A clinical protocol for immediate dental implant placement in post-extraction-infected sites decontaminated with Er,Cr:YSGG laser

BACKGROUND

Placement of dental implants into fresh extraction sockets offers some advantages, such as reduced treatment times and enhanced patient comfort. The Er,Cr:YSGG (Erbium, Chromium-doped: Yttrium, Scandium, Gallium, and Garnet) laser can significantly reduce bacterial concentration after the extraction of a compromised tooth. The aim of this article is to provide a clinical protocol for the management of implants placed in infected extraction sites decontaminated with Er,Cr:YSGG laser.

METHODS

A compromised tooth, which was an abutment for a fixed bridge, with clinical and radiological signs of infection was extracted. The infected site was treated and decontaminated with an Er,Cr:YSGG laser device (Biolase iPlus®) and two implants (Straumann®) were placed in the same surgery, in order to rehabilitate the edentulous area. The intervention was completed by tissue regeneration with biomaterials.

RESULTS

Prosthetic rehabilitation after the surgical phase allowed us to provide correct function and satisfactory esthetics. In the follow-up visit, clinicians found good tissue healing and did not observe any complications, such as implant loss or peri-implantitis. The technique used in our study is repeatable and predictable, but patient selection is very important for this type of protocol as the presence of contraindications can lead to failure. The photoacoustic effect exerted by this type of laser has been proven to be effective against many pathogens. Several authors have previously demonstrated the effectiveness of this technique.

CONCLUSIONS

Immediate implantation in infected sites decontaminated with Er,Cr:YSGG laser does not seem to contribute to an increased risk of failure; however, it is necessary to follow a certain set of protocols and procedures to prevent peri-implantitis and other complications.

High-Power Laser Application for Immediate Implant Placement in Infected Sites: A Systematic Review

Objective: The purpose of this study was to review the literatures regarding the treatment outcomes of applying laser to the infected sites in immediate implant placement. The review tended to primarily target a question: does applying high-power laser have any positive effect on infected sites in immediate implant placement? Background: Although immediate placement of dental implants has been referred to as a predictable and successful procedure, it is prone to the presence of infection that interferes with the healing process, and triggers the failure of implants. Materials and methods: A thorough electronic database search was conducted on PubMed/Medline, Embase, Web of Science, Google Scholar, and the Cochrane library in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Two writers worked separately on screening the eligible studies, assessing whether there was a risk of bias, and extracting the required data. Results: Five out of the 60 studies nominated by the database search matched the inclusion criteria. The studies were carried out on a total of 192 patients with 296 implants in all. Ultimately, the study focused on 245 implants whose infected bed had been already decontaminated and prepared with the help of the high-intensity laser, used either alone or in combination with other approaches before implantation. With only nine failures, the implants inserted in infected and irradiated areas had a 96.3% overall survival rate. Conclusions: Taking the limitations of the review into account, the authors arrived at the conclusion that high-power laser irradiation can be beneficial for immediate implant placement in infected sites.

Initial Development of an Immediate Implantation Model in Rats and Assessing the Prognostic Impact of Periodontitis on Immediate Implantation

BACKGROUND

To establish an immediate implantation rat model and to evaluate the effects of pre-existing periodontitis and two different socket rinse solutions on immediate implantation prognosis.

METHODS

Sprague-Dawley (SD) rats were randomly divided into three groups before immediate implantation, including the control group, the group with experimentally induced periodontitis (EP), in which rats have been experimentally induced periodontitis before implantation, and the group with induced periodontitis and with extraction sockets rinsed with three percent H2O2 (EP-H2O2), in which rats have been induced periodontitis before implantation, and extraction sockets were rinsed with three percent H2O2. Periodontitis was induced by ligating the thread around the molars for four weeks. Six weeks after titanium alloy implants were self-tapped and left to heal transmucosally, maxillae were dissected after the clinical examination to perform micro-CT and histological analysis.

RESULTS

An immediate implantation model was successfully built in rats. There was no significant difference in implant survival rates between the EP and control groups. However, the clinical examination results, micro-CT analysis, and histological analysis in EP and EP-H2O2 groups showed a significantly worse prognosis than in the control group. Three percent H2O2 showed a similar effect with saline.

