding antibiotic prophylaxis regimens. The objectives of this systematic review are to assess the need to prescribe antibiotics to prevent early implant failure and find the most appropriate antibiotic prophylaxis regimen. The electronic search was conducted in PubMed/MEDLINE, Scielo and Cochrane Central Trials Database for randomized clinical trials of at least 3 months of follow-up. Eleven studies were included in the qualitative analysis. Antibiotics were found to statistically significantly reduce early implant failures (RR = 0.30, 95% CI: 0.19-0.47, p < 0.00001; heterogeneity I2 = 0%, p = 0.54). No differences were seen between preoperative or both pre- and postoperative antibiotic regimens (RR = 0.57, 95% CI: 0.21-1.55, p = 0.27; heterogeneity I2 = 0%, p = 0.37). A single preoperative antibiotic prophylaxis dose was found to be enough to significantly reduce early implant failures compared to no antibiotic (RR = 0.34, 95% CI: 0.21-0.53, p < 0.00001; heterogeneity I2 = 0%, p = 0.61). In conclusion, in healthy patients a single antibiotic prophylaxis dose is indicated to prevent early implant failure.

The survival rates and risk factors of implants in the early stage: a retrospective study

Background

Few large-sample studies in China have focused on the early survival of dental implants. The present study aimed to report the early survival rates of implants and determine the related influencing factors.

Methods

All patients receiving dental implants at our institution between 2006 and 2017 were included. The endpoint of the study was early survival rates of implants, according to gender, age, maxilla/mandible, dental position, bone augmentation, bone augmentation category, immediate implant, submerged implant category, implant diameter, implant length, implant torque, and other related factors. Initially, SPSS22.0 was used for statistical analysis. The Chi-square test was used to screen all factors, and those with p < 0.05 were further introduced into a multiple logistic regression model to illustrate the risk factors for early survival rates of implants.

Results

In this study, we included 1078 cases (601 males and 477 females) with 2053 implants. After implantation, 1974 implants were retained, and the early survival rate was 96.15%. Patients aged 30–60 years (OR  2.392), with Class I bone quality (OR  3.689), bone augmentation (OR  1.742), immediate implantation (OR  3.509), and implant length < 10 mm (OR  2.972), were said to possess risk factors conducive to early survival rates.

Conclusions

The early survival rate of implants in our cohort exceeded 96%, with risk factors including age, tooth position, bone quality, implant length, bone augmentation surgery, and immediate implantation. When the above factors coexist, implant placement should be treated carefully.

Microbiological findings in early and late implant loss: an observational clinical case-controlled study

Background

Implants are a predictable and well-established treatment method in dentistry. Nevertheless, looking at possible failures of dental implants, early and late loss have to be distinguished. The intent of the study was to report microbiological findings on the surface of implants with severe peri-implantitis, which had to be explanted.

Methods

53 specimens of implants from 48 patients without severe general illnesses have been examined. The groups investigated were implants that had to be removed in the period of osseointegration (early loss, 13 patients with 14 implants) or after the healing period (late loss, 14 patients with 17 implants). The implant losses were compared with two control groups (implants with no bone loss directly after completed osseointegration, two to four months after implant placement (17 patients with 17 implants) and implants with no bone loss and prosthetic restoration for more than three years (5 patients with 5 implants)). Data about the bacteria located in the peri-implant sulcus was collected using amplification and high throughput sequencing of the 16S rRNA gene.

Results

The biofilm composition differed substantially between individuals. Both in early and late implant loss, Fusobacterium nucleatum and Porphyromonas gingivalis were found to be abundant. Late lost implants showed higher bacterial diversity and in addition higher abundances of Treponema, Fretibacterium, Pseudoramibacter and Desulfobulbus, while microbial communities of early loss implants were very heterogeneous and showed no significantly more abundant bacterial taxa.

Conclusions

Specific peri-implant pathogens were found around implants that were lost after a primarily uneventful osseointegration. P. gingivalis and F. nucleatum frequently colonized the implant in early and late losses and could therefore be characteristic for implant loss in general. In general, early lost implants showed also lower microbial diversity than late losses. However, the microbial results were not indicative of the causes of early and late losses.

Prescription of Antibiotic Prophylaxis for Dental Implant Surgery in Healthy Patients: A Systematic Review of Survey-Based Studies

Background: Systemic antibiotic prophylaxis is frequently prescribed by dentists performing dental implant surgery to avoid premature implant failure and postoperative infections. The scientific literature suggests that a single preoperative dose suffices to reduce the risk of early dental implant failure in healthy patients. Material and Methods: A systematic review was made based on an electronic literature search in the PubMed-Medline, Embase, Web of Science, Scopus and Open Gray databases. The review addressed the question: "which antibiotic prophylaxis regimens are being used in dental implant surgery in healthy patients according to survey-based studies?" The identification, screening, eligibility and inclusion phases were conducted according to the PRISMA statement by two independent reviewers. The following data were collected: country, number of surveyed dentists, number of dentists who responded (n), response rate, routine prescription of antibiotic prophylactic treatment (yes, no, or conditioned prescription), prescription regimen (preoperative, perioperative or postoperative) and antibiotic choice (first and second choice). Cohen's kappa coefficient (k) evaluated the level of agreement between the two reviewers. The analysis of risk of bias was performed follow the Joanna Briggs Institute checklist for observational studies. A descriptive statistical analysis was performed to calculate total target sample, sample size and total mean. Results: A total of 159 articles were identified, of which 12 were included in the analysis. Two thousand and seventy-seven dentists from nine different countries on three continents were surveyed. The median response rate was low and disparate between studies. About three-quarters of the surveyed dentists claimed to routinely prescribe systemic antibiotic prophylaxis for dental implant surgery. The prescription regimen was perioperative, postoperative and preoperative, in decreasing order of frequency. The most frequent first choice drug was amoxicillin, with amoxicillin-clavulanic acid as second choice. Conclusions: A majority of dentists from different countries do not prescribe systemic antibiotic prophylaxis for dental implant surgery following the available scientific evidence and could be overprescribing. Efforts are needed by dental educators and professionals to reduce the gap between the use of antibiotic prophylaxis for dental implant surgery as supported by the scientific evidence and what is being done by clinicians in actual practice.

The Relationship Between Serum Level of Vitamin D3 and Osseointegration Around the Dental Implant

At present, dental implants are used more than before, and their high success rate is attributed to sufficient osseointegration, which depends on prosthetic-, implant-, and patient-related factors. The quality and quantity of bone and the host response are the main patient-related factors. Vitamin D3 affects bone metabolism by stimulating both osteoclasts and osteoblasts. This study aimed to review the human studies on the efficacy of vitamin D3 for dental implant osseointegration. Search of the literature yielded only 4 studies on human models, of which 2 showed the optimal efficacy of vitamin D3 for dental implant osseointegration, whereas the remaining 2 did not report any positive effect. However, this finding may be related to the small sample size of the vitamin D3-deficient group, which can compromise statistical analyses. In conclusion, vitamin D3 seems to be effective for dental implant osseointegration, although further research is required on human models.

Does alcohol consumption protect against late dental implant failures?

PURPOSE

Social factors have been implicated in the development of peri-implant pathologies, including implant failure. This study aims to investigate whether alcohol consumption affects late dental implant failures.

METHODS

A retrospective cohort study evaluated implants placed between 2006 and 2012 at the Philadelphia Veterans Affairs Medical Center. The primary predictor variable was alcohol consumption, measured as nonconsumption and mild, moderate, and heavy consumption. The primary outcome variable was late dental implant failure. Univariate, bivariate, and multivariate statistics were applied, with P < .05 used to define statistical significance.

RESULTS

Our cohort consisted of 103 patients and 295 implants with a 5-year minimum follow-up. Most patients were male (93%) with an average age of 60 at the time of implant placement. Late implant failure was associated with 30 implants. Compared to nonconsumption, mild consumption was associated with a 75% decrease in late implant failure (P = .0494), moderate consumption was associated with a 60% decrease (P = .3826), and heavy consumption was associated with a 200% increase (P < .1782). Compared to mild consumption, heavy consumption was associated with an 847% increase in late failure (P = .0135).