CONCLUSION

This study presented a protocol for establishing a rat immediate implantation model and showed that periodontitis history might negatively affect the prognosis of immediate implantation. These findings urge caution and alternative strategies for patients with periodontal disease history, enhancing the long-term success of immediate implantation in dental practice. Additionally, the comparable outcomes between 3% H2O2 and saline suggest the use of saline as a cost-effective and safer alternative for implant site preparation in dental practice.

Retrospective analysis of dental implants immediately placed in extraction sockets with periapical pathology: immediate implant placement in infected areas

BACKGROUND

The aim of this study is to examine the survival rates of immediate implants placed in extraction sockets with chronic periapical pathology.

METHODS

69 patients and 124 immediate implants were included in the study. The patients included in the study were examined in 3 groups. Group 1: Patients who underwent tooth extraction with periapical pathology and immediate implant placement. Group 2: patients who underwent tooth extraction with periapical pathology, immediate implant placement and guided bone regeneration. Group 3: Patients who underwent tooth extraction with periapical pathology, sinus lift procedure and immediate implant placement. In statistical analysis, t-test and Anova analysis were used in the evaluation of quantitative data, cross-tables and chi-square (χ2) test were used in the evaluation of classified qualitative data. Statistical significance was determined as p < 0.05.

RESULTS

It was observed that 116 (95.55%) of 124 implants were successful and 8 (4.45%) failed. The success rate was 97.2% in Group 1, 93.5% in Group 2 and 81.8% in Group 3. A significant correlation was found between the study groups and implant success in terms of χ2 test (p = 0.037). A significant relationship was found between smoking and success in terms of the χ2 test (p = 0.015).

CONCLUSIONS

High survival rates are observed for immediate implant placement in sockets with periapical pathology. The success rates observed in guided bone regenerations simultaneously with immediate implant placement are at satisfactory levels. In cases where simultaneous sinus lifting procedures are required, the success rates were observed to be significantly lower. In case of adequate curettage and debridement in sockets with periapical pathology, high implant survival rates are observed. As the complexity of the surgical procedure increases, treatment protocols may progress in safer ways.

Immediate dental implant placement in post-extraction-infected sites decontaminated with Er,Cr:YSGG laser: a retrospective cohort study

Dental implants placed in fresh extraction alveoli provide several advantages, including shorter treatment periods and improved patient comfort. After a compromised tooth extraction, the Er,Cr:YSGG laser can considerably reduce bacterial concentration. The objective of this controlled study conducted after at least 1 year of follow-up was to compare the use of immediate post-extraction implants in infected sites treated with laser (test group) versus conventional implants in edentulous sites (control group) through an analysis of pre- and post-operative radiographs. The study was based on a series of patients treated between 2014 and 2019, with a 1-year minimum follow-up, and up to over 4 years. An analysis of the clinical history of the treated patients and pre- and post-operative radiographs was performed to evaluate the implant success and to measure the marginal bone level (MBL). Overall, 149 implants were studied. There was only one failure in the test group (1%) and no failures in the control group. The test group gained 0.1 mm of the MBL compared to the baseline, while the control group lost 0.1 mm of the MBL. The difference between the two groups of only 0.2 mm was not statistically significant (P = 0.058). Immediate dental implants in infected sockets debrided and decontaminated using Er,Cr:YSGG laser do not appear to enhance the likelihood of failure; however, peri-implantitis and associated problems must be avoided by following a certain set of protocols and procedures.

Lipid Nanocarriers-Loaded Nanocomposite as a Suitable Platform to Release Antibacterial and Antioxidant Agents for Immediate Dental Implant Placement Restorative Treatment