CONCLUSIONS

Results from this retrospective cohort analysis suggest that mild alcohol consumption is associated with a decrease in late dental implant failures.

Multicenter clinical trial on dental implants survival rate: a FDS76® study

BACKGROUND

Implantology, thanks to its predictability in oral rehabilitations, has become a widespread method for rehabilitating edentulous patients, offering excellent patient satisfaction. Improving the quality of oral health, especially if rehabilitation involves minimal short and long-term complications, leads to an improvement in the quality of life of our patients.

METHODS

This clinical study was conducted to evaluate the short and long-term complications (up to 18 months) of implant-prosthetic rehabilitations performed with a new dental implant (FDS76^®, Italy).

RESULTS

The results showed a limited number of complications or implant failures.

CONCLUSIONS

Knowing the latter could certainly help improve both surgical and dental materials performance.

Multicenter clinical trial on dental implants survival rate: a FDS76® study

BACKGROUND

Implantology, thanks to its predictability in oral rehabilitations, has become a widespread method for rehabilitating edentulous patients, offering excellent patient satisfaction. Improving the quality of oral health, especially if rehabilitation involves minimal short and long-term complications, leads to an improvement in the quality of life of our patients.

METHODS

This clinical study was conducted to evaluate the short and long-term complications (up to 18 months) of implant-prosthetic rehabilitations performed with a new dental implant (FDS76^®, Italy).

RESULTS

The results showed a limited number of complications or implant failures.

CONCLUSIONS

Knowing the latter could certainly help improve both surgical and dental materials performance.

Sinus Augmentation with Simultaneous, Non-Submerged, Implant Placement Using a Minimally Invasive Hydraulic Technique

Background and objectives: To evaluate whether sinus augmentation, using a minimally invasive implant device, via a non-submerged surgical approach, might negatively influence the outcome. Materials and Methods: A retrospective cohort study was conducted by evaluating patients’ files, classifying them into two groups. Fifty patients (22 men 28 women) were included in the study, 25 in each group. The use of an implant device based on residual alveolar ridge height for sinus augmentation, radiographic evaluation, insertion torque, membrane perforation, post-operative healing, and a minimum of 12 months follow-up were evaluated. Results: The mean residual alveolar ridge height was 5.4 mm for the non-submerged group and 4.2 mm for the submerged group. There were no intraoperative or postoperative complications (including membrane perforations). The mean insertion torque was 45 N/cm for the study group and 20 N/cm for the control group. Complete soft tissue healing was observed within three weeks. Mean bone gain height was 8 mm for the study and 9.3 mm for the control group. All implants osseointegrated after 6–9 months of healing time. Mean follow-up was 17.5 months, range 12–36 months. Marginal bone loss at last follow-up was not statistically significantly different: 1 mm in the non-submerged vs. 1.2 mm in the submerged group. Conclusions: Submerged and non-submerged healing following maxillary sinus augmentation was comparable provided residual alveolar ridge height >5 mm and insertion torque >25 N/cm.

Fifteen-Year Follow-up of Short Dental Implants in the Completely Edentulous Jaw: Submerged Versus Nonsubmerged Healing

PURPOSE

Short implants are a minimally invasive alternative in the management of alveolar bone atrophy. This study aimed to assess the influence of the surgical approach (1-stage vs 2-stage) on the 15-year survival and marginal bone loss of short implants in a fixed complete denture.

MATERIALS AND METHODS

A retrospective clinical study was conducted in a single private dental clinic that included short implants placed between January 2001 and December 2002.

RESULTS

Forty-one short implants supported 18 screw-retained complete dentures. The mean follow-up time was 15 ± 3 years. The surgical approach (1-stage vs 2-stage) did not significantly affect implant survival and marginal bone loss. The implant survival rate was 90.2%.

CONCLUSIONS

Short dental implants could be predictably indicated to support fixed complete dentures. The implants could be placed through a 1- or 2-stage surgery.

How old is old for implant therapy in terms of early implant losses?