Immediate implant placement is a single-stage restorative approach for missing teeth widely used to overcome the ridge remodeling process occurring after dental extractions. The success of this procedure relies on opportune osseointegration in the surrounding tissues. To support this process, a multifunctional nanocomposite, to be applied in the fresh post-extraction socket, was here designed, prepared, and characterized. This formulation consists of quercetin (QRC)-loaded nanostructured lipid carriers (NLCs) entrapped in a chitosan-based solid matrix containing ciprofloxacin (CPX). QRC-NLCs were prepared by homogenization followed by high-frequency sonication, and thereafter this dispersion was trapped in a chitosan-based CPX-loaded gel, obtaining the nanocomposite powder (BioQ-CPX) by lyophilization. BioQ-CPX displayed desirable properties such as high porosity (94.1 ± 0.5%), drug amounts (2.1% QRC and 3.5% CPX). and low swelling index (100%). Moreover, the mechanism of drug release from BioQ-CPX and their ability to be accumulated in the target tissue were in vitro and ex vivo elucidated, also by applying mathematical models. When trapped into the nanocomposite, QRC stressed under UV light exposure (50 W) was shown to maintain its antioxidant power, and CPX and QRC under natural light were stable over nine months. Finally, both the measured antioxidant power and the antimicrobial and antibiofilm properties on Staphylococcus aureus demonstrated that BioQ-CPX could be a promising platform to support the single-stage dental restorative treatment.

Implant Periapical Lesion: A Narrative Review

Implant periapical lesion (IPL) is an infectious-inflammatory alteration surrounding an implant apex. It is a multifactorial disease that may ultimately cause implant failure. The diagnosis of IPL is based on examination of clinical manifestations and apical radiolucency. Many etiologies have been attributed to IPL, including preexisting microbial pathology and surgical trauma. Moreover, many systems have been used to classify IPL based on different parameters. To date, non-surgical and surgical treatment, as well as removal of failed implants, have been considered to successfully manage IPL. However, prevention of IPL surpasses all modes of treatment. An increased number of IPL cases are expected as implants have become standard for tooth replacement in dentate arches. Therefore, it is necessary to understand IPL more comprehensively. Herein, an introduction to IPL, including its etiology, diagnosis, classification, treatment, and prevention, has been undertaken.

Immediate Implant Placement in Non-Infected Sockets versus Infected Sockets: a Systematic Review and Meta-Analysis

Objectives

The aim of this systematic review is to compare immediate implant placement in infected extraction sockets with non-infected extraction sockets in terms of implant survival and function.

Material and Methods

An electronic search was conducted in PubMed, ScienceDirect, ISI Web of Knowledge and Google Scholar between January 2010 and February 2020. Studies evaluating implant survival rate and main clinical parameters were included for a qualitative and quantitative analysis.

Results

In total, nine studies were included and a pool of 2281 sockets were analysed. Compared with the non-infected group, the infected group showed no significant differences in implant survival rates (risk ratio [RR] = 0.99; 95% confidence interval [CI] = 0.98 to 1; P = 0.08). No significant statistical differences were found in marginal bone level (mean difference [MD] = -0.03; 95% CI = -0.1 to 0.04; P = 0.41), marginal gingival level (MD = -0.07; 95% CI = -0.17 to 0.04; P = 0.23), probing depth (MD = 0.06; 95% CI = -0.24 to 0.36; P = 0.7), modified bleeding index (MD = -0.00162196; 95% CI = -0.09 to 0.09; P = 0.97) and slight but significant changes were seen in width of keratinized gingiva (MD = 0.25; 95% CI = -0.3 to 0.8; P = 0.38) between the groups at the latest follow-up.

Conclusions

There were no significant difference in implant survival rates, marginal bone level, marginal gingival level, modified bleeding index and probing depth between infected sockets and non-infected sockets. However, slight but significant changes were seen in width of keratinized gingiva favouring the non-infected group.