OBJECTIVES

To assess, retrospectively, whether older age has an impact on implant osseointegration when compared with younger age.

METHODS

All patients ≥65 years old at implant installation, in an university setting over a time-period of 11.5 years, with complete anamnestic data and follow-up until prosthetic restoration were included, and any early implant loss (EIL; i.e. lack of osseointegration prior to or at the time-point of prosthetic restoration) was recorded. Further, one implant, from each of the elderly patients, was attempted matched to one implant in a younger patient (35 to <55 years old at implant installation) from the same clinic based on (a) gender, (b) implant region, (c) smoking status and (d) bone grafting prior to/simultaneously with implant installation. The potential impact of various local and systemic factors on EIL in the entire elderly population, and in the matched elderly and younger patient group was statistically assessed.

RESULTS

Four hundred forty-four patients ≥65 years old (range 65.1-91.3; 56.8% female) receiving 1,517 implants were identified; 10 patients had one EIL each (implant/patient level: 0.66/2.25%). Splitting this patient cohort additionally into four age groups [65-69.9 (n = 213), 70-74.9 (n = 111), 75-79.9 (n = 80) and ≥80 (n = 40)], EIL was on the implant level 0.41, 0.83, 0.34 and 2.26%, respectively, (p = .102) and on the patient level 1.41, 2.70, 1.25 and 7.50%, respectively, (p = .104); multilevel analysis showed weak evidence of association of increasing age with higher EIL rate (p = .090). Matching was possible in 347 cases, and 5 (1.44%) and 9 (2.59%) EIL in the elderly and younger patients, respectively, were observed (p = .280). EIL could not be associated with any systemic condition or medication intake.

CONCLUSIONS

Elderly patients ≥65 years old presented a similarly low EIL rate as younger patients 35 to <55 years old, while patients ≥80 years old may have a slight tendency for a higher EIL rate. Hence, ageing does not seem to compromise osseointegration, and if at all, then only slightly and at a later stage of life.

Repeated failure of implants at the same site: a retrospective clinical study

Background

Implants are becoming the first choice of rehabilitation for tooth loss. Even though they have a high success rate, failures still occur for many reasons. The objective of this study is to analyze the reasons for recurring failure at the same site and the results of re-implantation.

Methods

Thirteen patients (11 males and 2 females, mean age 60 ± 9.9 years) who experienced implant surgery failure at the same site (same tooth extraction area) two or more times in the Department of Oral and Maxillofacial Surgery, Seoul National University Bundang Hospital, between 2004 and 2017 were selected. The medical records on a type, sites, diameter, and length of implants; time and estimated cause of failure; and radiographs were reviewed. Data were collected and analyzed retrospectively, and the current statuses were evaluated.

Results

A total of 14 implants experienced failure in the same site more than two times. Twelve implants were placed in the maxilla, while 2 implants were placed in the mandible. The maxillary molar area was the most common site of failure (57.1%), followed by the mandibular molar, anterior maxilla, and premolar areas (14.3% each).The first failure occurred most commonly after prosthetic treatment (35.7%) with an average period of failure of 3.8 months after loading. Ten cases were treated as immediate re-implantation, while the other 4 were delayed re-implantation after an average of 3.9 months. The second failure occurred most commonly after prosthetic treatment (42.9%), with an average of 31 months after loading; during the healing period (42.9%); and during the ongoing prosthetic period (14.3%). In 3 cases (21.4%), the treatment plan was altered to an implant bridge, while the other 11 cases underwent another implant placement procedure (78.6%).Finally, a total of 9 implants (64.3%) survived, with an average functioning period of 60 months.

Conclusions

Implants can fail repeatedly at the same site due to overloading, infection, and other unspecified reasons. The age and sex of the patient and the location of implant placement seem to be associated with recurring failure. Type of implant, bone augmentation, and bone materials used are less relevant.

Anodised or turned dental implants?