Immediate Implant Placement in Infected Sockets: A Consecutive Cohort Study

Introduction: Immediate placement of implants in a fresh post-extraction socket is an increasingly popular and established treatment option. However, active infection in the extraction site may adversely affect the outcome of this procedure. This study was designed to assess the clinical results of immediate placement of dental implants in infected extraction sockets using a standardized protocol, which included (a) the use of an Er,Cr:YSGG laser for the decontamination of the infected socket prior to implant insertion, and (b) the utilization of an in situ hardening alloplastic bone graft substitute to augment the gap between the implant surface and the labial plate of bone. Patients and Methods: A retrospective record review was used to identify 68 patients who had implants placed as per the described protocol. A total of 126 implants were placed in 68 patients (65 implants in the maxilla, 61 implants in the mandible). The implants were loaded 136 ± 73 days (mean ± standard deviation; range: 37–400 days) after implant placement. Eight patients (16 implants) were subsequently lost to follow up. Results: 105 of the 110 implants (95.45%) placed immediately in the infected sites using the described protocol survived after prosthetic loading. Conclusion: Immediate implant placement in previously infected sites using the protocols mentioned in our study with laser decontamination of the socket, grafting with an in situ hardening alloplastic bone graft material and non-submerged healing shows a similar survival rate to the published success rates for immediate implants placed in non-infected sites.

Laser Therapy for Infected Sites and Immediate Dental Implants in the Esthetic Zone: A Case Report and Review of Literature

Placement of postextraction dental implants has become a common practice. Here, we reviewed current literature, along with clinical procedures, outcomes, and incidence of complications, associated with immediate implants in infected postextraction sites. The YSGG (yttrium, scandium, gallium, and garnet) laser can significantly reduce the bacterial concentration after extracting a compromised tooth. We treated a 40-year-old woman with a compromised tooth in the esthetic zone, presenting clinical and radiological signs of infection, particularly a periapical periodontitis. The tooth was extracted after administering local anesthesia using Optocain® (mepivacaine and adrenalin 1 : 100,000), following which the site was treated with an ErCr : YSGG (erbium, chromium-doped yttrium, scandium, gallium, and garnet) 2780 nm laser device (Biolase iPlus®). The implant (Straumann® fixture) was inserted with minimum 35 N torque, 1 mm below the most apical bone peak. Bio-Oss® and resorbable membrane were applied to improve bone healing. The use of ErCr : YSGG laser has ensured success of implant therapy performed on an infected site. There were no complications such as peri-implantitis or loss of peri-implant bone. The implant achieved good primary stability, immediate placement into an infected site did not increase complications, and the 5-year follow-up confirmed the treatment success.

Effect of Laser Radiation on Infected Sites for the Immediate Placement of Dental Implants

Objective: The study aims to evaluate the feasibility of erbium-chromium: yttrium-scandium-gallium-garnet (ErCr:YSGG 2780 nm) laser irradiation on infected and/or inflamed post-extraction sites for the immediate placement, and when possible, immediate loading, of endosseous implants. Background: Post-extraction site infection is a serious complication. Surgical and nonsurgical options are available to treat such event, together with various decontamination methods. However, there is still no consensus on which treatment is the most effective. Materials and methods: Sixty-six patients were included in the study for a total of 94 post-extraction implants, inserted in the maxilla and mandible. All patients were eligible for implant therapy, having at least one compromised tooth requiring extraction, along with sign of inflammation and/or infection. Surgery and socket decontamination were performed using an ErCr:YSGG laser. To improve bone healing, Bio-Oss^® and resorbable membrane were used in 57 patients. Eleven implants were immediately loaded, whereas 83 were loaded within 3-6 months, depending on the extraction site. Intraoral radiographs were taken at 1, 3, 6, 9, and 12 months from the implant placement to assess the alveolar bone level and treatment's outcome. Albrektsson criteria were chosen to evaluate the treatment success rate. Results: Follow-up went from 6 months to 4 years. Success rate was 94.6% (89/94): three implants failed to integrate due to poor patient compliance, being expelled during the second week, whereas two implants presented factory defects (abutment). No sockets presented signs of residual infection during follow-up. Conclusions: The combination of mechanical, chemical, and laser treatment was proven to be highly effective for the disinfection of post-extraction sites. The ErCr:YSGG laser is a useful tool, not only for his practicality as a surgical device but also as a disinfection tool, granting optimal results after implant surgery.