Data sourcesAn electronic search without time or language restrictions was undertaken using several databases: PubMed/Medline, Web of Science and the Cochrane Oral Health Group Trials Register and ongoing clinical trials. Manual searches were performed in dental implant related journals and reference lists of identified studies, and relevant reviews were scanned for possible additional studies.Study selectionEligibility criteria included human clinical studies, either randomised or not, comparing implant failure rates, MBL and/or post-operative infection in any group of patients receiving turned (machined) and anodised-surface (TiUnite) implants, both from the same implant manufacturer.Data extraction and synthesisThe titles and abstracts of all reports identified through the electronic searches were read independently by the three authors. For studies appearing to meet the inclusion criteria, or for which there were insufficient data in the title and abstract to make a clear decision, the full report was obtained. Disagreements were resolved by discussion between the authors. Quality assessment of the studies was executed according to the Newcastle-Ottawa scale (NOS), which is a quality assessment tool used when observational studies are also included in systematic reviews.ResultsThirty-eight publications were included. The results suggest a risk ratio =2.82(95%CI, 1.95 - 4.06, P < 0.00001) for failure of turned implants when compared to anodised-surface implants. Sensitivity analyses showed similar results when only the studies inserting implants in maxillae or mandibles were pooled. There were no statistically significant effects of turned implants on the MBL (mean difference [MD]=0.02, (95%CI, 0.16 - 0.20; P = 0 82) in comparison to anodised implants. The results of a meta-regression considering the follow-up period as a covariate suggested an increase of the MD with the increase in the follow-up time (MD increase 0.012 mm year 1), however, without a statistical significance (P = 0.813). Due to lack of satisfactory information, meta-analysis for the outcome 'post-operative infection' was not performed.ConclusionsWithin the limitations of the existing investigations, the present study suggests that turned implants have a statistically higher probability to fail than anodised-surface implants, regardless of whether the implants were placed in maxilla or mandible. There were no statistically significant effects of turned implants on the MBL when compared with anodised implants. A comparison of post-operative infection between the implant types was not possible, due to lack of sufficient information. The reliability and validity of the data collected, the limitations of the quality assessment tool and the potential for biases and confounding factors are some of the shortcomings of the present study. The results have to be interpreted with caution due to the presence of several confounding factors in the included studies.

Low serum vitamin D and early dental implant failure: Is there a connection? A retrospective clinical study on 1740 implants placed in 885 patients

Background. Since osseointegration depends on bone metabolism, low levels of vitamin D in the blood may negatively affect bone formation around dental implants. To date, only a few studies have investigated the possible connection between serum levels of vitamin D and early dental implant failure (EDIF), i.e. failure that occurs within 4 months after placement, before the connection of the prosthetic abutment. The aim of this study was to investigate whether there is a relationship between low serum levels of vitamin D and EDIF.

Methods. Data used for this retrospective study were derived from the records of a private dental clinic. Inclusion criteria were patients who had been treated with dental implants, inserted with a submerged technique from January 2003 to December 2017. EDIF was the outcome of this study. Chi-squared test was used to investigate the effect of patient-related variables (age, gender, smoking habit, history of periodontal disease and serum levels of vitamin D) on EDIF.

Results. Originally, 885 patients treated with 1,740 fixtures were enrolled in this study. Overall, 35 EDIFs (3.9%) were reported. No correlation was found between EDIF and the patients' gender (P=0.998), age (P=0.832), smoking habit (P=0.473) or history of periodontal disease (P=0.386). Three EDIFs (11.1%) were reported in 27 patients with serum levels of vitamin D <10 ng/mL, 20 EDIFs (4.4%) in 448 patients with levels between 10 and 30 ng/mL, and 12 EDIFs (2.9%) in 410 patients with levels >30 ng/mL. Although there was a clear trend toward an increased incidence of EDIF with lowering of serum vitamin D levels, no statistically significant difference (P=0.105) was found among these three groups.

Conclusion. Within its limitations (retrospective design, low number of patients with severe blood levels of vitamin D enrolled), this study failed to demonstrate a significant relationship between low serum levels of vitamin D and increased risk of EDIF. However, since a dramatic increase in EDIFs with lowering of vitamin D levels in the blood has been reported, further clinical studies with appropriate design (prospective or randomized controlled studies on a larger sample of severely deficient patients) are needed to better investigate this topic