Effect of Low-Level Laser Irradiation on Stability and Marginal Bone of Narrow Implants Retaining Overdentures in Moderately Controlled Diabetic Patients

The researchers investigated the influence of low-level laser irradiation (LLLI) on implant stability and marginal bone of small-diameter implants retaining mandibular overdentures in patients with moderately controlled diabetes. Twenty patients (mean age = 59.32 ± 4.1 years) with moderately controlled diabetes mellitus (glycated hemoglobin A1c [HbA1c] = 8.1%-10.0 %) were rehabilitated by maxillary and mandibular conventional dentures. Two small-diameter implants (3 × 12 mm) were inserted in the canine areas of the mandible and immediately loaded by mandibular dentures. In a split-mouth design, LLLI was applied to 1 of the 2 implants in a random order (study group [SG]); the other implant was left as a control (control group [CG]). For each patient, gallium aluminum-arsenide diode low-level laser (940-nm wavelength, 0.50 ± 2 mW output power, 0.004 cm² spot size; Epic, Biolase, Inc, San Clemente, Calif) was applied around each implant with total delivered energy of 90 J (equally divided by 6 irradiation points) in 3 sessions. The application was done immediately after implant insertion, 3 days and 1 week after surgery. Implant stability (measured by Periotest) and marginal bone loss (MBL; measured by cone beam computerized tomography) were evaluated at implant loading (T1), 6 months (T6), and 12 months (T12). One implant failed in the CG and no failures occurred in the SG, resulting in 95% and 100% survival rates, respectively. The SG recorded higher Periotest values than the CG at all observation times. However, the difference was significant (P = .039) at T6 only. The SG recorded lower MBL values than the CG. No difference in MBL was detected between groups or peri-implant sites (mesial, distal, buccal, and lingual) at T6 and T12. Within the limits of this study, LLLI had no effect on marginal bone around immediately loaded small-diameter implants retaining overdentures in patients with moderately controlled diabetes. However, it was beneficial in improving implant stability 6 months after overdenture insertion.

Immediate dental implants placed into infected sites present a higher risk of failure than immediate dental implants placed into non-infected sites: Systematic review and meta-analysis

Background

Alveolar infection is known as a risk factor for implant failure. Current meta-analysis on the theme could not prove statistically that immediate dental implants placed into infected sites have a higher risk of failure than immediate dental implants placed into non-infected sites. The purpose of this meta-analysis was to determine the effectiveness of immediate dental implants placed into infected versus non-infected sites.

Material and Methods

Seven databases were sought by two reviewers. Randomized or non-randomized clinical trials that compared the placement of dental implants into infected versus non-infected sites were eligible for the study. Exclusion criteria were: papers in which the survival rate was not the primary outcome; papers without a control group; studies with less than one year of follow-up; studies whose patients did not receive antibiotic therapy; studies with medically compromised patients; duplicated papers. Risk of bias assessment was performed with the Cochrane Collaboration tool.

Results

Of the 3.253 initial hits, 8 studies were included in both qualitative and quantitative synthesis (kappa=0.90; very good agreement). Forest plot for implant failure showed that immediate implants placed into infected sites presented a statistically significant risk of failure that is almost 3 times higher than when placed into non-infected sites (risk ratio= 2.99; 95% confidence interval: 1.04, 8.56; p= 0.04; 935 implants; i2= 0%). Peri-implant outcomes showed no statistical difference.

Conclusions

Immediate dental implants placed into infected sites presented a statistically significant higher risk of failure than immediate dental implants placed into non-infected sites. Peri-implant outcomes were not statistically affected in this intervention.

Key words:Dental implants, infection, tooth socket, systematic review, immediate placement.

Effects of Bacterial Contamination on Dental Implants During Surgery: A Systematic Review

INTRODUCTION

Contamination during surgery negatively influences the prognosis of orthopaedic implants; however, it has not been proven whether contamination influences the success of dental implant treatment. The aim of the systematic review was to investigate if there exists evidence in the literature whether contamination of dental implants during surgery affects osseointegration and clinical success.

MATERIALS AND METHODS

Four data bases were used for the literature search. Primary studies and reviews regarding both clinical and preclinical research were eligible. Rating of the summarized quality of the evidence was performed.

RESULTS

Five preclinical studies were included. Because of the estimated high risk of bias in all included studies and extensive differences in study design between the included studies, meta-analysis was not performed and no reliable aggregated data could be extracted.

CONCLUSIONS

It is suggested that the scientific evidence with regard to the current topic is insufficient. Further controlled studies are warranted.